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Biomedical subjects

J I Bernstein

Publications and source records attributed to J I Bernstein.

4 recordsLinked to original sources

Failure of adjuvant chemotherapy in testicular cancer.

Two cases of failure of adjuvant chemotherapy after retroperitoneal lymph node dissection of Stage II nonseminomatous germ cell tumors are described. In both cases, initial surgical resection was complete, and two cycles of chemotherapy with cisplatin, vinblastine, and bleomycin were administered in an appropriate dose and schedule. Although one patient remains without evidence of disease 12 months after initiation of salvage chemotherapy with cisplatin, etoposide, and bleomycin, the other patient died of progressive disease despite intensive treatment with cisplatin and etoposide. Adjuvant therapy for Stage II germ cell tumors is not conventional treatment, and should be applied only in investigative settings where the long term effects and toxicity can be monitored, and does not reduce the need for frequent and thorough follow-up of treated patients.

Adult

A phase II study of cisplatin and cytosine arabinoside for recurrent squamous cell carcinoma of the head and neck.

Based on experimental data suggesting synergy between cisplatin and cytosine arabinoside, 17 patients with recurrent squamous cancer of the head and neck were treated with this combination. The response rate was 18% with no complete responses, and the partial responses were of brief duration. There were moderate hematologic and gastrointestinal toxicities and two therapy-related deaths. The study was stopped early because of low response. When compared to results reported for cisplatin alone, the combination of cisplatin and cytosine arabinoside offered no clear advantage.

Adult

Combined modality therapy for adults with small noncleaved cell lymphoma (Burkitt's and non-Burkitt's types).

Between June 1979 and June 1984 18 adult patients with small noncleaved cell lymphoma (SNCL) (diffuse undifferentiated lymphoma, Burkitt's and non-Burkitt's types of the Rappaport classification) were treated with high-dose cyclophosphamide, doxorubicin, vincristine, prednisone, midcycle high-dose methotrexate, and intrathecal methotrexate. Early in the course of treatment, hyperfractionated radiotherapy (125 cGy, every two days, for 1,500 to 2,250 centigray [cGy]) was administered to unresected masses greater than 10 cm in their greatest dimension. Chemotherapy was administered every 21 days for six to ten cycles. Treatment was generally well tolerated; however, one patient died of probable tumor lysis syndrome. With a median follow-up of 1.2 years, actuarial survival was 66.8% and relapse-free survival (RFS) was 71.3% for the entire group. All treatment failures and deaths occurred in patients with stage D disease. RFS projected at 2 years was 100% for stages A and AR and 60.6% for stage B, C, and D (P = .13 Gehan). Two-year RFS for patients with stage A, AR, B, or C disease was 100 v 41% for those with stage D disease. Patients with adverse prognostic features (n = 7)--unresected bulk measuring greater than 10 cm, pretreatment serum lactate dehydrogenase (LDH) 500 IU/L (normal, 200) or involvement of CNS or bone marrow--had a projected RFS of 28.6% compared with 100% for those patients without these features (P = .002 Gehan). Too few patients received induction radiotherapy to assert its role in therapy. By using aggressive multiagent therapy, cure can be expected in a high percentage of adults with SNCL. In the subset with adverse prognostic features, more effective therapy is necessary.

Abdominal Neoplasms