Richard K. Desser

High-dose consolidation therapy with autologous stem cell rescue in stage IV breast cancer.

We designed a phase II study to determine whether induction chemotherapy (CT) consisting of leucovorin, vincristine, methotrexate, doxorubicin, and cyclophosphamide (LOMAC) followed by high-dose intensification chemotherapy (ICT) with cyclophosphamide, thiotepa, and autologous stem cell rescue (ASCR) could increase the complete response (CR) rate and survival in women with stage IV breast cancer. Twenty-nine women were enrolled on study; 16 patients had received prior adjuvant chemotherapy and no patient had received chemotherapy for stage IV disease. Two patients were found to be ineligible and excluded from further analysis. Of the 27 patients treated, four (15%) obtained a CR and 15 (56%) a partial response (PR) after LOMAC induction, for an overall response rate of 70%. Of the 22 patients treated with ICT, 12 patients had a CR, and nine were in PR after induction and converted to CR after ICT. The toxicities included nausea/vomiting, mucositis, diarrhea, dermatitis, alopecia, and infections secondary to neutropenia. The 1-year survival is 60%; the median has not yet been reached. The time to treatment failure for patients on study is 10 months. The treatment approach of ICT and ASCR following induction chemotherapy can lead to an improved CR rate in stage IV breast cancer. How this increased CR rate leads to a prolonged disease-free survival requires further follow-up.

Risk of severe infection in patients with Hodgkin's disease or lymphoma after diagnostic laparotomy and splenectomy.

Excerpt In many treatment centers in the United States and abroad, case evaluation in Hodgkins disease or lymphoma has come to include diagnostic laparotomy and splenectomy. Introduction of this m...

Acute nephrotoxicity following cis‐dichlorodiammine‐platinum

The effects of a single dose of cis‐diamminedichloroplatinum (DDP) on the kidney function were investigated in 14 patients with disseminated malignancy and normal renal function. A single dose of DDP (30–50 mg/m2) caused severe proximal tubular dysfunction with increased urinary losses of calcium, magnesium, and amino acids. Phosphate excretion was not affected. DDP can cause proximal tubular dysfunction and close attention must be paid to serum calcium and magnesium levels.

Avascular Necrosis of the Femoral Head with Combination Therapy

Four patients with malignant lymphoma who were treated with multiple courses of combination chemotherapy, consisting of cyclophosphamide, Oncovin, procarbazine, and prednisone (COPP), developed avascular necrosis of the femoral head(s). Disorders usually associated with the development of avascular necrosis were absent. The total prednisone dose received by each patient was small. Avascular necrosis of the femoral head should be considered in the differential diagnosis of bone pain in patients receiving multiple courses of combination chemotherapy.

Extended mantle radiation therapy for pathologic stage I and II Hodgkin's disease.

Between 1968 and 1983, 135 patients with pathologic stage (PS) I and II Hodgkins disease were treated with extended mantle radiation technique (EMRT) at Michael Reese Hospital and the University of Chicago Center for Radiation Therapy. EMRT combines both standard mantle and para-aorta fields (M-PA) in one port. Actuarial disease-free survival at 5 and 10 years was 82.5%. Actuarial overall survival was 96% and 83% at 5 and 10 years, respectively. Acute complications were evaluated in 112 patients available for analysis. Severe nausea and vomiting occurred in 13%, weight loss of greater than 10% of body weight in 19%, and acute hematologic toxicity in 4% of patients. Bone marrow suppression was transient and did not interfere with subsequent delivery of salvage treatment with either chemotherapy or radiation therapy in 22 patients who relapsed. The cost of EMRT is 40% lower than the cost of treatment with M-PA. The median treatment time was 38 days, 33% less than the 56 days for M-PA field assuming no inte...

The predictive value of serial bone scans in assessing response to chemotherapy in advanced breast cancer

A retrospective analysis was made of 25 patients with breast cancer treated only with chemotherapy in order to determine the predictive value of technetium‐99m bone scanning in determining response to chemotherapy. Whole‐body scanning demonstrated bone healing in only 3 of 25 patients. However, the presence of stable disease on bone scan correlated with a good prognosis as 12 patients with stable scans had a significantly longer survival time than did the 13 patients who showed progression on scans (17.7 and 7.8 months, respectively P <1 > 0.005, Wilcoxan). Our analysis indicates that bone scans are a relatively crude technique for monitoring response to chemotherapy in patients with breast cancer.

Response to secondary therapy in patients with adenocarcinoma of the breast previously treated with adjuvant chemotherapy

The response to secondary therapy, chemotherapy or hormonal, is examined in 26 patients with adenocarcinoma of breast who failed adjuvant chemotherapy. Response rates to tamoxifen or combination chemotherapy, cyclophosphamide, methotrexate, and 5‐FU (CMF) or Adriamycin and vincristine (AV) were similar to response rates reported for Stage IV patients, never exposed to cytotoxic agents. Survivals in these 26 patients were similar to those reported for Stage IV patients never exposed to cytotoxics. It is concluded that adjuvant chemotherapy does not lessen future response to secondary therapies or decrease survival.

Prognostic factors in patients with non‐small cell bronchogenic carcinoma and brain metastases

Prognostic factors were examined in 38 patients with nonsmall cell lung carcinoma and brain metastases. The most important factors were the response to total therapy (corticosteroids, radiotherapy, and chemotherapy) and the presence of brain metastases alone; these factors had the most impact on survival. Age, sex, histologic type of lung cancer, and initial performance status were not prognostically important. Our results indicate that certain subgroups of patients with nonsmall cell lung carcinoma and brain metastases have a favorable prognosis and should be treated aggressively.

Breast conserving surgery and definitive irradiation for early stage breast cancer

Breast conserving surgery and postoperative breast radiotherapy were used to treat 219 cases of AJCC Stage I and II breast carcinoma at the Michael Reese and University of Chicago Hospitals. Most patients were treated with lumpectomy and axillary sampling followed by breast irradiation to a dose of 46 Gy followed by a boost dose of 14-16 Gy to the surgical bed. The 5-year actuarial local control is 92%. Follow-up is 1 to 10 years and the median follow-up is 36 months. Of the seven patients who recurred in the breast, three failed in the boost site and three failed adjacent to the boost site. The seventh patient recurred diffusely in the breast and skin. Four of the seven recurrences were in patients with positive surgical margins. The 5-year actuarial relapse-free survival is 80%. Factors which had an adverse affect on the cosmetic results were a scar length greater than 8 cm and a volume of resected breast tissue greater than 100 cm3. Treatment related complications were minor and infrequent. Breast conserving surgery followed by radiation therapy is effective in achieving local control with good to excellent cosmetic results.

Combined modality therapy for stage IIIMO non‐small cell lung cancer. A five‐year experience

Between 1975 and 1980,101 patients with inoperable Stage IIIMO non‐small cell lung carcinoma were entered into combined radiotherapy and chemotherapy trials at Michael Reese Hospital and University of Chicago Hospital. Sixty‐four percent of the patients responded. Median survival for all patients was 8.8 months, Responders survived 13.7 months and nonresponders 4.6 months (P = 0.002). Patients treated with 4200 rad had a higher response rate than those treated with 3Ooo rad (74% versus 54%, P = 0.04) but there was no difference in survival. Although all patients with squamous cell carcinoma died by 30 months, 18% of patients with adenocarcinoma and 20% of patients with large cell carcinoma are long‐term survivors. Brain metastases occurred more frequently in patients with large cell or adenocarcinoma than in patients with squamous cell carcinoma (P = 0.02). The prognostic effect of age, initial performance status, sex, histology, and tumor extent are examined. Toxicity was substantial with a 13% treatment‐related mortality. Combined modality therapy may benefit selected patients with non‐squamous cell types, but more effective chemotherapeutic agents are needed. Prophylactic cranial irradiation in patients with large cell carcinoma or adenocarcinoma may decrease the incidence of subsequent brain metastases.