Simon G. Allan

Adult neuroblastoma: report of three cases and review of the literature

Adult neuroblastoma is an uncommon malignancy. The authors report three additional cases and review the 39 reported cases in the world literature. Presentation in the abdomen is the most common; a high rate of lower limb presentation is also observed. Incidence is equal between sexes with a median age of presentation of 34 years. Survival is greatest after surgical intervention (median, 20.5 months) compared with no surgery (median, 12.5 months). Chemotherapy may benefit individual patients but does not have a major impact on survival. Radiotherapy is indicated for localized, inoperable primaries or painful metastases. The survival rates of this group of patients parallels that of childhood neuroblastoma, Stage III‐IV. Cancer 57:2419–2421, 1986.

Prognosis at presentation of small cell carcinoma of the lung

Prognostic factors in 411 patients with small cell lung carcinoma have been retrospectively analysed. Univariate analysis of continuous variables showed that prognosis was worse with deteriorating performance status, extensive disease, positive bone scan, increasing age, elevated total white cell count, alkaline phosphatase, lactate dehydrogenase, and decreased serum chloride and albumin. Low serum sodium was less clearly associated with poor survival. Cox multivariate regression showed that performance status, disease extent, age and raised lactate dehydrogenase and white cell count were independent prognostic factors. When disease extent was excluded from analysis, performance status, age, total white cell count, lowered serum chloride and raised lactate dehydrogenase were significant independent prognostic variables.

Low grade stage I and II non-Hodgkin's lymphoma: Results of treatment and relapse pattern following therapy

Sixty-four patients (37 stage I and 27 stage II) with low grade non-Hodgkins lymphoma were treated by surgical excision alone (two patients) or with radiotherapy (53 patients), chemotherapy (five patients) or both (four patients). Actuarial survival was 80.7% at 5 years and 77.9% at 10 years. Actuarial recurrence-free survival at 10 years was 49.4% for stage I and 38.0% for stage II patients. Local control was achieved in 52 out of 56 (93%) patients treated with a radiation dose of 30 Gy or greater. There was no advantage for extended compared with involved, field irradiation. A multivariate analysis identified age, sex, stage and disease site as independent prognostic variables for survival.

Cis-platinum and vindesine in combination in the treatment of non-small cell lung cancer

Sixty-three patients with advanced non-small cell carcinoma of the bronchus were treated with a combination of cis-platinum and vindesine. All patients had measurable disease and were of good performance status; none had received prior chemotherapy or radiotherapy. Thirty-three per cent of patients responded, with five patients achieving complete remission. Median duration of response was 4 months, with a median survival of 14 months in the responsers, compared with 6.5 months in the whole group and 4.8 months in the nonresponders. Severe toxicity was encountered, with alopecia, gastrointestinal toxicity and neurotoxicity common. Myelosuppression and renal toxicity were not dose-limiting. Thus the activity of this drug combination is confirmed, but severe toxicity precludes its widespread use in clinical practice.

Phase II trial of vindesine and VP16-213 in the palliation of poor-prognosis patients and elderly patients with small cell lung cancer

SummaryForty-three previously untreated patients, all of whom had poor-prognosis small cell lung cancer and/or were >65 years old, received treatment with vindesine and VP16-213. Thirteen patients had limited disease and 30 extensive disease. Response rates (CR+PR) of 86% (CR 29%) and 66% (CR 17%) were seen in patients with limited and extensive disease, respectively. Time to relapse was short in those responding (4–4.5 months), and most responders required additional treatments. The overall toxicity was minimal and patient compliance was high. This combination is useful for the palliative treatment of small cell lung cancer when aggressive chemotherapy is inappropriate.

Bereaved relatives’ perspectives of the patient’s oral intake towards the end of life: A qualitative study

Background: Patients approaching death often have a decreasing oral intake, which can be distressing for relatives. Little is known about the relatives’ experiences with and perceptions of oral intake at the end of life. Aim: This study aims to contribute to a more thorough understanding of relatives’ concerns regarding decreased oral intake of the patient at the end of life. Design: Qualitative interview study: semi-structured interviews were transcribed verbatim and analysed using qualitative content analysis. Setting/participants: Twenty-three bereaved relatives of patients who had been referred to a New Zealand palliative care service were interviewed. Results: All relatives experienced significant changes in patients’ oral intake at the end of life. Oral intake towards the end of life was considered important and is perceived as meaningful by relatives in different ways, such as nutritional value, enjoyment, social time, daily routine and a way of caring. Relatives responded differently to decreasing oral intake; some accepted it as inherent to the dying process, others continued efforts to support the patient’s oral intake. Some relatives perceived decreasing oral intake as the patient’s choice, and some viewed maintaining oral intake as part of the battle against the disease. Relatives recalled limited communication with health-care professionals concerning oral intake at the end of life. Conclusions: This study revealed the complexity of meaning relatives’ experiences with dying patients’ decreasing oral intake. Their perceptions and concerns were related to their awareness of the imminent death. These findings can guide staff involved in care delivery to better support relatives.

Prognosis in small cell carcinoma of the lung – Relationship to human milk fat globule 2 (HMFG2) antigen and other small cell associated antigens

Forty fixed tissue sections from patients with small cell lung carcinoma (SCCL) have been stained with a panel of 10 monoclonal antibodies using a peroxidase anti-peroxidase method and the incidence of staining has been compared to patient characteristics at presentation and to survival. An inverse association between HMFG2 staining and survival was found with median survival in HMFG2 negative patients 13 months compared to 8 months for HMFG2 positive patients. No such association was found with the other antibodies and no association was found between staining and disease extent or primary versus secondary deposits with this panel of antibodies. Epidermal growth factor receptor was detected in 3/38 presentation biopsies and in these 3 patients mean survival was only 5 months. Further prospective study of HMFG2 as a prognostic indicator in SCCL is suggested.

Review article : Emesis in the patient with advanced cancer

The control of symptoms related to far advanced cancer has improved dramatically in recent years, making the passage of death more tolerable for such patients. The major impact of analgesic control now allows research efforts to focus on other distressing symptoms such as nausea and vomiting. The emetic process is a complex physiological and psychological one of multifactorial aetiology. Rapid improvement in our understanding of these processes is allowing the more rational use of known antiemetics and the development of new antiemetic agents. A rapid expansion of the literature of cytotoxic-induced emesis has pointed to new antiemetic agents and new schedules of administration. This review emphasises the need to identify the cause of emesis before attempting indirectly to block the emetic process with antiemetic drugs. It also outlines the many areas where research could be applied to unravel some of the questions about which antiemetic to use, in what dose, and perhaps to identify the main site of emetic stimulus. More effective research is required, but the outlook for improved control of nausea and vomiting in the terminally ill patient is good.

Emesis due to cancer chemotherapy: Results of a prospective, randomised, double-blind trial of varying doses of metoclopramide in the management of cis-platinum-induced vomiting

A randomised, double-blind prospective trial was conducted to determine the relative anti-emetic efficacy of three dose levels of metoclopramide in cancer patients receiving combination chemotherapy including cis-platinum. With consecutive courses of chemotherapy, 60 patients received doses of either 3,5 or 10 mg/kg metoclopramide (50, 54 or 55 courses respectively) in a randomly assigned sequence. Major control of emesis (less than or equal to 2 vomits) was achieved in 38% of 159 patient treatments. There were no significant differences in either anti-emetic efficacy or the incidence of side-effects between the three doses used. It is concluded that while metoclopramide is an effective anti-emetic for patients receiving cisplatinum therapy, no advantage accrues to the use of doses in excess of 3 mg/kg (total dose).

Influence of therapy on local control and survival in stage I and II intermediate and high grade non-Hodgkin's lymphoma

In a consecutive series of 113 patients with localized (Stage I and II) intermediate and high grade non-Hodgkins lymphoma we have retrospectively analysed patterns of survival and relapse in relation to presenting features and therapy. Two patients were treated by complete surgical excision. Seventy-two were treated by radiotherapy (RT), 19 by chemotherapy (CT) and 20 by combined CT and RT. A number of different chemotherapy combinations were employed. Overall survival for Stage I patients was 68.3% at 5 years and 65.5% at 10 years; for Stage II patients it was 61.2% at 5 years and 52.2% at 10 years. Recurrence-free survival for Stage I patients was 51.4% at 5 years and 42.1% at 10 years; for Stage II patients it was 46.2% at both 5 and 10 years. Local control by radiation was achieved in 59/72 (82%) patients treated with less than 40 Gy and 19/20 (95%) treated with 40 Gy or more. There was no advantage for extended field irradiation when compared with involved field. Eleven of 19 (58%) patients treated by CT alone achieved complete response (CR). For patients responding completely to CT there was no clear advantage for irradiation of originally involved bulky sites. For patients with Stage II and bulky Stage I disease there was a significant (P = 0.05) improvement in recurrence-free survival (RFS) and a trend (P = 0.192) towards improved overall survival for patients treated by CT alone or together with RT compared with RT alone. Independent variables identified by multivariate analysis were age, with better survival for younger patients (P = 0.034) and histopathological group, with better survival for DPDL compared with DH (P = 0.015).