Simon B. Sutcliffe

Outcome analysis of localized gastrointestinal lymphoma treated with surgery and postoperative irradiation.

One hundred thirteen patients with localized gastrointestinal lymphoma treated by surgery and postoperative irradiation between 1967 and 1985 were reviewed. At 15 years, actuarial survival of this group was 40.6%, with a cause-specific survival of 69.2% and a relapse-free rate of 64%. Two-thirds of relapses occurred at distant sites. In Stage IA and IIA patients with no residuum or with positive resection margins, (N = 90) only site of involvement and stage predicted for relapse. Age, histologic subtype group, and depth of bowel wall invasion did not affect relapse risk. In the very favorable group (Stage IA, IIA, no residuum or microscopic residuum), 8.4% of patients with stomach lymphoma relapsed compared to 25% of patients with small bowel lymphoma. The risk of early relapse was higher in those with Stage IIA small bowel lymphoma than those with Stage IA small bowel lymphoma. We continue to recommend adjuvant abdominal irradiation for patients with Stage IA, IIA completely resected stomach lymphoma and Stage IA completely resected small bowel lymphoma. We recommend combined modality therapy for patients with completely resected Stage IIA small bowel lymphoma and all other localized gastrointestinal lymphoma where visible residual disease is present.

Non-hodgkin's lymphoma of the thyroid gland: Prognostic factors and treatment outcome

Abstract Purpose: Non-Hodgkins lymphoma presenting in the thyroid gland is uncommon. A review of the Princess Margaret Hospital experience was performed to assess treatment outcome and prognostic factors in this rare extranodal presentation of localized lymphoma. Methods and Materials: Fifty-two patients treated at the PMH between 1978 and 1986 were identified and their records reviewed retrospectively. Staging procedures revealed 16 patients with Stage I, 28 with Stage II, and eight with Stages III or IV disease. Five patients were treated on a protocol designed for anaplastic carcinoma of thyroid and they were excluded from detailed analysis. Of 39 patients with Stages I and II disease, 18 were treated with radiotherapy alone, three chemotherapy alone, and 18 combined modality therapy. Combined modality therapy was used mainly in patients with large tumor bulk. Results: The overall 5-year actuarial survival and cause-specific survival were 56% and 64%, respectively. The overall relapse-free rate was 61% at 5 years. Among the 39 patients with Stages I and II disease, the 5-year actuarial survival, cause-specific survival, and relapse-free rate were 64%, 73%, and 66%, respectively. There were no significant differences in outcome between those treated with radiotherapy alone and those treated with combined modality therapy (cause-specific survival: p = 0.25, relapse: p = 0.06). A univariate analysis showed that the only variable to reach statistical significance was tumor bulk. Age was marginally significant while stage and histology were not statistically significant, possibly due to the fairly homogeneous distribution of patients in each of these variables. Patients with progression or relapse of lymphoma after initial treatment frequently died of disease. Isolated gastrointestinal relapses occurred in three cases, representing 27% of all relapses. Conclusion: Based on the above results, we recognize that the majority of patients with localized thyroid lymphoma require combined modality therapy and we recommend radiotherapy alone only for a small, select group of patients with Stage I disease and small tumor bulk.

Localized extradural lymphoma: survival, relapse pattern and functional outcome

Between 1967 and 1988, 22 patients were treated at The Princess Margaret Hospital (PMH) for localized (stage IE) non-Hodgkins lymphoma (NHL) presenting with spinal extradural compression. The median age of the patients was 55 years (range 18-76). Back pain (20 patients) and leg weakness (18 patients) were the commonest complaints at presentation. Seven patients (30%) were non-ambulatory (paraplegic or severely paretic) and four had imparied sphincter function. Diffuse histiocytic lymphoma (12 cases) was the commonest histology. All patients initially had laminectomy decompression and were referred to PMH post-operatively. One patient (with coincident metastatic carcinoma of the breast) was treated palliatively. The remaining 21 patients received radical post-operative treatment: radiation therapy (XRT) alone in 12 cases (25-45 Gy), radiation therapy plus systemic combination chemotherapy (combined modality therapy, CMT) in 9 cases. The overall actuarial survival for the radically treated patients was 55% at 10 years and there was a significant difference (p = 0.037) between those treated by XRT alone (33%) and those who received CMT (86%). Only one patient from each treatment group failed locally but the distant recurrence-free survival for the XRT group was 32% compared to 100% for the CMT group (p = 0.017). One patient developed primary central nervous system (CNS) relapse. The functional results of treatment were excellent: 19 of the 21 radically treated patients regained or retained normal ambulatory status and the remaining two patients had only minor disability. Decompressive surgery and radiotherapy for localized extradural lymphoma ensures a high rate of local control and functional recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Hodgkin's disease: Combination chemotherapy for relapse following radical radiotherapy

Abstract The results of Mustine, Vinblastine, Procarbazine, Prednisolone (MVPP) combination chemotherapy for relapsed Hodgkins disease in 33 patients who were treated initially by definitive radiotherapy are analyzed. Twenty three of 27 (85%) who received chemotherapy at first relapse achieved complete remission (CR); 20 of these remained in remission at periods of 13–96 months (median 53 months) from treatment. Six patients were retreated by irradiation at first recurrence and all suffered further relapse within 14 months. Only 3 (50%) of this group achieved CR with subsequent chemotherapy. The results of radiotherapy for early stage Hodgkins disease are improving now that certain presentations that are associated with high risk for relapse when treated by irradiation alone are recognized. The high CR rate obtained with MVPP in patients with recurrence following radiotherapy suggests that chemotherapy may reasonably be withheld in the initial management of localized disease, thus reducing the risk of iatrogenic complications associated with combined modality therapy.

Hodgkin's disease occurring during acute leukaemia in remission.

Three patients with acute lymphoblastic leukaemia are reported in whom Hodgkins disease developed during chemotherapy-maintained remission. This association has been reported only once before. The pathogenesis of the Hodgkins disease in these patients is discussed, including the possible role of anti-leukaemic therapy.

The management of stage 111a hodgkin's disease

Abstract Forty patients with pathological Stage IIIA Hodgkins disease were allocated to receive either total nodal irradiation (TNI) or 6 cycles of chemotherapy with Nitrogen Mustard (Mustine), Vinblastine, Procarbazine and Prednisolone (MVPP) as initial treatment. The complete remission rate for both groups was 100%, with 5-year actuarial disease-free survival figures of 74 and 87% for TNI and MVPP respectively (median duration of follow-up = 48 months). Eighty-eight per cent of TNI treated patients were alive at 5 years compared with 100% in the MVPP group. Three patients died, two who were treated with TNI and one who received MVPP. Treatment related morbidity included one patient with osteonecrosis and one with a second malignancy. Given the length of follow-up available, these results demonstrate no significant difference between TNI and MVPP for patients with Stage IIIA disease; it is unlikely that further patient entry into this particular study will allow any conclusion to be reached regarding the optimal form of management. We would recommend that individual disease characteristics within Stage IIIA be used as a basis for future treatment decisions with the understanding that further information regarding morbidity may become available with prolonged follow-up.

The global cancer epidemic: opportunities for Canada in low- and middle-income countries

As economic disparities lessen in some areas of the world, the burden of cancer has increased. In 2008, cancer caused more deaths worldwide than tuberculosis, HIV/AIDS and malaria combined (8.1 million v. 4.3 million).[1][1] More than 20% of all cancer deaths occur in low-income countries (per

REMISSION-RATES IN HODGKIN'S DISEASE

virus antibody using the haemagglutination-inhibition technique. 7 of the 22 showed a four-fold or greater rise in titre to influenza A/Port Chalmers/l/73. There was no significant antibody response to A/Hong Kong/8/68 or B/Hong Kong/5/72 influenza antigens. These 7 patients all had clinical disease suggestive of dengue. However, in contrast to the dengue patients, all had respiratory symptoms. In the few patients with dengue, respiratory symptoms, and some form of haemorrhage, there was no evidence of a concomitant influenza. Of the patients with influenza, 1 had a mild encephalitis, 1 pneumonia, and the remaining 5 had some form of bleeding—hæmatemesis in 1 and epistaxis in the other 4. The apparent influenza infection might have been only incidental to the bleeding diathesis. However, severe haemorrhagic manifes-