Biomedical subjects
Publications and source records attributed to C R Freeman.
Metastases to the skin from internal malignant neoplasms are an uncommon and often preterminal event. Cutaneous metastases from a carcinoma of the uterine cervix, however, have rarely been reported, even in the advanced stages of the disease. A patient was initially seen with cutaneous metastases and was found to have an extensive tumor in the pelvis, which proved to be a squamous cell carcinoma arising in the cervix.
There have been varying frequencies cited for the occurrence of abnormal brain CT scans in leukemic patients and conflicting evidence about the significance of these abnormalities and their relationship to sanctuary therapy. Our study of CT brain scans in 26 long survivors of acute lymphoblastic leukemia showed an overall prevalence of 35% abnormal scans. There was no statistically significant difference between the number of abnormal scans in patients given radiotherapy as part of their CNS prophylaxis and those receiving only intrathecal methotrexate. Because the children in each treatment group were evenly matched with respect to other treatment variables possibly relevant to the causation of abnormal brain scans, a strong case is made for more rigorous design of such studies, preferably in a prospective fashion, looking simultaneously at other parameters of brain structure and function.
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Between January 1971 and December 1978, 117 consecutive patients with unilateral early stage carcinoma of the breast were treated with limited surgery, with or without the addition of postoperative radiotherapy. Local excision alone was found to be inadequate treatment for T1 and T2 carcinoma of the breast. Local recurrence rates were also high in patients with T1 and T2 lesions treated by local excision plus relatively low dose radiotherapy. Local recurrence was, however, infrequent after partial mastectomy, and no local failures were observed after partial mastectomy plus postoperative radiotherapy to a dose of 5000 rad in 5 weeks. Morbidity with such treatment is minimal and cosmetic results are generally excellent.
The results of treatment for 39 consecutive children with retinoblastoma that was diagnosed between 1951 and 1978 were analyzed. Failure to achieve local control within the eye and the development of metastatic disease occurred in seven patients. These patients are considered individually. Delay in diagnosis, older age at presentation, and extraocular extension of disease at diagnosis were associated with treatment failure and were closely interrelated. Modified radiotherapy techniques using wider fields may prevent failure even in those cases diagnosed late and in those with extraocular extension. Indications for intrathecal and systemic chemotherapy in this disease are discussed.
While osteogenic sarcoma has been well-recognized as a late complication of exposure to high doses of ionizing radiation in the orthovoltage energy range, it has been less frequently reported in patients treated with megavoltage radiation. This potential complication should, however, not be dismissed as an occurrence to be seen only after high-dose orthovoltage radiation. We have recently seen two children who developed osteogenic sarcoma following treatment with megavoltage radiation and combination chemotherapy for primary bone tumors. The implications in regard to aggressive multimodality treatment for pediatric malignancies are discussed.
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Primary intracranila choriocarcinoma, either alone or with malignant teratoma, is a rare tumor. The 22 reported cases of primary intracranila mixed choriocarcinoma and malignant teratoma are reviewed, and a further case is added. This 4 1/2-year-old girl presented with multiple cranial nerve palsies, panhypopituitarism and markedly elevated blood and urine human chorionic gonadotrophin (HCG) titres. After subtotal removal of the suprasellar tumor, supervoltage radiation was given with a remarkably rapid and complete response. She died 14 months after diagnosis with no evidence of local recurrence nor of distant metastases.
MR scans of 87 pediatric patients with brain stem gliomas were retrospectively reviewed to develop a new classification scheme based on MR imaging. The scheme that has been developed utilizes primarily T2-weighted images, as these most accurately show tumor extent. Tumors are characterized as to location of origin, focality, direction and extent of tumor growth, degree of brain stem enlargement, degree of exophytic growth, and presence or absence of cysts, necrosis, hemorrhage, and hydrocephalus. The use of this classification allowed identification of differences in a population of patients who were selected to be as similar as possible. This system will aid in the assessment of new protocols for treatment of brain stem tumors.