Leiomyoma of the Esophagus

Seven cases of leiomyoma of the thoracic esophagus were successfully treated by simple extramucosal enucleation of the neoplasm, and one case of leiomyoma of the cardia was cured after esophago-gastric resection. The rarity of this neoplasm, which often shows a non-esophageal symptomatology, is emphasised and the diagnostic aids are described. The treatment of choice is conservative surgery, which is indicated in all cases, both because of the expanding character of the lesion and its possible malignant evolution.

Relationship between Nutritional Status and Tumor Growth in Humans

Aims and background

There is considerable evidence from studies on tumor-bearing animals that nutritional support aimed at maintaining a good nutritional status can indeed promote tumor growth. Experience in humans, however, is scanty and controversial, this issue never having been extensively investigated. The purpose of this study was to analyze whether there exists a relationship between nutritional status and tumor growth in patients with non-Hodgkin's lymphoma. The hypothesis behind it was that if it is true than an abundant availability of substrates promotes tumoral growth, then the better the nutritional status the higher the tumor cell proliferation.

Methods

Two hundred and forty six adult patients with non-Hodgkin's lymphoma were characterized according to nutritional status (percent of weight loss as compared to usual body weight, serum albumin, serum cholinesterase, number of lymphocytes) and rate of incorporation of 3H thymidine labelling index in the tumor tissue. The values of serum albumin, serum cholinesterase and lymphocytes were subdivided into three classes adopting as cut-off points the tertile values of their distribution, while weight loss was scored as a “no” and a “yes”. The association between nutritional parameters and labelling index was evaluated by a univariate analysis (X2 test and Mantel-Haenszel X2 test and the odds ratio) and by a logistic multiple regression model.

Results

Results of the univariate analysis show a statistically significant association between “poor” nutritional status (depressed nutritional indexes) and “high” labelling index (increased tumoural growth), while the multiple regression analysis found that the only significant association was that between low serum cholinesterase and high labelling index.

Conclusions

These data demonstrate for the first time in a large series of patients that maintenance of a good nutritional status does not have any deleterious effect on the tumor growth.

Solitary Pancreatic Metastasis Occurring 20 Years after Nephrectomy for Carcinoma of the Kidney

This report describes a case observed in December 1983: a woman who underwent right nephrectomy in 1963 for kidney carcinoma, developed a solitary metastasis to the pancreas, and was operated on again. She is disease free more than one year after.

Lymphographic Evaluation of 285 Testicular Tumors

Since 1961, 285 cases of testicular neoplasms have been investigated by means of lymphangiography at the National Cancer Institute of Milan. Bilateral foot lymphangiography was performed in 233 cases, 46 patients had combined funicular and foot lymphangiography, and in 6 only funicular lymphangiography was performed. Lymphangiograms were probative for secondaries in the retroperitoneal lymph-nodes in 162 cases (56.8 %). The most frequent site of metastasis was the para-aortic nodes (154 cases) with bilateral involvement in 68. Funicular lymphangiograms showed metastasis in the primary testicular lymph-centre in 28/52 investigated cases, and in 6 this was the only site of metastasis. These lymph-nodes are not visualized by foot lymphangiography. Radiological investigations other than lymphangiography were performed in 236 instances. I.V.P. was unable to visualize involved but not enlarged lymphnodes, but proved to be useful in defining the extent of large metastases. G.I.T. was performed in 59 cases and in 4 instances showed retrogastric metastases, which were not visualized by lymphangiography. Also R.P.P. visualized high retroperitoneal metastases in 2 cases with negative lymphangiograms. V.I. were positive only in far advanced cases. Histological lymphographic correlation was possible in 61 cases. Sensitivity (% correct positive lymphangiograms) was 96 % and specificity (% correct negative tests) was 89 %. False negative lymphangiograms occurred only in previously operated patients. In these cases only foot lymphangiography may be performed and the primary testicular lymph-center cannot be visualized.

Primary chemoradiation therapy with fluorouracil and cisplatin for cancer of the anus: results in 35 consecutive patients

PURPOSE

This prospective phase II study was designed to test the activity and toxicity of a regimen of fluorouracil (5-FU) and cisplatin (CDDP) in combination with radiation therapy in the treatment of epidermoid cancer of the anal canal.

PATIENTS AND METHODS

Thirty-five consecutive patients with untreated epidermoid cancer of the anal canal were candidates for chemoradiation therapy (CRT). Staging of cancer was as follows: T1, 26%; T2, 60%; T3, 14%; and N1, 2,3, 26%. No patient had distant metastases. The treatment protocol consisted of two to three cycles of chemotherapy starting on days 1 and 21 and concurrent radiotherapy at a daily dose of 1.8 Gy up to a total dose of 36 to 38 Gy in 4 weeks, delivered to the anal region, perineum, middle and lower pelvis, and inguinal and external iliac nodes. Radiotherapy was then delivered to the anoperineal region and metastatic inguinal nodes to a total dose of 18 to 24 Gy in 10 fractions. Chemotherapy consisted of 24-hour intravenous (IV) infusion of 5-FU 750 mg/m2 on days 1 to 4 and CDDP 100 mg/m2 by 60-minute IV infusion on day 1.

RESULTS

All patients received two cycles of chemotherapy; the second was delayed in three patients because of leukopenia that was evident in 11 (31%). In eight patients, a third cycle was added. They all experienced nausea or vomiting; one patient showed signs of cardiotoxicity and one developed proctitis, dermatitis, and diarrhea (grade 3). Complete regression (CR) was assessed in 33 patients (94%); nine patients with metastatic lymph nodes also had CR. Two patients had a partial response (PR); both underwent abdominoperineal resection, which was not curative in one. Two patients (6%) had a local recurrence; in one, this was associated with hepatic metastases. One of these patients underwent surgery and is alive after about 4 years, while the other is undergoing chemotherapy. After a median follow-up duration of 37 months, 94% of patients are alive without evidence of disease and 86% are colostomy-free.

CONCLUSION

This regimen is well tolerated; its toxicity does not exceed that observed with the combination of 5-FU and mitomycin (MMC). Compared with our previous experience based on the classic CRT (5-FU, MMC, and radiation), the objective response rate observed with this new combination was similar. However, the local recurrence rate, observed in patients treated with the new regimen, was lower (6% v 24%). According to more recent data from the literature, primary CRT is the elective indication in epidermoid cancer of the anus and replacement of MMC with CDDP seems an effective and logical evolution.

Incidence of sexual dysfunction in male patients treated surgically for rectal malignancy

Sixty male patients surgically treated for colorectal cancer were interviewed by structured questionnaire to evaluate the etiology of sexual dysfunction and quality of life. Patients were divided into three groups: 20 who underwent low anterior resection, 20 subjected to Miles' abdominoperineal amputation, and 20 who underwent high anterior resection. Statistical evaluation of the three groups, by use of the chi-square test and Student's t test, showed that extent of the surgical dissection plays the most important role, although psychologic problems are also involved.

Lymphographic evaluation of 250 patients with malignant melanoma

Foot lymphography was performed in a selected group of 250 patients with malignant melanoma, with different sites of origin and of various stages. The overall incidence of metastases was 40%. The case material was evaluated in detail; the tumors of the inferior limb and those on different sites, e.g., vulva and abdomen, were considered separately. In the group of 188 patients with melanoma of the inferior limb, the incidence of metastases was 42%. In 51%, histologic confirmation was obtained. In the group of 62 patients with melanoma of different sites of the body, the incidence of metastases was 34% and histologic confirmation was obtained in 21 patients. The values of accuracy, sensitivity, and specificity based on the histologic confirmation of the lymphographic reports ranged from 88% to 96%. These data justify the use of lymphography in the initial diagnostic work-up and in the follow-up of these patients.

Talc Pleural Poudrage in the Treatment of Recurrent Neoplastic Effusions

Between 1966 and 1970, 23 talc pleural poudrages for neoplastic effusions were performed in 22 patients at the National Cancer Institute in Milan. No recurrence was observed in 16 cases and in another 2 the effusion recurred to a minor degree. Talc poudrage was ineffective in 2 patients and 3 died postoperatively. The median survival of the patients who had a complete remission of their pleural effusions was 8 months, with minimum of 2 months and maximum of 2 years. The best results were obtained in patients with pleural mesotheliomas or pleural metastatic carcinomas other than lung cancer. Talc pleural poudrage seemed to be more effective when performed early in patients not yet in the preterminal phase.