bluuebunny/crossref_metadata_2025 huggingface dataset:
Late effects of treatment of cancer in infancy
Authors: Pastore Guido , Antonelli Richard , Fine William , Li Frederick P. , Sallan Stephen E.
Published: February 2007

Eighty‐six children were diagnosed with cancer in infancy, followed for at least 5 years, and assessed for late effects of disease and therapy. One child subsequently died from respiratory failure and 3 died from second primary cancers. Another patient survived second primary cancers of the skin. The high frequency of new cancers (4 observed, 0.09 expected) was attributable to host susceptibility factors and treatment effects. Kyphoscoliosis was diagnosed in 44 patients, 40 of whom had received radiotherapy to the spine. Other patients had neurologic deficits, pulmonary fibrosis, hypoplastic breasts, bowel adhesions, thyroid nodules, musculoskeletal defects, and liver fibrosis associated with tumor therapy. Sequelae of cancer were more common after treatment in infancy than in later childhood. Improved treatments and knowledge of natural history can reduce adverse effects of therapy.
Treatment of small cell lung cancer: Intensive remission induction, radiation therapy, and maintenance chemotherapy
Authors: Bezwoda W. R. , Derman D. P. , de Moor N. G. , Kallenbach J.
Published: February 2007

Forty‐eight patients with small cell lung cancer were treated with an intensive therapy regimen which included induction chemotherapy with vincristine, adriamycin, procarbazine, and methotrexate. This was followed by radiation therapy given to areas of residual disease after restaging. Maintenance chemotherapy with cyclophosphamide, methotrexate, and procarbazine was then given to patients who had entered complete remission (CR). Fifteen out of 17 patients with limited disease (88%) achieved complete remission. Remission rates for patients with extrathoracic metastases were somewhat lower. Seven of 11 patients (64%) of patients with a single extrathoracic metastatic site achieved CR, while only 6/20 (30%) with multiple extrathoracic metastases went into remission. Median survival for patients who achieved complete remission was 17 months.
Radiation dose to the thyroid in the treatment of acute lymphoblastic leukemia (ALL)
Authors: Rogers Paul C. J. , Fryer Christopher J. H. , Hussein Sherali
Published: February 2007

Sixteen children who received cranial irradiation for CNS prophylaxis of leukemia were evaluated for dose of radiation received to the thyroid. Radiation dose received by the thyroid varied between 2.8 to 7.5% of the given dose to the cranium. This is sufficient radiation to increase the risk of long‐term thyroid pathology.
Plasma phenylalanine: Tyrosine ratios during high‐dose methotrexate‐citrovorum “rescue”
Authors: Hilton Mary A. , Patel Chandrakant C. , Bertolone Salvatore J. , Kmetz Donald R. , Clark Larry W.
Published: February 2007

We have measured phenylalanine and tyrosine in the plasma of patients with osteogenic sarcoma undergoing chemotherapy with high‐dose methotrexate (HDMTX) citrovorum factor rescue (CFR). During 14 treatments in six different patients, the phenylalanine to tyrosine ratio (PHE/TYR) at 21 to 38 hours was elevated over pretreatment levels. The observed increase in plasma phenylalanine is attributed to inhibition by MTX of the phenylalanine hydroxylase system of the liver, which is not folate‐dependent and thus is not corrected by administration of CF. A post‐infusion increase in PHE/TYR of 571% after 22 hours in one patient and of 410% after 30 hours in another were associated with marked MTX toxicity. The greatest increase in PHE/TYR seen in a patient who did not experience toxicity was was 249% in 21 hours. Thus, in this group of patients, there appears to be a correlation between evidence of clinical MTX toxicity and the magnitude of the percentage increase in PHE/TYR in the plasma, which indicates inhibition of a liver enzyme and thus reflects the intracellular concentration of MTX.
Restaging laparotomy in the management of the non‐Hodgkin lymphomas
Authors: Aisner Joseph , Wiernik Peter H.
Published: February 2007

The intensity of treatment and the extent of restaging necessary to document the level of response to therapy in patients with non‐Hodgkin lymphoma (NHL) remains controversial. One hundred patients with advanced non‐Hodgkin lymphoma were randomized to treatment with cyclophosphamide, vincristine, plus prednisone or cyclophosphamide, doxorubicin, vincristine, plus prednisone combination chemotherapy. After induction therapy sequential noninvasive restaging including lymphangiogram and 67gallium scan yielded 33 patients in clinical complete remission and 38 patients in partial remission. Twenty of these 38 patients in partial remission had complete normalization of all clinical and chemical tests (“apparent” clinical partial remission); however, lymphangiogram, gallium scan, abdominal sonogram, or abdominal CAT scan remained abnormal. In these 20 patients in “apparent” clinical partial remission, exploratory laparotomy was performed to further assess disease status. Laparotomy revealed evidence of residual disease in only four patients (20%). When correlated with the laparotomies the accuracy of repeat lymphangiograms and gallium scans was 17% and 50%, respectively. Thus, restaging lymphangiogram and gallium scan in NHL patients in “apparent” clinical partial remission are inaccurate, and “second look” operations are recommended for accurate appraisal of response to therapy. The assessment of true complete remission should help define the role of aggressive treatment.
Metastatic epidural tumors in children
Authors: Ch'ien Lawrence T. , Kalwinsky David K. , Peterson Gregory , Pratt Charles B. , Murphy Sharon B. , Hayes F. Ann , Green Alexander A. , Hustu H. Omar
Published: February 2007

Spinal cord compression is a rare but serious complication of malignant diseases in children. Epidural cord compression was noted in 81 patients within the past 17 years at this center. The complication developed at different times during the course of the primary disease. For 29 of our patients, cord dysfunction was one of the initial signs of cancer—Ewing sarcoma, neuroblastoma, Hodgkin disease, and malignant lymphoma. By contrast, for most of the patients with osteosarcoma and rhabdomyosarcoma, it appeared later in their clinical course.

The treatment outcome of patients who were paraplegic with complete loss of sensory function for ≫48 hours was poor. Only four of 22 in this group became ambulatory. Ten patients with osteosarcoma did not undergo laminectomies because they all had multiple metastases and terminal disease. Paraplegia developed in all ten. There was no difference in ambulatory rates among other patients, with or without laminectomies.
Hepatic artery infusion with 5‐fluorouracil and mitomycin‐c in metastatic colorectal carcinoma phase ii study
Authors: Theodors Asgeir , Bukowski Ronald M. , Lavery Ian , Hewlett James S. , Livingston Robert B. , Buonocore Edward
Published: February 2007

Thirty‐two patients with hepatic metastases colorectal carcinoma were treated with hepatic artery infusion (HAI) employing 5‐fluorouracil (5‐FU) and mitomycin‐C (mito‐C). Catheters were placed percutaneously via the femoral artery. Two schedules were employed: (I) 5‐FU 1,200 mg/m2 IA (D1‐4) and mito‐C 8 mg/m2 IA (D1 +D4); (2) 5‐FU 1,200 mg/m2 IA (D1‐6) and mito‐C 8 mg/m2 IA (D1 +D4). Courses were repeated every 4 weeks. Thirty patients with measurable disease were evaluable, 22 received schedule I and 8 patients schedule II. Complete response occurred in two patients (6.7%) and partial response in 13 patients (43.3%). Five patients (16.7%) had minimal regression. The overall response rate was 66.7%. Median survival of all patients from start of treatment was 11.2 months. Median survival of responders and nonresponders was 12.4 months and 4.6 months, respectively (P <0.05). No differences in response rates, duration of response, or survival was seen between the two schedules. Drug toxicity was moderate to severe, but morbidity of HAI per se was minimal. Intermittent HAI of 5‐FU and mito‐C is a well‐tolerated treatment modality associated with few serious complications. The response rate, duration of response, and the survival is comparable to continuous HAI infusion of 5‐FU or floxuridine (FUDR). As given in this study, mito‐C did not appear to provide added benefit.
Metastatic adenocarcinoma of unknown primary site: Analysis of 245 patients seen at the johns hopkins hospital from 1965‐1979
Authors: Markman Maurie
Published: February 2007

A retrospective review of 245 patients with metastatic adenocarcinomas of unknown primary site (ACUP) seen at The Johns Hopkins Hospital from 1965‐1979 was undertaken. The median survival was 3.1 months. Age, sex, race, and year of diagnosis did not appear to influence survival. Patients having their major site(s) of disease above the diaphragm experienced a significantly longer survival than patients whose disease was below the diaphragm (5.3 versus 2.3 months, P < 0.05). As a group, patients treated with chemotherapy had no improvement in survival. However, the small number of patients treated with either cyclophosphamide or doxorubicin or both drugs had a median survival of greater than 9 months compared to 2.6 months for untreated or local radiotherapy‐treated patients and 3.2 months for patients treated with 5‐fluorouracil.
Prolonged survival of patients with extrapulmonary small cell carcinoma arising in the neck
Authors: Kasimis Basil S. , Wuerker Raymond B. , Malefatto Jerry P. , Moran Edgar M.
Published: February 2007

Two patients with extrapulmonary small cell carcinoma localized in the neck survived for more than two‐years without systemic therapy. This suggests that there may be a subset of small cell carcinomas characterized by slow growth, resulting in an indolent clinical course. By light and electron microscopy, we were unable to identify features of this indolent form which differ from those of the aggressive form of pulmonary or extrapulmonary small cell carcinoma.
Lymphoblastic lymphoma: Late relapse in childhood
Authors: Levine Peter L. , Berberich F. Ralph , Burke Jerome S. , Mott Martin G. , Wilbur Jordan R.
Published: February 2007

This report describes two children with lymphoblastic lymphoma who relapsed more than 21/2 years from diagnosis. Relapses occurred at seven and 20 months after completion of treatment. Their therapy consisted of an intensive pulse chemotherapy program combined with radiation therapy. Initial relapse after two years' treatment has been extremely rare in patients receiving contemporary chemotherapy programs, and two‐year survival without disease has been considered a cure. These cases illustrate that late relapses can occur after intensive chemotherapy and that two‐year disease‐free survival must not be interpreted as a complete cure.
Posttransfusion hepatitis in acute nonlymphocytic leukemia: Lack of a beneficial influence
Authors: Markman Maurie , Braine Hayden G. , Vaughan William P.
Published: February 2007

Thirty‐five patients with acute nonlymphocytic leukemia (ANNL) entered complete remission (CR) and survived 16 weeks following induction therapy with high‐dose timed sequential chemotherapy without maintenance therapy. These patients were analyzed to test the hypothesis that acute posttransfusion hepatitis (APTH) has a beneficial influence on the course of ANNL. Ten patients developed evidence of APTH while 25 did not. Median length of CR was 22 weeks for both groups while median survival was longer in patients not developing APTH (75 weeks vs 58 weeks) (P > 0.5). Possible explanations for the discrepancy between these results and those previously reported are discussed.
Growth in children with acute lymphocytic leukemia: A pediatric oncology group study
Authors: Berry D. H. , Elders M. J. , Crist W. M. , Land V. , Lui V. , Sexauer A. C. , Dickinson L.
Published: February 2007

We have studied 127 children from 5 participating institutions as to the effect of acute lymphoblastic leukemia (ALL) or the therapy used in the treatment of ALL on growth, growth hormone concentrations, and somatomedin activity. The study (SWOG No. 7581) was initiated in December 1975 and was closed to new entry in September 1979 and to data collection in February 1981. Heights, weights, and blood samples for growth hormone and somatomedin activity were obtained at the time of initial diagnosis and at intervals during the 55 months of observation. The percentage of boys <4 years of age below the 50th percentile is significantly greater than the expected 50% for both initial and final height (P<0.01). Girls <4 years appeared to have significantly different percentile height distribution from the normal for their final height measurement (P<0.05) but not for their initial height measurement. No other significant differences in the percentile height distribution were found. When growth rate, since time of diagnosis of ALL, is compared to the expected growth of normal children of the same age by linear regression analysis, there is a difference in the slope of the lines. Children with ALL are significantly shorter. The mean initial growth hormone and somatomedin concentration, 6.2 ng/ml and 1.3 μg/ml, respectively, vs mean remission growth hormone and somatomedin of 2.5 ng/ml and 1.1 μg/ml, respectively, were different. This was significant at P<0.01. The slope of the computed regression lines for multiple analysis of growth hormone and somatomedin were negative for more than 60% of the patients when compared to the initial concentration. These data suggest that a significant number of the children <4 years of age are short prior to the onset of therapy, and this persists throughout the course of their disease. Second, there is a reduction in growth rate during intensive therapy or the first year of the disease, with a normal growth rate thereafter. Third, growth hormone and somatomedin concentrations appear to be higher at the time of onset of the disease and decrease while on therapy.
Results of treatment of high risk childhood acute lymphoblastic leukemia
Authors: Kende George , El‐Najjar Khamis , Ben‐Bassat Isaac , Neuman Yoram , Ballin Ami , Ramot Bracha
Published: February 2007

Sixteen children with high risk acute lymphoblastic leukemia (ALL) who had one or more of the following risk factors: white cell count over 50 × 109/liter, mediastinal mass, age under 2 or over 10 years, extramedullary involvement, or T‐cell markers, were treated by a new protocol. All attained complete remission and 11 are still in their continuous first remission for 6‐53 months. High activity of adenosine deaminase (ADA) in the leukemic cells seems to be an independent risk factor, as in the high ADA level group, 4 out of 7 patients relapsed and died, while none of the 8 patients with low ADA levels relapsed or died.
A new chromosomal abnormality in a patient with acute myelomonocytic leukemia
Authors: Young Paul C. , Dickerman Joseph D. , Allen Elizabeth F. , Herklots A. Richard
Published: February 2007

We report a 15‐month‐old boy with acute myelomonocytic leukemia [French‐American‐British classification M4 (FAB‐M4)] whose leukemic cells demonstrated a translocation 46,XY, t(9;11)(p24;q12) that has not been described previously.
Radiation‐induced pneumothorax
Authors: Epstein David M. , Littman Philip , Gefter Warren B. , Miller Wallace T. , Raney R. Beverly
Published: February 2007

Pneumothorax is an uncommon complication of radiation therapy to the chest. The proposed pathogenesis is radiation‐induced fibrosis promoting subpleural bleb formation that ruptures resulting in pneumothorax. We report on two young patients with primary sarcomas without pulmonary metastases who developed spontaneous pneumothorax after irradiation. Neither patient had antecedent radiographic evidence of pulmonary fibrosis.
Comparison between X‐ray and bone scan detection of bone metastases in patients with rhabdomyosarcoma
Authors: Quddus Fauzia F. , Espinola Danilo , Kramer Sandra S. , Leventhal Brigid G.
Published: February 2007

A comparison of radiographic and 99mTechnetium methyldiphosphonate scintigraphic evaluations for extent of skeletal disease was made retrospectively in 17 pediatric patients with Group III and IV rhabdomyosarcoma. Thirteen children had evidence of skeletal metastases. Of these, four exhibited multiple sites of blastic as well as lytic skeletal involvement on x‐rays that were not detected by bone scans: two at the time of initial diagnosis, and two at relapse in children with prior radiotherapy to involved bones. In three additional patients a greater extent of bony disease was evident on x‐rays than on bone scan. Neither the pathology of the tumor, lytic versus blastic quality of the bone lesion, nor lesion size per se was found to correlate with the failure to detect them on the bone scan. Although bone scans have greater sensitivity than x‐rays for the detection of metastatic bone involvement in several adult and pediatric neoplasms, in the case of rhabdomyosarcoma, the radiographic exam appears to be a more sensitive indicator in some patients and should be considered an essential study in the evaluation of skeletal involvement by this tumor.
Ependymoma, glioblastoma, and acute leukemia in a child
Authors: Goffman Thomas E. , Woo Shiao Y. , Manz Herbert , McCullough David , Sinks Lucius F. , Chun Byngkyu K. , Miller Robert W.
Published: February 2007

A 5‐year‐old boy developed an ependymoma; 3 years later, after chemotherapy and radiotherapy, he developed glioblastoma multiforme and acute myeloblastic leukemia. His maternal grandmother had died at a young age of colon cancer. Since ependymoma is not known to predispose to other cancers, the unusual sequence of malignant disease may have been due to combined therapy in a susceptible host.
Continuous five‐day infusion of pala and 5FU: A pilot phase II trial
Authors: Presant Cary A. , Ardalan Bach , Multhauf Phyllis , Chan Clara , Staples Russell , Green Leland , Browning Scott , Carr Brian I. , Chang Fong‐Fu , Thayer William
Published: February 2007

In order to determine whether a simultaneous infusion of N‐(phospho‐n‐acetyl)‐L‐aspartic acid (PALA) was able to increase the rate of antitumor response to 5‐fluorouracil (5‐FU), a pilot study was conducted. Of 10 evaluable patients with previously drug‐untreated colorectal carcinoma, there were only two partial responses, lasting 2.3 and 1.6 months. No partial responses were observed in three evaluable patients with soft tissue sarcomas. The dose‐limiting toxicity was dermatitis. The simultaneous infusion of PALA and 5‐FU is not likely to produce a high number of antitumor responses of long duration in patients with colorectal carcinoma.
Leukemia presenting as central nervous disease without bone marrow involvement
Authors: Ganick Dorothy J. , Sondel Paul M. , Gilbert Enid F. , Borcherding Wayne
Published: February 2007

A case of a nine‐year‐old boy who presented with central nervous system leukemia is described. This case was unusual because he presented without initial bone marrow involvement. Bone marrow involvement was documented 15 months after central nervous disease was diagnosed. Immunologic marker studies revealed that the spinal fluid blasts lacked definable B‐cell, pre‐B cell, T‐cell, and pre‐T cell surface markers. The marker studies helped to define the nature of the disease process.
Reactivity of subpopulations of mouse spleen cells to concanavalin a in vitro
Authors: Laing Calbert A. , Walters Curla S.
Published: February 2007

Subpopulations of spleen cells of mice bearing virus‐induced mammary tumors were assessed for responsiveness to Concanavalin A (Con A) under in vitro xenogeneic and syngeneic culture conditions. When cultured with human A+ plasma (xenogeneic), spleen cells of normal, nontumor‐bearing BALB/c mice exhibited a high degree of synthesis as compared to unstimulated cells in response to Con A. Spleen cells of mice inoculated with tumor exhibited response exceeding that of their normal counterparts by 59%. When normal BALB/c sera (syngeneic) was used as the supplement, no response of normal spleen cells was observed upon stimulation by Con A; however, spleen cells from tumor bearing individuals demonstrated heightened activity. Tumor‐bearer spleen cell response to Con A of mice inoculated with 1 × 106 viable cells was biphasic. The peak of the first phase appeared as early as 10 days postinoculation and declined within 3 days after its appearance. The peak of the second phase appeared within 6 days following decline of the first and declined drastically within 3 days after its appearance. Coincidental with the onset of the second phase, the tumor became ulcerated, purulent, and necrotic. Both phases were predominantly T‐cell mediated.
Congenital ichthyosis and endodermal sinus tumor of the ovary in a ten‐year‐old child
Authors: Lopez Massimo , Papaldo Paola , Sciarretta Francesco , Barduagni Aldo
Published: February 2007

Acquired ichthyosis is very likely to be associated with a malignancy, especially with Hodgkins disease. The association of congenital ichthyosis with malignant tumors has been so far reported only in two instances. Herein we report on a third case. Due to the small number of cases, no conclusion can be drawn about the correlations between the two diseases.
Gastrointestinal involvement with myeloma
Authors: Benson W. J. , Scarffe J. H. , Houwen B. , Crowther D.
Published: February 2007

A patient with IgA‐k multiple myeloma is presented. There was initially a good response to chemotherapy but the patient later developed small intestinal obstruction. This was due to multiple polypoid plasmacytomas. The mesenteric nodes were also involved, and were found on immunofluorescence microscopy and flow cytometry with double fluorescent labelling to be composed of two separate populations of cells (IgA‐k and IgG‐k), one population having a diploid content of DNA and the other tetraploid. These two distinct cell populations differed in both proliferative characteristics and size. The findings are discussed and the literature relating to gastrointestinal involvement in plasma cell dyscrasias reviewed.
Psychosocial aspects of pediatric leukemia: From diagnosis through the first six months of treatment
Authors: Kupst Mary Jo , Schulman Jerome L. , Maurer Helen , Morgan Elaine , Honig George , Fochtman Dianne
Published: February 2007

Newly diagnosed children with leukemia and their families were subjects of a longitudinal study to describe coping behaviors, to determine adequacy of coping, and to discover predictors of healthy coping with leukemia.

Families were followed for six months during which time they were interviewed, completed tests and scales, and were rated by physicians, nurses, and psychosocial staff. Families showed a wide variety of reactions and coping behaviors. The data supported the hypothesis that most families cope well despite the stresses of the first six months post‐diagnosis. Based on physicians' ratings, psychosocial intervention appeared to be effective for mothers during the early outpatient phase of treatment. Age of child, previous coping, coping of other family members, a good support system, and lack of additional stresses were significantly correlated with healthy coping. The need for longitudinal assessment of coping was stressed.
Rhabdomyosarcoma of the larynx treated by laser surgery combined with radiotherapy and chemotherapy
Authors: Kedar A. , Kuten A. , Joachims H. Z. , Ben‐Arieh Y. , Yudelev M.
Published: February 2007

The case of a 6‐year‐old boy with rhabdo‐myosarcoma of the larynx, treated by laser surgery combined with external radiotherapy and chemotherapy, is presented. Using this treatment modality, cure was affected without comprising laryngeal function.
Chronic myelomonocytic leukaemia in infancy: A case report
Authors: Stockley R. J. , Eden O. B.
Published: February 2007

The case of an infant with the clinical and haematological features of chronic myelomonocytic leukaemia is reported. The infant presented with a peripheral blood monocyte count of 12,000 cell/mm3 (12.0 × 109 cell/L) but no lymphadenopathy, hepatomegaly, nor splenomegaly. No treatment was given for 14 months during which time the monocytosis persisted. Myeloblasts then appeared abruptly in the peripheral blood reaching a peak of 1,500,000 cell/mm3 (1,500 × 109/L). Cytotoxic Chemotherapy was initially successful but the blast soon became resistant and the child died. Chronic myelomonocytic leukaemia is usually associated with the elderly and the significance of this case is discussed.
Cytosine arabinoside induced liver damage: Histopathologic demonstration
Authors: Pizzuto Javier , Avilés Agustin , Ramos Ernesto , Cervera Jorge , Aguirre Jesús
Published: February 2007

Two patients with acute leukemia developed abnormal liver function tests after the administration of cytosine arabinoside. Other possibles causes for such abnormalities were not likely. In both patients a close chronologic relationship between the administration of the drug and the appearance of the laboratory abnormalities was noted. The liver damage was also documented by biopsy. To our knowledge this is the first time that the hepatotoxic effects of cytosine arabinoside are histologically demonstrated.
Skeletal scintigraphy and radiography at onset of acute lymphocytic leukemia in children
Authors: Clausen Niels , Gøtze Hans , Pedersen Aase , Riis‐Petersen JøRn , Tjalve Elsebet
Published: February 2007

99mTechnetium skeletal scintigraphy performed at the time of diagnosis was compared with pain and radiographs in 24 children with acute lymphocytic leukemia. Localized intense uptake of the labeled compound in one or several metaphyses and increased uptake in diaphyses were typical findings by scintigraphy. The skeleton of each child was subdivided into 18 regions, and investigated for the presence of pain and for possible radiographic and scintigraphic abnormalities. In a total of 432 regions (18 regions in each of 24 children), pain was present in 23 regions, radiographic anomalies in 54 regions, and abnormal technetium uptake in 98 regions. Signs and symptoms were most often found in the lower extremities. Pain and radiographic or scintigraphic abnormalities were not regularly found in the same skeletal regions. The individual number of radiographic abnormalities was negatively correlated with age, whereas the number of regions with abnormal technetium uptake was positively correlated with age. No significant correlation was found between the number of abnormal scintigraphic or radiographic regions and the clinical outcome of the disease.
Letter to the editor. Acute leukemia following retinoblastoma
Authors: Sinniah Davendralingam , Taib Norazizah Bte Mohd , Menaka Negaretnam , Peng Lin Hai
Published: February 2007

Improved prognosis for children with retinoblastoma is sometimes complicated years later by the appearance of second malignancies [1‐5]. Although acute leukemia is included among these, only two cases have so far been reported and both succumbed to their second cancer [6,7].
Cyclophosphamide, Doxorubicin, and Cisplatin Combined in the Treatment of Advanced Sarcomas
Authors: Edmonson John H. , Hahn Richard G. , Schutt Allan J. , Bisel Harry F. , Ingle James N.
Published: February 2007

Twenty‐five patients with evaluable histologically confirmed inoperable metastatic sarcomas were treated once every four weeks with cyclophosphamide, doxorubicin, and cisplatin in doses of 400, 40, and 60 mg/m2, respectively. Cyclophosphamide and doxorubicin were given by rapid intravenous injection followed immediately by cisplatin by slow intraveneous infusion (2‐6 hr) in 1 liter of 0.45% saline with mannitol added. Leukopenia, alopecia, and vomiting were common side effects and three patients refused further treatment because of vomiting following their initial courses. No drug‐related deaths occurred and we removed no one from the study because of toxicity problems. Among the 9 patients who experienced objective tumor regression were 2 of 2 with hemangio‐sarcoma, 3 of 5 with malignant fibrous histiocytoma, 3 of 5 with osteosarcoma, and 1 of 1 with pleomorphic liposarcoma of bone. Although not therapeutically gratifying, these results appear to be better than any previously observed at our institution.
Results of Treatment of 18 Children With Hodgkin Disease With MOPP Chemotherapy as the Only Treatment Modality
Authors: Ekert H. , Waters K. D.
Published: February 2007

Eighteen children with Hodgkin disease (16 previously untreated; two relapsed) were treated with MOPP chemotherapy (nitrogen mustard, vincristine, prednisone, procarbazine) only. Ten had clinical stage I and II disease, four had stage III, and four had stage IV. In ten patients, the clinical stage was confirmed by staging laparotomy. Six courses of MOPP were given to eight stage I and II patients and two stage IV patients. Between 7 and 12 courses were given to two stage I and II, and six stage III and IV patients. Dose reduction of 75‐50% was required in 13% and delay of treatment in 22% of the first six courses of MOPP. Hematologic toxicity, minor and major viral infections, and nausea and vomiting were the major complications. Complete remission (CR) was obtained in 17 patients. Of these 17, there has been one death in CR, and one relapse. Sixteen patients have discontinued treatment and have been observed off treatment for 8 months to 7.5 years. The actuarial disease‐free survival with a median follow‐up of 28 months is 80% and overall survival is 92%.
Administration of a complex chemotherapy regimen: Inpatient versus outpatient treatment
Authors: Pasmantier Mark W. , Coleman Morton , Silver Richard T. , Mamaril Aurora P. , Quiguyan Cirila C. , Galindo Armando
Published: February 2007

The ability to administer a complex chemo‐therapy regimen, adriamycin and cis‐platinum, was evaluated in two different settings, inpatient and outpatient. On comparison, outpatient administration proved superior. This resulted from the interest and experience of the staff administering the medications. It is recommended that outpatient administration of chemotherapy, even with complex protocols, be employed whenever feasible.
Improving the medical record for clinical oncology research by adaptation to a microcomputer
Authors: Dearth Jim , Brown Nancy , Hiett Tee
Published: February 2007

In clinical oncology, much of the research is conducted in the milieu of patient care and the traditional medical record is used for collection of data. A clinical study manager reviewing medical records is frequently faced with problems such as omissions of data, illegible notes, and inconsistent locations of data within the various formats. At The Children's Hospital in Birmingham, Alabama, we developed a microcomputer‐based medical record system in an attempt to improve the quality of clinical research. Our system is based within our division and provides for a single point of transcription of clinical data when the patient is initially seen. Our entire practice is managed on the system, with numerous reports available that range from individual patient information to summary reports on protocol studies.
Mediastinal mass in acute lymphoblastic leukemia
Authors: Chilcote Robert R. , Coccia Peter , Sather Harland N. , Robison Leslie L. , Baehner Robert L. , Nesbit Mark E. , Hammond Denman
Published: February 2007

Patients with acute lymphoblastic leukemia who have a mediastinal mass at the time of diagnosis are said to have a poor prognosis. However, many factors which may not be independent contribute to the success of treatment. We compared the disease characteristics and results of therapy in children having large mediastinal masses and lymphoblastic leukemia without mediastinal mass. Patients with a mediastinal mass had less evidence of marrow failure but were burdened with considerably more leukemic cells as measured by peripheral blood white count and extent of lymphadenopathy. Since the presence of mediastinal mass was strongly associated with these and other poor prognostic characteristics, we used multivariate techniques to determine which characteristics were independently associated with an increased risk for relapse. White count, extent of lymphadenopathy, age, and sex were significant predictors of early relapse, but when controlled for these variables the presence of a mass did not predict prognosis.
Phase II evaluation of chlorozotocin in metastatic sarcomas
Authors: Presant Cary A. , Bartolucci Alfred A.
Published: February 2007

Twenty‐nine evaluable patients with anthracycline‐resistant metastatic bone or soft tissue sarcomas were treated with chlorozotocin, 150 mg/m2 every 6 weeks. Four patients (14%) achieved partial responses. The most severe toxicity was usually thrombocytopenia (which occurred in 31% of patients). Chlorozotocin has only minimal activity in drug‐resistant metastatic sarcomas.
Splenectomy after angiographic embolization of the splenic artery in patients with massive splenomegaly and severe thrombocytopenia, in juvenile subacute myelomonocytic leukemia
Authors: Steinherz Peter G. , Exelby Philip R. , Young Jean , Watson Robin C.
Published: February 2007

Splenectomy for massive splenomegaly in thrombocytopenic patients refractory to platelet transfusions carries increased surgical risks. Blocking of the splenic artery may reduce the size of the organ, prolong the survival of transfused platelets, and reduce the surgical complications. We describe four cases of extreme splenomegaly and thrombocytopenia where successful splenectomy was carried out after angiographic embolization of the splenic artery in children with ju venile chronic myelogenous leukemia. Significant improvement was observed in platelet counts and in the survival of platelets after transfusions in three of the patients. There was a concomitant decrease in transfusion requirements. Isoimmunization prevented prolonged platelet survival in the fourth case. We recommend earlier splenectomy in these patients to reduce transfusion requirements and delay the onset of poor platelet survival after transfusions.
Transitional cell carcinoma of the nasal passages: Dramatic response to chemotherapy
Authors: Sooriyaarachchi Gamini S. , Skuta Gregory L. , Busse Joel M.
Published: February 2007

Transitional cell carcinoma of the nasal passages and sinuses is an uncommon tumor of the head and neck, for which the efficacy of chemotherapy has not been previously reported. A dramatic and complete tumor response to chemotherapy with cis‐platinum, methotrexate, and bleomycin is described in a patient with advanced proptosis due to extensive local recurrence of transitional cell carcinoma. Relevant literature on this rare histologic type of head and neck cancer has been reviewed.
A hypothesis to explain the enigmatic natural history of neuroblastoma
Authors: Cassady J. Robert
Published: February 2007

A hypothesis is developed for neuroblastoma that attempts to explain the enigmatic natural history of this tumor and the variation in success of therapy as a function of the age of the child at diagnosis. It is postulated that neuroblastoma arising in the young patient has a relative paucity of clonogenically viable stem cells, whereas tumors arising in the older children have a substantial number of such clonogenic cells, as in most human tumors.
Occult ganglioneuroma with diarrhea: Localization by venous catecholamines
Authors: Schuman Andrew J. , Alario Anthony J. , Pitel Paul A.
Published: February 2007

Neural crest tumors can be complicated by secretory diarrhea mediated by vasoactive intestinal peptide (VIP). An eight‐month‐old male with a several‐month history of secretory diarrhea is described. Elevated urine vanillylmandelic adic (VMA), total urine catecholamines, and plasma VIP indicated that a neural crest tumor was responsible for his protracted diarrhea. An extensive search for the tumor including CT scans of his head, neck, thorax, abdomen, and pelvis was unre vealing. A selective vena caval catheterization showed elevated catecholamines in a sample obtained above the renal veins. Subsequent laparotomy disclosed a benign ganglioneuroma arising from the left adrenal; the diarrhea resolved after its removal. Selective venous sampling proved useful in establishing the tumor's location where other techniques had been unsuccessful.
Correlation of gonadal function with histology of testicular biopsies at treatment discontinuation in childhood acute leukemia
Authors: Uderzo C. , Locasciulli A. , Marzorati R. , Adamoli L. , Di Natale B. , Nizzoli G. , Cazzaniga M. , Masera G.
Published: February 2007

Testicular open‐wedge biopsy was performed in 35 children in complete remission from acute lymphoblastic leukemia without clinical signs of leukemic testicular infiltration at the time of treatment discontinuation. Histological investigation showed thickening of the tunica propria of the seminiferous tubules in 13 of 35 patients. In 5 of 35 patients, the tubular fertility index was markedly reduced; in 5 of 6 pubertal patients, decreased spermatogenesis or aplasia of germinal epithelium was observed. Histologic damage was found mainly in the germinal cells both in patients treated with cytosine arabinoside and cyclophosphamide and in those treated with antiblastic drugs not considered damaging to the gonads. The extent of impairment was independent of age at start of treatment. On the other hand, endocrinological investigation carried out at the crucial moment of treatment suspension showed normal hypothalamic‐hypophyseal‐gonadal function as well as normal anthropometric data, bone age, and pubertal stage in the majority of patients. Testicular leukemia was found in only one patient (2.8%) whereas three children with negative testicular biopsies had testicular relapses within 7 months. Therefore, in view of the limits of light microscopy in diagnosing leukemic infiltration at treatment discontinuation, we propose the use of more sophisticated techniques, possibly within 6 months of suspension of therapy.
Incidence of neuroblastoma in infancy in Japan
Authors: Sawada Tadashi , Kidowaki Takuro , Sugimoto Tohru , Kusunoki Tomoichi
Published: February 2007

Since 1974, we have been mass screening for neuroblastoma in 6‐month‐old infants using a VMA (vanilmandelic acid) spot test in Kyoto City. Fifteen (48.4%) of the 31 childhood neuroblastoma cases registered in this city during the recent 8‐year‐period, 1974‐1982, were under 1 year of age. The annual number of cases per year was 3.9 cases under 15 years with 1.9 cases under 1 year of age. As the number of children under 15 years of age in this city was 292,000 according to the National Census of the Human Population in 1975, the annual incidence of this tumor in childhood was 3.9/292,000 (13.3/million). And as the number of live births was 161,153, the annual detection rate for this tumor in infancy increased to 15/161,153 (93/million) from 1974 to 1982. We found that many neuroblastomas could be detected in infancy by a VMA spot test and/or a careful physical examination.
Treatment of small cell carcinoma of the lung with copp
Authors: Nixon Daniel W.
Published: February 2007

The COPP regimen (cyclophosphamide, Oncovin, procarbazine, prednisone) was one of the first chemotherapy programs to prolong survival in small cell lung cancer (SCLC) significantly. Results with this regimen in 50 patients with SCLC show an overall median survival of 10 months. Survival was decreased with more extensive disease. Patients given COPP plus irradiation to the primary lesion lived longer than those given COPP alone, but this difference was not statistically significant. Toxicity was relatively mild. The COPP regimen can be considered, especially in advanced SCLC, if coexisting cardiac or renal disease precludes the use of agents toxic to these organs.
Late recurrence in Hodgkin's disease: A report of two cases
Authors: Green J. A. , Arnold A. M. , MacBeth F. R. , Mead G. M. , Williams C. J. , Wright D. H. , Whitehouse J. M. A.
Published: February 2007

Two cases of Hodgkin's disease are described who relapsed 22 and 19 years after regional radiation therapy. One of the patients also developed a carcinoma of the large bowel soon after first relapse. The importance of long follow‐up and documentation of cause of death in Hodgkin's disease is stressed.
Impact of the timing of triple intrathecal therapy on remission induction in childhood acute lymphoblastic leukemia: A pediatric oncology group study
Authors: Hvizdala Eva , Berry D. H. , Chen Timothy , Dyment Paul G. , Kim Tae H. , Steuber C. Philip , Sullivan Margaret P.
Published: February 2007

Five weekly doses of triple intrathecal (IT) chemotherapy (methotrexate, hydrocortisone, cytosine arabinoside) starting on day 1 of treatment were added to systemic induction therapy in a regimen (Arm 3) that was compared to three other regimens (Arms 1, 2, and 4) in which central nervous system (CNS) prophylaxis was initiated after complete marrow remission (CR) was attained. The CR rate for Arm 3 was only 83% as compared to 91‐92% for other Arms. The lower CR rate was the result of a significantly higher death rate during induction for patients receiving early CNS prophylaxis (10.6 vs 0.9‐3.5%). These differences were only observed in high risk patients as defined in the study. The early death rate was especially high (30%) in Arm 3 for children who were less than 2 years of age. Infection was the primary cause of morbidity and mortality. Severe infection following the initiation of induction therapy was found in 16.7% of patients on Arm 3 vs 1.8‐6% on other regimens. Immediate triple IT chemoprophylaxis during induction therapy of acute lymphoblastic leukemia as use in this study appears to be associated with increased susceptibility to infection and this form of CNS prophylaxis has increased hazards of morbidity and mortality in infants and other high risk patients.
Acute nonlymphocytic leukemia developing during the course of Ewing's sarcoma
Authors: Link Michael P. , Donaldson Sarah S. , Kempson Richard L. , Wilbur Jordan R. , Glader Bertil E.
Published: February 2007

Two children with Ewing's sarcoma developed acute nonlymphocytic leukemia (ANLL) during the course of their illness. One patient developed ANLL after apparently successful treatment of his primary malignancy with radiation therapy and multiagent chemotherapy. In the second patient, acute leukemia developed before the administration of radio‐therapy or systemic chemotherapy. The development of secondary ANLL after Ewing's sarcoma has been reported only twice previously, most likely representing a therapy‐induced complication. The occurrence of ANLL in Patient 2 prior to therapy suggests that these two disorders may have a more than treatment‐related association. Close follow‐up of long‐term survivors of Ewing's sarcoma with surveillance for secondary acute leukemia is advised.
Volume doubling measurement of spherical and ellipsoidal tumors
Authors: Spears Colin Paul
Published: February 2007

Volume doubling rulers are described for rapid estimation of tumor volume using projection areas of single‐plane images such as chest radiographs. The potential utility of the rulers derives in part from the convenient relationships that exist for the interconversion of volume, volume doubling number, and decimal log growth or cell kill. The traditional approach to tumor volume doubling time determination, originated by Collins [1] uses the average diameter of approximately spherical tumors; analysis of the geometry of volume doubling shows this method to be nearly as accurate as methods that assume elliptical eccentricity, but only up to a tumor image length/width ratio of 1.5. For ratios greater than 1.5, it is shown that the clinical practice of taking perpendicular diameters is inherently more accurate. Where two perpendicular radiographic views of a tumor ellipsoid are available, it is shown that calculation of volume using the longest projection radius should result in less than one single volume doubling underestimate due to out‐of‐plane orientation of the long axis of the tumor.

These methods should find greatest utility in measurement of multiple metachronous tumors that are well‐circumscribed, convex in perimeter, and have low length/width ratios.
Cancer in Hiroshima: 35 years after the bomb
Authors: Miller Daniel G.
Published: February 2007

After the 1945 atomic bomb explosions, attention was initially drawn to the leukemogenic effect of atomic radiation. Mortality studies over the years have shown that the leukemogenic effect has been gradually declining, and the incidence of solid tumors has been increasing. There was a shorter latent period for the appearance of excess leukemia mortality than for solid tumors. It appears that the risk for developing solid tumors becomes greatest when the population enters the age group at which that particular form of cancer most commonly occurs. The leukemogenic and carcinogenic risks are also greater in those exposed to radiation in the younger age groups. There are implications in these studies for cancer control with regard to radiation safety in diagnostic radiology and the peaceful uses of atomic energy; in addition, they emphasize the moral obligation involved in limiting the proliferation of atomic weapons. These observations may also be parallel to the experience of oncologists with second primary cancers after the administration of chemotherapy.
Treatment of refractory lymphoproliferative diseases with daily, low‐dose vincristine, continuous infusion of bleomycin, and high‐dose prednisone
Authors: Gomez German A. , Han Tin , Ozer Howard , Henderson Edward S.
Published: February 2007

Vincristine 0.25 mg/m2 by IV push and bleomycin 5 units daily by continuous infusion were given on days 1, 2, 3 and 4, together with prednisone 1,000 mg/m2 po in 4 divided doses either on days 1, 3, 5, and 7 (6 patients) or on days 1 and 3 (11 patients) to 17 patients with various lymphoproliferative diseases who had failed their previous treatment program. Fourteen were leukopenic and/or thrombocytopenic. Of 10 patients with non‐Hodgkin's lymphoma 2 achieved complete remission and 5 a partial response. Both patients with Hodgkin's disease achieved partial response. A decrease in plasma M protein (median decrease 51%) was observed in 3/3 patients with multiple myeloma and 2/2 with Waldenstrom's macroglobulinemia. Decrease in tumor cell infiltration by 48%, 58% and 100% was observed in 3 patients (2 with macroglobulinemia and 1 with myeloma) in the bone marrow. Leukopenia of less than 3,600/mm3 and thrombocytopenia of less than 70,000/mm3 reverted to normal in 5/7 and 7/10 patients, respectively. Remission duration ranged from 4 to 35+ weeks (median 17 weeks). Three patients had severe Gl bleeding. Psychosis controlled by phenothiazines was observed in one, and bleomycin toxicity (anaphylaxis, skin rash, and lung toxicity, one each) was observed in 3 patients. No severe neurotoxicity was observed.
Influence of local‐regional lymph node metastases on prognosis in neuroblastoma
Authors: Rosen Eliot M. , Cassady J. Robert , Kretschmar Cynthia , Frantz Christopher N. , Sallan Stephen E. , Levey Raphael
Published: February 2007

Data relative to the prognostic and therapeutic significance of lymph node metastases in regionally confined neuroblastsoma (Evans stages II‐III) are scant. We have analyzed lymph node status in order to assess the significance of nodal involvement. Disease‐free survival (minimum follow‐up of 2 years) was 84% (21/25) among node‐positive patients compared with 95% (18/19) for node‐negative patients (P > 0.1, two‐tailed test). These results contrast with the results from two other centers in which lymph node involvement was a significant adverse prognostic indicator. The use of intensive multimodal therapy including surgical resection of the primary tumor, wide‐field radiation therapy to the tumor bed and regional lymph nodes, and chemotherapy may have accounted for the better survival in our node‐positive patients.