Early diagnosis of brain metastases in an unselected population of cancerous patients

Immunomodulatory activity of human leukocyte interferon in cancer patients: results obtained during pulse therapy schedule

We evaluated and previously reported the efficacy of alpha-interferon (alpha-IFN) in 84 cancer patients (19). IFN was administered in a pulse fashion given for 3 consecutive days every 4 weeks. We also evaluated the immunomodulatory effect of IFN which constitutes the basis for the current report. Before, during and after courses of IFN treatment, the immune status of the patients was assessed by: (i) circulating immune complexes, (ii) change in lymphocyte type including (a) natural killer (NK) cells, (b) T-cell subsets (suppressor, helper) and (c) HLA-Dr antigen positivity, (iii) myelopoietic differentiation, (iv) macrophage-dependent tumor cytotoxicity with measurements of macrophage-derived growth factor (MDGF), (v) granulocyte functions, (vi) antibody formation against IFN, and (vii) antiproliferative activity of IFN. In addition, LDH, beta-2 microglobulin, and CEA as tumor markers were obtained. High serum or plasma IFN levels were associated with increased activity of T suppressor cells, increased HLA-Dr antigen, and increased NK activity. The increase of these three parameters was directly related to tumor response. In vitro inhibition of tumor cells in tissue culture by IFN culture was predictive of objective tumor response in those patients whose tumor cells were tested. In addition, IFN induced release of MDGF by monocytes. It is apparent that in addition to direct antitumor effect, IFN has multiple modulatory effects on the immune system in man that may aid in tumor control when given in a pulse schedule.

Cranial nerve palsies in metastatic breast cancer due to osseous metastasis without intracranial involvement

Between August 1972 and March 1981, ten patients with metastatic breast cancer presented to M.D. Anderson Hospital and Tumor Institute at Houston Medical Breast Clinic with cranial nerve palsies (incidence, 0.13%). Eight of ten patients had extensive metastases at the base of the skull that was causing cranial nerve compression. Two patients had no bone involvement and were suspected to have soft tissue disease, one retro-orbitally and the other at the base of the skull. None of the patients had evidence of intracranial disease. The most frequently affected cranial nerves were V and VII, with 70% and 60% of patients having palsies of these nerves respectively. The estimated median survival of the patients from time of onset of cranial nerve palsy was 20 months; the palsies improved in 50% of patients who received regional therapy.

Premorbid psychological factors as related to cancer incidence

In planning for studies relating psychological factors and/or stress (PF&/oS) to cancer, one should be aware of epidemiological findings that might contribute to or even account wholly for any found relationships. Most studies have not examined the known biological causes of cancer, nor have they described a rationale for relationships sought. The two broad mechanisms leading to cancer, carcinogens and lowered resistance to it, include physical and chemical causes, viruses and chronic infection, medication, genetic predisposition, hormonal stimuli, and aging. Interfering variables may bias or dilute a real relationship. Validity and reliability of instruments measuring PF&/oS are so variable as to warrant considerable care in their use. The latent periods of different cancers are measured in years, not months, with consequent potent impact on possible inferences drawn from prebiopsy and short prospective studies. In these and in retrospective studies, cancer can have strong and biasing effects on apparently straightforward PF&/oS measurements, as can iatrogenic effects. Some theoretical issues are discussed. The known prospective studies are discussed and reasons are given for the view that they are less convincing then many seem to think. A sketch of a model relating PF&/oS to cancer appearance is outlined, with some theoretical implications, and issues in research design are addressed.