Breast cancer: are imaging studies cost effective following breast cancer and adjuvant therapy?
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Adult↗
Biomedical subjects
H J Lerner
Publications and source records attributed to H J Lerner.
Mishandling misconduct: the NSABP lumpectomy trial. National Surgical Adjuvant Breast and Bowel Project.
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Breast Neoplasms↗
Eastern Cooperative Oncology Group: a comparison of adjuvant doxorubicin and observation for patients with localized soft tissue sarcoma.
Forty-seven patients with stage I, II, or III soft tissue sarcoma were entered into a prospective randomized Eastern Cooperative Oncology Group (ECOG) adjuvant protocol. Eligibility included conservative or radical primary treatment for local cure. Patients were then randomized to control or Adriamycin (Adria Laboratories, Columbus, OH). Adriamycin was administered at 70 mg/m2 (slow push, every 3 weeks for seven courses for a maximum of 550 mg/m2). To date, 32 patients, 17 males and 15 females, with an age range of 17 to 75 years (median, 44 years) have been followed sufficiently long to be included in this analysis. Nine patients have died. The median follow-up of the remaining 23 patients is 30 months (range, 2 to 50 months). Survival was not significantly different between Adriamycin or control. However, the disease-free interval was slightly different in favor of observation. This preliminary report does not support the hypothesis that Adriamycin is an effective adjuvant therapy for soft tissue sarcoma. Due to the small numbers, these results must be interpreted in relation to our ability to detect a difference, if in fact one existed. These preliminary data suggest that adjuvant Adriamycin not be used outside the confines of a clinical trial such as the current intergroup adjuvant sarcoma study.
Adult↗
Randomized comparison of three adriamycin regimens for metastatic soft tissue sarcomas.
This study addressed two major questions regarding therapeutic use of Adriamycin ([Adr] Adria Laboratories, Columbus, OH) in adult soft tissue sarcomas: the influence of dosing schedule and the value of adding imidazole carboxamide (DTIC) to Adr. Patients with objectively measurable metastatic soft tissue sarcomas were randomized to Adr 70 mg/m2 intravenously (IV) day 1 and every 3 weeks (94 patients); Adr 20 mg/m2 IV day 1, 2, and 3, and 15 mg/m2 IV day 8 and weekly thereafter (89 patients); and Adr 60 mg/m2 IV day 1 and DTIC 250 mg/m2 days 1 to 5, repeated every 3 weeks (92 patients). The regimens using Adr as a single agent resulted in an equivalent response frequency (18% and 16%) and survival (median, 8.0 and 8.4 months). DTIC significantly increased (P less than .02) the overall response frequency of Adr to 30%. However, DTIC did not influence survival (median, 8.0 months) or increase the number of complete responses. The toxicities of the two single-agent regimens differed: Adr weekly resulted in more stomatitis (P = .09) and less hematologic toxicity (P less than .05). DTIC resulted in substantially increased toxicity, primarily gastrointestinal (P less than .002); overall, 98% of patients receiving Adr-DTIC experienced moderate or worse toxicity. To decrease the potential for error in interpretation of treatment results, histopathological confirmation of diagnosis was undertaken by a panel of reference pathologists; pathology slides were submitted on 97% of entered patients. The on-study clinical diagnosis was affirmed in 199 of 316 patients (63%) with a final review. In 23% of patients, the panel agreed with the diagnosis of soft tissue sarcoma, but not with the type. In 14%, the panel concluded that a diagnosis of mesenchymal malignancy could not be affirmed. Final treatment results were based on the 275 pathologically confirmed, eligible patients. The most common histological subtype entered was leiomyosarcoma (99 patients). The response to Adr-DTIC of this subtype was higher (44%) than that of any other subtype. However, this difference alone was not responsible for the overall superiority of the combination. This confirmed that the combination of DTIC plus Adr adds to the response rate of Adr alone in soft tissue sarcomas. Whether the increased response frequency, without an impact on survival, is worth the significantly greater toxicity remains a subjective judgement that must be made within the context of the individual patient.
Adolescent↗
A randomized prospective comparison of methotrexate with a combination of methotrexate, bleomycin, and cisplatin in head and neck cancer.
Combination chemotherapy with methotrexate, bleomycin, and cis-diamminedichloroplatinum (II) was compared to weekly therapy with methotrexate alone in a randomized prospective trial in 163 patients with recurrent or metastatic squamous cancer of the mucous membranes of the head and neck. The combination produced responses in 48% compared to 35% for methotrexate alone, with 16% complete remissions versus 8%, respectively. The difference in overall and complete remission rates is significant (P = 0.04) using a one-sided binary regression test. Median time to disease progression among responders was 5.8 months for the combination and 5 months for methotrexate, and median survival was 5.6 months in each group. Toxicity was similar in the two groups. Ambulatory patients, those without fixed neck nodes and those without distant metastases, responded more often. Poor performance status, distant metastases, history of heavy smoking, and adjacent organ invasion by the primary tumor were associated with shorter survival, as were weight loss, the presence of tumor in the neck, and heavy alcohol consumption. The addition of bleomycin and cisplatin to methotrexate produces more remissions, and especially complete remissions, but has not made a major impact on the course of far-advanced head and neck cancer.
Adult↗
Evaluation of bleomycin, chlorozotocin, MGBG, and bruceantin in patients with advanced soft tissue sarcoma, bone sarcoma, or mesothelioma.
Patients with objectively measurable soft tissue sarcoma, bone sarcoma, or mesothelioma who had failed at least one prior chemotherapy regimen received either bleomycin (20 U/M2 i.v. day 1 each week), chlorozotocin (150 mg/M2 i.v. q6 weeks), MGBG (500 mg/M2 i.v. each week, escalated in 50 mg/M2 weekly increments to a maximum dose of 700 mg/M2), or bruceantin (5.5 mg/M2 days 1, 8, 15, and 22, with cycles repeated every 6 weeks). One hundred eighty patients were evaluable: 53 on bleomycin, 51 on chlorozotocin, 38 on MGBG, and 38 on bruceantin. Two partial responses resulted from bleomycin, and one each from chlorozotocin and MGBG. Both responders on bleomycin had mesothelioma. Seventy-four percent of the patients were of ECOG performance status 0 or 1, and over half on each arm had moderate or worse toxicity. At these doses and schedules, none of the four drugs tested was active against previously treated sarcomas. Bleomycin, however, should be considered for further evaluation in mesothelioma patients.
Adolescent↗
Malignant mesothelioma. The Eastern Cooperative Oncology Group (ECOG) experience.
The Eastern Cooperative Oncology Group has conducted a retrospective review of their experience of 96 patients with a tissue diagnosis of malignant mesothelioma treated between 1972 and 1980 on four separate sarcoma chemotherapy protocols. Thirty-two of the 96 patients were diagnosed and treated in South Africa. There were 75 males and 21 females with an age range of 27 to 78 with a median of 58.1 years. All, except for 28 patients, had some form of prior therapy. The median time from the onset of symptoms to diagnosis was 12 weeks; from the diagnosis to randomization was 15.1 weeks. Only 12 of the 96 patients demonstrated an objective regression. The responses were 7/51 on Adriamycin with 2 complete responses (complete responses--38 weeks and 52 weeks), 2/24 on Adriamycin combinations, 2/7 on cycloleucine, 1/3 on bleomycin, and 0/10 on non-Adriamycin combinations. Only 1/28 responded to a cross-over therapy (Adriamycin). The median survival from the start of protocol chemotherapy was 7.4 months and 7.5 months for Adriamycin treated patients. The median survival for responders was 29.9 months, compared to 6.3 months for nonresponders. The median survival for this entire series from the time of first symptoms was 15.2 months. The median survival for the 7 patients with abdominal mesothelioma was 12 weeks. There was a slight improvement in survival for the South Africans as compared to the Americans. Malignant mesothelioma in this series, was a rapidly lethal, nonresponsive disease whose treatment will require new therapies.
Abdominal Neoplasms↗
Carcinoma of the anal gland: case report and review of the literature.
Anal gland cancer is often insidious in its presentation with no evidence of an intraluminal mass. It is frequently slow-growing and often thought to be a perirectal or ischiorectal abscess. Repeated incision and drainage is performed until a biopsy reveals the diagnosis. A very wide resection is then necessary to totally remove the tumor.
Adenocarcinoma, Mucinous↗
A phase II study of m-AMSA in patients with malignant mesothelioma.
Nineteen patients with histologically confirmed malignant mesothelioma were treated with m-AMSA at the University of Pretoria. All patients had evaluable disease and an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0-3. m-AMSA 120 mg/m2 was given IV every 3 weeks. Hematopoietic suppression was the major side-effect. Eleven patients developed leukopenia. There was one partial response (16 weeks), and a no change status was documented in 12 patients (median duration of 20 weeks). The median survival time of patients was 27 weeks from entry on study. Radionuclide ventricular ejection fraction tests were performed to evaluate cardiac function.
Abdominal Neoplasms↗
Intraoperative cholangiography. A review of indications and analysis of age-sex groups.
A retrospective review was performed of patients who had biliary tract stone formation as the primary diagnosis for hospitalization and indication for surgery. Five hundred and eighty-nine consecutive charts were reviewed of patients admitted between 1975 and 1979. Intraoperative cholangiography was performed in 166 patients of whom 22 had common duct exploration. Choledochotomy in this series was performed in 63 cases without utilizing pre-exploratory cholangiography. A normal intraoperative cholangiogram was found to be 100% accurate; however, an abnormal cholangiogram was associated with a 16% false positive rate of exploration of the common duct. The incidence of unsuspected common duct stones detected only by intraoperative cholangiography was 2.3%. Age-sex analysis confirms a 10-year mean age difference between men and women within the population of this study (p less than 0.001). This age-sex difference is maintained in patients without common duct pathology as well as in patients with sterile bile. However, the mean age difference between male and female patients with either demonstrable common duct obstruction by stones or infected bile as determined by routine intraoperative culture is not statistically significant. A review of the role of intraoperative cholangiography, and the experience at Northeastern Hospital is discussed.
Adult↗
Methotrexate alone or with regional subcutaneous Corynebacterium parvum in the treatment of recurrent and metastatic squamous cancer of the head and neck.
Patients with advanced, incurable squamous cancer of the head and neck were randomly assigned to treatment with weekly methotrexate alone or methotrexate with Corynebacterium parvum given subcutaneously in weekly bilateral doses in sites around the neck. The addition of C. parvum did not alter the response rate, response duration, survival (either median or long-term) or severity of toxic effects compared to treatment with methotrexate alone. Response rates were higher for patients without distant metastases, ambulatory patients, and those younger than age 65 years. Median survival was improved for responders to chemotherapy and for those initially ambulatory. C. parvum given subcutaneously has no place in the treatment of far advanced cancer of the head and neck.
Adult↗
Breast carcinoma in a 46, XX true hermaphrodite.
Muscinous breast carcinoma occurred in a 67-year-old true hermaphrodite who had been reared as a male. The peripheral blood karyotype was 46, XX. A left ovary and right ovotestis were intra-abdominal. Other tumors included an ovarian thecoma and an intestinal leiomyoma. Two previously reported cases of breast cancer in true hermaphrodites are cited.
Adenocarcinoma, Mucinous↗
Estrogen receptor protein and its correlation to recurrent breast cancer. A study of 213 patients at the Pennsylvania Hospital.
The value of having estrogen receptor protein analysis is more widely appreciated, and the estrogen receptor determination at the time of biopsy or mastectomy is rapidly becoming a standard procedure. The patients with positive estrogen receptors (and progesterone receptors) are now identified as those who will respond to hormone ablation or manipulation. Some authors have stated that a positive estrogen receptor has a "protective" value against regional metastasis and early recurrence. At the time of biopsy, a portion of the tumor is frozen in liquid nitrogen and sent for estrogen receptor (and progesterone receptor) analysis. The 200 breast cancer patients had estrogen receptors performed with 118 estrogen receptors positive and 82 estrogen receptors negative. The following is an analysis of the 130 mastectomy patients. Negative nodes: ER+, 50; ER-, 20. One to three positive nodes: ER+, 23; ER-, 12. Four and more positive nodes: ER+, 15; ER-, 10. At the present time, the data is being correlated to the patient's age, the time of recurrence, and its relationship to estrogen receptors and progesterone receptors.
Breast Neoplasms↗
Section on Cancer Chemotherapy, Department of Surgery, Pennsylvania Hospital, Philadelphia.
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Breast Neoplasms↗
Squamous-cell carcinoma of the pilonidal sinus: report of a case and review of the literature.
Squamous-cell cancer developing in chronic pilonidal sinuses is extremely rare. Thousands of pilonidal cysts and sinuses are operated upon each year, and malignancy is almost never encountered. Only 26 cases of malignancy arising in pilonidal sinuses are reported in the world literature. We report and document a squamous-cell cancer arising in a chronic pilonidal sinus and also review the world literature.
Adolescent↗
Malignant fibrous histiocytoma: report of five cases and a review of the literature.
Five cases of malignant fibrous histiocytoma are presented and the relevant literature is reviewed. All the patients had locally extensive tumor or eventual recurrent or metastatic disease. Determining malignancy by histologic criteria is difficult. Therefore, histologic, gross, and clinical behavior of the tumor is important. Though the role of radiation therapy and chemotherapy is not yet established, it appears that at least wide "cancer resection," if possible, is the treatment of choice. The unusually high incidence of nonresectable, recurrent, or metastatic disease in retroperitoneal histiocytomas raises the question as to whether all three modalities of therapy should be used in the treatment of tumors at this particular site.
Adult↗
Gastric carcinoma survival at the Pennsylvania Hospital -- 1964 to 1974.
Despite major improvements in diagnosis, anesthesia, surgical techniques, and postoperative care, the survival rate for adenocarcinoma of the stomach remains a dismal one. In our series of 109 patients, almost all patients seen were diagnosed too late to effect any kind of surgical care. In the period from January 1964, to December 1974, 122 patients were admitted to Pennsylvania Hospital with a diagnosis of gastric adenocarcinoma. Of the 109 patients followed to their death, only seven survived 5 years; the longest survival was 80 months. Among the 33 patients not resected, median survival was only one month. Of the 74 patients who had surgical resections survival ranged from a median of 5.5 months for those who had total gastrectomy to a median of 8 months for those receiving subtotal gastrectomy.
Adenocarcinoma↗
Acute myelogenous leukemia in patients receiving chlorambucil as long-term adjuvant chemotherapy for stage II breast cancer.
Thirteen consecutive stage II breast cancer patients were treated with long-term adjuvant chemotherapy using chlorambucil. At least three of these patients developed acute myelogenous leukemia (AML). All three patients (and possibly a fourth) who developed AML were postmenopausal, received continuous chlorambucil for greater than or equal to 4 years, had acute red cell anemia at the time of treatment, and had a wbc count in the range of 2700-7700/mm3. After the chlorambucil was discontinued, the wbc count began to slowly rise and the patient developed clinical AML. In all three patients, the diagnosis of AML was established by pathologists on the basis of bone marrow biopsy, aspirate, and peripheral smears. Each of these was subsequently reviewed by the hematologist who treated the patients for AML. Patients who have breast cancer (or any other solid tumor malignancy) are at risk to develop a second malignancy. However, an increasing number of reports are appearing suggesting more than just a casual relationship between leukemia and the use of alkylating agents. This may be related to the dose and duration of therapy with these agents.
Adult↗