R. Moore

Metastatic pattern of malignant melanoma: A study of 216 autopsy cases

Abstract The metastatic pattern and causes of death were analyzed by autopsy of 216 patients with histologically proven advanced malignant melanoma. These cases constituted 3 per cent of all the autopsies done for cancers from 1959 to 1954 at Roswell Park Memorial Institute, Age range was from six to eighty-six years, with a median value of 49.5 years. Male to female ratio was 1.5:1. Multiple organ metastases were present in 95 per cent of the patients. The most common organs involved were lymph nodes (73.6 per cent), lungs (71.3 per cent), liver (58.3 per cent), brain (49.1 per cent), bone (48.6 per cent), heart (47.2 per cent), adrenal glands (46.8 per cent), and gastrointestinal tract (43.5 per cent). Single organ metastasis was extremely uncommon in malignant melanoma of cutaneous origin. The incidence of histologically different, second primary cancer was 7.4 per cent. The most common cause of death was respiratory failure because of massive involvement of lungs in addition to pleura. The second leading cause of death was complications of brain metastases (increased intracranial pressure and hemorrhage). The median survival was twenty-four months. It appears that this is a selected group of patients with a worse prognosis than expected overall.

Prognostic parameters in recurrent malignant melanoma

In 361 patients with recurrent malignant melanoma, the clinical stage was the strongest determinant of subsequent survival (P < 0.01). In Stage IV, the number of initial, distinct lesions was important. Patients presenting with a single metastatic nodule had median survival ten months, whereas those with two or more metastatic nodules had median survival 6.9 months (P < 0.05). The length of disease‐free interval from excision of the primary to recurrence correlated consistently with subsequent survival in patients with regional lymph node metastases. Those with disease‐free interval less than one year had median survival 15.8 months with 16% surviving at five years, while those with interval one year or longer had median survival 23.7 months with 30% surviving at five years (P < 0.05). In Stage IV, the correlation of survival with disease‐free interval became significant only with 24 months as the demarcation point of length of disease‐free interval. Age and sex affected the disease‐free interval, but not survival after recurrence.

Primary carcinoma of the renal pelvis

Primary carcinoma of the renal pelvis is believed to represent nearly 8% of all malignant renal tumors. The clinical problems of this tumor have been a continuing challenge to early diagnosis and successful therapy. The present experience of 78 cases using the classification of Grabstald showed there is a significantly direct relationship between the tumor stage and the tumor grade. Of these cases, 39.7% manifested bladder malignancy; 38.6% had ureteral tumors. Nephro‐ureterectomy with removal of a cuff of bladder as well as frequent followup of cystoscopic examinations continues to offer the best chance of survival. Surprisingly, urine cytology has been, to date, of little value as a screening test because of only slightly better than 30% accuracy. The long‐term results using postoperative radiation as well as various chemotherapeutic agents or both are presently not encouraging. Only 10.3% of cases had known occupational exposure to various known carcinogens. Cancer 33:1642–1648, 1974.

Lymphedema after groin dissection

Abstract Groin dissection was performed in 67 patients, of whom 40 had superficial groin dissection and 27 had ilioinguinal dissection. The incidence of overall lymphedema of a mild to moderate degree was 21 percent. Lymphedema was observed more frequently (26 percent) in patients with primary lesions in the leg when compared with those with lower trunk lesions (6 percent, p

Modes of regional chemotherapy

Abstract Injection of Am (2 mg/kg) into the hepatic artery or portal vein of dogs gives higher liver tissue levels (15.1 μg/g) than systemic intravenous administration (6.4 μg/g). This difference is increased by injection of the drug distal to the temporarily occluded hepatic artery or portal vein. Bolus injection of Am (1 mg/kg) into the femoral artery of dogs results in no detectable ipsilateral calf muscle levels and no subsequent macroscopic changes in the extremity. When injected distally to the temporarily occluded femoral artery, muscle drug levels were below the level of sensitivity of the fluorometric assay used, but all animals showed varying degrees of ipsilateral skin ulcerations and melanosis. With a tight tourniquet applied to the extremity proximally and maintained for 15 min after Am injection, 40-fold or higher muscle levels of Am were found, compared to those after simple intraarterial injection. There was fairly uniform drug distribution throughout the infused limb and minimal systemic leak. Severe ulcerations occurred after injection of 1 mg Am/kg with tourniquet application. With reduction of the dose to 0.25 and 0.125 mg/kg, erythema in the first 2 weeks and melanosis of the skin at 2 to 4 weeks occurred and involved the whole extremity. This technique of intraarterial injection of chemotherapeutic drug(s) with a proximal tourniquet has a potential clinical applicability in extremity tumors; high tissue drug levels are obtained and frequent administration is possible via an indwelling catheter. With the present development of the ability to assay microconcentrations of drugs in tissues, a critical reappraisal of the methods of regional infusion chemotherapy should now be possible, in association with the physiochemical characteristics of the drugs used.

Tourniquet Infusion Versus Hyperthermic Perfusion

The tourniquet infusion method was compared with hyperthermic perfusion in canine limbs by using Adriamycin, actinomycin‐D, and melphalan. Tourniquet infusion provided comparable tissue levels with Adriamycin and significantly higher levels with actinomycin‐D and melphalan in the treated extremity than hyperthermic perfusion with the same drugs and dosages. Higher systemic leak was observed, more so with melphalan, with the tourniquet infusion method.

Surgery in recurrent malignant melanoma

Seventy‐nine consecutive patients with resectable, recurrent malignant melanoma were treated with surgical excision, followed by adjuvant chemotherapy. Of 7 Stage IIIA patients, 6 remain alive; 5 are disease‐free at 27 months. Of 33 patients with advanced stage IIIB disease with fixed tumor masses, including 16 cases that involved two nodal groups, 10 patients (30%) remain disease‐free at 30 months. Of 12 Stage IIIAB patients, one remains disease‐free at 26 months. Of 27 Stage IV patients, 7 (25%) remain disease‐free at 36 months. Characteristic of those patients who remain disease‐free is the initial presence of 3 or less discrete metastatic lesions, and a long prior disease‐free interval. Surgical removal of metastatic lesions of malignant melanoma, in combination with chemotherapy, offers improved palliation in patients with a small number of metastatic lesions and a long previous disease‐free interval.

Early growth of experimental tumors and the onset of concomitant immunity

Abstract On repeated experiments, the rate of take of a given threshold inoculum of T241, B-16, SV40, L1210 or rat Wilms tumor in their syngeneic strains was not increased by additional tumor implanted concomitantly in other site(s), suggesting that early tumor growth is not dependent on an overwhelming by the tumor load of systemic host factors. There is no evidence in vivo of immune response in allogeneic or syngeneic tumors initially, following inoculation. Such evidence, in the form of tumor rejection or decreased rate of challenge take, does not appear at any definite interval from the time of inoculation, but its onset varies with the size of initial inoculum and coincides approximately with the time of early palpability of the tumor nodule. The take of a threshold inoculum apparently depends on its interaction with local host factors.

Long-Term Survival Determinants in Wilms’ Tumor

This is a retrospective report of 54 patients with the diagnosis of Wilms tumor treated at Roswell Park Memorial Institute from 1946 to 1977. The age ranged from 1 month to 57 years with a mean of 7.2 years and a median age of 5 years. An analysis of the survival results showed that patients continued to die of disease until 66 months post-diagnosis, making the 5-year survival a much better evaluation criterion for this group than the traditional 2-year survival. Males fared significantly better in this series (p less than 0.01). This was not due to detectable differences in age group, or histology. While the older age group (more than 15 years old) showed a somewhat better survival outlook for the first 2 years post-diagnosis, this difference became negligible at 5 years post-diagnosis.

Failure of Actinomycin D Entrapped in Liposomes to Prolong Survival in Renal Cell Adenocarcinoma-Bearing Mice

The potential prolongation of survival of actinomycin D entrapped in liposomes was examined in Balb C/Cr mice inoculated intrarenally with renal cell adenocarcinoma. There were five groups of animals: group A, a control group, received phosphate-buffered saline 0.3 cm3 i.p.; group B received free actinomycin D 300 micrograms/kg i.p.; group C received liposomes containing actinomycin D 300 micrograms/kg i.p.; group D received a mixture of free actinomycin D 300 micrograms/kg and empty liposomes i.p.; group E received empty liposomes i.p. The best median survival was of group D (free drug) - 54 days followed by group C (liposome entrapped actinomycin D) 45.2 days and group E (a mixture of free and entrapped actinomycin D) - 42 days. In vitro studies utilizing cell lines obtained from the tumor showed no statistical difference in ID50 or in cytotoxicity between the cells treated with free actinomycin D and those treated with liposomes containing drug.