Biomedical subjects
Publications and source records attributed to L Repetto.
The validity of a selective surgical attitude towards primary tumours of the hepatic hilus after accurate pre- and intra-operative staging is stressed. Moreover the active management for both radical and palliative purposes is justified by some personal observations of the specific anatomoclinical behaviour of these tumours.
Personal experience of 6 hepatectomies at the some time as primary colorectal tumour excision is reported. Like most Italian and foreign Authors, the paper stresses the negligible mortality and morbidity after this double surgery. Moreover, in these particular patients, it was never necessary to postpone hepatectomy. Finally, emphasis is placed on the importance of intraoperative echography for the identification of micrometastasis in one or two lobes, for the correct staging of the primary tumour and for oncologically appropriate hepatectomy.
A series of 129 patients with International Federation of Gynecology and Obstetrics (FIGO) stage III-IV ovarian cancer, were evaluated with ultrasound examination and second look surgery. Results of both modalities were correlated in order to assess the reliability of ultrasound in detecting residual disease. After six cycles of chemotherapy, ultrasound was negative in 94 patients and positive in 35 patients. At second look, 57 patients were in complete pathologic remission, 16 had microscopic residual disease, 23 had macroscopic disease less than 2 cm, and 33 had macroscopic disease greater than 2 cm. Correlating ultrasonography and laparotomy, high correlations were seen in patients with no residual disease (92.2%); on the other hand, ultrasound examinations exhibited poor sensitivity and specificity in patients with microscopic disease (6.2%) and residual disease less than 2 cm (8.6%). Using ultrasound discrimination among patients with no residual disease, microscopic disease, or macroscopic disease less than 2 cm does not appear possible. Our suggestion is that ultrasound is not able to replace second look laparotomy in the detection of minimal residual disease in ovarian cancer patients.
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A preliminary study of the distribution of the 99mTc complex of hexamethylpropylene amine oxime (HM-PAO) in 12 patients with brain neoplasms before, during, and after radiotherapy has been performed. Untreated brain tumors were found to exhibit a range of 99mTc-HM-PAO uptake, varying from areas of markedly increased isotope activity to photopenic areas, when compared to normal brain tissue. A ratio of 99mTc-HM-PAO tumor uptake to contralateral normal tissue uptake was calculated prior to and during radiotherapy. This ratio tended to return towards unity in lesions responding to therapy. A predictable alteration in whole brain 99mTc-HM-PAO uptake during radiotherapy was not demonstrated. Unlike the radiolabeled amines, 99mTc-HM-PAO localizes in primary tumors, probably indicating that its uptake mechanism is independent of non specific amine receptors. 99mTc-HM-PAO may be useful in the study of brain tumor physiology and response to therapy.
Carboplatin (JM8) and etoposide (VP16) have demonstrated activity against a range of solid tumours. A retrospective study has looked for evidence of enhanced radiation pneumonitis when these drugs are employed in conjunction with irradiation. Twenty-nine patients with limited disease small cell lung cancer (S.C.L.C.) received JM8 (300 mg/m2) and VP16 (300 mg/m2) at intervals of 3-4 weeks for 4 cycles followed by thoracic irradiation. Twenty-one were evaluated and compared with 21 matched non-S.C.L.C. patients treated by radiotherapy alone. Patients were stratified into three groups according to the radiation dose schedule normalised using Wara's modification of Ellis' formula (n = 0.38, t = 0.06) [28]. Group 1 received less than 1014 rets, Group 2 1015-1250 rets and Group 3 greater than 1250 rets. Radiological pneumonitis was observed in 57% (12/21) of patients receiving combined modality treatment compared to 71% (15/21) of patients receiving radiation alone with evidence of a radiation dose-response relationship for the appearance of pneumonitis in both groups of patients (p greater than 0.1). In conclusion, no enhancement of radiation pneumonitis by carboplatin (JM8) or etoposide (VP16) has been observed.
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Twenty-five patients with cutaneous melanoma were imaged with F(ab')2 fragments of antimelanoma monoclonal antibody (MoAb) 225.28S labeled with 99mTc and 131I or 111In. Out of 16 patients without evidence of metastatic lesions, 6 false-positive cases were observed. Only 4 out of 9 patients with known lesions showed positive findings (globally 8 of 19 metastatic sites). In conclusion, antimelanoma MoAb was of little help in radioimaging and stating this disease.
The antitumoral activity and toxicity of a new daunorubicin analog (4-demethoxydaunorubicin, IMI 30, Idarubicin) was tested in 20 consecutive patients with non-small cell lung cancer mostly pretreated with chemotherapy. The drug was administered orally at a dose of 15 mg/m2 for three days every 3-4 weeks. There were no clinical responses. Hematological and nonhematological toxicities were mild.
A total of 116 asymptomatic patients with malignant skin melanoma entered a multiple staging work-up including chest X-ray, multiple nuclear scans and abdominal ultrasonography. All 116 chest X-rays and 68 brain scans performed gave negative findings. Liver scans resulted in 1/66 false-positive findings. Out of 73 bone scans, 5 gave false-positive results. Only 2 out of 66 abdominal ultrasonographies showed abnormal findings and were found to be true-positive on surgical exploration. Due to the low yield in detecting silent metastases, such a multiple staging work-up would not be regarded as a routine staging program.
Fifty-two previously untreated patients with small-cell lung carcinoma (SCLC) were treated with a combination of carboplatin 300 mg/m2 intravenously (IV) on day 1 and etoposide 100 mg/m2 IV on days 1 through 3 every 28 days for four courses. Patients with limited disease (LD) subsequently received thoracic radiotherapy; no prophylactic cranial radiotherapy was used. Forty-four patients (85%) achieved an objective response, including 82% (29% complete remissions) of LD patients and 88% (13% complete remissions) of extensive-disease (ED) patients. Median response duration for LD patients was 7 months and 5.5 months for ED patients. Median survival for both LD and ED patients was 9.5 months. Myelosuppression was the main toxicity, with World Health Organization (WHO) grade 3/4 leucopenia occurring in 44% of patients. There was one (2%) treatment-related neutropenic death. Treatment was otherwise well tolerated, and in particular no renal toxicity, neurotoxicity, or ototoxicity was seen. This new combination is highly active in terms of response rate, but response duration and survival is disappointing, and might be improved by prolonged treatment or by the use of additional drugs in combination.
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Fourteen consecutive melanoma patients with evaluable metastatic disease were treated with combination chemotherapy including procarbazine, vincristine and lomustine (POC). All but two patients had been previously treated with single agent chemotherapy (dacarbazine 11 patients, melphalan plus hyperthermia 1 patient). One transient partial response and 4 stable disease were noted. Median overall survival was 5 months. In our experience POC seems unlikely to improve the response rate compared with other chemotherapy combinations. Patient characteristics can partially explain the contrasting results reported in the literature.
An analysis of 127 women with metastatic breast cancer was carried out. All patients were treated with aminoglutethimide: of 117 evaluable patients, 29 responded, 46 remained stable and 42 progressed. A series of patients' characteristics were analyzed for their prognostic importance for response to this drug. The most important features able to predict response were found to be a previous response to tamoxifen and a long disease-free survival after mastectomy.
Thirty-five small cell lung cancer (SCLC) patients were treated with combination chemotherapy including adriamycin, cyclophosphamide, etoposide (ACE). Out of 32 evaluable patients there were 21.9% complete responses and 53.1% partial responses with an overall median survival of 37 weeks (50 weeks for patients with limited disease and 34 weeks for patients with extended disease). Toxicity was generally well tolerated. In conclusion the ACE regimen results in being active and safe in the treatment of SCLC.
A phase II study with mitoxantrone has been carried out in 30 metastatic breast cancer patients. Of 26 evaluable patients 7 (26.9%) experienced a partial response; 7 (26.9%) patients had stable disease and 12 (46.1%) had progression. Major toxicity observed was: nausea and vomiting in 52% of patients, moderate hair loss in 53% of patients and leukopenia in 53%.
A case of primitive T cell lymphoma of the oropharynx is reported. Clinical, morphological and immunological features of the case are summarized and described according to morphological and immunological criteria proposed by Waldron and Frizzera.