A phase I study of prolonged infusion 5-fluorouracil and concomitant radiation therapy in patients with squamous cell cancer of the head and neck

The radiosensitization properties of 5-FU are well documented, and clinical trials have suggested improved local control and survival in head and neck cancer. Clinical trials to date have used bolus injection or short term (less than or equal to 5 days) 5-FU infusions. To determine the maximum tolerated dose (MTD) of 5-FU given as continuous intravenous infusion for 12 weeks concomitant with conventional radiation therapy, 18 patients with advanced inoperable head and neck cancers were treated with conventional irradiation and 100, 200, 250, or 300 mg/m2/day of 5-FU. A dose of 250 mg/m2/day was determined to be the maximum tolerated dose and is recommended for Phase II studies.

Extradural spinal cord compression from metastatic tumor

Extradural spinal cord compression (ESCC) as a consequence of metastasis from various primary cancers represents the most common type of malignant lesion affecting the spinal cord. It has been estimated that 5% of all patients with systemic cancer who are autopsied have pathologic evidence of tumor invading the extradural space. The incidence of ESCC is expected to increase due to improved survival of the cancer patient. The current approach to the diagnosis of ESCC depends upon the recognition of early symptoms and signs of spinal cord compression. Despite the increasing clinical awareness of these complications, irreversible loss of ambulation continues to occur in over half of these patients. Early diagnosis is critical since onset of spinal cord injury may be sudden, often progressing to irreversible paralysis in a period of hours. Consequently, physicians dealing with cancer patients must maintain a high index of suspicion. This paper analyzes prognostic factors based on our prospective study and emphasize the use of diagnostic tests in early recognition of ESCC before onset of neurologic deficits.

Extradural spinal cord compression: analysis of factors determining functional prognosis--prospective study

The treatment results in 59 patients with extradural spinal cord compression (ESCC) who were treated with irradiation between April 1987 and December 1988 were analyzed prospectively. Eighty percent of the patients presented with back pain, which preceded ESCC by an average of 6 weeks. The most common primary tumor was lung cancer (27% of cases), followed by prostate cancer and breast cancer. The prognostic significance of pretreatment motor function, degree of spinal cord block, radiosensitivity of tumor, and radiation dose schedule was determined with multivariate analysis. Only pretreatment motor function was found to be a significant factor in determining functional prognosis (P = .0058). Even with the increasing clinical awareness of ESCC, 78% of the patients in the current series were nonambulatory at presentation. Therefore, computed tomographic myelography or magnetic resonance imaging is recommended for patients with back pain and bone destruction at the site of the complaint if local radiation treatment is not planned.

Retinoids and butyrate modulate fibroblast growth and contraction of collagen matrices

Wound healing in the eye may lead to undesirable sequelae such as proliferative vitreoretinopathy and scarring of glaucoma filtering fistulas. We therefore sought to manipulate in vitro two key wound healing processes--cell proliferation and contraction of extracellular matrices--using vitamin A (VA), retinoic acid (RA), and n-butyrate (BUT). These substances modulate growth and differentiation of normal and neoplastic cells. We examined the effects of these agents on cultured rabbit fibroblast proliferation and contraction of collagen matrices. Dermal fibroblast proliferation was unaffected by VA, stimulated by RA, and inhibited by BUT. Scleral fibroblast proliferation, in contrast, was stimulated by both VA and RA. All three agents mildly inhibited fibroblast contraction of collagen matrices. We conclude that 1) VA, RA, and BUT have differential effects on rabbit fibroblast proliferation; 2) retinoid effects on fibroblast growth vary with the tissue of origin; and 3) VA, RA, and BUT modestly inhibit fibroblast contraction of extracellular matrices. This study suggests that fibroblast-mediated processes in ocular wound healing and cicatricial disease may be differentially modulated by retinoids and BUT.

Radiotherapy as an adjunct in the management of Merkel cell carcinoma

Four patients with a diagnosis of Merkel cell carcinoma initially underwent surgery followed by radiotherapy. Recurrent disease prompted use of radiation in three cases. The three cases of recurrent disease illustrate the aggressiveness of Merkel cell carcinoma and also provide further documentation of the radiosensitivity of this tumor. Additionally, these cases suggest that surgery alone frequently is inadequate to achieve local control of disease.

Radiation alone in the treatment of cancer of the uterine cervix: analysis of pelvic failure and dose response relationship

This retrospective analysis involves 569 patients with invasive cancer of the uterine cervix treated with irradiation alone between 1969 and 1980. Treatment consisted of external and intracavitary irradiation and treatment policy remained consistent throughout the study interval. In early stage disease (FIGO IA, IB, and IIA), pelvic failure was 4.6%, 11.2%, and 8.2%, respectively. In late stage disease (FIGO IIB, III, and IVA), pelvic failure was 30.1%, 52.3%, and 69.2%, respectively. Further analysis revealed that total dose at point A is well correlated with pelvic control. An aggressive treatment is crucial in late stage disease in determining the probability of pelvic tumor control and survival. Methods of dose prescription, dose-response relationships, treatment philosophy and its therapeutic implications are discussed.

Superior segmental optic hypoplasia. A sign of maternal diabetes

In a review of 10 patients with superior segmental optic nerve hypoplasia, all of whom were the children of diabetic mothers, 17 of 20 eyes had one or more of four characteristic findings in the optic disc: relative superior entrance of the central retinal artery, pallor of the superior disc, superior peripapillary halo, and thinning of the superior peripapillary nerve fiber layer. We believe that the presence of these four signs of superior segmental optic nerve hypoplasia strongly suggests maternal diabetes.

Intraperitoneal chromic phosphate in ovarian cancer: risks and benefits

Between March 1977 and December 1985, 59 patients were treated with intraperitoneal chromic phosphate at The University of Alabama Birmingham Hospitals and its affiliates. Twenty-seven patients received primary adjuvant therapy. Thirty-two patients were treated "secondarily" after tumor recurrence or after a "positive" second-look laparotomy. Associated morbidity was noted to be 12% with reoperation required in 7%. Early stage and grade tumors demonstrate a good prognosis. Little, if any, benefit was demonstrated in "secondary" therapy of advanced stage and grade tumors.

Analysis of treatment modalities and their failures in stage IB cancer of the cervix

This is a retrospective analysis of 240 patients who had clinical Stage IB cancer of the cervix treated with radiation between 1969 and 1980. Of these, 186 patients were treated with a combination of external and intracavitary radiation therapy, and 54 patients received adjuvant postoperative radiation therapy. The minimum follow-up was 5 years. In the group who received only radiation therapy, the overall recurrence in 170 patients (excluding 16 patients found at laparotomy to have unresectable disease) was 17% (29 of 170); pelvic recurrence was 9% and distant metastases alone was 6%. In the group who received the adjuvant postoperative radiation therapy, 16 patients had a simple hysterectomy followed by vaginal ovoid and/or external pelvic irradiation for an unexpected Stage IB cancer of the cervix. Their overall recurrence was 37.5% (6 of 16). Pelvic recurrence was the most common treatment failure with a recurrence of 31%. Significant prognostic factors were depth of stromal invasion and status of surgical margins. Thirty-eight patients had a radical hysterectomy followed by postoperative radiation therapy because of positive pelvic lymph nodes and/or close surgical margins. In patients with positive pelvic lymph nodes, the overall recurrence was 39% (9 of 23); pelvic recurrence was 13%. Distant metastases, the most common treatment failure, was 26%. In seven patients with close surgical margins, five recurred in the pelvis. There was no distant metastases without pelvic failure. Five of eight patients with close paracervical margins recurred in the pelvis. All five of these patients were treated with vaginal ovoid irradiation alone. Whole pelvic irradiation plus vaginal ovoid irradiation is necessary in those with close paracervical margins. The vaginal ovoid irradiation alone should be limited to very selected patients with positive vaginal margins only.

Adjuvant postoperative radiation therapy following radical hysterectomy in stage IB CA of the cervix--analysis of treatment failure

Among 240 patients treated by radiation therapy for clinical Stage IB cancer of the cervix between 1969 and 1980, 38 patients received postoperative pelvic radiation therapy after radical hysterectomy because of positive pelvic lymph nodes and/or close surgical margins. The overall recurrence was 45% (17 of 38), and the major complication rate was 15% in minimum 5-year follow-up. In patients with positive pelvic lymph nodes, the pelvic recurrence was 13% (3 of 23). However, distant metastases alone was 26% (6 of 23), which was the most common treatment failure. In 11 patients with close surgical margins, eight patients had paracervical margins and three had vaginal margins. All five patients with paracervical margins treated with vaginal ovoid irradiation only had pelvic recurrence. No local failure occurred in the other three patients treated with whole pelvic irradiation. All patients with vaginal margin alone treated with vaginal ovoid or whole pelvic irradiation had no recurrence of cancer in the pelvis. On the basis of our data, whole pelvic irradiation with or without vaginal ovoid irradiation is necessary in those with a close paracervical margin. In patients with close vaginal margin, whole pelvic irradiation with or without vaginal ovoid irradiation is recommended. The vaginal ovoid irradiation alone should be limited to very selected cases.

Skeletal metastases from cancer of the uterine cervix: frequency, patterns, and radiotherapeutic significance

The records of eight hundred two patients who received primary radiotherapy for invasive cervical cancer between 1969 and 1985 were reviewed. The incidence of bone metastasis was 1.9% (15/802). Lumbar spine involvement was the most common site, followed by the pelvic bones. Lumbar spine involvement was characterized by unilateral destruction of one or several contiguous vertebrae. All 10 patients with lumbar spine involvement were associated with a para-spinal mass. In seven of ten patients, this bone destruction due to direct extension from metastatic para-aortic tumor was the only recurrent cancer. In contrast, involvement of a long bone, a rib or the skull indicates hematogenous bone metastasis. When a spine X ray or bone scan is positive in the lumbar area in a cervical cancer patient with back pain, a CT scan should be performed to determine the extent of the underlying tumor. This will allow more accurate establishment of a radiation treatment plan, and will improve the chances for successful palliation.

Use of ultrasound scan in prostatic I-125 implantation

The average dimension of prostate was measured by transabdominal ultrasonography preoperatively to compare with direct intraoperative measurements in 28 patients undergoing suprapubic I-125 seed implantation for the treatment of prostatic cancer. A highly significant correlation (r = 0.932) was found between these two measurements. Transabdominal ultrasonography is a relatively simple and accurate non-invasive method of determining the number of I-125 seeds needed to implant the patient with prostatic malignancy.

High-energy irradiation in the management of chondrosarcoma

We present a retrospective analysis of seven patients with chondrosarcoma of the bone treated by high-energy irradiation between 1961 and 1976. Its major role in this series was prevention of local recurrence in cases with inadequate resection. In three of the five cases in which radiation therapy was adjuvant rather than primary treatment, long-term local control was obtained in a dose of 5,000 to 6,500 rads in five to six weeks. Although primary treatment of chondrosarcoma is surgical, high-dose radiation therapy is indicated when surgical resection is not possible. Chondrosarcoma can respond to high doses of irradiation even though the response is slow.

Uterine perforation during intracavitary application. Prognostic significance in carcinoma of the cervix

All cases of uterine perforation occurring during intracavitary application for carcinoma of the cervix over a 13-year period (1968-1981) were reviewed. There were 14 perforations out of 799 applications in 622 patients, for an incidence of 2.25% of patients and 1.75% of applications. In most cases, it is sufficient to halt the application and carefully monitor the patient, as supported by the uneventful post-perforation course in 12 cases. Nine patients (64%) underwent subsequent intracavitary application without further complications; of these, 8 are still living or died without evidence of tumor. In the other 5, it was impossible to locate the cervical canal on subsequent applications. Alternative treatments, results of therapy, and analysis of failures are presented. The authors conclude that there is no direct evidence that uterine perforation alters the prognosis following radiation therapy for carcinoma of the cervix.

Improved external radiation technique for the treatment of carcinoma involving lower rectovaginal areas

The authors describe a technique which allows minimal radiation of the perineum while permitting delivery of a nearly homogenous radiation dose to a carcinoma involving the lower vagina and rectosigmoid colon as well as the pelvic lymph nodes.

Metastatic carcinoma to the tongue: a report of two cases and a review of the literature

Metastatic tumors of the oral cavity are uncommon. Most of them are located in the mandible while only a small percentage are found within the soft tissues. Two cases of metastatic bronchogenic carcinomas to the tongue are described. Review of the literature showed that cancer of the lung was the most common primary lesion that metastasized to the soft tissues of the oral cavity. The base of the tongue was the most prevalent site of metastases to soft tissue within the oral cavity.

Metastatic carcinoma to the tongue: a report of two cases and a review of the literature

Metastatic tumors of the oral cavity are uncommon. Most of them are located in the mandible while only a small percentage are found within the soft tissues. Two cases of metastatic bronchogenic carcinomas to the tongue are described. Review of the literature showed that cancer of the lung was the most common primary lesion that metastasized to the soft tissues of the oral cavity. The base of the tongue was the most prevalent site of metastases to soft tissue within the oral cavity.

Radiation therapy for early stage carcinoma of the glottic larynx

The results of radiation therapy of 79 patients with early carcinoma of the vocal cord are reported. Nine (13%) of the 69 patients with stage I disease had local recurrence, and two (20%) of the ten patients with stage II disease had local recurrence without local node metastasis. Subsequent control of radiation failure by surgical salvage was 100%. Close follow-up of the patients after radiation therapy and biopsy of suggestive areas are emphasized for early detection of residual or recurrent tumor.