Biomedical subjects
C M McBride
Publications and source records attributed to C M McBride.
Combined modality therapy of malignant melanoma.
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Hepatic hyperthermia by total isolation and regional perfusion in vivo.
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Pelvic recurrence of cancer after abdominoperineal resection of the rectum.
Records of 122 patients with carcinoma of the rectum treated by abdominoperineal resection at M. D. Anderson Hospital and Tumor Institute between 1967 and 1972 were reviewed with regard to local pelvic recurrence and survival. Local recurrence rates for men were: stage IB, 14%; II, 23%; and III, 21%; and for women: IB, 6%; II, 15%; and III, 35%. Forty-one percent of the male patients and 54% of female patients had nodal metastasis at the time of their initial operation. The high pelvic recurrence rates in women may lend support to consideration of a posterior exenteration in all female patients with advanced carcinoma of the rectum.
Regression of regionally advanced melanoma after arterial infusion with cis-platinum and actinomycin-D.
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Immunotherapy for recurrent malignant melanoma: efficacy of BCG in prolonging the postoperative disease-free interval and survival.
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Malignant melanoma in children and young adults: effect of diagnostic criteria on staging and end results.
Since the entity of "juvenile melanoma" was first described, many pathologists have been reluctant to diagnose malignant melanoma in childhood by pathologic criteria alone. In this series of 125 cases, pathologic criteria are used to distinguish malignant melanoma of childhood from spindle and epithelioid nevus. Among the patients reviewed, 110 cases (86%) occurred between ages 13 and 20 years, and 15 cases (14%) in children under 12. There were 60 males (54%) and 50 females (46%) in the older age group, and six males (41%) and nine females (59%) in the childhood group. In the 13 to 20 age group, there were 24% head and neck primary melanomas, 38% truncal primaries, 30% limb primaries, and 7% indeterminate, as opposed to 35% head and neck, 23% truncal, and 41% limb in the group under 12. In the 13 to 20 year group, 66% were stage I, 11% stage II, 12% stage III, 2% stage IV and 7% indeterminate while in the 12 and under group, 76% were stage I, 12% stage III, and 12% stage IV. Mortality rates were 49% for the 13 to 20 year group and 60% for the 12 and under group.
The surgeon as oncologist.
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Hepatic arterial infusion of Corynebacterium parvum and chemotherapy.
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Regional chemotherapy by isolation-perfusion.
For 20 years, regional chemotherapy by isolation-perfusion has been employed for limb and selected pelvic lesions using high doses of drugs without systemic side effects. When used prophylactically, it is combined with local excision of the lesion and primary closure reducing the number of skin grafts and recurrence rate for local or intransit disease. Overall survival rate is better than for patients treated by surgery, and perfusion patients also do better with secondary therapy. For advanced melanoma patients with intransit metastasis, a 50% five-year survival may be less than expected. For patients with soft tissue sarcomas < 5 cm in diameter, the five-year survival is just under 80% and just over 40% for those > 5 cm. Complications may occur in 10% of patients treated by prophylactic perfusion, and the rate increases as the dosage and number of drugs are increased, up to a 37% complication rate for patients with advanced disease in a limb.
Response of malignant melanoma to plasma exchange, surgical debulking, and Corynebacterium parvum.
A 48 year old man with extensive cutaneous and subcutaneous metastatic malignant melanoma responded to treatment by repeated plasma exchanges, partial surgical debulking of tumor masses, and intravenous Corynebacterium parvum. Circulating immune complexes were measured by the serum C1q binding method. Tumor regression coincided with serum C1q binding reduction to normal levels. Clinical relapse was preceeded by recurrent elevation of serum C1q binding activity.
Carcinoma of the breast: analysis of total lymph node involvement versus level of metastasis.
The histologic presence of axillary lymph node metastasis is the most commonly used indicator or prognosis for patients with operable breast cancer. The record of 385 patients treated by 380 radical mastectomies between the years 1944 and 1972 were reviewed to clarify this. The axillary nodes recovered were evenly distributed. The median number of positive lymph nodes at each level was two; 50% had involvement of only one level. The number of lymph nodes identified increased with the number of positive nodes. When compared with similar patients, survival curves for those having a single involved node and also those having multiple metastatic nodes were similar whether the node were in the proximal, middle, or distal levels. The 10-year determinate survival for patients with fewer than five positive positive nodes was just under 50%. High positive nodal counts, or involvement of more than one level, were associated with local recurrence of disease.
Chronic myelogenous leukemia: management of splenectomy in a high-risk population.
Splenectomies have been performed on 58 patients with chronic myelogenous leukemia (CML) during the last 16 years. For the 27 patients operated upon during the first 12 years, the operative mortality was 26%. Four patients also had to be re-explored for bleeding and three required drainage of subphrenic abscesses. There has been no operative mortality in the 31 patients operated using a standardized procedure during the last four years but two had to be re-explored for bleeding and one required drainage of a subphrenic abscess. The operative risks for leukemic patients are infection, perhaps related to granulocyte abnormalities and hemorrhage in patients with thrombocytopenia or qualitative platelet abnormalities. When the splenectomy in patients with CML is timed with the patient's chemotherapy cycle, the use of local antibiotics and platelet concentrates should permit a safe operation. Survival rates were not comprised even when the patients had their splenectomy during CML-blast crisis.
Adjuvant immunotherapy and chemoimmunotherapy in colorectal cancer (Dukes' class C): prolongation of disease-free interval and survival.
The poor postsurgical prognosis in patients with colorectal cancer of the Dukes' C classification has prompted a clinical trial of adjuvant immunotherapy versus chemoimmunotherapy intended to prolong either the disease-free interval or the overall survival or both. One hundred and twenty-one patients have been entered on this study. Fifty-two patients received BCG alone and 69 patients received the combination of 5-FU and BCG. The disease-free interval and the overall survival were compared with similar parameters in a group of historical controls with similar prognostic characteristics who were operated on in our institution prior to the initiation of the current study. There was no difference as yet between BCG alone and the combination of 5-FU + BCG in terms of both the disease-free interval and the survival. Both treatments, however, had significantly better results than the surgical controls. Adjuvant therapy, especially with BCG is advocated for patients with colorectal carcinoma, Dukes' C class, following potentially curative surgery.
Role of simple mastectomy in treating patients with breast cancer.
From 1945 to 1971, 473 patients had simple mastectomies as the primary treatment for their breast cancer (421 had either a simple mastectomy alone [26%], a simple mastectomy followed by postoperative radiation therapy [64%], or preoperative irradiation followed by simple mastectomy [10%]). More than one half of these patients were "inoperable" by standard surgical criteria. The local recurrence rate was 24%, which compares favorably with the reported 48% local recurrence rate for "inoperable" patients treated by radical mastectomy. These recurrences were on the chest wall in two thirds of the patients and in the regional lymph nodes of the other third. No statistical differences in survival or recurrence rate could be correlated with the site of the primary cancers in the breasts or among the three treatment groups.
Prolongation of postoperative disease-free interval and survival in human colorectal cancer by B.C.G. or B.C.G. plus 5-fluorouracil.
83 patients with colorectal carcinoma of the Dukes' C class were randomised to receive postoperative adjuvant therapy with B.C.G. alone or in combination with oral doses of 5-fluorouracil (5-F.U.), and have been followed for up to thirty months. Results were compared with carefully selected historical controls who were treated by surgery alone. A statistically significant prolongation of both disease-free interval and overall survival was observed in 50 patients receiving the combination of B.C.G. and 5-F.U. (P=0.03, P=0.01 respectively) as well as in 33 patients receiving B.C.G. alone (P=0.03, P=0.05 respectively). The efficacy of B.C.G.+5-F.U. was independent of the number of tumour-involved lymph-nodes in the surgical specimen. In contrast, B.C.G. given alone appears to be highly effective among 10 patients with 6 or more positive lymph-nodes (P less than 0.04) and ineffective (as yet) among 23 patients with 5 or less positive lymph-nodes. These results suggest that adjuvant immunotherapy, with or without chemotherapy, can improve the prognosis of surgically treated patients with colorectal carcinoma of the Dukes' C class.
Immunocompetence, immunodeficiency and prognosis in cancer.
Immunocompetence and prognosis are related in solid tumors, malignant lymphomas, and acute leukemia. Among the parameters of immunocompetence vigorous delayed-type hypersensitivity responses to recall antigens or to primary immunization with Keyhole limpet hemocyanin, vigorous in vitro lymphocyte blastogenic responses to mitogens such as PHA, and relatively high B-lymphocyte levels, all correlate with a good prognosis. The spectrum of immune reactivity as measured by established delayed-type hypersensitivity to recall antigens and in vitro blastogenic responses to mitogens and antigens is similar in melanoma patients and their nontumor-bearing spouses. In melanoma, only patients with widespread inoperable metastatic disease show severe immunological deficiency and this is selective for certain antigens. There are highly significant differences in response to specific antigens when patients with melanoma and lung cancer are compared. Immunotherapy with BCG and C. parvum can boost immunocompetence as measured by recall DTH skin testing. However, the relationship between the initial immunocompetence and prognosis still holds in patients receiving BCG immunotherapy to prevent recurrence of melanoma. These data indicate that a broader survey of immunological reactivity in cancer patients is needed, that immunological testing is useful in cancer prognosis clinically, and that the results of immunological testing can be used to evaluate therapy and to indicate new pathways for improved treatment.
Primary carcinoma of the liver.
Since 1947, 173 patients have been seen with primary carcinoma of the liver; 68 percent had hepatomas, 26 percent cholangiocarcinomas, and 6 percent mixed-cell carcinomas. Of these patients, 9 percent were Stage I or unstaged, whereas 28 percent were Stage III and had short lengths of survival. The 108 patients with Stage II carcinoma of the liver were analyzed according to treatment regimens. Thirty-one patients were observed but untreated; 47 patients were treated by systemic chemotherapy and 25 patients were treated by surgical resection. Three patients were treated by infusion chemotherapy and two by dearterialization. When primary carcinoma of the liver is resectable, approximately 20 percent of patients may be expected to become long-term survivors. If not resectable, short-term improvement in length of survival (8 to 13 months) may be obtained by systemic or infusion chemotherapy and by hepatic dearterialization. Earlier diagnosis and an aggressive surgical approach lends hope for some cures for patients with this difficult disease.