Effect of localized hyperthermia on TA3Ha tumor transplanted subcutaneously in the tails of mice

Localized hyperthermia (43 degrees) in single or multiple fractions was applied to mouse mammary adenocarcinoma TA3Ha implanted into the s.c. tail tissue of strain A mice. The effects of heat on the growth of local tumors, on the pattern of metastasis, and on the survival periods of the hosts were studied. Hyperthermia was administered by heating the tumor-bearing tails in a water bath. Multiple 30-min hyperthermia treatments at 5- or 7-day intervals controlled local tumor growth better than did a single 30-min treatment or multiple 30-min treatments at 3-day intervals or at intervals longer than 7 days. Heat treatments that produced cytostatic effects on tumors, sparing the normal tissue, had no effect on either the survival of the hosts or the extent of metastasis to the lungs and the lumbar lymph nodes. However, local treatments reduced the frequency of renal lymph node metastasis, indicating that concurrent metastases in different sites may exhibit differential heat sensitivities.

Treatment of breast carcinoma recurrent after adjuvant chemoimmunotherapy

Between July 1975 and June 1979, 194 patients with State II or III breast carcinoma were randomized to receive either L-phenylalanine mustard (L-PAM), cyclophosphamide and 5-fluorouracil and prednisolone (CFP), or CFP and BCG. Sixty-one patients have recurred despite the adjuvant chemoimmunotherapy trial. Fifty-three are evaluable for survival and 36 for response to chemo-hormonal therapy. Those treated with a chemo-hormonal regimen for their first recurrence exhibited a 53% objective response rate to cytotoxic therapy or a 35% response to hormonal therapy. Prior exposure to L-PAM, cyclophosphamide, or 5-fluorouracil did not preclude response to "salvage" therapy regimens containing those agents. Neither menopausal status, estrogen receptor content, size of the primary tumor, adjuvant treatment, nor extent of the recurrence had any effect on subsequent survival. Overall, the entire group exhibited median survival of 37 months from initial diagnosis and 13 months from recurrence. Unlike recurrent Hodgkin's disease, there was no demonstrable relationship between the length of the disease-free interval and the likelihood of subsequent response to cytotoxic or hormonal treatment. Comparison is made to the results of "salvage" therapy administered after three other large adjuvant treatment series.

Improved therapeutic index of cis-diammine dichloro platinum by diethyldithiocarbamate in rodents

cis-Diammine Dichloro Platinum (DDP) is an effective antitumor agent. However, nephrotoxicity remains a major dose limiting factor in its clinical application. The present experiments with Fischer 344 rats showed that diethyldithiocarbamate, an alkyl dithiocarbamate, prevents DDP induced acute nephrotoxicity, and increases the LD50 from 8.3 to 10.8 mg/kg. The subacute DDP toxicity was also prevented by the DTC in B6D2F1/J mice. Further, studies with L1210 Leukemic mice indicate that DTC in dosages up to 250 mg/kg did not interfere with the antitumor effects of DDP. The present experiments, therefore, add evidence to the thesis that thiol compounds may "selectively" protect normal tissues against agents which form interstrand or intrastrand cross links with DNA. Thiol compounds, therefore, may have a wider clinical application in patients receiving cancer chemotherapy.

Development and evaluation of cancer chemotherapy drug information cards (DIC)

Cancer patients often receive multiple drugs. It is often difficult for them to differentiate between signs and symptoms caused by cancer from those induced by medications. Drug information cards (DIC) may serve a useful purpose to circumvent some of these problems. Here I describe DICs and their evaluation by patients. A vast majority (85%) of patients approved of these cards, and 67% would recommend them to others. I conclude that DICs are useful for cancer patients, and their role in nononcologic patients needs evaluation.

Causes and evaluation of tumor-induced hypoglycemia

We treated four patients who had hypoglycemia and nonpancreatic tumors. Two had pleural mesothelioma, one had primary fibrosarcoma of the liver, and one had pheochromocytoma metastatic to the liver. We propose four mechanisms for this syndrome: (1) insulin or insulin-like activity produced by the tumor, (2) decreased gluconeogenesis, (3) disruption of glucagon metabolism, and (4) increased utilization of glucose by the tumor. The local effects of the tumor in hepatic parenchyma may also play an important role. The important diagnostic tests are an insulin-glucose ratio, to rule out insulinoma, and fasting glucose levels. An assay of nonsuppressible insulin-like activity can be performed and is of investigative interest, but does not aid in individual patient therapy. Treatment consists of control of the tumor.

Peritoneal washing therapy for pseudomyxoma peritonei

Two patients with pseudomyxoma peritonei (PP) had repeated intraperitoneal washing with 5% dextrose in water. Both responded to this therapy with decrease in abdominal girth. The second patient is alive, without abdominal distention, more than 112 weeks since beginning peritoneal washing therapy (PWT) for ovarian PP. Biochemical assays of urine before and after PWT show that acid mucopolysaccharide is excreted in the urine, probably after being absorbed through the peritoneal surface. The long-term effects of this procedure on renal function are not known, but PWT appears to be reasonable and safe ambulatory therapy for PP.

Metastatic basal cell carcinoma

The primary mode of spread of basal cell carcinoma is by direct extension. From 1894 to June 1977, 119 cases of metastatic basal cell carcinoma were reported in the world literature. We wish to report five additional cases. It is our feeling that the spread of these tumors is by the interstitial route. It is standard teaching that the interstitial embolic spread of cancer does not occur, but these five cases give strong supporting evidence to the previously reported suggestion that this route of spread may be common. The concept has considerable implications regarding treatment of most cancers.

Adjuvant chemotherapy for stage II and III breast carcinoma

Stage II or III breast carcinoma patients were assigned to one of three adjuvant chemotherapy groups after mastectomy. The efficacy of melphalan, vs cyclophosphamide, fluorouracil, and prednisone (CFP), vs CFP plus BCG vaccine was compared in 173 patients treated for five days every six weeks for the first postoperative year. Tumor size, unfavorable local signs, extent of axillary nodal involvement, menopausal status, and participating hospital were considered in assigning patients to treatment groups. The median follow-up time was 26 months; 24.2% of the patients were studied for more than three years. Recurrent disease occurred in 31.6% of the patients in the melphalan group and in 13.4% and 13.2% in the other two groups. Six patients died of metastatic tumor; three others died of other causes. A favorable significant difference exists for polychemotherapy in prolonging disease-free interval in our series.

Urinary bladder metastases from breast carcinoma

Four patients with primary carcinoma of the breast metastatic to the urinary bladder are described. Hematuria was present in 3 of the 4 patients. Two of the 4 women had received steroidal drugs which may have a role in the development of this unusual metastasis. This complication developed no sooner than 32 months after diagnosis of malignant breast disease and occurred shortly before death in 2 of the patients. Bladder metastasis in women with a history of breast carcinoma may be more prevalent than has previously been suspected.

Neurologic involvement in glucagonoma syndrome: response to combination chemotherapy with 5-fluorouracil and streptozotocin

A 34-year-old man presented with classic glucagonoma syndrome manifested by weight loss, dermatitis, stomatitis, anemia, and mild diabetes mellitus. The diagnosis of glucagonoma was made by light and electron microscopic demonstration of a metastatic alpha cell carcinoma in a liver biopsy specimen. Plasma glucagon concentration was abnormally high. The patient also had symptoms and signs of involvement of the central nervous system. Radionuclide and CAT scans of the brain, negative CSF cytology and myelography excluded the possibility of metastases or other space-occupying lesions. Glucagon was demonstrated in the CSF. We postulate that the neurologic symptoms were due to direct or indirect effect of this hormone on the brain. Following therapy with streptozotocin and 5-fluorouracil, the patient had a subjective and objective clinical and hormonal remission of his disease including amelioration of his neurological impairment.

Preoperative physical assessment of thyroid glands in previously irradiated patients

The Evanston Hospital maintains an Irradiated Thyroid Evaluation Clinic that has evaluated 695 patients since 1975. One hundred fourteen patients were retrospectively analyzed, and an attempt was made to correlate the preoperative physical examination with the pathologic specimen after thyroidectomy. There was no statistically significant difference between the incidence of carcinoma in glands containing a single nodule (23 per cent) and in multinodular glands. Postirradiation thyroiditis complicated the physical description of glands preoperatively. The categorization of physical findings served only to identify persistent thyroid abnormalities, which must be explored surgically. The overall incidence of carcinoma in the 114 available cases was 34 per cent, with nodal metastases in 18 per cent of the patients with carcinoma.

The value of bone scans in the management of patients with carcinoma of the breast

The bone scan has become a major staging and screening test for patients with carcinoma of the breast. The routine use preoperatively of bone scans to detect occult osseous metastases has been advocated to prevent radical operations on patients with Stage IV disease. Periodic use post-operatively of bone scans has also been advocated to detect metastic disease before the onset of symptoms. In view of the prevalence of this disease, the implications of this approach in terms of cost alone warrant consideration. All bone scans obtained of patients with carcinoma of the breast during a five year period were reviewed and the results correlated with the pathologic stage of the disease, the presence or absence of symptoms and pertinent clinical data. The sensitivity, specificity and predictive value of the bond scan was then analyzed for each group. Recommendations for the use of bone scans in patients with carcinoma of the breast are based upon these data.

A randomized comparison of two dosage schedules of methyl CCNU: three-week versus six-week treatments

Two dose schedules of methyl CCNU were compared for drug effect and toxicity. One hundred thirteen patients were stratified by tumor site, performance status, and prior chemotherapy and randomized to 100 mg/m2 q 3 wk or 200 mg/m2 q 6 wk orally. Response rates were similar (12% vs. 18%, respectively, in the major tumor sub-types studied) and survival was equivalent. Hematologic toxicity, however, was significantly different, with earlier time to the most severe blood count depressions, more frequent occurrence of severe depression, and a larger percentage of patients requiring dosage reduction on the 6-week regimen. We conclude that the 3-week regimen is superior due to its improved tolerance and is recommended especially for combination drug therapy.

Studies of amygdalin (laetrile) toxicity in rodents

Amygdalin (laetrile), given to Fischer 344 rats in doses of 250, 500, and 750 mg/kg intraperitoneally daily for five days, caused mortalities of 30.8% 44.1%, and 56.8%, respectively. The mode of death and the elevated serum cyanide levels in the dying animals strongly suggested cyanide poisoning as the cause of death. These findings seriously question the use of amygdalin in clinical medicine under any circumstances.

Carcinoma in a heterotopically auto-implanted nipple

Modified radical mastectomy with transplantation of the nipple in the groin for possible breast reconstruction was performed in a patient. Carcinoma developed in the transplanted nipple. Careful pathological examination of the breast tissue from the site of excised nipple should be carried out. In patients showing presence of tumor cells at that site, nipple transplantation may be deleterious.

Islet cell tumors of the pancreas: clinico-biochemical correlations

Islet cell tumors produce a spectrum of syndromes. Intensive investigations of these tumors have enhanced our understanding of cellular origin, physiology and biochemistry of the islet hormones. Biochemical studies on the hormones are helpful in the diagnosis and treatment planning of the islet tumors. For example, insulinoma and glucagonoma can be diagnosed more readily by demonstration of proinsulin and proglucagon-like components, respectively, in the blood. Similarly, measurement of vasoactive intestinal polypeptide is not only useful in the diagnosis, but also in the follow-up of patients with pancreatic cholera syndrome. This mini-review examines these and other clinico-biochemical correlates seen in islet tumors.

Symptomatology as an indicator of recurrent or metastatic breast cancer

Eighty-seven patients with recurrent breast cancer after mastectomy were analyzed for patterns of recurrence and methods of detection. After an average disease-free interval of 30 months, 38% developed osseous metastases, 16% recurred locally, 10% had local plus systemic disease, 10% showed pulmonary metastases and the remainder were distributed among liver, brain, and remaining breast disease. In 79 patients recurrence was heralded by symptoms. Physical examination in five asymptomatic patients revealed local or supraclavicular recurrence. In only three asymptomatic patients was recurrence documented by "routine" chest x-rays (in two), or liver enzymes/liver scan (in one). No asymptomatic disease was found by bone scan. It is concluded that periodic history, physical examination, and chest x-rays are the most important components in the follow-up of breast cancer patients. Radioisotope scans and other radiographs are valuable in confirming symptomatic disease and detecting additional diseases, but cannot be recommended routinely in the asymptomatic patient because of low yield and cost.

Chemoimmunotherapy of head and neck cancer

The present review aims at developing a perspective for surgeons of the role of chemoimmunotherapy in the management of head and neck cancer. The biochemical pharmacology of high dose methotrexate with leucovorin "rescue" is also discussed. The need for a combined modality approach in the treatment of patients with this cancer is emphasized.

Endometrial carcinoma following estrogen therapy for breast cancer. Report of three cases

Three patients with metastatic breast cancer responded to diethylstilbestrol (DES) therapy, but later they developed endometrial carcinoma. Evidence is presented to support the hypothesis that endometrial carcinoma can occur in breast cancer patients receiving diethylstilbestrol therapy.

Thyroid disease following irradiation for benign conditions

One hundred twenty-five patients with a history of prior irradiation to the head and neck region for benign disease underwent thyroidectomies between 1967 and 1976 at Evanston Hospital. One hundred twenty-four had a palpable abnormality. Forty-two had carcinoma, and nine of these had nodal metastases. Palpation was found to be more accurate than thyroid isotope scan in finding carcinoma within an abnormal gland. Some form of irradiation thyroiditis was found in one half of the resected specimens.

Acute erythroleukemia complicating prolonged chemotherapy for ovarian carcinoma

Two patients with ovarian carcinoma developed acute erythroleukemia following prolonged chemotherapy with an alkylating agent. An analysis of our patients, together with literature review of similar cases, suggests that the duration of chemotherapy may have been the most important factor in the leukemogenesis. We suggest that the duration of chemotherapy required to achieve a cure in patients with ovarian carcinoma in complete remission can be determined only by prospective controlled trials.

Effect of pregnenolone-16alpha-carbonitrile, a microsomal enzyme inducer, on the regenerating rat liver

PCN, a microsomal enzyme inducer, given orally (10 mg in 1 ml water twice daily for 5 days), increased liver weight and mitotic activity in intact as well as in partially hepatectomized rats. Electron microscopy revealed SER proliferation in the hepatocytes of animals treated with PCN alone. Accumulation of SER membranes was also evident in the liver cell cytoplasm of untreated, partially hepatectomized rats; it was however, more pronounced in the hepatocytes of partially hepatectomized animals given PCN. These results indicate that the steriod has a marked effect on the regeneration rat liver.