ABSTRACT
From 1971 to 1988 72 cases of carcinoma of the anal canal were treated by external beam radiotherapy, most commonly by 5000 cGy in 20 fractions given over 4 weeks. The actuarial survival at 5 years was 66% and the disease specific survival 78%. Nine patients had inguinal node metastases at diagnosis; their 5-year disease specific survival was 75%. 63 patients were inguinal node negative at presentation; their 5-year disease specific survival was 78%, by UICC 1987 staging: T1 71%, T2 88%, T3 41%, T4 42%. 17 patients developed local recurrence; 10 were suitable for abdominoperineal (AP) resection which was successful in 7. The probability of local control was related to T stage. 13 patients were left with a colostomy because of recurrence, 2 had a colostomy for radiation damage and 4 had their local recurrence managed palliatively, without a colostomy. As a result, 53 of the 72 patients (74%) were left with a functional anus. Severe late complications occurred in 6 (8%).
Subject(s)
Anus Neoplasms/radiotherapy , Aged , Anus Neoplasms/mortality , Anus Neoplasms/pathology , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Recurrence, Local , Radiotherapy/adverse effects , Radiotherapy/methods , Radiotherapy Dosage , Survival RateABSTRACT
This study represents retrospective analysis of 87 patients with a carcinoid tumour of the gastrointestinal tract seen and followed in the British Columbia Cancer Agency (BCCA) from 1960 to 1986. In 49 cases, the primary site was the small bowel. The rest of the cases were distributed as follows: 11 appendix, 10 rectum, 5 stomach, and 7 undetermined. We extrapolated the Dukes' and modified Astler-Coller surgicopathological classifications used for colorectal cancer for use in our cases of carcinoid tumour of the gastrointestinal tract. A strong correlation was found, using this staging, with disease-specific survival. Other prognostic factors included histologic differentiation, the presence of macroscopic residual disease after initial surgery, and level of 5-hydroxyindoleacetic acid (5-HIAA) in urine. Among 51 patients with surgically grossly removed disease, there was a tendency for the development of distant and distant/locoregional recurrence more often than locoregional recurrence alone. The liver was the commonest site of distant recurrence. Analysis of the effect of radiotherapy or chemotherapy on carcinoid tumour of the gastrointestinal tract proved unsuccessful because only a small portion of the patients had this treatment, and it was used mainly for palliation.
Subject(s)
Carcinoid Tumor/mortality , Gastrointestinal Neoplasms/mortality , Adult , Carcinoid Tumor/pathology , Carcinoid Tumor/therapy , Female , Gastrointestinal Neoplasms/pathology , Gastrointestinal Neoplasms/therapy , Humans , Hydroxyindoleacetic Acid/urine , Male , Middle Aged , Neoplasm Staging , Prognosis , Retrospective Studies , Time FactorsABSTRACT
The effect of the vasodilator hydralazine on tumor vascular function has been evaluated in C3H/He mice bearing subcutaneously implanted SCCVII squamous cell carcinoma. Changes in microregional perfusion following hydralazine administration were observed using a double fluorescent staining technique. Hydralazine-induced alterations in tumor blood flow were measured using laser Doppler flowmetry. The results obtained indicate that hydralazine causes a dose-dependent reduction in functional tumor vasculature implying complete flow stasis and/or vascular collapse in some vessels. Fifteen minutes after a dose of 10 mg/kg intravenously, perfusion in 36 +/- 5% (SEM) of tumor vessels was completely abolished. In addition to cessation of perfusion in individual vessels, hydralazine eliminated flow in large patches of vasculature distributed non-uniformly throughout the tumor. Hydralazine (10 mg/kg i.v.) resulted in a 67 +/- 5% (SEM) reduction in tumor red blood cell (RBC) flow as measured by laser Doppler techniques. The mean number of moving red blood cells declined by 35 +/- 8%, suggesting a reduction in microvascular volume. These results support the hypothesis that following hydralazine administration, perfusion stops completely in some blood vessels probably as a result of vascular collapse or flow stasis.
Subject(s)
Carcinoma, Squamous Cell/blood supply , Hydralazine/pharmacology , Neoplasms, Experimental/blood supply , Animals , Erythrocyte Indices , Female , Male , Mice , Mice, Inbred C3H , Microcirculation/drug effects , Microscopy, FluorescenceABSTRACT
We report the case of a 72-year-old woman in whom the sole manifestation of recurrent endometrial adenocarcinoma was a large splenic mass. The clinical presentation mimicked that of malignant lymphoma. Although as many as 9% of carcinomas are associated with splenic metastases, such involvement is typically encountered only at autopsy and associated with widespread extrasplenic metastases. In contrast, we have found only three other reported cases of gynecological malignancy in which a splenic mass was the sole presenting manifestation of recurrent tumor.
Subject(s)
Adenocarcinoma/secondary , Lymphoma/diagnosis , Ovarian Neoplasms , Splenic Neoplasms/secondary , Adenocarcinoma/diagnosis , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Adult , Aged , Diagnosis, Differential , Female , Humans , Neoplasm Metastasis , Splenectomy , Splenic Neoplasms/diagnosis , Splenic Neoplasms/pathology , Splenic Neoplasms/surgeryABSTRACT
The potential use of tumour blood flow reductions, induced by the vasodilator hydralazine, in cancer therapy are described. Data obtained in experimental tumour systems indicate that with appropriate scheduling and drug combinations, hydralazine can increase the therapeutic effectiveness of certain chemotherapeutic agents whether used alone or in combination with other modalities such as radiation or hyperthermia.
