Sameer Rafla

A brief poms measure of distress for cancer patients

The authors describe an 11-item short form of the Profile of Mood States 58-item Total Mood Disturbance Score (TMDS). The Brief TMDS was derived from a sample of 619 adults with mixed cancer diagnoses, and replicated on a second sample of 295 lung cancer patients. Internal consistency of the Brief TMDS and the correlations of the Brief TMDS with the full TMDS were highly satisfactory for both samples. Given the difficulty many medically ill people have with lengthy self-report scales, and the increasing importance of measuring distress as an adjunct to patient care, this measure shows promise as a rapid, reliable tool.

Malignant parotid tumors: natural history and treatment.

Sixty‐seven cases of histologically proven malignant parotid tumors are presented. Forty percent of the tumors were differentiated adenocarcinoma, while malignant mixed tumors (or pleomorphic adenocarcinomas) formed 18%. The remaining types of malignant salivary tumors are also represented in the series. The natural history and spread of these tumors are studied in detail, with lymph‐node metastasis occurring in 25% of the cases and distant metastasis in 20%. Malignant tumors involve largely the retromandibular portion of the parotid gland in over 40% of the cases and the preauricular portion in about one‐fifth of the cases. Both regions are affected in a further fifth of the cases. A combination of surgery and radiotherapy was the method employed for curative therapy, with radiotherapy alone reserved mainly for palliation. While the overall five‐year survival was 42%, late recurrences constitute a serious problem with eventual demise of about half of these patients. Various factors affecting the prognosis, including histological type of tumor, method of treatment and response to radiotherapy are discussed. Cancer 40:136–144, 1977.

Hodgkin disease in patients 60 years of age or older. Histologic and clinical features of advanced‐stage disease

Background. This article reviews the salient pathologic and clinical features of 171 patients with Stage III‐IV disease who were 60 years of age or older who were treated on four Hodgkin disease (HD) protocols from 1969 to 1988.

Single, sequential, and multiple alkylating agent therapy for multiple myeloma: a CALGB Study.

Four intravenous (IV) alkylating agent regimens were tested in 615 previously untreated patients with multiple myeloma. Patients were randomized to receive melphalan, cyclophosphamide, and carmustine in combination (MCBP), sequentially (Seq-MCBP), or in combination with doxorubicin (MCBPA). The fourth group received IV melphalan (MP) as the only alkylating agent. All groups received a tapering dose of prednisone. Toxicity was similar for all regimens although the nadir of cytopenia was reached more quickly for the regime including melphalan only. Response as measured by reduction in myeloma protein or other parameters were similar for the four treatments. Survival was significantly poorer for the group receiving the alkylating agents in sequence. The survival of high tumor cell load patients who were azotemic was better in the groups treated with IV MP or with the combination of IV MCBP. In view of the simplicity and probable cost savings attached to single-agent treatment, a melphalan/prednisone regimen should be considered as initial therapy for all patients with myeloma.

Changes in cell-mediated immunity in patients undergoing radiotherapy.

The cell‐mediated immune status of 147 patients who received radiotherapy was evaluated using in vitro tests (PHA, E‐rosette and spontaneous blastogenesis) both before and 6 weeks after the end of radiation. All patients had verified malignancies, involving the bronchus in 29 cases, breast in 28, female genital system in 26, head and neck in 20 and bladder in 15. Patients suffering from bronchogenic carcinomas or malignancies of the head and neck showed a relative high degree of immune suppression. Our findings indicate a trend towards some improvement in PHA reactivity, as well in as the percentage of E‐rosette‐forming cells after treatment, which is more noticeable in patients with pelvic or breast tumors. A relationship seems to exist between the tumor load and the immune status, which reverts to a normal pattern when the former is extinguished. Moreover, patients with poor clinical response display a profoundly depressed level of immune status without any improvement after treatment.

Comparison of oral melphalan, CCNU, and BCNU with and without vincristine and prednisone in the treatment of multiple myeloma. Cancer and leukemia group B experience

A total of 361 evaluable patients with previously untreated multiple myeloma were randomized to receive oral melphalan (0.15 mg/kg/day for seven days, followed by 0.05 mg/kg/day after recovery from the nadir of the leukocytes), BCNU (150 mg/m2 intravenously every six weeks) or CCNU (100 mg/m2 orally every six weeks). All patients received a tapering six‐week course of prednisone starting at 0.8 mg/kg for the first two weeks. At week 22, one‐half of the patients were randomized to receive vincristine (1 mg/m2) and prednisone (0.6 mg/kg for seven days) every two months in addition to previous therapy. The melphalan treated patients showed a significantly higher overall objective response frequency (59%), according to Myeloma Task Force criteria, when compared to those treated with BCNU (40%) or CCNU (42%). The survivals for all patients were not statistically different for the three treatment programs. However, the good‐risk patients treated with melphalan had significantly longer survival (P = 0.02) than the equivalent patients who received BCNU or CCNU. The addition of vincristine and prednisone at week 22 did not significantly increase the percentage of subsequent objective responses or prolong the subsequent survival of any treatment group. It is concluded that oral melphalan is superior to BCNU and CCNU in producing objective responses and in prolonging survival in good risk patients. Cancer 50:1669‐1675, 1982.

Augmented therapy of extensive hodgkin’s disease: radiation to known disease or prolongation of induction chemotherapy did not improve survival—results of a cancer and leukemia group B study

PURPOSEnThis prospective randomized trial in extensive untreated Hodgkins disease was undertaken to assess the potential benefit of augmented therapy (12 months chemotherapy or radiation to known disease) compared to standard 6 months chemotherapy.nnnPATIENT AND METHODSnA total of 258 patients, mostly Stage IV, were randomized to four treatment regimens consisting of six cycles of CCNU, vinblastine, procarbazine, and prednisone (CVPP); 12 cycles of CVPP; six cycles of CVPP followed by 25 Gy radiotherapy; or three cycles CVPP, 25 Gy radiotherapy, and three cycles CVPP.nnnRESULTSnComplete remissions were achieved in 65% of all patients. A 58% overall 5-year survival rate was obtained. Relapses in irradiated areas of known disease occurred in only 6% of responding patients. There was, however, no statistical difference in response frequency, disease-free survival, or overall survival among the four regimens. Elderly patients responded less frequently.nnnCONCLUSIONnWhile radiotherapy provided control of local (known) disease, no impact on overall survival was apparent. Likewise, doubling the duration of chemotherapy did not improve response or survival. Augmentation of therapy with either radiotherapy or more chemotherapy in this study was of no benefit compared to the standard 6 months of treatment.

Submaxillary gland tumors.

Thirty‐five submaxillary gland tumors are reviewed; 13 are pleomorphic adenomas (or benign mixed tumors), and the remaining 22 are distributed among the different forms of malignant salivary tumors the natural history of benign, as well as malignant tumors, is discussed the relationship between the routes of spread of malignant tumors and the anatomy of the submaxillary gland is elaborated. Results of treatment are discussed and while those of pleomorphic adenomas are satisfactory with only one recurrence (of 13 tumors), those of malignant tumors are rather disappointing with only one survival free of disease out of 12 patients followed for 5 years the response of these tumors to radiotherapy is evaluated; they are not as radioresistant as widely claimed. Preoperative radiotherapy followed by surgical excision is recommended as the treatment of choice for malignant tumors.

Effect of spirogermanium on V79 Chinese hamster cells.

CHINESE HAMSTER V79 CELLS were exposed to spirogermanium (SG), and their mitotic activity, population growth, plating efficiency, viability (dye exclusion), and clonogenicity were assayed. Mitotic frequency of cultures in SG decreased initially with increasing drug concentration and later plateaued at varying levels depending on drug concentration. Cultures continuously exposed to SG showed drug concentration-dependent growth inhibition, with no effect at 0.1–0.2 μg/ml and increasing toxicity above 0.5 μg/ml. Cytolysis was enhanced by the simultaneous presence of amphoterocin B and by exposing cells to SG at 42°C. Hypoxia protected cells from drug-induced lysis. The loss of membrane-intact cells was inversely related with population density at the time of drug exposure. Short exposures (up to 5 hours) at 20 μg/ml showed that cell killing was primarily through reduction of dye-excluding cells within a matter of hours and secondarily through loss of proliferative capacity. Prolonged drug contact (24 hours) at lower concentrations (1–5 μg/ml) accentuated the effect on clonogenicity. These results suggest that for clinical potency, prolonged drug contact may be beneficial.

Brachytherapy improves outcomes in young men (≤60 years) with prostate cancer: A SEER analysis

PURPOSEnThe aim of the study was to compare prostate cancer-specific mortality (PCSM) in young men with clinically localized prostate cancer treated by either external beam radiation (EBRT) alone or brachytherapy with or without external beam radiation.nnnMETHODS AND MATERIALSnUtilizing the Surveillance, Epidemiology and End Results database, 15,505 patients ≤60xa0years of age diagnosed with prostate cancer between 2004 and 2009 and treated with radiation therapy alone were identified. Incidence of PCSM was determined for both groups and compared using competing risk models.nnnRESULTSnThe overall 8-year PCSM for the study population was 1.9% (95% confidence interval [CI]: 1.6-2.2). For patients treated with EBRT or brachytherapy with or without external beam, the 8-year PCSM was found to be 2.8% (CI: 2.2-3.4) and 1.2% (CI: 0.9-1.6), respectively (pxa0<xa00.001). Univariable analysis demonstrated that brachytherapy was associated with lower PCSM risk (hazard ratioxa0= 0.40; CI: 0.30-0.54; p < 0.001). High Gleason risk category, black race, higher Tumor (T) stage, and higher grade were all associated with greater mortality risk (p < 0.01). On multivariable analysis, brachytherapy continued to be associated with a significantly lower mortality risk (hazard ratioxa0=xa00.65; CI: 0.47-0.89; pxa0=xa00.008). Subgroup analyses found that among those with Gleason score ≥8, younger patients had increased risk of PCSM (pxa0= 0.001).nnnCONCLUSIONSnIn men ≤60xa0years of age with prostate cancer, radiation therapy continues to offer excellent outcomes. After adjusting for relevant variables, the use of brachytherapy was associated with reduced PCSM compared to treatment with EBRT alone.