Proceedings: Cellular immunity in cured cancer patients

Radiation-induced immune changes in patients with cancer of the cervix

Immunological methods were used to estimate the therapeutic effect of irradiation and its influence on the immune capacity of patients with cervical cancer. Patients were examined during and following radiotherapy by means of lymphocyte counts, lymphocytic response to phytohaemagglutinin (PHA), and the depressive effect of their sera on the response of normal lymphocytes PHA stimulation. Lymphocyte counts and lymphocyte responses during radiotherapy were depressed to 20 to 50 per cent and 10 to 33 per cent respectively of the values found before treatment. Lymphopenia and depressed T-cell function persisted for years in many patients. The highest values for both lymphocyte counts and reactivities were found in those patients who had unexpectedly good responses to radiotherapy. The immunodepressive effect of patients' sera on normal lymphocyte reactivity decreased and disappeared during therapy and was not present in previously treated patients showing a good prognosis, whereas it showed no change or even increased during therapy in patients with a poor prognosis. The results suggest that not only does immune capacity influence the effect of radiation and the prognosis of the patient, but also that study of the serum-depressive effect could give important information about both the dosage and therapeutic effects of irradiation.

Immunologic impairment in patients with non-lymphoid cancer: correlation with the tumoral stage, response to treatment and survival

The cellular immunity has been studied in 121 patients by solid nonlymphoid tumors, and in 50 healthy patients, 11 with benign tumors, with the use of techniques of in vivo dinitrochlorobenzene (DNCB) and in vitro lymphocyte response to phytohemagglutinin to observe the correlation between both tests and the clinical stage of the disease, the response to chemotherapy and surgery, prognosis, and survival. Patients with anergy presented tumoral irresectability, lack of response to chemotherapy, advanced disease, and limited survival. In the patients with good immune response, the disease was limited, responding with greater frequency to therapy and presenting a higher rate of survival. Consequently, the immunologic study of a neoplastic patient can guide us toward a therapeutic behavior and a prognosis.

Immunologic assessment of regional lymph node histology in relation to survival in head and neck carcinoma

Histologic material from 84 cases of squamous cell carcinoma of head and neck regions was studied by double blind retrospective analysis. Sections of lymph nodes draining the tumors were examined microscopically to assess the morphologic pattern of response. Patients whose lymph nodes demonstrated active immunologic responses in the form of expanded inner cortices or increased numbers of germinal centers had 5-year survival rates significantly greater than those patients whose regional lymph nodes showed an unstimulated pattern. None of the patients whose lymph nodes showed the depleted pattern survived 5 years. These correlations were independent of the stage or grade of the tumor. Metastases occurred much more frequently in patients having regional nodes showing an unstimulated or depleted pattern than in those whose regional nodes showed evidence of immunologic activity. The data support the concept of a relationship between immunologic activity, progression of neoplasia, and survival. Morphologic assessment of immunologic activity in lymph nodes draining malignant tumors appear to be of significant value in the predicting survival.

Immunologic aspects of human sarcomas

Forty-seven patients with mesenchymal sarcoma seen at the Mayo Clinic were tested for humoral and cellular immunologic responsiveness by means of a humoral cytotoxicity test, skin tests for delayed-type hypersensitivity, and lymphocyte transformation with concanavalin A, phytohemagglutinin, and pokeweed. Prospective follow-up of the clinical and laboratory results revealed that patients with low humoral cytotoxic indices, anergic skin test responses, or low lymphocyte transformation responsiveness tended to have the worst short-term clinical outlook.

Correlation of tumor burden with in vitro lymphocyte reactivity and antibodies to herpesvirus tumor-associated antigens in head and neck squamous carcinoma

In 94 patients with squamous carcinoma of the head and neck region, the clinical extent of tumor was correlated with in vitro lymphocyte reactivity (LR) to phytohemagglutinin (PHA) and serum complement-fixing antibodies to herpes simplex virus (HSV)-induced tumor-associated antigen (TAA). Forty-six patients were tumor-bearing and 48 were considered cured. Controls were 41 age-matched normals with histories of similar cigarette consumption. In 15 patients with Stage I carcinomas of the larynx, among whom the tumor diameter was 5 mm or less, mean LR or PHA did not differ from controls and 7 of 11 tested (63%) had antibodies to HSV-TAA. In 83 patients with more extensive tumors, LR to PHA was significantly lower than controls and 42 of 44 tested (95%) had antibodies to HSV-TAA. In both groups, LR to PHA was similar among tumor-bearing and cured patients. The study delineates a clinical tumor burden associated with impaired LR to PHA and a high incidence of antibodies to HSV-TAA in patients with squamous carcinomas of the head and neck region, and shows a correlation between the immune defects in clinically cured patients and tumor extent prior to treatment.

T-lymphocyte levels in the peripheral blood of patients with cancer of the head and neck

Percentage and levels of circulating T-lymphocytes were studied in forty-six patients with squamous cell carcinoma of the head and neck before and/or after treatment and compared with control values obtained in fifty-one healthy volunteers. Mean percentages of circulating T-cells and mean T-cell levels in cancer patients prior to treatment were significantly lower than control values. After surgery or radiation therapy the mean percentage of T-cells remained lower in comparison with that of the controls whereas T-cell levels in patients evaluated after surgical treatment increased in comparison with pretreatment values and were not significantly different from those of the controls.

Prolonged depression of cellular immunity in cured laryngopharyngeal cancer patients treated with radiation therapy

Immune competence was evaluated in cured patients who had been treated by irradiation for carcinoma of the laryngopharynx, and compared with that of similar patients treated by surgery alone, and normal controls. Cellular immunity was determined by quantitation of in vitro phytohemagglutinin (PHA)-induced lymphocyte reactivity and peripheral blood thymus-dependent lymphocyte (T cell) levels. Humoral immunity was assessed by measurement of serum immunoglobulin levels and by the effect of serum on in vitro normal lymphocyte reactivity to PHA. In 21 patients who were studied for 4-23 years (mean 8.4) after surgical treatment alone for laryngopharyngeal carcinoma, neither cellular nor humoral immunity differed from that of 44 controls. In contrast, 14 patients who had been irradiated and subsequently cured for 4-15 years (mean 9.0) prior to evaluation displayed significantly impaired cellular immune competence when compared to normals and patients treated by surgery alone. Since previous determinations of the effects of radiation therapy have been in patients who received irratiation to the thymic region or large area of bone marrow, this study indicates that radiation therapy for cancer administered via portals that encompass a minimal area of the immune system may be associated with prolonged impairment of cellular immunity.

Thymus-dependent lymphocyte levels in bronchogenic carcinoma: correlations with histology, clinical stage, and clinical course after surgical treatment

The in vitro spontaneous lymphocyte rosette (T cell) assay was used to determine cellular immunologic competence in 112 patients with bronchogenic carcinoma. Among preoperative patients with localized tumors. T cell levels were significantly lower than in 237 normal controls. With advanced stages of disease, T cell levels declined progressively among patients with squamous cell carcinoma, oat cell carcinoma, and undifferentiated carcinoma, but not among patients with adenocarcinoma. Squamous carcinoma patients considered cured had persisting low T cell levels, but cured adenocarcinoma patients had normal levels. Serial determinations that showed a fall in T cell levels preceded the development of clinically evident metastases by an average of 2.5 months. Postoperative patients with rising T cell levels have remained clinically free of disease. The data indicate that T cell levels correlate with extent of tumor and clinical course of patients with bronchogenic carcinoma. The assay may, therefore, provide a rational basis for the selection of patients who are at high risk for the development of recurrence after surgical resection and who may benefit from the early institution of adjunctive therapy.

Prognostic evaluation of regional lymph node morphology colorectal cancer

Histologic sections from 143 patients treated with surgery for infiltrating adenocarcinoma of the distal large bowel were studied with emphasis on the morphologic characteristics of the regional lymph nodes. Lymph nodes were classified into four groups designated lymphocyte predominance, germinal center predominance, lymphocyte depletion, and unstimulated. Results were correlated with the extent of disease and five year survival data. There was no significant association between the histologic pattern of the lymph nodes and the extent of the primary lesion. There was a higher survival rate in patients whose nodes showed germinal center predominance (71 per cent) compared with those whose nodes showed lymphocyte predominance or the unstimulated pattern (both 54 per cent), but these results were not statistically significant.

Antibodies to herpesvirus nonvirion antigens in squamous carcinomas

Serums from tumor-bearing patients, cured patients, and normal subjects were examined for antibodies to the separated complement-fixing reactive components of nonvirion antigens of herpesvirus type 1 and type 2. The occurrence of antibodies to the antigens was similar in serums from tumor-bearing patients and cured patients. Antibodies to the antigens were observed among 21 of 24 (87 percent) cervical cancer cases, 44 of 49 (90 percent) laryngeal cancer cases, 15 of 24 (62 percent) cases of squamous cell carcinomas of the head and neck excluding the larynx, 2 of 24 (8 percent) nonsquamous cell cancer cases, and 3 of 51 (6 percent) normal subjects. By contrast, no differences were found in the titers of neutralizing antibodies to the virus in serums from laryngeal cancer patients and controls. The observations support an etiologic role of herpesviruses in cervical cancer and in laryngeal cancer, and possibly other squamous cell cancers of the head and neck.