Impact of changes in the treatment of nasopharyngeal carcinoma: an experience of 30 years.

Two hundred and twenty-eight patients with nasopharyngeal carcinoma were treated in a single institution in a 31-year period. Overall survival (OS), disease-free survival (DFS), and complete response (CR) rates were analyzed. In addition, survival and control rates from 1960 to 1975 and from 1976 to 1991 were evaluated. In the latter group, a comparative study was performed between patients treated with neoadjuvant chemotherapy (NCT) before radiotherapy (RT) (45) and patients treated with radiotherapy alone (45). OS at 5 and 10 years were 42 and 34%, and DFS rates were 35 and 30%, respectively. CR was achieved in 184 patients (81%). Tumor progression and survival were strongly associated with T-category. Use of fashioned blocks, age and T-category were the most important factors influencing survival in a multivariate analysis. In the patients treated with NCT, rates of CR and OS were not significantly different when compared with the concurrent RT alone group. Ninety-nine patients had recurrence (54%) and 58 received rescue treatment. Modern radiotherapy techniques have greatly assisted in the improvement of tumor control rates. Chemotherapy must be further evaluated and new treatments for relapsed patients are needed.

Infusional chemotherapy (EPOCH) in patients with refractory or relapsed lymphoma.

Seventeen patients with refractory (7 cases) or relapsed (10 cases) lymphoma were treated with a continuous infusion of etoposide, vincristine, and doxorubicin, in addition to cyclophosphamide (bolus) and prednisone (regimen EPOCH). Six patients (4 with Hodgkin's disease) achieved a complete response (CR) (35%; 95% CI: 14-62%). However, 5 of 6 patients had achieved a CR with their initial therapy. Myelosuppression was the most serious effect (29% of patients with grade IV leukopenia after the first course). There were two treatment-related deaths. Doses were lower than originally reported (median: 68%). Infusional therapy with EPOCH is an active regimen in these heavily pretreated patients, particularly in relapsed Hodgkin's disease. It seems a useful protocol to prove chemosensitivity before bone marrow transplantation. However, the true role of infusional treatment has to be determined in clinical trials.

Primary renal lymphoma: report of 3 cases and review of the literature.

Primary renal lymphoma is a controversial entity. Only 29 cases have been reported since 1980. Diagnostic criteria are not well established. We report here 3 new cases and review the literature. Primary renal lymphoma was considered on the basis of uni- or bilateral nonobstructive nephromegaly with or without renal failure. In all cases, the diagnosis was made after renal biopsy. Extrarenal abdominal involvement was excluded by imaging techniques. The role of staging laparotomy remains controversial. Chemotherapy is the treatment of choice, but the prognosis is poor. We propose a clinical definition of primary renal lymphoma in order to achieve a better management of the disease.

ProMACE-C-MOPP in aggressive non-Hodgkin's lymphoma. Long-term results in 45 patients treated in a single institution.

Forty-five previously untreated patients with intermediate or high-grade non-Hodgkin's lymphoma were treated with the Pro-MACE-C-MOPP regimen (flexitherapy). The median age of the patients was 51 years, 51% had constitutional symptoms, 78% were in Ann Arbor stage III-IV, 40% had two or more involved extranodal sites and 87% had serum lactate dehydrogenase (LDH) above 225 U/l. Twenty-two (49%) patients had immunoblastic lymphoma (Working Formulation). Overall, 40% of the patients attained complete response (CR) and there were no relapses. The dose-limiting toxicity was myelosuppression (69% of the patients with WBC less than 1.9 x 10(9)/l). Three deaths were attributed primarily to chemotherapy, but another two patients died of long-term complications of therapy. After a median follow-up of 50 months (18-80), 15 patients (33%) were alive without lymphoma. Only histologic subtype (intermediate vs. high) and abdominal involvement were prognostic factors for CR rate. Our results indicate that ProMACE-C-MOPP is an effective regimen for intermediate-grade lymphomas. However, in high-risk patients the regimen seems to be less effective than originally reported.

[Very late recurrence (14 years) of a lymphoblastic leukemia-lymphoma]. / Recidiva muy tardía (14 años) de un linfoma linfoblástico leucemizado.

We report a two and a half years old girl diagnosed in 1972 of lymphoblastic leukemia-lymphoma with pleural, mediastinal and bone marrow involvement. Clinical remission developed with chemotherapy (induction and maintenance). This situation persisted until June 1986 (14 years after the diagnosis and 11 years after cessation of any therapy), when mediastinal mass, pleural effusion and bilateral renal infiltration developed again, and also peripheral lymphadenopathy; bone marrow involvement is now absent. This case is considered as an exceptionally late relapse. Other possibilities are discussed, while the difficulty to define "cure" in these patients is emphasized.