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1.
Curr Treat Options Oncol ; 1(4): 303-12, 2000 Oct.
Article in English | MEDLINE | ID: mdl-12057156

ABSTRACT

Malignant peritoneal mesothelioma is an aggressive neoplasm that rapidly spreads within the confines of the abdominal cavity to involve most accessible peritoneal and omental surfaces. Current treatments are unsatisfactory, and new approaches are needed. We have noted prolonged survival in selected patients after intensive multimodality treatment. Our current experimental regimen includes initial laparotomy with omentectomy, resection of peritoneal implants, and placement of bilateral peritoneal Port-a-Caths (Sims Deltec, Inc., St. Paul, MN); repeated courses of intraperitoneal chemotherapy with doxorubicin, cisplatin, and interferon gamma; second-look laparotomy and intraoperative hyperthermic perfusion with mitomycin and cisplatin; and whole abdominal radiation. Patients with peritoneal mesothelioma who are not candidates for this approach can sometimes be palliated with systemic (intravenous) chemotherapy using doxorubicin or mitomycin, alone or in combination with cisplatin or carboplatin. Newer agents such as gemcitabine and multitargeted antifolate (pemetrexed disodium, LY231514) show promise of greater effectiveness.


Subject(s)
Mesothelioma/therapy , Peritoneal Neoplasms/therapy , Antineoplastic Agents/therapeutic use , Clinical Trials as Topic , Combined Modality Therapy , Diet Therapy , Humans , Mesothelioma/mortality , Mesothelioma/pathology , Peritoneal Neoplasms/mortality , Peritoneal Neoplasms/pathology , Radiotherapy , Survival Rate
2.
Ophthalmic Plast Reconstr Surg ; 14(1): 67-71, 1998 Jan.
Article in English | MEDLINE | ID: mdl-9513247

ABSTRACT

Multiple myeloma is a plasma cell malignancy often associated with destructive skeletal lesions. Orbital involvement in multiple myeloma is rare. Risk factors for orbital involvement have not been established, although risk may vary with immunoglobulin subtype. Early detection of orbital plasmacytoma may affect treatment and clinical course. A case is reported of multiple myeloma without elevated serum immunoglobulins that involves the orbit, and the implications of early detection are discussed. The patient was first examined by an ophthalmologist 13 months after multiple myeloma was diagnosed and 5 months after the external appearance of an orbital tumor. Urine protein electrophoresis demonstrated kappa light chains. Hypergammaglobulinemia was not detected. Plain-film roentgenography showed orbital involvement at the time of initial diagnosis. An impressive clinical response to external beam radiation therapy was seen. Attention to immunoprotein characteristics in multiple myeloma may help to identify risk factors for orbital involvement. Early detection may permit safer and equally effective treatment. All patients with multiple myeloma should undergo thorough ophthalmic examination at the time of initial diagnosis.


Subject(s)
Multiple Myeloma/diagnosis , Orbital Neoplasms/diagnosis , Antineoplastic Agents/therapeutic use , Bence Jones Protein/urine , Biomarkers, Tumor , Biopsy , Follow-Up Studies , Humans , Immunoelectrophoresis , Immunoglobulins/blood , Male , Middle Aged , Multiple Myeloma/drug therapy , Multiple Myeloma/metabolism , Multiple Myeloma/radiotherapy , Orbit/diagnostic imaging , Orbit/pathology , Orbital Neoplasms/drug therapy , Orbital Neoplasms/metabolism , Orbital Neoplasms/radiotherapy , Tomography, X-Ray Computed
3.
Cancer Invest ; 14(4): 335-9, 1996.
Article in English | MEDLINE | ID: mdl-8689428

ABSTRACT

Small cell carcinoma of the pancreas is a very rare malignancy with 18 cases reported in the literature, of which only 3 were treated with chemotherapy. A 52-year-old man was diagnosed with small cell carcinoma originating in the head of the pancreas and invading the duodenum. He was treated with a similar approach as for localized small cell lung cancer, with six cycles of combination chemotherapy and local radiotherapy, and went into complete remission. After 3 months, he developed liver metastases along with an enlarged left supraclavicular lymph node. He was treated with two cycles of CVA, but developed lung metastases and was treated with ifosfamide/mesna. However, his overall condition deteriorated and hospice care was instituted until the patient's demise. The patient survived 14 months following diagnosis, significantly longer than the 15 reported patients with small cell pancreatic carcinomas not treated with chemotherapy. Combination chemotherapy and radiation therapy as it is utilized for small cell lung cancer appear to be beneficial for small cell carcinoma of the pancreas.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Small Cell/therapy , Lung Neoplasms/secondary , Lung Neoplasms/therapy , Pancreatic Neoplasms/therapy , Carcinoma, Small Cell/diagnostic imaging , Carcinoma, Small Cell/pathology , Carcinoma, Small Cell/secondary , Combined Modality Therapy , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Duodenal Neoplasms/secondary , Duodenal Neoplasms/therapy , Fatal Outcome , Humans , Ifosfamide/administration & dosage , Lung Neoplasms/drug therapy , Male , Mesna/administration & dosage , Middle Aged , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/pathology , Radiotherapy Dosage , Tomography, X-Ray Computed , Vincristine/administration & dosage
4.
Radiology ; 195(2): 413-7, 1995 May.
Article in English | MEDLINE | ID: mdl-7724759

ABSTRACT

PURPOSE: To characterize the skeletal and bone marrow magnetic resonance (MR) imaging changes during and after treatment of childhood soft-tissue tumors. MATERIALS AND METHODS: Three boys with soft-tissue sarcomas of the popliteal fossa underwent surgery, radiation therapy, and chemotherapy. Plain radiographic and MR imaging findings were correlated with the effect of treatment. RESULTS: After radiation therapy, MR images revealed findings that resembled those of rickets at sites of irradiation in the three patients. These findings included metaphyseal sclerosis, metaphyseal fraying, and epiphyseal plate widening. Bone marrow imaging changes were temporally related to therapy. During chemotherapy, reconversion to hematopoietic marrow was noted in nonirradiated areas in two patients, but after cessation of all treatment, these areas converted back to fatty marrow. Irradiated areas of bone marrow remained fatty throughout therapy in the three patients. CONCLUSION: Awareness of the MR imaging findings related to antineoplastic treatment of soft-tissue tumors is important to distinguish these changes from progression of primary disease.


Subject(s)
Sarcoma, Ewing/pathology , Sarcoma, Synovial/pathology , Soft Tissue Neoplasms/pathology , Adolescent , Bone Marrow/pathology , Bone Marrow/radiation effects , Child , Combined Modality Therapy , Femur/pathology , Femur/radiation effects , Humans , Knee , Magnetic Resonance Imaging , Male , Sarcoma, Ewing/therapy , Sarcoma, Synovial/therapy , Soft Tissue Neoplasms/therapy , Tibia/pathology , Tibia/radiation effects
5.
Cutis ; 55(4): 221-4, 1995 Apr.
Article in English | MEDLINE | ID: mdl-7796614

ABSTRACT

A 68-year-old white man presented to the inpatient service at Columbia-Presbyterian Hospital with a chief complaint of a progressively enlarging tumor of the right infraorbital region for many years and multiple, pink papulonodules on his head, neck, and trunk. A biopsy specimen of the right infraorbital and back lesions demonstrated an infiltrating adenocarcinoma with prominent signet ring cells, and small lumen formation. Results of an extensive work-up revealed bone marrow metastases and no evidence of a primary malignancy. We present a case of primary sweat gland carcinoma with metastases to the skin based upon history, clinical presentation, results of physical examination, histopathologic examination, immunohistochemical studies, and response to 5-fluorouracil chemotherapy. Due to the rarity of the tumor, the diagnosis is usually not made until the tumor(s) is invasive. An excellent response to systemic chemotherapy with 5-fluorouracil in metastatic sweat gland carcinoma was noted in this case.


Subject(s)
Carcinoma, Signet Ring Cell/drug therapy , Carcinoma, Signet Ring Cell/secondary , Fluorouracil/therapeutic use , Orbital Neoplasms/pathology , Skin Neoplasms/drug therapy , Skin Neoplasms/secondary , Sweat Gland Neoplasms/pathology , Aged , Bone Marrow Diseases/pathology , Bone Neoplasms/drug therapy , Bone Neoplasms/secondary , Carcinoma, Signet Ring Cell/pathology , Facial Neoplasms/pathology , Head and Neck Neoplasms/pathology , Humans , Male , Scalp/pathology , Sweat Gland Neoplasms/drug therapy , Thoracic Neoplasms/pathology
6.
J Dermatol Surg Oncol ; 12(2): 146-9, 1986 Feb.
Article in English | MEDLINE | ID: mdl-3944331

ABSTRACT

This report describes a patient with histologically confirmed multiple cutaneous metastases from a skeletal chondrosarcoma and reviews the two previously published cases of this very unusual pattern of metastasis. We conclude that metastatic chondrosarcoma should be considered in the differential diagnosis of multiple cartilaginous tumors of the skin, and that radiotherapy may play a role in the management of metastatic chondrosarcoma.


Subject(s)
Chondrosarcoma/secondary , Skin Neoplasms/secondary , Bone Neoplasms/pathology , Chondrosarcoma/pathology , Female , Humans , Middle Aged , Skin/pathology , Skin Neoplasms/pathology
7.
Oral Surg Oral Med Oral Pathol ; 59(6): 622-6, 1985 Jun.
Article in English | MEDLINE | ID: mdl-3859824

ABSTRACT

Metastases to the oral cavity from nonoral malignant lesions occur rarely. We report the case of a woman with chondrosarcoma of the pelvis in whom gingival metastases, in addition to pulmonary, skin, and brain metastases, developed. Clinical course, x-ray correlation, histopathologic review, and treatment modalities are described. The six previously reported cases of chondrosarcoma metastatic to the oral cavity are tabulated and analyzed. Metastases should be included in the differential diagnosis of gingival lesions in patients with prior or current nonoral malignant tumors.


Subject(s)
Bone Neoplasms , Chondrosarcoma/secondary , Gingival Neoplasms/secondary , Pelvic Bones , Chondrosarcoma/therapy , Combined Modality Therapy , Female , Gingival Neoplasms/therapy , Humans , Middle Aged
8.
Gynecol Oncol ; 18(1): 1-17, 1984 May.
Article in English | MEDLINE | ID: mdl-6714798

ABSTRACT

Pathologically documented cases of stage II cancer of the endometrium in 52 women (adenocarcinoma in 43 and adenoacanthoma in 9) who were treated between 1952 and 1973 at the Mayo Clinic were studied retrospectively. Hysterectomy was necessary for inclusion in the study; 49 women received planned primary surgical treatment of their disease, and, in addition, 25 patients received radiation treatment postoperatively. Overall survival was 69.2% at 5 years. Variables found to have a statistically significant influence on survival were (1) extent of involvement in the endometrial cavity, (2) histologic grade of the tumor, and (3) maximal depth of invasion in either the myometrium or the cervix. The presence of abnormal nodes in women who had Wertheim hysterectomies and the use of radiation therapy did not appear to influence survival. It is concluded that primary treatment of stage II carcinoma of the endometrium by surgery and postoperative radiation produces acceptable results and, through the advantages of surgical staging, provides more exact knowledge of the true extent of the disease.


Subject(s)
Adenocarcinoma/surgery , Uterine Neoplasms/surgery , Uterus/pathology , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Adult , Aged , Cervix Uteri/pathology , Combined Modality Therapy , Demography , Endometrium/pathology , Female , Humans , Hysterectomy , Lymph Node Excision , Lymph Nodes/pathology , Middle Aged , Myometrium/pathology , Neoplasm Staging , Organ Size , Probability , Time Factors , Uterine Neoplasms/mortality , Uterine Neoplasms/pathology
9.
Cancer ; 47(10): 2430-2, 1981 May 15.
Article in English | MEDLINE | ID: mdl-7272897

ABSTRACT

A review of 1670 patients with endometrial cancer who were treated between 1952 and 1976 revealed that 15 patients had received radioactive colloidal gold as an adjunct to surgery. Most of the patients had follow-up more than ten years, and all had microscopic tumor contamination of the peritoneal cavity. Of the 15 patients, 13 had biopsy of peritoneal metastases and underwent resection of gross metastatic lesions that were more than 2 mm in diameter. The other two patients had direct extension of the tumor through the uterus into the peritoneal cavity without visible metastasis. The radiogold was inserted from 4-37 days after the initial surgical procedure. The dosage ranged from 100-140 mCi. At follow-up, from 11 years seven months to 24 years two months after treatment, seven patients were alive without evidence of disease. Three died of intercurrent disease, 16 years, and 14 years, and 14 years two months after treatment. Five patients died of cancer, two with local recurrence and three with distant metastases to lung or bone (or both).


Subject(s)
Gold Radioisotopes/therapeutic use , Uterine Neoplasms/radiotherapy , Adult , Aged , Brachytherapy , Female , Follow-Up Studies , Humans , Middle Aged , Neoplasm Staging , Radiotherapy Dosage , Uterine Neoplasms/surgery
12.
Med Pediatr Oncol ; 9(2): 119-20, 1981.
Article in English | MEDLINE | ID: mdl-7194964

ABSTRACT

Three patients with locally advanced head and neck squamous cell cancer received concomitant radiation therapy (XRT) and cis-diamminedichloroplatinum (CDDP). The dose of 6,000 rads was to be administered in two 3,000-rad courses separated by 3 weeks. The CDDP, 30 mg/m2, was to be given intravenously on days 2 and 12 of each half of XRT. We were especially concerned with the occurrence of an abscess in one patient and an abscess with hemorrhage in another. In addition, each patient experienced severe and intractable nausea, vomiting, and a pervasive feeling of ill-health which seemed out of proportion to that usually observed from either XRT or CDDP alone. If the findings in this pilot study are confirmed, the toxicity of XRT with concurrent CDDP as used in our study may well obviate routine clinical usage.


Subject(s)
Cisplatin/therapeutic use , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Aged , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/radiotherapy , Cisplatin/adverse effects , Humans , Male , Middle Aged
13.
Am J Obstet Gynecol ; 136(7): 872-88, 1980 Apr 01.
Article in English | MEDLINE | ID: mdl-7361835

ABSTRACT

During the 10-year period ending December, 1972, 577 patients with Stage I endometrial cancer received their primary treatment at the Mayo Clinic. The average age of the group was 60.8 years. The higher-grade lesions were found in older individuals. The data did not show that high grade was related to age at menopause. The initial therapy was total abdominal hysterectomy and bilateral salpingo-oophorectomy. The absolute survival at 5 years was 92.7% for Stage IAG1, 86.5% for IAG2, 68.2% for IAG3, 89.6% for IBG1, 76.4% for IBG2, and 62.9% for IBG3.


Subject(s)
Adenocarcinoma/surgery , Uterine Neoplasms/surgery , Adenocarcinoma/mortality , Adenocarcinoma/radiotherapy , Adult , Age Factors , Aged , Cesium Radioisotopes , Dilatation and Curettage , Estrogens/adverse effects , Female , Humans , Menopause , Middle Aged , Minnesota , Neoplasm Recurrence, Local , Neoplasms, Multiple Primary , Obesity/complications , Parity , Radium/therapeutic use , Risk , Uterine Neoplasms/mortality , Uterine Neoplasms/radiotherapy
14.
Mayo Clin Proc ; 53(4): 207-11, 1978 Apr.
Article in English | MEDLINE | ID: mdl-273132

ABSTRACT

Children with leukemia who have extremely high leukocyte counts (more than 100,000/mm3) when seen initially are at high risk of early sudden death, usually from massive intracerebral hemorrhage. Nine such patients were seen during a 39-month period. Eight had pronounced adenopathy and hepatosplenomegaly without severe anemia or thrombocytopenia. The first six patients died suddenly. Cerebral perivascular infiltration and increased blood viscosity are the probable pathophysiologic mechanisms. A treatment program was developed, the goal being the early elimination of blast cells. Three consecutive patients patients presenting with leukocyte counts greater than 100,000/mm3 were treated with emergency cranial irradiation, and all three survived to receive systemic chemotherapy.


Subject(s)
Leukemia/complications , Leukocytosis/complications , Acute Disease , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Leukemia/therapy , Leukemia, Lymphoid/complications , Leukemia, Myeloid/complications , Leukocytosis/therapy , Male
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