bluuebunny/crossref_metadata_2025 huggingface dataset:
Liver resection in malignant disease
Authors: Edwards William H. , Blumgart Leslie H.
Published: February 2007

As more surgeons become familiar with the techniques of hepatic resection and the mortality and morbidity decrease, the indications for resection of malignant disease within the liver broadens. The preoperative assessment of malignant liver lesions, as well as the definition of resectability, are outlined. Indications for operative intervention as well as the results obtained are covered. The personal experience of the authors at the Royal Postgraduate Medical School Hepatobiliary Unit, Hammersmith Hospital, in dealing with malignant lesions of the liver is detailed with respect to procedures performed and postoperative morbidity and mortality. Hepatocellular carcinoma, hilar cholangiocarcinoma, and metastatic colon carcinoma are discussed in detail. The authors' experience with each of these diseases is presented.
Intraoperative radiotherapy in stage I and II lung cancer
Authors: Hilaris Basil S. , Nori Dattatreyudu , Martini Nael
Published: February 2007

Lung cancer is the leading cause of cancer deaths in both men and women in the United States. Treatment depends on the type and stage of lung cancer. For stage I and II cancer, surgery is usually the treatment of choice. Radiation therapy is used in patients who are considered poor risks for surgical resection. Intraoperative brachytherapy is an effective alternative to external irradiation in this group of patients. From 1958 to 1984, 55 patients with non‐small‐cell lung cancer were explored at Memorial Sloan Kettering Cancer Center and found to have surgical stage I or II tumors, which were considered to be unresectable mainly because of severe obstructive pulmonary disease precluding adequate resection. All these patients were treated with intraoperative brachytherapy at the time of the thoracotomy. Forty‐four percent of these patients received in addition external irradiation, mainly to the mediastinum. The overall 5‐year survival calculated by the Kaplan‐Meier Method was 32%, and the local disease‐free survival was 63%. Cox regression multivariant analysis demonstrated that there is a distinct subgroup with a better prognosis based on tumor site and patient's age—ie, patients who were younger than 58 years of age and had right‐side lesions.
Current role of chemotherapy in the management of ovarian cancer
Authors: Yakushiji Michiaki
Published: February 2007

A discussion of the current role of chemotherapy in the management of ovarian cancer, based on results obtained from studies by Kurume University Hospital and the Japan Society of Obstetrics and Gynecology (JOG) group, is presented. Higher response rates were obtained for epithelial cancer when combinations of cisplatin, adriamycin, and cyclophosphamide were used. However, cancers such as ovarian cancer that form huge tumor masses cannot be cured completely with chemotherapy alone. Therefore, we think that effective combinations of chemotherapy and surgical treatment are the key to improving patients' prognoses.
Studies on the special tumor marker of cervical cancer of the uterus
Authors: Kato Hiroshi
Published: February 2007

Although cervical cancer is the most common malignancy of the gynecologic system, very few tumor markers have been specially prepared for this disease. This article reviews some of the current investigations of those markers, particularly describing TA‐4, a tumor antigen of cervical squamous cell carcinoma, which has currently been widely used in clinical practice.
Patterns of inheritance of colonic polyps
Authors: Watne Alvin L.
Published: February 2007

While the inheritance pattern of familial polyposis coli is established as an autosomal dominant pattern, the expression of the various extracolonic manifestations associated with the neoplastic polyposis is less well understood. The discrete polyp cancer syndrome may not be recognized unless both polyps and colon cancer are considered in the inheritance pattern. The hamartomatous polyps follow a Mendelian‐dominant inheritance pattern for the Peutz‐Jeghers syndrome, while the inheritance pattern for the juvenile polyposis syndromes is less clear. Cowden's disease appears in a Mendelian dominant pattern, but the occurrence of colonic polyps is less well documented. The ganglioneuromas follow a mendelian dominant inheritance pattern, while the relationship and occurrence of colonic polyps in association with Torre's syndrome is uncertain. The Mendelian dominant inheritance pattern for the cancer family syndrome is documented; the role of colon polyps in this syndrome is less well understood. A further understanding of the inheritance patterns of these various colon polyps will lead to more understanding of the basic disease and help in prevention and early detection for treatment and cure.
Dental and bone abnormalities in patients with familial polyposis coli
Authors: Carl William , Herrera Lemuel
Published: February 2007

Dental and bone abnormalities of the maxilla and mandible are present in approximately 80% of patients with familial polyposis coli. The dental abnormalities include impacted teeth (other than third molars), supernumerary teeth, congenitally missing teeth, fused roots of first and second molars, and unusually long and tapered roots of posterior teeth. The bone lesions consist mostly of osteomas, either isolated or in clusters, in the maxilla and mandible or of exostoses with lateral and/or lingual extensions. Since dental and bone abnormalities are already present early in life there is a strong suggestion that they may be used as diagnostic features in the recognition of familial polyposis coli.
Incidence of associated diseases in familial polyposis coli
Authors: Bülow Steffen
Published: February 2007

In this review we present diseases associated with hereditary polyposis syndromes. In addition to the known extracolonic manifestations of the so‐called Gardner's syndrome, other important diseases are carcinomas of the thyroid and of the small bowel and bile duct adenoma. The incidence of these diseases is discussed.
Enteric continence and the ileal pouch‐anal procedure
Authors: Pezim Michael E. , Pemberton John H. , Dozois Roger R.
Published: February 2007

The ileal pouch‐anal procedure maintains enteric continence by preserving critical physiological mechanisms.
Causes of death in patients with familial polyposis coli (FPC)
Authors: Herrera‐Ornelas Lemuel , Elsiah Sayed , Petrelli Nicholas , Mittelman Arnold
Published: February 2007

Autopsy reports from patients with familial polyposis coli were obtained from the Roswell Park Memorial Institute Registry as well as clinical data on patients with familial polyposis coli with regard to their causes of death. Although the latter group did not undergo autopsy they were the subject of a close follow‐up. From this data it is clear that diagnosis at an early age may not diminish the chances of the patient with familial polyposis to develop cancer. Removal of the colonic mucosa does not provide absolute assurance that patients with this condition will be cured, as these patients remain at considerable risk for developing other benign and malignant lesions of the gastrointestinal tract and perhaps also of other organs. Close follow‐up of FPC patients who have had surgery for colorectal polyps or cancer is necessary. Other proliferative abnormalities of FPC patients include an abnormal fibroblastic response, tendency to develop adhesions, and the propensity for developing desmoids. Desmoids may follow a slow but unrelenting course with a lethal outcome. Autopsy findings support the view that there should be no distinction between familial polyposis coli and Gardner's syndrome.
Biochemical markers in patients with familial colonic neoplasia
Authors: Luk Gordon D. , Silverman Ann L. , Giardiello Francis M.
Published: February 2007

Many potential markers, including biochemical markers, have been studied in an attempt to identify the presence of early colorectal neoplasia or risk of neoplasia, particularly in those families with hereditary colonic neoplasia syndromes. Unfortunately, most of these markers are useless in screening or diagnosis. Nevertheless, such markers as carcinoembryonic antigen (CEA) and CA19‐9 may have a role in pretherapeutic and post‐therapeutic monitoring of disease or recurrence. The newer tumor markers, including the carbohydrate markers, ornithine decarboxylase (ODC) and the polyamines, are of great interest as potential tumor markers; ODC and the polyamines may also have a future potential as therapeutic targets. However, further studies are needed to determine their true sensitivity and specificity in hereditary colonic neoplasia syndromes, as well as in patients without genetic syndromes who are at risk for colorectal cancer.
Endoscopic Nd‐YAG laser treatment of gastrointestinal polyps in patients with familial polyposis
Authors: Herrera‐Ornelas Lemuel
Published: February 2007

The introduction of the laser into clinical practice has augmented our options for local control of neoplasias. Herein is presented a preliminary report in the use of laser via endoscopy in selected patients with inherited gastrointestinal polyposis.
Alterations in DNA methylation in human colon neoplasia
Authors: Feinberg Andrew P. , Vogelstein Bert
Published: February 2007

A review of studies on DNA methylation in colonic neoplasia is presented. Hypomethylation of a wide variety of genes from throughout the genome was seen in all colon cancers studied. These changes preceded malignancy because benign adenomas were also affected.
Tissue culture assays in familial polyposis coli: Observations and considerations
Authors: Kopelovich Levy
Published: February 2007

The present studies illustrate the utility of biomarkers that occur systemically in two of the relatively frequent, dominantly inherited, precancer disorders: adenomatosis of the colon and rectum (ACR) and neurofibromatosis (NF). These biomarkers provide insight about the initiated cell phenotype, systemic abnormalities and cancer progression, genetic determinants of cancer predisposition, and clinical‐genetic considerations. In conjunction with clinical signs, these biomarkers can be used to determine gene expression and gene penetrance. Biomarkers are currently being used in a study of a kindred in which, remarkably, a patient manifested both ACR and NF. Extension of these studies may permit the early detection of cancer in the general population, including “cancer‐cured” individuals.
Colonic cell proliferation in familial polyposis
Authors: Lipkin Martin
Published: February 2007

Methods are presented for measuring cell proliferation in inherited gastrointestinal polyposis syndromes and related diseases. Future studies should be aimed at the identification of potentially susceptible individuals and interventions to inhibit tumor development.
Tissue culture model of adenoma invasion
Authors: Friedman Eileen A.
Published: February 2007

Colon carcinoma cells cocultured with adenoma cells were examined under various experimental conditions. Carcinoma cells were shown to have a selective advantage over adenoma cells. This advantage is enhanced by exposure to a tumor promoter.
Dynamics of glycoprotein metabolism in familial polyposis coli‐derived colonic epithelial tissue
Authors: Quinlan Dennis C. , Davidson Ann , Watne Alvin L.
Published: February 2007

Familial polyposis coli is a disease state that offers an opportunity to obtain colon tissue in a predictable manner in terms of identifying putative premalignant markers. Our results support the hypothesis that a sequential series of alterations occur in the dynamics of glycoprotein metabolism as normal colonic mucosa progresses to colon adenocarcinoma. Specifically, both nonmalignant polyps and colon adenocarcinoma tissue expressed diminished glycosylation of proteins, whereas an elevated level of activity for membrane‐associated glycosyltransferases does not appear until colon cancer itself develops.
Much abnormality in colonic mucosa in patients with familial polyposis coli
Authors: Muto Tetsuichiro , Acawa Senichiro , Ooya Masatoshi , Morioka Yasuhiko
Published: February 2007

Colonic mucosa of the left colon in 41 patients with familial polyposis coli (FPC) was stained by a periodic acid‐thionin Schiff/potassium hydroxide/ periodic acid‐Schiff method in which the normal colonic mucosa usually stained red and carcinoma stained blue or purple. In FPC 82.9% stained blue or purple whereas 35.5% stained blue or purple in normal controls. The data suggest that sialomucin properties of the flat mucosa surrounding polyps in FPC are different from those of the normal colon and that this simple technique may be useful for the early detection of high‐risk family members in the FPC family.
Much histochemistry in colonic polyps and cancer
Authors: Boland C. Richard
Published: February 2007

Mucins are the predominant glycoproteins found in gastrointestinal epithelia, and their structures differ according to the location in the GI tract and the state of cellular differentiation. Different forms of mucin are secreted in colonic polyps and cancers compared to those found in the normal colon. This paper reviews the methods available to probe mucin structure and the state of knowledge regarding the structures of neoplasia‐associated mucins. Many of the assumptions made in the interpretation of classical histochemical stains on tissue sections have recently been questioned, and new insight into mucin structure has been gained from the development of newer methodologies such as lectin histochemistry and immunocytochemistry that use well‐defined monoclonal antibodies.
Sarcomas of the jaw
Authors: Yoel José , Aguilar Osvaldo González , Simkin David Oscar , Barg Salomón
Published: February 2007

A retrospective analysis is made of 61 patients with clinical and histological diagnosis of pure sarcomas of the jaw treated between 1950 and 1984. Surgery was the treatment of choice in 41 cases. Biopsy or palliative treatment were undertaken in the remaining patients. Twenty‐four cases relapsed before 12 months, and 12 relapsed before 3 years. Twenty‐four died before 12 months, nine before 2 years, and three after 2 years. At present there is no evidence of disease in eight patients: three out of 25 fibrosarcomas (one more than 1 year, one more than 13 years, and one more than 14 years), three out of 15 chondrosarcomas (one more than 1 year, one more than 13 years, and one more than 14 years), and two out of 15 osteosarcomas (one more than 18 years). The prognosis is gloomy. However, an early diagnosis and radical surgery contribute to an improvement in the course of the disease.
An improved technique of radical neck dissection with an analysis of long‐term results of 1,000 operated cases of head and neck cancer
Authors: Li Chen‐Chuan , Ou Shen‐Ming , Zheng Zong‐Yuan , Liao Fang‐Rong
Published: February 2007

An improved technique of radical neck dissection is presented with a report of all 1,000 operated cases of the head and neck region from 1964 to 1980 at the Affiliated Tumor Hospital of Zhongshan Medical College, in Guangzhou, China. The practice has proved that our operative procedures are time‐saving, with less blood loss during operation, fewer operative mortalities, fewer complications, better end results, better cosmetic effects, and that the techniques are easier to master.
Latissimus dorsi and rectus abdominis breast reconstruction postmastectomy: Musculocutaneous breast reconstruction
Authors: Montoreano Isidoro E. , Pujato Domingo
Published: February 2007

The female breast is one of the most important physical expressions of femininity. Removal of this sexual organ can induce severe psychological effects. In our service the final decision for breast reconstruction is always made by the patient. We have done this operation on 115 patients: 43 with the latissimus dorsi technique (LDT) and 72 with the rectus abdominis technique (RAT). At present we prefer the RAT, done simultaneously with mastectomy or delayed, since the breasts obtained with it have in general a very natural and harmonious appearance.
Comparative study of long‐term effects of surgical excision and excision combined with radiotherapy or chemotherapy in breast cancer: An analysis of 192 cases
Authors: Zhou Hui‐Nan , Wan De‐Sen , Yang Ming‐Tian , Zhan You‐Ging
Published: February 2007

Clinical data of 192 patients with breast cancer with a primary lesion of 2‐5 cm (stage II according to the criteria recommended by the UICC) and with histopathologically confirmed positive axillary lymph nodes were analyzed. The patients were divided into three groups: 1) surgical excision alone; 2) surgery plus irradiation; and 3) surgery plus chemotherapy. It was shown that the 5‐year survival rates for these groups were 40.5%, 61.0%, and 62.0%, respectively (P < .05).
Histological diagnosis and grading of soft‐tissue sarcomas
Authors: Leyvraz Serge , Costa José
Published: February 2007

Grading methodology for soft‐tissue tumors is not yet unequivocally established. The authors use a system that is an elaboration upon that of the National Cancer Institute: grade 1 or low‐grade lesions are malignant lesions with minimal risk of metastases with a tendency for local recurrence if not totally excised, and with a capability for progression to a higher grade with recurrence; grades 2 and 3 are high‐grade lesions with a significant risk of metastases; grade 2 are lesions with intermediate aggressiveness, and grade 3 are highly malignant lesions with dissemination early in the course of the disease. Whereas the great majority of grade 3 lesions recur within 24 months of the initial diagnosis, patients with grade 2 lesions may go recurrence‐free beyond 36 months. Although more experience is needed in grading soft‐tissue sarcomas, it is hoped that grading will continue to contribute to the management of patients with malignant tumors of the soft tissue. It represents an adjunct to histological typing, which is useful in conveying the degree of biological aggressiveness as judged by histological features. Histologically 80% of the lesions can be classified on the basis of hematoxylin and eosin‐stained sections and other conventional special stains. In some instances electron microscopy and immunohistochemistry are necessary for histotyping. The most challenging area for histopathological differential diagnosis remains the distinction of tumor‐like reactive conditions, and pleomorphic benign tumors from sarcomas.
Tumors of the peripheral nervous system
Authors: Ariel Irving M.
Published: February 2007

Most nerve tumors (benign and malignant) do not arise from the nerves per se, but from the supporting cells; tumors arising from the cells of Schwann are termed schwannoma or neurilemmoma—benign or malignant. Surgical extirpation is the most effective treatment for these tumors. Radiation therapy can offer significant palliation and prolongation of life, but no cures have been observed. Benign tumors can be treated by local surgical extirpation; malignant tumors must be radically resected, including major amputation where indicated. Neurofibromatosis (von Reckling‐hausen's disease) is a genetic error of metabolism with a proclivity to produce multiple neurofibromas and, in about 10% of the patients, malignant neurilemmomas. Of 100 patients with malignant neurilemmomas treated by the author, 74 were considered determinate; among them, the 10‐year “cure” rate was 32%. Patients with von Recklinghausen's disease had almost as good a 10‐year survival rate as those with solitary malignant schwannoma (30% vs. 39%).
Soft‐tissue sarcoma: Initial characteristics and prognostic factors in patients with and without metastatic disease
Authors: Torosian Michael H. , Friedrich Mdclaudia , Godbold James , Hajdu Steven I. , Brennan Murray F.
Published: February 2007

Five hundred and sixty‐five patients with soft‐tissue sarcoma were admitted to Memorial Sloan‐Kettering Cancer Center from July 1, 1982 to July 1, 1985. Clinical and pathologic factors were analyzed to identify initial characteristics and to determine factors associated with prognosis and the development of metastasis. In decreasing order of frequency, the most common sites of primary tumor were the extremity (51.1%), retroperito‐neum/viscera (28.8%), trunk (15.9%), head and neck (3.7%) and breast (0.4%). The most common histologie types were liposarcoma (21.4%), malignant fibrous histiocytoma (20.2%), leiomyosarcoma (20.0%), fibrosarcoma (11.0%), and tendosynovial sarcoma (9.6%). One hundred and twenty‐eight patients (22.7%) had metastases in a median follow‐up period of 19 months. Metastasis was more common in patients with retroperito‐neal and visceral sarcomas than in patients with extremity sarcomas. Patients with leiomyosarcomas were more likely to develop metastases than those with other histologie types. Fibrosarcoma and liposarcomas were the least likely to develop metastases in this time frame. Tumors greater than 5 cm in diameter occurred more frequently in patients with metastases. Actuarial survival was related to the site of primary tumor and the histologie type and grade of malignancy. Multivariate analysis indicated that patients with low‐grade sarcomas, extremity sarcomas, and fibrosarcomas and patients without metastatic disease demonstrated significantly improved survival. In patients with metastases, disease‐free interval (< 365 or >365 days) was significantly related to overall survival. Thus the development of metastatic disease and prognosis in patients with soft‐tissue sarcoma is significantly associated with specific clinical and pathologic factors, including site of primary tumor, histologie type, histologie grade, and disease‐free interval.
Patterns of metastatic spread following resection of extremity soft‐tissue sarcomas and strategies for treatment
Authors: Huth James F. , Eilber Frederick R.
Published: February 2007

This study examines recurrence patterns in 255 patients with soft‐tissue sarcoma treated with preoperative chemotherapy and radiation, followed by limb‐sparing surgery. Eighty‐five patients developed metastatic disease: 13 had isolated local recurrence, 43 had isolated pulmonary metastases, 11 had metastases to lung and elsewhere, and 18 had metastases to multiple sites. Of the patients with isolated pulmonary metastases, 19/43 had resection of the metastases, and 9 are disease free. All 13 patients with local recurrences had resection of the recurrence, and 9 remain disease‐free. Patients with multiple sites of recurrence had a 2‐year survival of less than 10%. Resection of metastases is beneficial to a small number of patients who develop metastatic disease.
Incidence of metastases to lymph nodes from soft‐tissue sarcomas
Authors: Ariel Irving M.
Published: February 2007

Lymph node metastases occur in an appreciable number of soft‐tissue sarcomas. The histologic subtype plays a most important role. Synovial sarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma, and an‐giosarcoma manifest relatively frequently such metastases, whereas fibrosarcoma, liposarcoma, and malignant schwannoma do so very infrequently. With the use of the newer radiologic techniques, it is expected that this feature will be more clearly defined and taken into account in planning the treatment. For histologic subtypes known frequently to manifest metastases to the regional lymph nodes, the latter should be considered for inclusion in the surgical and/or radiation treatment plan, particularly for primary tumors situated close to a nodal basin; and careful follow‐up of these nodes should be practiced.
Soft‐tissue sarcoma: Mayo clinic experience
Authors: Sim Franklin H. , Pritchard Douglas J. , Reiman Herbert M. , Edmonson John H. , Schray Mark F.
Published: February 2007

Soft‐tissue tumors encompass a wide variety of lesions and continue to pose a difficult treatment problem. The outlook, however, is improving, and there have been recent advances in pretreatment assessment, clinico‐pathologic correlation, and adjuvant treatment programs. We retrospectively reviewed our experience in a large series of soft‐tissue tumors treated at the Mayo Clinic as well as recent experience using chemotherapy and radiation treatment.
Chemotherapy of advanced soft‐tissue sarcomas
Authors: Antman Karen H. , Elias Anthony D.
Published: February 2007

The most active single agents in soft‐tissue sarcomas are doxorubicin (Adriamycin) and ifosfamide, with response rates of 20‐35%. Dacarba‐zine (DTIC) has a response rate of 16%. A randomized trial of 5 g/m2 of ifosfamide versus 1.5 g/m2 of cyclophosphamide noted a higher response rate for ifosfamide with less myelosuppression. Both randomized studies of doxorubicin with or without DTIC documented an increased response rate for the combination. In contrast, three randomized trials of doxorub‐icin‐based regimens with and without cyclophosphamide have failed to detect an advantage for the addition of cyclophosphamide. Thus, the most active combination for soft‐tissue sarcomas is doxorubicin and DTIC. The role of the addition of ifosfamide is currently under evaluation.
Adjuvant Chemotherapy for Soft‐Tissue Sarcoma: A Critical Appraisal
Authors: Elias Anthony D. , Antman Karen H.
Published: February 2007

Adjuvant chemotherapy, established in the treatment of osteogenic sarcoma, Ewing's sarcoma, and rhabdomyosarcoma, currently remains controversial in adult soft‐tissue sarcoma. Because the survival of the control arms in randomized studies is significantly better than historical controls, only randomized studies with nontreatment control arms will be analyzed here. None of the 11 reported adjuvant studies showed a significant survival advantage for chemotherapy overall. Although subset analyses are less reliable, the National Cancer Institute reported a significant prolonged survival and disease‐free survival for the subset of chemotherapy‐treated extremity primaries. The M.D. Anderson and Italian studies observed a significant disease‐free survival advantage; however, survival was not significantly different in the former and survival statistics were not provided in the latter study. In the subset of central body lesions none of the studies revealed a significant survival advantage for chemotherapy. Adjuvant chemotherapy should be considered investigational for adult soft‐tissue sarcomas.
Concepts in Limb‐Sparing Treatment of Adult Soft Tissue Sarcomas
Authors: Lawrence Walter
Published: February 2007

Pretreatment assessment of patients with soft tissue sarcomas of the extremities requires careful attention to a biopsy approach that will establish the precise diagnosis and will not compromise the subsequent definitive operative procedure. Also, staging procedures are required to evaluate the status of both local and distant sites. Limb‐sparing surgery for high grade extremity soft tissue sarcomas is a feasible and appropriate approach in approximately 90% of patients with such lesions. Wide gross surgical margins around the sarcoma are the optimal operative approach. Circumstantial evidence is convincing that local treatment failure can be reduced by adjuvant regional radiation treatment when surgical margins are narrow, and end results appear to be equal to those obtained by more extensive surgical resection alone. Adjuvant radiation following operation with optimal gross surgical margins has not been established as adding benefit. Although some groups treating soft tissue sarcomas do use intraarterial chemotherapy in conjunction with these other modalities, there is, as yet, no convincing evidence that this aspect of the multimodality treatment adds to local and/or systemic disease control. The efficacy of adjuvant systemic chemotherapy for high grade soft tissue sarcomas remains to be established within the context of prospective clinical trials.
Selective combination of modalities in soft tissue sarcomas: Limb salvage and survival
Authors: Karakousis C. P. , Emrich L. J. , Rao U. , Khalil M.
Published: February 2007

One hundred fifty‐two consecutive patients with soft tissue sarcomas were operated in the period 1977 through 1985. Eighty‐seven patients with minimum resection margin of 2 cm or greater had no further local therapy, whereas 65 patients with minimum margin less than 2 cm had adjuvant postoperative radiation. Of 121 patients with extremity sarcomas, only 5 (4%) were managed with amputation. The overall 5‐year survival rate is 58%, and for patients with extremity tumors, 67%. The 5‐year local recurrence rate in extremity sarcomas was 10% for patients with minimum surgical margins 2 cm or greater and no further local therapy, and 6% for those with lesser surgical margins and adjuvant postoperative radiation. With selective combination of modalities limb salvage can now be practiced in 96% of the patients with acceptable local control and survival rates.
Surgical management of soft tissue sarcomas, with an analysis of 313 cases
Authors: Guo‐Hui Li , Jin‐Qing Li , Yong‐Hui Cai , Min Huang
Published: February 2007

From 1964 to 1978, 313 patients, 192 males and 121 females, with soft tissue sarcoma underwent surgery in our hospital. All patients have been followed up for over 5 years. One hundred ninety patients (60.7%) had recurrence of the tumor after previous surgery. The tumor was located in the head in 55 cases, in the trunk in 136, and in the extremities in 122 cases. Regional lymph node metastases occurred in 23 patients (7.4%). Fibrosarcoma, neurofibrosarcoma, and rhabdomyosarcoma were the types mosts commonly encountered in this series. The 5‐year survival rate, according to the extent of surgical resection for 117 patients with local resection, was 47.9%; for 75 patients with wide local resection, 62.7%; for 43 patients with amputation, 18.6%; and for 78 patients with local resection combined with irradiation, 48.7%. For the whole series, the 5‐and 10‐year survival rates were 47.6% and 35.8%, respectively. The 5‐year survival rates of stages I, II, III, and IV (TNM classification) were 60%, 46.9%, 40%, and 22.2%, respectively.
Is interferon with or without vinblastine the “treatment of choice” in metastatic renal cell carcinoma? the norwegian radium hospital's experience 1983–1986
Authors: Fosså Sophie D.
Published: February 2007

Fifty‐seven of 66 patients with metastatic renal cell carcinoma (RCC) were evaluable for response after treatment with Interferon (IFN) — Alfa 2a (Roferon A, Roche) with or without Vinblastine (VB). Three different dose schedules were used in 3 subsequent trials: protocol 1: (18 evaluable patients): IFN 36 × 106 U tiw ± VB 0.1‐0.15 mg/kg/2–3 week; protocol 2: (13 patients): IFN 18 × 106 U tiw ± VB 0.1 mg/kg/3 week; protocol 3: (26 patients): IFN 18 × 106 U tiw ± VB 0.1 mg/kg/3 week. Twelve of the 57 patients obtained an objective response (CR:1; PR: 11). Regarding the main indicator lesions responses were seen in lung metastases (10), lymph node metastases (1), and bone metastases (1). The median response duration was 243 days. No significant impact of the IFN/VB treatment on survival could be demonstrated. Flulike symptoms represented the main toxicity. Four patients developed mental confusion, and in 2 patients with visual disturbances retinal exudation was observed. In more than half of the patients, the drug(s) had to be reduced, delayed, or finally discontinued due to toxicity. It is concluded that IFN with or without VB yields a 15–20% response rate in metastatic RCC. Due to the considerable toxicity of the treatment and the lack of proof of survival improvement, the clinical usefulness of IFN therapy in RCC remains questionable. However, on the background of the present therapeutic nihilism in metastatic RCC, additional clinical trials using IFN in RCC are justified.
Effect of alpha‐ and gamma‐Interferon and tumor necrosis factor on colony formation of two human renal tumor xenografts in vitro
Authors: Beniers A. J. M. C. , Peelen W. P. , Hendriks B. Th. , Schalken J. A. , Debruyne F. M. J.
Published: February 2007

The in vitro antitumor activity of alpha‐ and gamma‐interferon as well as tumor necrosis factor was tested on two human renal cell carcinoma xenografts—RC‐43 and NC‐65. A dose‐dependent inhibition of colony formation in soft agar was found for both tumor lines. NC‐65, however, showed no sensitivity for gamma‐interferon. Combination drug tests showed a synergistic effect on colony formation of both tumor lines. The strongest inhibition was shown by the combination of alpha‐interferon and tumor necrosis factor. We conclude that both interferons as well as tumor necrosis factor show direct in vitro cytostatic effects against renal tumor direct in vitro cytostatic effects against renal tumor cells.
Interferon therapy of metastatic renal cell cancer
Authors: Muss Hyman B.
Published: February 2007

There is no curative therapy for metastatic or recurrent renal cell carcinoma (RCC). Almost three‐quarters of such patients die of their malignancy in 1 year and less than 5% of such patients are alive at 3 years. Few patients respond to hormonal therapy or chemotherapy, and when responses occur, they are usually brief and partial with little impact on survival. Interferon therapy in metastatic RCC has been associated with response rates of approximately 15–20%, and tumor regression has been demonstrated in patients treated with both partially purified and, more recently, recombinant interferon. Analysis of published trials shows no clear dose‐response relationship; however, the highest therapeutic index appears associated with a daily dosage of 5–10 million units. The time to response is variable and may occasionally be prolonged; however, some patients have durations of response exceeding 12 months. Although ne‐phrectomy may be associated with higher response rates, review of available data indicates that nephrectomy has frequently been an eligibility criteria, and indeed there are adequate descriptions of responses in patients that have not undergone this procedure. Patients with pulmonary metastases have the highest response rate. Recently, laboratory and clinical investigations of interferons and several chemotherapeutic agents, notably vinblastine, suggest synergy, but further data is needed to confirm these findings. The role of interferon therapy in improving survival is unknown. There is little doubt, however, that symptomatic patients who respond to interferon therapy may show improvement in their quality of life and prolongation of survival.
Adverse reactions in long‐term interferon treatment
Authors: Levens W. J. , Fischer N. , Ingehag W. , Rubben H.
Published: February 2007

Adverse reactions in interferon treatment were studied in long‐term treatment schedules. Thirteen patients with metastatic renal cell carcinoma treated with 107 units interferon‐2b s.c. daily for 6 months showed serious side effects. The general condition worsened in 10 patients. The average weight loss was 7 kg per patient. The remissions achieved (1 complete, 2 partial) were seen after 2–3 months of treatment. In 11 patients treated in an adjunctive setting (107 units interferon‐2b s.c. 3 times weekly) side effects were less severe. Generally the treatment was tolerated well. In one patient the general condition worsened, weight loss was mild and restricted to the first treatment month.
A phase I‐II study of high‐dose recombinant human interleukin‐2 in disseminated renal‐cell carcinoma
Authors: Javadpour N. , Lalehzarian M.
Published: February 2007

Natural interleukin‐2 is a lymphokine with an immunoregulatory function. The recombinant interleukin‐2 (rIL‐2) is cloned from a human lympho‐blastoid T‐cell line for this trial. The gene is expressed in Å‐coli, allowing production of large quantities of rIL‐2. This study is an open label phase I‐II trial designed to evaluate the toxicity and efficacy of a rIL‐2 in disseminated renal cell carcinoma. After surgical resection of the primary tumor, 3 × 106 units/m2day rIL‐2 is administered by 2‐hr IV infusions daily for 5 days every other week for a total of eight cycles. At the conclusion of eight cycles of therapy, the patients were re‐evaluated for response. Patients with complete and partial responses were eligible to receive an additional eight cycles every other week. Patients demonstrating progressive disease during this study were withdrawn. The toxicities of the high‐dose rIL‐2 included transient hypotension, pyrexia, malaise, and skin rashes. The transient hypotension responded to fluid replacement, and the other toxicities also responded to symptomatic treatment. The early results in ten patients indicate two partial and one complete response. We have concluded that administration of high‐dose interleukin‐2 has acceptable toxicities with encouraging response and deserves a phase III study.
Histopathologic risk factors for breast cancer in women with benign breast disease
Authors: Page David L. , Dupont William D.
Published: February 2007

Mammary epithelial hyperplasia indicates an increased likelihood of carcinoma development as it does in other organs. Prospective studies have demonstrated that in the premammography era about 70% of women undergoing surgical biopsy had no increased risk of cancer and have little if any hyperplastic alteration. About 25% of women have well‐developed hyperplastic changes and have a risk elevation, controlled for age, of 1.5–2 times that of the general population. Less than 5% of women have atypical hyperplasia demonstrating some histologic features of carcinoma in situ, which indicates a risk elevation of 4–5 times. This is about one half the risk associated with microscopic carcinoma in situ. Therapeutic implications of these premalignant lesions rest predominantly in their indication for the heightened intensity of subsequent breast cancer surveillance and screening.
Mass screening to reduce mortality from breast cancer
Authors: Strax Philip
Published: February 2007

It is generally agreed that the best and possibly the only means to reduce mortality in breast cancer is to detect the disease in its early, most curable stage. This usually means detection when nodes are negative and often when the lesion is nonpalpable. The best method with which to achieve this goal is periodic examination including clinical study and mammography when the woman is apparently well, as is done in mass screening. This applies today to all women over 40 yr old. A baseline examination at age 35 yr is helpful. Radiation risk is today considered to be minimal, if any, and probably is not even measurable. Cost is important. The dedication of the screening institution is most important in this regard. The chief stumbling block is a lack of motivation on the part of subjects to accept or even demand the examination. This needs to be stimulated through contacts with women directly and with their physicians.
Breast cancer detection epoch
Authors: Byrd Benjamin F. , Hartmann William H.
Published: February 2007

The Action and Planning Committee on Breast Cancer Control was formed in 1970 by the American Cancer Society, based on their earlier successful experience with early‐detection programs for uterine cancer. The original intention was to support 12 centers for 2 years, but with the passage of the Conquest of Cancer Act in 1971, and the consequent availability of more funds for cancer programs, the American Cancer Society and the National Cancer Institute decided jointly to expand the program to 27 Breast Cancer Detection Demonstration Project Centers, with 280,000 women participating, who would be examined annually for 5 years. Data from the examinations, which included history, physical examination, mammo‐gram, and thermogram, were subjected to a continuing computer analysis. The thermogram was deleted after the second year. Although patients were randomly selected, there was an almost identical number of subjects in two age groups—35–49 years and 50–75 years. The results of the study are presented, and the importance of the program's efforts at breast self‐examination education as contained in the program's original protocol, is discussed.
Surgical treatment of primary breast cancer
Authors: Wickerham D. Lawrence , Fisher B.
Published: February 2007

The background to the Halstedian era of breast cancer treatment is sketched, and the development of the changes in surgical treatment are outlined, with a review of the most important findings from the several clinical trials conducted to evaluate the alternative operative procedures. Included is a short description of operative techniques; also pathological examination of the operation specimen, and the use of radiation therapy when performing a segmental mastectomy are briefly described. This review is based almost entirely on observations from clinical trials conducted by the National Surgical Adjuvant Breast and Bowel Project.
Primary surgical treatment of breast cancer
Authors: Urban Jerome A.
Published: February 2007

An unexpected rise in breast cancer mortality has been reported for 1984 and 1985 in white women below 50 years of age in the United States. During the preceding 10 years, there had been a progressive drop of approximately 1% in breast cancer mortality for each successive year. This recent increase in mortality occurred despite the increased use of adjuvant chemotherapy; it is most likely a direct result of the current tendency to downgrade the need for adequate primary therapy. Several recent prospective randomized studies that evaluated the relative efficacy of mastectomies of varying extent have shown a direct relationship between local control and long‐term survival. They also demonstrated that specific operative procedures were most effective for the appropriate clinicopathological stage of disease. Stage I cancers can be treated effectively by modified mastectomy, but radical mastectomy is superior for control of stage II and stage in disease. Inner‐quadrant cancers are most effectively managed by extended radical mastectomy, which includes excision of the internal mammary nodes. Excellent surgical technique was employed in all studies, which included observed follow‐up of 10–20 years. Optimal local control and long‐term survival were achieved by the appropriate operative procedure.
Primary radiation therapy for stage I and II breast cancer
Authors: Fisher Scot , Brady Luther W.
Published: February 2007

In 1987 there were estimated to be approximately 130,000 new cases of breast cancer diagnosed in the United States. Presently, about 20–30,000 of these cases are treated with primary radiotherapy, although many more of the 90,000 stage I and II breast cancer cases are eligible for this form of treatment. Appropriate selection must be employed, including the size and site of the primary tumor, the size of the breast, the potential for multifocal disease, and the age of the patient. When proper selection is used, primary radiotherapy for stage I and II disease yields equivalent overall survival and NED survival when compared to traditional mastectomy. The benefit is preservation of the breast with good to excellent cosmesis in the vast majority of patients.
Adjuvant chemotherapy for breast cancer
Authors: Bonadonna Gianni , Valagussa Pinuccia
Published: February 2007

The development of the use of chemotherapy in the treatment of breast cancer is discussed. Its contribution in the primary management of this disease lies not only in the limited but consistent reduction in mortality, but it has helped to elucidate the biological complexity of breast cancer. Also, it has stimulated basic scientists and research physicians to integrate their efforts, which is expected to result in further clinical progress.
Treatment of advanced breast cancer with chemotherapy
Authors: Ward John H. , Eyre Harmon J.
Published: February 2007

Metastatic breast cancer continues to take thousands of lives each year despite the advances in screening and adjuvant therapy. Chemotherapy in advanced disease is an intervention which can successfully lead to palliation (prolongation of quality survival) in the majority of women who are treated, but it does not constitute a curative intervention. New agents or innovative modalities will be needed to make a significant impact on the survival of this group of women.
Inflammatory breast cancer: Advances in therapy
Authors: Ellis Lee M. , Bland Kirby I. , Copeland Edward M.
Published: February 2007

Inflammatory breast cancer is the most aggressive breast neoplasm and one of the most ominous solid tumors. Because of distinct clinical characteristics, diagnosis can usually be made on clinical grounds. Biopsy including the overlying skin may demonstrate dermal lymphatic invasion, although the absence of dermal lymphatic invasions should not deter aggressive therapy. Surgery or irradiation alone has little effect on the natural history of this disease since lymphatic invasion and distant metas‐tases are often present at presentation. Inflammatory breast cancer should be considered a systemic disease. Accordingly, aggressive combined modality therapy including multi‐drug chemotherapy, surgery, and irradiation have prolonged disease‐free survival and overall survival.
Rehabilitation of the breast cancer patient
Authors: Scanlon Edward F. , Feldman Joseph L.
Published: February 2007

No treatment program for breast cancer is complete without arrangements for rehabilitation. This includes consideration of the emotional and psy‐chosocial factors, as well as the physical problems that arise as the result of the treatments. The most important person in planning rehabilitation is the treating physician, but a multidisciplinary team provides optimal results. In recent years, the most dramatic improvements in rehabilitation have been seen in the psychosocial area, but improvements have also been made in restoring the patient to normal physical activity.
Breast reconstruction after mastectomy
Authors: Bostwick John
Published: February 2007

The goal of breast reconstruction is to reconstruct breasts which meet the patient's expectations both psychologically and aesthetically, while adhering to the principles of sound oncological management. Breast reconstruction is usually started around 3 to 9 mos after mastectomy. The simplest method of reconstruction uses tissue available after mastectomy and a silicone implant. The recent advances with tissue expansion of the skin of the mastectomy site can permit reconstruction without the use of a flap. The latissimus dorsi flap from the back is a useful source of muscle and skin and the transverse rectus abdominus musculocutaneous flap provides tissue from the lower abdomen enabling breast reconstruction without the use of a silicone implant. Fat and skin from the buttocks may be used in a microsurgical transfer technique. Prophylactic mastectomy and immediate breast reconstruction are still controversial, but are options for the woman who is worried about the development of breast cancer. The reconstruction of the nipple and areola is only done after reconstructed breast symmetry is ascertained.
State of the art of lasers in oncologic surgery
Authors: Aronoff B. L.
Published: February 2007

The laser first described by Shawlow and Townes in 1957 was built by Ted Maiman in 1960. Many forms of lasers rapidly evolved using solids, liquids, and gasses from the medium. Applications in many fields grew rapidly; medicine has been in the forefront. Many branches of medicine found applications in surgical oncology, pulmonary, dermatology, vascular surgery, and, now, infectious diseases using this modality. This paper discusses part of the benefits for research and treatment of cancer.
Photodynamic therapy—new approaches
Authors: Dougherty Thomas J.
Published: February 2007

Photodynamic therapy (PDT) requires a photosensitizer within a target tissue and activation by proper‐wavelength radiation at appropriate energy level to achieve complete eradication of that tissue. Whereas the first clinical results were reported nearly a decade ago, only in the past few years has the necessary technology been available for development of phase III controlled clinical trials. Photofrin II, the trade name for a mixture of oligomeric porphyrins, is effective in treatment of a wide variety of malignant tumors and is the subject of Phase III controlled trials in bladder and lung. New photosensitizers are being developed that may be both more efficient and less likely to cause the generalized cutaneous photosensitivity associated with Photofrin II. Further advances in light sources and delivery systems portend an even broader acceptance of PDT in medical and biological science.