bluuebunny/crossref_metadata_2025 huggingface dataset:
Chemotherapy of advanced gastric cancer with 72‐hour continuous intravenous 5‐fluorouracil infusion at 2‐week intervals
Authors: Shah Amil , Macdonald Walter C.
Published: February 2007

Twenty‐nine patients with advanced gastric adenocarcinoma were treated with 72‐hour continuous intravenous infusion of 5‐fluorouracil (30 mg/kg/24 hr) at 2‐week intervals. Six patients (21%) achieved partial response and four (14%) had stabilization of their disease. The median duration of partial response was 8 months, with a range of 5‐19 months. The median survival time for all patients from the start of chemotherapy was 8 months. Various prognostic factors important in determining response and survival are analyzed.
Chlorozotocin treatment of advanced gastrointestinal cancer
Authors: Veronesi A. , Magri M. D. , Tirelli U. , Galligioni E. , Figoli F. , Zagonel V. , Tumolo S. , Grigoletto E.
Published: February 2007

From April 1981 to December 1981, 34 consecutive patients with advanced gastrointestinal cancer were treated with chlorozotocin at the dosage of 40 mg/m2 daily for 5 consecutive days (30 mg/m2 in patients pretreated with chemotherapy) every 6 weeks. In the 30 patients evaluable for response, a 3.3% objective response rate was encountered. Toxicity was not significant and consisted mainly in reversible myelosuppression. Median survival was 3 months. At the dosage and schedule used, chlorozotocin does not seem to be an effective agent in the treatment of advanced gastrointestinal cancer.
The samuel C. Harvey memorial lecture: Progress and responsibilities of educators in smoking control
Authors: Schuman Leonard M.
Published: February 2007

It is a privilege to have been asked to present the Harvey Lecture to this group of professional cancer educators. When I was asked by Dr. Kennedy to fill the void left by the illness of Henry Kaplan, he referred to his request in somewhat embarrassed terms, such as my obviously playing “>It is a privilege to have been asked to present the Harvey Lecture to this group of professional cancer educators. When I was asked by Dr. Kennedy to fill the void left by the illness of Henry Kaplan, he referred to his request in somewhat embarrassed terms, such as my obviously playing” I wish publicly to allay his embarrassment by reassuring him, your program committee, and all of you that I deem it an honor to substitute for a man who has contributed so much to radiobiology and hence to an understanding of the mechanisms of carcinogenesis and cancer therapy. Indeed, my only regret is that I am not now sitting among you listening to his remarks.
Combination chemotherapy with vincristine (NSC‐67574), procarbazine (NSC‐77213), prednisone (NSC‐10023) with or without nitrogen mustard (NSC‐762) (MOPP vs OPP) in children with recurrent brain tumors
Authors: Cangir Ayten , Ragab Abdelsalem H. , Steuber Philip , Land Vita J. , Berry Daisilee H. , Krischer Jeffrey P.
Published: February 2007

Seventy‐three patients under 18 years of age with a recurrent central nervous system tumor were randomized to receive combination chemotherapy with MOPP or OPP. Patients were stratified according to the tumor type into four major disease‐categories: (1) medulloblastoma, (2) astrocytoma and other glioma, (3) ependymoma, and (4) miscellaneous tumors to provide equal distribution of patients for each treatment within each disease category. Evaluation of response was based on computerized brain scan findings. Thirty‐five patients received MOPP and 38 received OPP treatment. There were three complete and six partial remissions among patients receiving MOPP and one complete and five partial remissions among patients receiving OPP. In addition, six patients on MOPP had stable disease for seven to 21 months. Only two patients on OPP had stable disease(6 and 36 months). Most of responses in both treatment regimens occurred in patients with medullo‐blastoma and astrocytoma. Median duration of remission was ninemonths for the MOPP and 11 months for the OPP. Two patients on MOPP regimen had fatal myelosuppression. Although the more toxic MOPP regimen produced more responses than OPP in children, differences in the duration of response or survival were not statistically significant (P=.79 and P = .84, respectively).
Anthracycline‐induced cardiomyopathy in children: A report of six cases
Authors: Dearth J. , Osborn R. , Wilson E. , Kelly D. , Mantle J. , Rogers E. , Malluh A. , Crist W.
Published: February 2007

Although anthracycline antibiotics are among the most useful chemotherapy agents, the risk of producing cardiomyopathy and the absence of a reliable noninvasive technique to predict subclinical cardiomyopathy remain a major problem. We retrospectively reviewed our experience with anthracyclines over a 5‐year period. Cardiomyopathy developed in 6 of 112 patients (5.3%) treated with anthracyclines and was fatal in 5 of the 6 patients. Our incidence and mortality rates are higher than those previously reported.
The diagnosis of pleural effusions—Are cancer markers clinically helpful?
Authors: Wardman A. G. , Bowen M. , Struthers L. P. L. , Cooke N. J.
Published: February 2007

We submitted 83 consecutive patients with pleural effusion to routine clinical investigation; 57 were diagnosed as malignant, 18 as benign, and 8 were not diagnosed. Pleural fluid and serum were analysed for carcinoembryonic antigen (CEA), acid glycoprotein (AGP), antichymotrypsin (ACT), C‐reactive protein (CRP), α2‐pregnancy associated glyco protein (α2‐PAG) and ferritin. Multivariate discriminant analysis was performed on the results of the protein measurements. CEA and ACT values in serum and fluid were found to give a good discriminating function between the benign and malignant groups. The use of such an analysis, in a clinical context, is discussed.
Cystathioninuria in patients with neuroblastoma
Authors: Rajnherc J. R. , van Gennip A. H. , Abeling N. G. G. M. , van der Zee J. M. , Voǔte P. A.
Published: February 2007

Urinary excretion of cystathionine and dopa metabolites was analyzed in 61 patients with active neuroblastoma before, and at regular intervals during treatment. Thirty‐seven patients with clinical evidence of active neuroblastoma excreted elevated levels of cystathionine before treatment was initiated; six other patients showed cystathioninuria at some time during treatment with chemo‐ or radiotherapy. The cause of the cystathioninuria remains unidentified. No relationship between excessive cystathionine excretion and liver impairment or liver metastases was established; nor was there evidence to support a consistent correlation with the ratio of the sum of the excretion values for vanilglycolic acid and vanilglycol to the excretion of vanilacetic acid. Our results indicate that absence of cystathioninuria correlates with an early clinical staging and thus with a favorable prognosis. Isolated cystathioninuria does occasionally occur in patients with neuroblastoma, permitting a presumptive diagnosis until later evidence can be obtained. Determination of cystathionine excretion is essential for an extensive biochemical evaluation of patients with neuroblastoma.
Autologous bone marrow transplantation in the treatment of children and adolescents with advanced malignant tumors
Authors: Baumgartner Christoph , Bleher E. Arnold , del Re Guido Brun , Bucher Urs , Deubelbeiss Kurt A. , Greiner Richard , Hirt Andreas , Imbach Paul , Lüthy Annette , Odavic Ranko , Wagner Hans Peter
Published: February 2007

Nineteen patients with advanced malignant tumors, less than 20 years old were treated with intensive chemotherapy (vincristine 2 mg/m2 i.v. and adriamycin 60 mg/m2 i.v. on day −7; cyclophosphamide 45 mg/kg i.v. on days −6 to −3), total body irradiation (TBI, 600 rads on day −1) and autologous bone marrow transplantation (ABMT, day 0). Prior to this procedure induction of complete or partial remission by conventional therapy was attempted. Ten patients had intra‐abdominal non‐Hodgkin's lymphoma (NHL); three, yolk sac tumor; three, Ewing's sarcoma; and three, neuroblastoma. The supportive care included reverse isolation, immunoglobulin 400 mg/kg i.v. q 2 weeks, cotrimoxazole per os, and cell support as needed. No correlation between the bone marrow dose and the time of hematological reconstitution could be established. Five of seven patients with intraabdominal NHL stage III (transplanted in first remission) are surviving disease‐free for 5 +, 5 +, 20 +, 23 +, and 35 + months after ABMT. None of three patients with intra‐abdominal NHL stage IV is surviving (two of them were transplanted in second remission). One of three patients with yolk sac tumor is surviving disease‐free for 27+ months. There are no survivors among the patients with Ewing's sarcoma and neuroblastoma. Only one of 19 patients was lost due to therapeutic complications, while 12 died due to tumor. Regarding treatment results for advanced intra‐abdominal NHL, the procedure described here is comparable to the best conventional regimens. In vitro methods for tumor cell eradication in the collected bone marrow might further improve the results of ABMT.
Significance of mediastinal metastatic disease in Wilms' tumor of favorable histology
Authors: Cushing Barbara A. , Watts Frederick B. , Brough A. Joseph , Philippart Arvin I. , Das Lakshmi
Published: February 2007

Although the results of the National Wilms' Tumor Study suggest poor outcome for children with metastases to intra‐abdominal, intracranial, skeletal, skin, diaphragm, or mediastinal sites, the incidence and course of mediastinal disease has not been described. Fifty‐four newly diagnosed Wilms' tumor patients at Children's Hospital of Michigan (1972‐1980) were studied for patterns of intrathoracic metastases. All had favorable histology; mean age (MA) at diagnosis was 4.5 years. Initial chemotherapy ranged from single agent to three‐drug combination (actinomycin, vincristine, adriamycin). Intrathoracic metastases occurred in 14 (26%) from 0‐28 months (median, 3.5 months) from diagnosis (MA, 5.8 years). Upon the discovery of intrathoracic metastases all received radiation (1,200‐2,000 rads) to the chest, some with supplementary doses to the mediastinum. Five children with parenchymal and one with parenchymal and hilar metastases appearing 0‐28 months after the time of diagnosis survive disease‐free 44‐127 months after metastases appeared (MA, 6.3 years). Eight children developed parenchymal and mediastinal metastases (MA, 5.4 years). Time from diagnosis to parenchymal metastases was 0‐7 months; time from diagnosis to mediastinal metastases was 0‐16 months; and in four, both sites appeared simultaneously. Death occurred in all eight patients 7‐25 months from diagnosis. Only one child had evidence of recurrence outside the chest. Potential risk factors and influence on survival are discussed.
Low molecular weight plasma proteins in the cerebrospinal fluid of children with hematological malignancies
Authors: Duggan M. B. , Whittaker J. A. , Cooper E. H. , Bailey C. C. , Robinson E. A.
Published: February 2007

The concentration of beta‐2‐microglobulin (β2‐m) and of post gamma globulin (P‐γG) was examined in serum and cerebrospinal fluid from children with acute lymphatic leukemia (ALL) and non‐Hodgkin's lymphoma (NHL). Data were analysed in order to determine whether concentration of β2‐m or P‐βG during remission would be of value in predicting relapse or eventual outcome. Mean serum concentration of β2‐m was similar in good and poor prognosis patients with ALL in remission and was not significantly altered in CNS or marrow relapse. Mean CSF concentration in NHL was also similar in both prognostic groups, and in poor prognosis patients was not significantly altered in relapse. The same pattern was seen when PγG was measured in CSF (serum concentration of this protein being too low for accurate determination). High within patient variability of levels of β2‐m and PγG appeared to relate to chemotherapy rather than the disease process. Concentration of PγG was persistently raised in three children with brain damage of differing etiologies. Levels of two other low molecular weight proteins, retinol binding protein and α1‐microglobulin, were also determined in order to establish that β2‐m and PγG concentration was not influenced by alteration in permeability of the blood‐brain barrier. The β2‐m and PγG concentration, although higher than reported in healthy children [5] does not appear to be of value as a prognostic indicator in ALL and NHL in children.
Pulmonary function in patients undergoing bone marrow transplantation
Authors: Serota Fredric T. , August Charles S. , Koch Penelope A. , Fox William , D'Angio Giulio J.
Published: February 2007

Pulmonary function was studied prospectively in 25 children with leukemia and aplastic anemia undergoing bone marrow transplantation (BMT). Whereas 11 patients have died, only one did so primarily due to interstitial pneumonia. Fourteen patients (56%) survived a median of at least 36 months. Seventeen patients received pulmonary function tests (PFTs). Four patients transplanted for leukemia in relapse following preparation with a very intensive regimen (cyclophosphamide, 200 mg/kg, total body irradiation, 1,000 rad, BCNU, cytosine arabinoside) developed restrictive lung changes. Patients undergoing BMT for aplastic anemia and leukemia in remission prepared with more commonly used and less intensive regimens maintained normal pulmonary function. As new regimens are devised, PFTs should be utilized to characterize the pulmonary toxicity of these regimens as well.
Rebound thymic hyperplasia in a child with cancer
Authors: Bell B. A. , Esseltine D. W. , Azouz E. M.
Published: February 2007

A case of biopsy‐proven thymic hyperplasia is described in a child with group I paratesticular rhabdosarcoma while on chemotherapy. Other cases of children with cancer reported with this phenomenon are reviewed. Tissue diagnosis is important to differentiate metastatic tumor and to rule out second malignances in these patients. The initial evaluations are facilitated by CT scanning of the chest and upper extremity venography.
Leukemic infiltration of the testes in acute nonlymphocytic leukemia
Authors: Wagner Virginia M. , Baehner Robert L.
Published: February 2007

Two children with ANLL in complete remission developed testicular relapse 18 and 34 months after diagnosis. Their clinical presentation was similar to that observed in patients with ALL. Although the testicular leukemia responded to between 2,400 and 3,000 rads, bone marrow relapse occurred within 4 months and death within 6 months of the testicular relapse. This points out the need for surveillance of the testicles in males with ANLL, and raises the question of need for testicular biopsy among long‐time male survivors.
Lithium treatment in adults with acute myeloid leukemia receiving chemotherapy
Authors: Horns Richard C. , Schrier Stanley L. , Greenberg Peter L.
Published: February 2007

To determine whether lithium can shorten chemotherapy‐induced neutropenia, 35 adult patients with newly diagnosed acute myeloid leukemia undergoing initial chemotherapy were randomized either to receive oral lithium started at the time of biopsy‐proven hypoplasia or to receive no lithium. This study failed to show statistically significant shortening of the duration of chemotherapy‐induced neutropenia in the lithium treatment group.
Amsa: A phase II trial in resistant and recurrent acute myelogenous leukemia
Authors: Boccia Ralph , Zighelboim Jacob , Champlin Richard E. , Kim Chun Choo , Gale Robert Peter
Published: February 2007

27 patients with resistant acute myelogenous leukemia (AML) were treated with AMSA. Three achieved a complete remission, and two a partial remission. Median survival for all patients was 12 weeks and was 16 weeks for responders.
CNS primitive neuroectodermal tumors of childhood
Authors: Ashwal Stephen , Hinshaw David B. , Bedros Antranik
Published: February 2007

Primitive neuroectodermal tumors (PNET) of the central nervous system in children are rare, highly malignant, cystic, and sometimes calcific, and hemorrhagic tumors sharply demarcated from adjacent brain. Microscopically they consist of small predominantly undifferentiated dark cells with neuronal, glial, and mesenchymal elements. We have recently diagnosed and treated five children with PNET. We will review their case histories as well as summarize the previous 133 reported cases with reference to presenting complaints, tumor location, neurodiagnostic studies, and the retrospective results of four treatment programs: 1) surgery alone; 2) surgery and radiation therapy; 3) surgery, radiation therapy, and chemotherapy at time of recurrence; and 4) surgery, radiation therapy, and chemotherapy at onset.
Early deaths in acute lymphoblastic leukemia (ALL): Results of the Italian pediatric cooperative group for therapy of acute leukemia (AIL‐AIEOP)
Authors: Dini Giorgio , Bartolini Marida , Massimo Luisa , Ceci Adriana , Paolucci Guido , Calculli Giovanni , Russo Antonio , Magro Saverio , Guazzelli Carlo , Cesana Bruno M. , Jankovic Moncilio , Massolo Fausta , Di Tullio Maria T. , Curto Margherita Lo , Marchi Antonietta , Macchia Pier Antonio , Mandelli Franco , Digilio Girolamo , Rosati Domenico , Acquaviva Antonio , Madon Enrico , Miniero Roberto , Tamaro Paolo
Published: February 2007

In this retrospective multicentric study, we report on early deaths (ie, those that occurred during the first month of treatment) in a total of 943 newly diagnosed ALL pediatric patients registered from 1976 to 1981 at 21 centers of the AIL‐AIEOP. Objectives of this study were as follows: (1) to verify the incidence and the cause of early death in a wide population of children with ALL and (2) to elucidate factors associated with early death and therefore to identify “high‐risk” groups of patients.

Out of the 943 ALL patients, 39 (4.1%) early deaths were registered. Main causes were infection, 20 patients (51.3%); hemorrhage, 11 patients (28.3%); uric acid nephropathy, 2 patients (5.1%); cardiac failure, 3 patients (7.6%); syndrome of inappropriate antidiuretic hormone secretion, 1 patient. Two patients died during the first week of unknown cause. Thirteen factors measured at diagnosis and possibly influencing the early death rate were analyzed. Using the chi‐square test, only three of these factors (age, mediastinum status, surface markers) appear to have any significant influence on the early death rate.

We also tried to determine how therapy influences this process by analyzing variations in the early death rate, other factors being equal. Significant differences in the early death rates were encountered in AIEOP protocols using different induction regimens.
The value of computerized tomography as a routine follow‐up procedure for patients with Wilms' tumor
Authors: Wilimas Judith A. , Hammond Elizabeth , Douglass Edwin C. , Champion John , Parvey Louis , Coburn Thomas
Published: February 2007

We performed routine computerized tomography (CT) of the chest and abdomen on patients treated for Wilms' tumor and reviewed the records of all patients who relapsed (10 patients) and 43 additional patients followed for at least 1 year. Routine chest radiographs and abdominal ultrasounds were compared with 210 CT examinations (107 chest and 103 abdomen). CT examinations were obtained at 6 months for stage I (13 patients) and at 3, 8, and 15 months for stages II, III, and IV (40 patients). Of the 10 patients who relapsed, only 2 were documented by CT scan in the absence of clinical symptomatology and presence of normal radiographs and ultrasound. Eight relapses were diagnosed by physical examination, chest radiograph, or ultrasound and confirmed by CT scan. Questionably abnormal CT scans were obtained in 7 patients, only 1 of whom eventually relapsed. Since only 2 of 210 routine CT examinations were the the only indicator of relapse, we conclude that the routine use of CT for follow‐up in Wilms' tumor is not warranted.
Extramedullary recurrence of acute lymphoblastic leukemia 15 years after initial diagnosis
Authors: Burton Gary V. , Weinberg J. Brice , Borowitz Michael J.
Published: February 2007

We describe a 19‐year‐old man with recurrence of a lymphoid malignancy involving the ethmoid sinus 15 years following diagnosis and 10 years after discontinuation of therapy for childhood acute lymphoblastic leukemia (ALL). The cytologic appearance and immunologic phenotype of the tumor cells suggest that this malignancy represents a recurrence of his original tumor. Initial relapse of ALL is unusual after 4 years of continuous remission off therapy. This case illustrates that late relapse can occur and may present with unusual sites of involvement.
Evaluation of cyclocytidine in reinduction and maintenance therapy of children with acute nonlymphocytic leukemia previously treated with cytosine arabinoside: A report from children's cancer study group
Authors: Movassaghi Nasser , Higgins Gussie , Pyesmany Allan , Baehner Robert , Chard Ronald , Sather Harland , Hammond Denman
Published: February 2007

A study of children in relapse with acute nonlymphocytic leukemia (ANLL) previously maintained in remission with combination chemotherapy including cytosine arabinoside (Ara‐C) was undertaken by Children's Cancer Study Group (CCSG) to assess the efficacy of cyclocytidine (Cyclo‐C), a depot Ara‐C, compared to parenteral Ara‐C given every 12 hr. The reinduction protocol consisted of daunomycin combined with either Ara‐C (Regimen 1) or Cyclo‐C (Regimen 2). One‐hundred thirty eligible patients were entered on the randomized study. Hematologic toxicity was significant in both regimens and resulted in four drug‐related deaths. Cardiac toxicity was observed in five patients, manifested only by abnormal echocardiogram or electrocardiogram patterns in three and congestive heart failure in two patients. Seventy‐seven of 112 evaluable patients achieved M‐1 or M‐2A marrow remissions (69%): 46 of 60 on Regimen 1 (75%), 30 of 52 on Regimen 2 (60%). The remission rate between the two regimens was not significantly different. There was no significant difference in the duration of remission comparing maintenance cyclophosphamide combined with Ara‐C or with Cyclo‐C. Addition of VP‐16 and CCNU to the maintenance therapy did not prolong the duration of remission. This study indicates that patients with childhood ANLL previously treated with Ara‐C and daunomycin can obtain a successful second remission. A single daily subcutaneous dose of Cyclo‐C was found to be as efficacious as Ara‐C given intravenously every 12 hr. The single dose schedule provides a convenient way to treat patients with relapsed ANLL in the outpatient setting.
Computerized tomography in the diagnosis of systemic candidiasis in patients with acute leukemia
Authors: Linker Charles A. , Degregorio Michael W. , Ries Curt A.
Published: February 2007

Seven patients with acute leukemia and systemic candidiasis presented with a clinical syndrome of fever, abdominal pain, organomegaly, and a cholestatic pattern of hepatic dysfunction with an elevated alkaline phosphatase and normal transaminases. The abdominal CT scan demonstrated diffuse hepatic and splenic abscesses in all seven patients. Culture and histology of liver biopsy specimens was nondiagnostic in four of five cases. The CT‐directed percutaneous needle aspirations of these lesions yielded diagnostic material in two of three cases. Culture‐negative visceral abscesses in persistently febrile patients with acute leukemia should be recognized as being due to candidiasis. The abdominal CT scan may be useful in identifying this clinical‐radiographic syndrome and in facilitating rapid diagnosis. Promptly administered antifungal therapy may lead to successful eradication of this infection.
Testicular infiltrates in children with acute lymphoblastic leukemia: A prospective study
Authors: Ortega Juan J. , Javier G. , Torán Nuria
Published: February 2007

The incidence of testicular infiltrates in 68 boys with acute lymphoblastic leukemia in first remission (1974‐81), was prospectively investigated through careful clinical examination and routine bilateral biopsies at 2‐3 years of remission. All boys were under 14 years of age and they were treated with protocols D.74 and Pethema 7/78. Seven patients (10.3%) presented an isolated testicular relapse (ITR) during the chemotherapy period. In 13 of the 43 testicular biopsies (31%) leukemic infiltrates were found, and in another two findings were controversial. Three boys, two with previous negative biopsies, had an ITR 6 to 18 months after therapy was stopped. Finally, three others had simultaneous relapses in testes and bone marrow, one during chemotherapy and two after suppression. In all, 23 patients (33.8%) in first remission had overt or occult ITR. Overall estimated incidence rate of testes leukemia is 40% in all the groups. Incidence of early and occult ITR was higher in boys with initial WBC counts over 20 × 109/1. Therapy in ITR generally consisted of local radiotherapy (20‐25 Gy), a new induction treatment followed by 2‐year maintenance treatment; in three patients with early ITR, orchidectomy was also performed and six were given a new CNS preventive treatment. Clinical course in the seven patients with early ITR was unfavourable in five, with subsequent hematological relapses and death; one had a long‐term disease‐free survival (80 + months) and the other was a recent case. Ten of the 13 patients with occult infiltrates continued in remission and four were off treatment with a follow‐up of over 66 months. The three patients with late ITR were in 2nd remission at 8‐18 months after a new cessation of therapy. It may be concluded from this study that prognosis in ITR is related to the phase of presentation: it is unfavourable in cases of early ITR, but in occult infiltrates, detected by routine biopsy, and in late ITR combined therapy is effective in most cases.
Pulmonary veno‐occlusive disease associated with microangiopathic hemolytic anemia and chemotherapy of gastric adenocarcinoma
Authors: Waldhorn Richard E. , Tsou Edward , Smith Frederick P. , Kerwin Donald M.
Published: February 2007

A 68‐year‐old man was treated with FAM (5‐fluorouracil, doxorubicin [Adriamycin], mitomycin‐C) for metastic gastric adenocarcinoma. Twelve months later while in complete clinical remission, pulmonary hypertension and microangiopathic hemolytic anemia were recognized, progressed, and ended in his demise 6 months later. At necropsy, minimal residual cancer and severe pulmonary venoocclusive disease was found. Pulmonary venoocclusive disease may occur in association with microangiopathic hemolytic anemia and cancer chemotherapy.
Secondary myelofibrosis with metastatic breast cancer simulating agnogenic myeloid metaplasia: Report of a case and review of the literature
Authors: Yablonski‐Peretz T. , Sulkes A. , Polliack A. , Weshler Z. , Okon E. , Catane R.
Published: February 2007

A patient with carcinoma of the breast, who developed a clinical syndrome resembling agnogenic myeloid metaplasia, is described. She was found to have secondary myelofibrosis with metastatic carcinoma of the marrow, extensive extramedullary hematopoiesis resulting in massive splenomegaly, and leukoerythroblastosis. These findings are rare and myeloid metaplasia with striking extramedullary hematopoiesis causing massive splenomegaly and mimicking agnogenic myeloid metaplasia is seldom seen in patients with metastatic carcinoma. Previous case reports of secondary extramedullary hematopoiesis simulating agnogenic myeloid metaplasia (AMM) in patients with solid tumors are also reviewed.
Stage II neuroblastoma—does adjuvant irradiation contribute to cure?
Authors: McGuire Warren A. , Simmons Doyle , Grosfeld Jay L. , Baehner Robert L.
Published: February 2007

Twenty‐one children with Stage II neuroblastoma diagnosed between 1973 and 1983 were analyzed retrospectively. Median age at diagnosis was eleven months (1 week to 153 months). Primary tumor was above the diaphragm in 67% and below the diaphragm in 33%. All patients underwent surgical resection and pathologic diagnosis was neuroblastoma in 76% and ganglioneuroblastoma in 24%. Regional lymph nodes were positive in three of eleven patients sampled. Sixty‐seven percent had gross residual disease, and thirty‐three percent had microscopic residual disease. Seventeen patients received postoperative irradiation and none has relapsed (median follow‐up 57 months). Four patients received surgery alone (median follow‐up 24 months); one local relapse occurred in this group and was subsequently treated with irradiation. All patients are alive and disease free, with a median length of follow‐up of 55 months. Radiation dosage was 1000‐1800 rad in patients less than 12 months of age, and 1800‐3000 rad in those greater than 12 months of age at diagnosis. The high disease‐free survival rate in both groups of patients, but especially in the group receiving adjuvant irradiation, emphasizes the need for a controlled, prospective study to determine which Stage II neuroblastoma patients, if any, would be benefitted by postoperative irradiation.
Neuroblastomas treated at the four major child oncologic clinics in Denmark 1943–1980: An evaluation of 180 cases
Authors: Carlsen Niels L. T. , Schroeder Henrik , Bro Poul V. , Erichsen Gunna , Hamborg‐Pedersen Bente , Jensen Kaj Bjoern , Nielsen Ole H.
Published: February 2007

One hundred and eighty cases of neuro‐blastomas from the four child oncology clinics are reviewed. The overall cure rate was 24%. During the 38‐year period, there was a significant increase in survival from 0% during the period of 1943–1950 to 32% during the period of 1971–1980. This improved survival rate is most likely a result of adjuvant chemotherapy. Forty percent of the patients appear chronically ill, which reflects the fact that nearly 60% have metastases when they are first seen. In localized disease (stages I–II), the prognosis was favourable (cure rate 69%), while the prognosis for disseminated disease (stage III–IV) was poor (cure rate 5%). A favourable outcome was seen in patients under 1 year (survival rate 46%), and in patients with primary tumours located in the neck or mediastinum (survival rate 48%). When related to stage, however, the survival rates for the former tumours were not significantly better in patients below 1 year or in patients with cervical or thoracic tumours. As is the case in other studies, we found that survival is significantly poorer in males.
Effective cisplatin (DDP) based chemotherapy in the treatment of hepatoblastoma
Authors: Douglass Edwin C. , Green Alexander A. , Wrenn Earl , Champion John , Shipp Melissa , Pratt Charles B.
Published: February 2007

Nine of 11 patients with hepatoblastoma treated with cisplatin (DDP) based chemotherapy had a complete (CR) or partial (PR) remission. Five of these patients had measurable pulmonary disease and four achieved a CR of pulmonary lesions. The average interval of disease control following DDP was three times that of Adriamycin (ADR). DDP is an effective agent in the treatment of hepatoblastoma.
Stage IV‐N: A favorable subset of children with metastatic neuroblastoma
Authors: Rosen Eliot M. , Cassady J. Robert , Frantz Christopher N. , Kretschmar Cynthia S. , Levey Raphael , Sallen Stephen E.
Published: February 2007

Among children over 1 year of age with Evans Stage IV neuroblastoma, there appears to be a small group with a relatively favorable prognosis. These patients have extensive lymph node metastases (cervical/axillary/thoracic/abdominal/pelvic), but no extranodal metastases. Three of six such patients (50%) are long‐term disease‐free survivors, compared with none of 40 patients with extranodal metastatic disease (p < 0.0002). Patients with only lymph node metastases (Stage “IV‐N”) may have a biologically more favorable tumor that is curable with conventional, intensive multimodality therapy.
Treatment of children with refractory acute lymphocytic leukemia with vincristine and diltiazem
Authors: Bessho Fumio , Kinumaki Hiroshi , Kobayashi Miyuki , Habu Hiroshi , Nakamura Kazuko , Yokota Shunichiro , Tsuruo Takashi , Kobayashi Noboru
Published: February 2007

Six children with refractory acute lymphocytic leukemia were treated with vincristine combined with diltiazem. In four of five children who took the drug as scheduled, a cytolytic effect was observed. One child showed massive cell destruction which caused hyperuricemic nephropathy. The only adverse effect was atrioventricular block in two children, which was completely reversible. Increased neurotoxicity was not observed in any child.
Comparison of stage IV and IV‐S neuroblastoma in the first year of life
Authors: Nickerson H. James , Nesbit Mark E. , Grosfeld Jay L. , Baehner Robert L. , Sather Harland , Hammond Denman
Published: February 2007

Clinical staging and factors related to survival were evaluated in 44 stage IV‐S and 44 stage IV patients with neuroblastoma, ages 0 to 12 months, seen at Childrens Cancer Study Group (CCSG) institutions from 1972 to 1979. In 73 patients with complete surgical staging, the life‐table projected survival at 3 years was 91% for stage IV‐S and 44% for stage IV. The only deaths in stage IV‐S disease occurred in three patients less than 2 months old at diagnosis. In stage IV‐S, 3 to 12 months old at diagnosis, the disease‐free survival was 97%. Chemotherapy or radiation therapy did not appear to improve the survival rate in stage IV‐S.

These studies further document a significant clinical and biologic difference between patients with stage IV and stage IV‐S neuroblastoma and suggest that they require different therapeutic management.
Avascular necrosis of bone following combination chemotherapy for acute lymphocytic leukemia
Authors: Felix Carolyn , Blatt Julie , Goodman Mark A. , Medina Jocelyn
Published: February 2007

Avascular necrosis of bone (AVNB) is a known complication of systemic adrenocorti‐costeroid therapy, and one which is thought to be dose‐related. However, despite the large amounts of prednisone which have been used in the standard treatment of acute lymphocytic leukemia (ALL), AVNB rarely has been reported in children with that disease. We described our experience with one adolescent with ALL who developed multifocal AVNB presenting as bone pain after aggressive chemotherapy that included a high cumulative dose of corticosteroids as well as other antitumor agents, some of which also have been associated with AVNB. Four similar cases from the literature are reviewed. Because the bone pain of AVNB can mimic that of leukemic relapse, this is an important entity to be aware of, and one which may become more common with increasingly aggressive combination chemotherapy.
Abnormal visual‐evoked potentials in leukemic children after cranial radiation
Authors: Russo Antonio , Tomarchio Salvatore , Pero Giuseppe , Consoli Giuseppe , Marina Roberto , Rizzari Carmelo , Schilirò Gino
Published: February 2007

Visual‐evoked potentials (VEPs) were studied in 55 asymptomatic children with leukemia or solid tumors in remission in order to detect subclinical demyelination of the optic pathway after CNS prophylaxis. In group I (11 patients with ALL studied prospectively), VEP latency was increased in ten after cranial radiation (CR) as compared with previous values. Group II (18 patients with ALL in maintenance) and group III (16 patients with ALL off therapy) were studied retrospectively and VEP latency was found above normal limits in 33 and 31%, respectively. In group IV (four patients with solid tumors and six with leukemia, all of whom received no CR), VEP latency was normal despite periodical intrathecal methotrexate administrations to five of them. We conclude that CR determines a slowing of conduction on VEP test, probably due to demyelination of the optic pathway, in a high proportion of patients. The future clinical significance of these findings must be established throughout a prolonged follow‐up period.
Risk factors in long‐term sequelae of central nervous system prophylaxis in successfully treated children with acute lymphocytic leukemia
Authors: Carli M. , Perilongo G. , Laverda A. M. , Drigo P. , Casara G. L. , Marin G. , Sotti G. , Deambrosis G. , Zanesco L.
Published: February 2007

Seventy‐two successfully treated patients with acute lymphocytic leukemia, all in first complete remission and all off therapy, who had received CNS prophylaxis (radiotherapy, 2,400 rad, plus intrathecal methotrexate), were studied by computed tomography (CD of the brain, EEGs, and neurologic evaluations 3 to 9 years after the end of prophylaxis. Thirty‐five patients showed CT brain scan abnormalities: intracranial calcifications (twelve); widening of the subarachnoid spaces (eight); isolated dilatation of ventricular spaces (three) and with frontal periventricular hypodensity (two); dilatation of ventricular and subarachnoid spaces (nine); and a hypodense area (one). Only 17 patients showed aspecific EEC abnormalities which were never linked to CT scan findings. None of our patients presented major motor deficits at the neurologic examination.

A stepwise logistic regression technique showed that age less than 5 years at the time of prophylaxis was the most important risk factor (p = 0.008) of CT brain scan abnormalities followed by neurets (p = 0.037) and sex (p = 0.10). Furthermore, the multivariate analysis pointed out that the interactions between these variables were not significant and the effects were only of the first order.
Leukemic iris infiltration as the only site of relapse in a child with acute lymphoblastic leukemia: Temporary remission with high‐dose chemotherapy
Authors: Behrendt H. , Wenniger‐Prick L. M. d. B.
Published: February 2007

A 12‐year‐old Caucasian boy developed leukemic hyphema with iris infiltration as the only relapse site during the third complete remission of his acute lymphoblastic leukemia. With high‐dose methotrexate, high‐dose cytosine‐arabinoside plus teniposide, and a 5‐week course of vincristine, prednisolone, and L‐asparaginase, a complete remission could be achieved. Maintenance treatment was reinstituted for 1 year. However, after stopping the treatment, the iris infiltrate reappeared, and this time the eye was irradiated after chemotherapeutic reinduction. Seven months later, the boy remains in complete remission. The pathogenesis of leukemic iris infiltration is discussed briefly.
Infantile lymphoblastic leukemia with(4;11) and septate uterus, double cervix, and double vagina: Case report and review of the literature
Authors: Morrow Robert C. , Dickerman Joseph D. , Clemmons Jackson J.
Published: February 2007

Translocation between chromosomes 4 and 11 has been associated with an aggressive subtype of acute lymphoblastic leukemia. To date, 32 cases have been reported, 12 of which have been in infants. We report the 13th infantile case and the first associated with a somatic abnormality (septate uterus with double cervix and double vagina).
Extravasation of dactinomycin, vincristine, and cisplatin: Studies in an animal model
Authors: Buchanan George R. , Buchsbaum Herbert J. , O'Banion Kathleen , Gojer Bernard
Published: February 2007

Extravasation of some cytotoxic drugs results in chemical cellulitis. Management of suspected extravasation has been empiric and difficult to evaluate clinically. We investigated dactinomycin, vincristine, and cisplatin by means of intradermal injections in Balb‐c mice. Reproducible skin lesions with concentric areas of induration, erythema, and ulcer‐ation developed in a time‐ and dose‐dependent fashion following injection of dactinomycin. Vincristine caused no lesions following initial intradermal administration, but repeat injection 7 days later was followed by a diffuse punctate ulcerative lesion suggesting a hypersensitivity reaction. Three concentrations (1.0, 0.1, and 0.01 mg/ml) of cisplatin elicited cellulitis following initial injection, but there was no correlation between lesion size and dose. Injection of saline, hydrocortisone, ascorbic acid, sodium thiosulfate, buffered DNA solution, and beta adrenergic agonists and antagonists after the injection of dactinomycin failed to prevent development of lesions. Heat application was also ineffective; however, local cold application prevented or markedly reduced reactions to dactinomycin. We conclude that the intradermal mouse model may be appropriate for the evaluation of the three drugs studied and that cold application is the best antidote among those tested fordactinomycin‐induced ulceration in this model.
Homer's syndrome: An unusual presentation of Hodgkin's disease
Authors: Simon Sheryl R. , Dorighi John A. , Branda Richard F. , Ershler William B.
Published: February 2007

Horner's Syndrome (ptosis, anisocoria, and anhydrosis) developed in a 22‐year‐old woman. A mediastinal mass was noted on chest x‐ray. Further evaluation led to a diagnosis of Hodgkin's disease, nodular sclerosis type. Horner's syndrome is an unusual initial manifestation of Hodgkin's disease, and, in this case, it was due to oculosympathetic damage from mediastinal compression. Because the potential for cure is high in Hodgkin's disease, this diagnosis should be considered in patients presenting with Horner's syndrome.
Treatment and outcome of undifferentiated carcinoma of the nasopharynx in childhood: A 13‐year experience
Authors: Lobo‐Sanahuja Francisco , Garcia Ivette , Carranza Alfonso , Camacho Alvaro
Published: February 2007

Between 1970 and 1983, 22 pediatric patients diagnosed as having undifferentiated nasopharyngeal carcinoma (UNC) were treated at the National Children's Hospital of Costa Rica; primary tumor with local extension (T3‐T4) was present in 45% of the patients, and metastasis of the cervical nodes (N1‐N3) in 82%. Patients were divided into groups A and B according to the type of treatment received. A description of both groups is as follows.

Ten patients were treated with 5,000 to 6,000 rads tumor dose to the primary and a 5,125‐rad dose was administered to the lower neck between 1970 and 1977 (group A). Six patients received postradiation therapy with cyclophosphamide and vincristine and two patients also received 5‐fluorouracil. The outcome in group A was as follows: four (40%) failed to respond, six (60%) achieved full remission initially with two subsequent relapses, and the remaining four are still alive and free of relapse after 90 to 160 months (average 130) (two were treated with Co60 alone and two with chemotherapy.

Twelve patients were treated with chemotherapy pre‐ and postradiation with CPM and adriamycin for a total of 12 months (group B) between 1978 and 1984. All (100%) achieved complete initial remission; two patients relapsed and died. Ten patients have remained in relapse‐free survival for 18–67 months (median 32).

Though this is not a controlled study, our experience indicates that pre‐ and postradiation chemotherapy is effective in prolonging the disease‐free survival in UNC and may allow a decrease of the radiation tumor dose.
Computed tomography of the abdomen and pelvis: Documentation of tumor response and progression in disseminated prostate cancer
Authors: Winkler Charles F. , Dunnick N. Reed , Eddy Joyce L. , Newman Richard D. , Ihde Daniel C.
Published: February 2007

Computed tomography of the abdomen and pelvis has been used to stage early prostatic cancer. We investigated its value in monitoring tumor response in more advanced disease. Serial computed tomography of the abdomen and pelvis was obtained along with multiple other staging tests prior to treatment and at 3‐ to 4‐month intervals thereafter in 32 patients with stage D2 tumor treated initially with combination chemotherapy and with hormones at progression. Pretreatment lymphography with follow‐up abdominal films was also performed. Initial computed tomography of the abdomen and pelvis showed evidence of node metastases in 35% of patients while lymphography was positive in 54%. Among 19 patients with tumor response and 25 with progression, the results of treatment were objectively documented by improvement or worsening, respectively, in a mean of 5.1 and 5.0 other staging tests, exclusive of computed tomography. Computed tomography of the abdomen and pelvis improved in 85% of responding patients examined. Progression was confirmed by worsening of computed tomography in 32%. Although lymphography was often abnormal prior to treatment, in our hands it was not useful in serial monitoring of tumor status. We conclude that serial computed tomography of the abdomen and pelvis, when initially positive, is a useful test to document objectively tumor response and progression in disseminated prostatic cancer.
Modified Capizzi maintenance regimen in children with relapsed acute lymphoblastic leukaemia
Authors: Pinkerton C. R. , Mills S. , Chessells J. M.
Published: February 2007

Improved survival of children with acute lymphoblastic leukaemia who relapse during therapy has been reported using the Capizzi maintenance regimen. We have treated ten such patients, without histocompatible donors, with this regimen, which consisted of fortnightly doses of vincristine (1.5 mg/m2) and an escalating dose of intravenous methotrexate (90–470 mg/m2) followed 24 hours later by asparaginase (15,000 units). Remission of disease had been successfully achieved in all patients using conventional therapy prior to the start of maintenance treatment. Cerebro‐spinal fluid concentrations of methotrexate were estimated serially in several patients but remained relatively low despite dose escalation. It appears that additional intrathecal chemotherapy is therefore necessary. Treatment was generally well tolerated but there is concern about the incidence of neurotoxicity in patients who had previously received cranial irradiation and intensive intrathecal therapy. The median duration of bone marrow remission was only 35 weeks (range 18–50). Two patients who had not been receiving IT therapy had early isolated CNS relapses. In conclusion, it appears that contrary to early expectations this treatment approach is unlikly to offer a significantly better outlook for these patients, in whom the chance of early marrow relapse remains high.
Phase II study: The combination DTIC, BCNU, actinomycin D, and vincristine in disseminated malignant melanoma
Authors: Creagan E. T. , Schutt A. J. , Long H. J. , Green S. J.
Published: February 2007

Thirty patients with disseminated malignant melanoma received the combination DTIC, BCNU, actinomycin D, and vincristine. The objective response rate was 17 percent concomitant with moderate‐to‐severe nausea and vomiting in 80 percent of patients. Hematologic toxicity was transient. In the dose and schedule that we used, the four‐drug regimen does not offer meaningful benefit for patients with advanced melanoma.
Acute myelogenous leukemia following complete remission of small cell carcinoma of the lung
Authors: Yu Peter P. , Waxman Jenny S. , Chahinian A. Philippe , Efremidis Anna P. , Holland James F.
Published: February 2007

The treatment of patients with small cell carcinoma of the lung (SCCL) with combination chemotherapy and radiation has dramatically improved survival in the past decade. With this increased survival, long term complications of therapy are becoming apparent. We report a patient who died of acute myelogenous leukemia (AML) while in complete remission from SCCL. Review of the literature indicates that there may be an increased incidence of AML following successful induction of complete remission in patients with SCCL.
Analysis of prognostic factors in acute lymphoblastic leukemia
Authors: Hammond Denman , Sather Harland , Nesbit Mark , Miller Dennis , Coccia Peter , Bleyer Archie , Lukens John , Siegel Stuart
Published: February 2007

Children with ALL who have a high probability of excellent response, long‐term survival, and cure when treated with widely available standard therapy can be identified at the time of diagnosis. Others can be identified who are at high risk of failure to respond, early relapse, and death. The importance of such prognostic characteristics is so great that they should be considered in the selection of appropriate treatment for each patient. Prognostic factors also must be considered in the design and analysis of clinical trials. All prognostic factors are not equally significant and many of them are closely associated. It is possible to rank them in importance and usefulness by appropriate statistical methods. As additional prognostic factors are identified, and as more effective and more specific therapies are developed, the relative importance of prognostic factors will change.