Raul Vera

Cancer of the nasopharynx: review of 43 cases treated with supervoltage radiation therapy.

Forty‐three cases of cancer of the nasopharynx treated at the Yale‐New Haven Hospital in the last 15 years were analyzed. The clinical aspects of the disease, the technique of therapy and results of treatment are presented. The five‐year cumulative survival in all the cases treated was 27%. Patients with lymphoepitheliomas seem to do better than those with squamous cell carcinoma. Even in patients with advanced disease, a cure is still possible after radical radiation treatment. Retreatment of recurrent disease is frequently successful in these tumors. The complications after curative radiotherapy even with the use of supervoltage are still relatively frequent. The incidence of distant metastases was 29%.

Enhancement of 6-thioguanine cytotoxic activity with methotrexate

Abstract Studies were completed to characterize the cytotoxic and biochemical interaction of methotrexate (MTX) and 6-thioguanine (6-TG). Pretreatment of L1210 leukemia cells for 3 hr with MTX substantially enhanced the cytotoxicity of 6-TG. The LD90 of 6-TG in cells pretreated with 1μM MTX was 0.9pM, compared to an LD90 of 800 pM when the two drugs were given concurrently and an LD90 of 30 pM resulted with 6-TG alone. HPLC analysis of intracellular metabolites demonstrated an increased conversion of 6-TG to 6-TG-nucleotides in cells pretreated with MTX. A marked enhancement of 6-TG incorporation into RNA also was noted (MTX→6-TG: 350 fmol/μg RNA vs 6-TG: 98 fmol/μg RNA). However, there was a suppression of 6-TG incorporation into DNA when cells were pretreated with MTX (MTX→6-TG: 170 fmol/μg DNA vs 6-TG: 690 fmol/μg DNA). These results suggest that: 1) an enhancement of 6-TG antileukemic activity can be obtained with MTX pretreatment, and 2) the enhancement of 6-TG cytotoxicity following MTX exposure is not associated with 6-TG incorporation into DNA, but rather with incorporation of 6-TG into RNA. This drug sequence may be beneficial in the clinical treatment of leukemia.

Malignant histiocytosis. Response to VP-16-213 and cytosine arabinoside

A patient with malignant histiocytosis who relapsed after receiving an Adriamycin (doxorubicin)‐containing combination and radiation therapy subsequently had a complete remission on VP‐16‐213 and cytosine arabinoside. She remains free of disease 32 months after achieving a complete remission. VP‐16‐213 and cytosine arabinoside (Ara‐C) deserve further evaluation in the treatment of this neoplasm.

The effective use of combined modality therapy for the treatment of patients with Hodgkin's disease who relapsed following radiotherapy.

FROM 1969 TO 1977, 124 PATIENTS with advanced staged Hodgkins disease were entered into a treatment protocol which consisted of three cycles of drugs (nitrogen mustard, vincristine, vinblastine, prednisone, and procarbazine) followed by radiation (1500–2000 rad) to previous sites of known disease. After completion of radiation therapy, two more drug cycles were given. There were 63 newly diagnosed patients with Stage IIIB and IVA or B disease and 61 patients who had relapsed from prior radiotherapy. The median follow-up is now in excess of 5 years. Of the relapsed patients, 86.9% entered a complete remission and 90.6% of these patients have remained in complete remission from 1 to 10 years. In comparison, 81% of the newly diagnosed patients entered a complete remission and 78.4% of these patients continue free of disease from 1 to 11 years. These differences were not statistically significant. The 10-year actuarial disease-free survival—79.8% for the 61 relapsed patients compared to 65.6% for the 63 newly diagnosed patients—was not significantly different either. The 10-year actuarial survival for the 40 patients who had relapsed to IIIB and IVA or B was 71.3% and approximated more closely those of newly diagnosed IIIB and IVA or B patients. This drug-radiotherapy protocol is very effective for the treatment of patients who have relapsed from previous radiotherapy.

Hodgkin's disease, intracranial involvement. Report of a case and review of the literature.

Intracranial hodgkins disease, an extremely uncommon finding, is reported in a 21-year-old man. This diagnosis, confirmed histologically, occurred in the presence of recurrent systemic disease, mixed cellularity type, which is typical for patients who have developed this complication. Review of the reported cases suggests there may be increasing incidence of intracranial involvement of Hodgkins disease.