William R. Meeker

Combined chemotherapy, radiation, and surgery for epithelial cancer of the anal canal

Combined chemotherapy and radiation therapy have been reported to produce a high incidence of complete regression of epithelial cancer of the anal canal, resulting in prolonged disease‐free survival. This modality has been advocated as an alternative to abdominoperineal resection as a primary treatment for this disease. Our group treated 19 patients between 1979 and 1985. Treatment included two infusions of 5‐fluorouracil (1000 mg/m2/24 hours), one dose of mitomycin C (15 mg/m2), and simultaneous whole‐pelvis radiation (3000 rad). The complete response rate was 88%. Three patients had anal cancer incompletely controlled by that therapy. They underwent abdominoperineal resections and are alive without disease at 10, 39, and 43 months, respectively. Actuarial disease‐free survival at 40 months was 87.5 ± 8.8 (% ± standard error of the mean [SEM]). Complications included gastrointestinal, hematologic, and cutaneous toxicity. These results confirmed a high complete response rate to this therapy. Local treatment failures may occur, but these may be salvaged with abdominoperineal resection.

Multiple biochemical markers in patients with gynecologic malignancies.

Plasma levels of carcinoembryonic antigen (CEA), alpha‐fetoprotein (AFP), and human chorionic gonadotropin (hCG) were measured in 253 patients with gynecologic malignancies and in 317 patients with benign gynecologic diseases. Plasma concentrations of each of these antigens were elevated in a significantly (p < 0.001) greater number of patients with invasive gynecologic cancers than in the control population. Carcinoembryonic antigen was the most commonly elevated marker, followed by AFP and hCG. Prior to therapy, over 85% of patients with ovarian or cervical cancer had elevated plasma levels of one or more antigens. Specifically, CEA was most often elevated in patients with mucinous adenocarcinomas of the ovary and endocervix. Alpha‐fetoprotein was most often increased in patients with germ cell or stromal tumors of the ovary and in patients with large‐cell nonkeratinizing cervical cancers. In contrast, hCG concentrations were highest in patients with serous cystadeno‐carcinomas of the ovary and in patients with keratinizing squamous cell carcinomas of the cervix. Plasma antigen levels were directly related to tumor differentiation and stage of disease, and generally returned to normal eight to 12 weeks following therapy. Effective plasma and tumor antigen screening during initial evaluation of patients with gynecologic tumors should help to identify the most appropriate antigen for immunodetection procedures and for serial plasma determinations following therapy.

Carcinoembryonic antigen in patients with gynecologic malignancy.

Carcinoembryonic antigen (CEA) was elevated (> 2.5 ng/ml) in 81 of 100 patients with gynecologic malignancy and in 17 of 95 patients with benign gynecologic disease. CEA concentration was, in general, related to the extent of disease, and in early stage cancer often returned to normal following complete surgical excision. Tumors were classified morphologically according to cell type, lymphoplasmacytic infiltration, necrosis, vascular invasion, desmoplasia, and degree of differentiation. The only histologic characteristic associated with elevated CEA levels was the presence of vascular invasion. Further investigation is needed to define the structure, function, and metabolism of CEA in patients with gynecologic malignancy.

Carcinoembryonic antigen (CEA) levels and tumor histology in colon cancer.

The demonstration of a tumor specific antigen (carcinoembryonic antigen) in 1965 raised the hope that the long-sought after “blood test for cancer” had been found [ 11, 121. Early optimistic reports suggested that the serum carcinoembryonic antigen (CEA) would be elevated or positive in as high as 90% of patients with colon cancer [9,24,27]. This original promise of CEA has not been fulfilled due to (1) a high incidence of false negatives in early lesions, (2) positive titers associated with malignancies outside the G.I. tract, (3) a significant number of false positives in patients with benign inflammatory disease [6, 9, 16, 20, 231. Despite these shortcomings, the CEA titer is elevated in over 70% of patients with carcinoma of the colon [5, 20, 251. During the past 5 years many investigators have tried to assess the role of CEA in cancer diagnosis, management and prognosis [2,20,21]. A number of studies have shown the plasma CEA may not be directly related to the size and extent of the colon cancer [ 1, 16,261. Recently we posed the question: Is the tumor associated with a high CEA titer histologically different from the tumor associated with a low CEA titer? In this study an attempt is made to answer that question by examining independently tumor

Cholecystectomy: to drain or not to drain. A randomized prospective study of 200 patients.

Abstract During the 24-month period commencing January 1975, 200 patients underwent elective cholecystectomy for chronic cholecystitis. According to a prospective randomized protocol, 100 patients were drained and an identical number were not drained. The two groups were similar with respect to age, weight, diabetic history, and all other measured clinical parameters. Patients who were not drained had less postoperative fever in terms of actual temperature elevation and duration of fever and were discharged from the hospital earlier. There was no difference in the incidence of wound infection or other complications between the two groups. This study confirms that elective cholecystectomy without drainage of the subhepatic space can be done safely and that less postoperative fever and shorter hospitalization can be expected.

The use and abuse of CEA test in clinical practice.

Charts of 437 patients having plasma carcinoembryonic antigen determinations during the period January 1, 1976 through April 30, 1976 were reviewed to determine whether CEA results led to clinical decisions altering management patterns. Data analysis disclosed that CEA test results did not result in any change in management in 167 patients with non‐neoplastic disease. Most had single determinations. In 270 patients with neoplastic disease, CEA results led to changes in management in one patient with lung cancer and two patients with colon cancer, which may have altered prognosis. In a fourth patient, CEA results led to discovery of unresectable pancreatic cancer at laparotomy. Cost benefit analysis indicated a CEA test cost of

Carcinoembryonic antigen in intraepithelial neoplasia of the uterine cervix.

5,047 0.50 per patient benefitted in 299 patients eligible for analysis. We conclude that maximal benefit to the patient results from serial CEA test use in follow‐up of colon cancer patients after curative therapy.

Association of cystic dilatation of intrahepatic and common bile ducts with Laurence-Moon-Biedl-Bardet syndrome

Carcinoembryonic antigen (CEA) was elevated (greater than 2.5 ng. per milliliter) in 29 of 100 patients with cervical intraepithelial neoplasia (CIN). CEA concentration was related to the amount of intraepithelial neoplasia and to the presence of glandular extension. Lymphoplasmacytic infiltration of tumor cells was unrelated to CEA levels. CEA values returned to normal within 8 weeks following surgery in 77 per cent of patients. A persistently elevated (greater than 5.0 ng. milliter) plasma CEA value following conization was associated with residual CIN in the cervix. These results suggest that sequential CEA determinations may be of value in the follow-up of those cervical cancer patients who initially have high plasma antigen levels.

Optimizing Primary Treatment for Advanced Laryngeal and Pyriform Sinus Carcinoma

Abstract This report describes the unusual occurrence of cystic dilatation of the intrahepatic as well as extrahepatic biliary tree together with features of the Laurence-Moon-Biedl-Bardet syndrome in a single patient. The simultaneous occurrence of two such uncommon entities as a chance event seems unlikely and gives support to the concept of congenital etiology of cystic dilatation of the bile ducts. It is hoped that this report will stimulate further investigation of this uncommon association.

α-Fetoprotein as a biochemical marker in patients with gynecologic malignancy

Advocates of chemotherapy plus radiation as the definitive treatment for patients with advanced laryngeal cancer often cite older studies that attribute cure rates of less than 50% to laryngectomy plus radiation. The outcomes of patients with stage III and IV laryngeal and pyriform sinus carcinoma from 1980 to 1989 (96 patients) were compared with those of patients treated from 1962 to 1977 (84 patients). Demographics, the extent of disease, and nodal involvement were similar between the groups. There were more operative complications (45% versus 22%; p < 0.01) and deaths (10% versus 2%; p < 0.01) in the patients who underwent irradiation preoperatively. Overall survival was improved in the recent group compared with the early group (73% versus 54% at 5 years; p < 0.03), as was disease-free survival (64% versus 38% at 5 years; p < 0.02). Results of treatment for advanced laryngeal and pyriform sinus carcinoma have improved significantly. These modern results should be used to evaluate newer treatment modalities.