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Biomedical subjects

R C Marcove

Publications and source records attributed to R C Marcove.

At least 19 recordsLinked to original sources
PubMed1992

Survival, prognosis, and therapeutic response in osteogenic sarcoma. The Memorial Hospital experience.

Two hundred seventy-nine consecutive patients with Stage II osteogenic sarcoma of the appendicular skeleton treated between 1976 and 1986 were studied to identify predictors of long-term survival. Survival was 77% and 73% at 5 and 10 years, respectively, with continuously disease-free survival being 70% and 69%. On univariate analysis, the most significant predictors of survival were the location of the primary lesion, local control of the tumor, and the degree of necrosis in the primary tumor after intravenous neoadjuvant chemotherapy (histologic response). On initial multivariate analysis, similarly, only location and histologic response to chemotherapy predicted disease-free outcome. After statistical control for local recurrence, only histologic response to chemotherapy was retained as an independent predictor, suggesting that in this data set, the location of primary lesion exerted its effect only secondarily through its association with the ability to provide local control. The risk of local recurrence was almost fivefold higher in tumors of the femur than in tumors of other locations (relative risk, 4.6) and, within the femur, was more than threefold higher in the proximal femur than in the distal femur (relative risk, 3.4). None of the other primary tumor or patient characteristics studied yielded independent predictive significance for survival. The rate of failure was almost fivefold as high in those with an incomplete response to chemotherapy compared with those with a complete response to chemotherapy (relative risk, 4.9; 95% confidence interval, 2.2 to 11). Even in those patients with minimal or no necrosis in the primary tumor, ultimately 62% and 54% were disease-free at 5 and 10 years, respectively.

Adolescent↗
PubMed1992

Primary skeletal non-Hodgkin's lymphoma in the pediatric age group.

The authors discuss rare primary skeletal non-Hodgkin's lymphoma in 16 patients treated from 1973 to 1989. The symptoms of these patients related to bone lesions in 95% of the cases. These bone lesions were monostotic or polyostotic, with or without regional and distant metastases. The locations of these lesions were long bones in 13 patients, pelvic bones in seven patients, and skull and vertebral bodies in two patients. The anatomical locations of these lesions in the bones were diaphysis alone in one patient, epiphysis in two patients, metaphysis in three patients, and a combination of diaphyseal, epiphyseal, and metaphyseal lesions in seven patients. Extraskeletal involvement was present in nine patients; extraskeletal sites included regional or distant lymph node involvement in seven cases, the mediastinum in two, lung nodules in two patients, the skin and subcutaneous regions in four patients; bone marrow in three patients, and peripheral nervous system (PNS) in one patient. Two patients had stage I disease, three had stage II disease, eight had stage III disease, and three had stage IV disease. The majority of patients had large noncleaved cell diffuse lymphomas or DHL by Rappaport classification. All patients were treated with the LSA2-L2 protocol; six patients received radiation therapy to the affected bone, and ten patients received no radiation therapy. Three patients failed on treatment within the first 4 months of therapy. Two patients developed a second tumor, one in the radiation therapy field and the other in a patient who received no radiation therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Complicated problems in osteogenic sarcoma including pulmonary metastasis, second bone involvement and cure rates.

A desirable goal in the treatment of osteogenic sarcoma is preservation of a limb, without sacrificing the principles of cancer surgery. This study describes the author's experience at the Memorial Sloan-Kettering Cancer Center in New York with limb salvage surgery for osteogenic sarcoma. One hundred ninety two patients are included in this study. The study shows that pre-operative chemotherapy is successful as demonstrated by the improved cure rates of each resection group. It was also found that limb sparing surgery is successful with or without chemotherapy as long as the surgical margins are adequate. Pulmonary resection surgery has also been shown to be successful as has surgery for a second bone involvement.

Antineoplastic Agents↗
PubMed1991

Osteoid osteoma. Diagnosis, localization, and treatment.

The preoperative insertion of a needle under computed tomographic scan, performed under local anesthesia, is a convenient and important new way to localize the nidus in osteoid osteoma. It necessitates less bone removal, which should reduce the postoperative fracture rate. It should also help to locate the lesion during surgery. Some clinical points and previously unstressed pathologic findings are also discussed.

Aspirin↗
PubMed1990

Lumbo-sacral chordoma with high-grade malignant cartilaginous and spindle cell components.

A recurrent lumbo-sacral chordoma with high-grade cartilaginous and spindle cell components is described. The tumor was excised from a 71-year-old man who previously had a conventional chordoma resected from his sacrum 26 years earlier. The original conventional chordoma was treated postoperatively with external beam radiation therapy, and the patient was free of disease until he presented at the age of 71 with leg weakness. Computerized tomography revealed a lumbo-sacral soft tissue mass. This was excised and found to have three distinct histologic aspects. The largest component was that of a conventional chordoma. The second component consisted of islands of malignant cartilage intimately admixed with the cells of the conventional chordoma. The third component consisted of high-grade malignant, poorly differentiated spindle cells. This case suggests that chondroid chordomas do exist and that they may also occur outside of the spheno-occipital region.

Aged↗
PubMed1989

Fibromyxoma of the bone.

Fourteen patients with fibromyxoma of the bone, a rare but relatively overlooked entity, are described. This tumor is different from a chondromyxoid fibroma in age distribution, clinical behavior and histologic appearance. Fibromyxoma occurs frequently in later life (after 50 years of age). It is usually not clinically aggressive and lacks the lobular pattern, chondroid matrix and cell variety of chondromyxoid fibroma. Secondary aneurysmal bone cysts developed in three patients. It behooves the pathologist to screen patients with aneurysmal bone cysts for evidence of pre-existing fibromyxoma, especially if the patient is less than 40 years of age. Treatment consists of curettage with or without cryosurgical procedures. Marginal excision may be necessary for an occasional aggressive lesion.

Adolescent↗
PubMed1988

Massive solitary tophus containing calcium pyrophosphate dihydrate crystals at the acromioclavicular joint.

A massive solitary tophus containing calcium pyrophosphate dihydrate (CPPD) crystals was resected from the distal clavicle and proximal acromion of a 62-year-old man who presented with a painful shoulder mass. The diagnosis was confirmed histologically and by X-ray diffraction. CPPD crystal deposition was found within bone, however, the articular cartilage was not involved. Other unusual features of the case include the size of the lesion, the monoarticular presentation and a peculiar discoloration of the overlying skin. The clinical presentation and radiographic features were initially consistent with a malignant process; thus the case demonstrates that CPPD arthropathy should be included in the differential diagnosis of periarticular tumors.

Acromioclavicular Joint↗
PubMed1988

Pseudoaneurysm of the popliteal artery with an unusual arteriographic presentation. A case report.

Pseudoaneurysms caused by osteochondromas during the second decade of life are well known. Arteriography is generally helpful in the diagnosis of a false aneurysm. In a 30-year-old man, the case was unique in that the arteriogram failed to show the aneurysm at all. Physical examination revealed yellow discoloration and tiny hemangiomas of the skin over the fossa poplitea. More emphasis should be placed on the physical examination and less on the arteriogram in making a correct diagnosis.

Adult↗
PubMed1987

Sacrococcygeal chordoma. A clinicoradiological study of 60 patients.

Sixty patients with sacrococcygeal chordoma, who were seen at this center between 1946 and 1985, were studied with particular attention to the radiographic findings. This study was undertaken because of the large number of these cases and comparison was made between the plain films available in 39 patients and the computed tomography CT studies in 22. Bone destruction was found in 78% on plain films but in 90% on CT. A soft tissue mass was identified in plain films in 60% but in 90% on CT. Calcific debris was found in plain films in 44% but in 87% on CT. Mostly the debris consisted of coarse irregular fragments and probably represented sequestrated necrotic bone. Myelography was performed in only 15 patients. Angiography was studied in 10 cases. Of the 60 patients 88% underwent surgical resection. The tumor recurred in 80% and in only 20% was there no evidence of recurrence. Distant metastases occurred in 24% of patients. Fifty percent survived 5 years; 28% survived 10 years; mean survival 7.5 years.

Adult↗
PubMed1987

Chondrosarcoma in the young. A clinicopathologic analysis of 79 patients younger than 21 years of age.

We have studied 79 patients with chondrosarcoma who were younger than 21 years of age; this number represents 16% of all patients with chondrosarcoma diagnosed and treated in this hospital during half a century. The appendicular skeleton (53%), the humerus (13%), and the femur (23%) were most frequently affected. The pelvic bones were also common locations (20%). Pain, the presence of a mass, and tenderness were the most common presenting complaints. Two-thirds of the sarcomas were central lesions; the rest were mostly of the peripheral type. In 22 patients (28%), the chondrosarcomas were secondary to pre-existing benign solitary or multiple cartilaginous lesions. Histologically, the chondrosarcomas were subdivided into conventional, myxoid, "mesenchymal," and spindle cell (dedifferentiated) variants. Microscopically, the chondrosarcomas were graded according to their increasing grade of malignancy (grade I: 24 patients; grade II: 23 patients; grade III: 32 patients). Detailed survival analysis was performed and survival comparisons were made between the various age groups, the time of treatment, the sex of the patients, various skeletal sites, and the histologic grade of malignancy of the chondrosarcoma. It appears that chondrosarcoma affecting younger individuals is, in general, a more ominous tumor as compared with adults; i.e., relatively more high-grade chondrosarcomas affect young people than adults. Another notable difference was the dissimilarity in the skeletal distribution pattern of the malignant cartilage lesions between adults and the young.

Adolescent↗
PubMed1985

Effect of intensive adjuvant chemotherapy on wound healing in 69 patients with osteogenic sarcomas of the lower extremities.

Reported surgical adjuvant trials in humans have resulted in little clinically significant impairment of wound healing. Such trials are often carried out with subtherapeutic doses or with the drugs administered relatively late in the wound healing process. It is the objective of our study to investigate the effect of intensive pre- and postoperative chemotherapy (BCD, ADR, HD-MTX) on wound healing in patients with osteogenic sarcomas. Wound healing was defined in our study as lack of infection. In a series of 110 patients with osteogenic sarcomas we analyzed the data of 69 patients with lower extremity lesions: of these, 54 patients had distal femur lesions and 15 had upper tibia and fibula lesions. All the patients underwent en-bloc resections and insertion of a prosthetic device. Pre- and postoperative antibiotics were given routinely. In 80% of our patients (55/69) an uneventful postoperative course was recorded with respect to wound healing. None of these required a secondary operative procedure. Débridement of the wound or débridement of the wound followed by skin grafting had to be performed in 14% (10/69) of the patients. Most of the amputations were performed early in this series of cases. After secondary surgery wound healing was uneventful in most of the patients. No patient died as a consequence of wound infection. Mixed bacterial infections were found in 13/14 patients. No single specific bacterium could be identified. One patient developed a fungal infection (aspergillosis). Eight infections were secondary to skin necrosis. In this series we later found the serious effects of the skin necrosis and slough could be reduced by early intervention with a muscle pedicle flap.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Intracortical osteosarcoma.

A case of osteosarcoma arising in the tibia of a 15-year-old boy is reported. Of particular interest was the benign roentgenographic appearance and the confinement of the tumor within the cortex of the bone, an extremely rare phenomenon consistent with origin within the primitive mesenchyme of the Haversian canals.

Adolescent↗
PubMed1984

Primary osteogenic sarcoma of the femur: a model for the use of preoperative chemotherapy in high risk malignant tumors.

The value of adjuvant chemotherapy in primary osteogenic sarcoma (OSA) is still considered controversial by some. One reason may be that various reported series include patients with widely varying prognostic variables. To address this, the effect of chemotherapy on the continuous disease-free (CNED) survival was analyzed in 100 patients aged 21 yr or less with OSA of the femur. This classically poor prognostic group of patients represented 51% of all primary OSA seen at the Memorial Sloan-Kettering Cancer Center during the study interval. This study includes all patients aged 21 yr or less with fully malignant (Grade III-IV/IV) OSA of the femur and no metastases treated from November 1973 through November 1981. The first (T-4) protocol (31 patients) consisted of high dose methotrexate (HDMTX) with leucovorin rescue, cyclophosphamide (Cyc), and adriamycin. In the second (T-7) protocol (23 patients) the dose of HDMTX was increased to 12 g/m2 for prepubescent patients, and bleomycin, Cyc, and dactinomycin replaced Cyc. The current (T-10) protocol (46 patients) uses the same CT as T-7, but patients not having a complete response of the primary tumor to preoperative CT receive additional cisplatinum (120 mg/m2) with adriamycin (30 mg/m2/day for two consecutive days). In 31 patients treated with T-4 the CNED survival was 32% with a minimum follow up of over 7 yr. On T-7, 15/23 patients with femur primaries had a CNED survival of 65% with all of the surviving patients followed for more than 5 yr. The addition of cisplatinum in T-10 has resulted in CNED survival rate of 77% in 34/44 patients (excluding two patients that died CNED during and after treatment); the median follow-up patients who are alive CNED is 33 months, with a minimum of 2 yr follow up on the last patient entered.

Adolescent↗