Implications of therapy choice on overall survival in metastatic renal cell carcinoma: a single institution experience.

PURPOSE: To compare the effect of high-dose interleukin-2 (HD IL-2) vs other cytokine therapies on 1-, 2, and 5-yr overall survival in patients with metastatic renal cell cancer (RCC). PATIENTS AND METHODS: We conducted a retrospective chart review of patients with untreated metastatic RCC treated by a single investigator. The different treatment groups included HD IL-2, low-dose IL-2 alone or in combination, interferon alpha alone and other therapies. The primary end point was survival from time of treatment. RESULTS: A total of 85 patients were studies with a median follow up of 13 mo (0.6-112.9). Median age at treatment was 59 yr with predominantly male patients and histology of clear cell type. Thirty-four percent received HD IL-2 and treatment was initiated less than 6 mo from the time of diagnosis in 66%. For all patients, median survival was 16 mo with a 5-yr survival of 12%. Two factors were good predictors of overall survival: Karnofsky performance status (KPS) of 100 (p < 0.0001) and soft tissue metastasis (p = 0.01). When comparing HD IL-2 to all other groups, median survival was 18 vs 14 mo and 1-yr survival was 74% vs 51%, respectively. CONCLUSION: HD IL-2 is associated with clinically meaningful improvement in median and 1-yr survival.

Neuronal ubiquitinated intranuclear inclusions in familial and non-familial frontotemporal dementia of the motor neuron disease type associated with amyotrophic lateral sclerosis.

Ubiquitinated cytoplasmic inclusions (Ub-CIs) in superficial frontal cortex and dentate gyrus neurons are the hallmark of frontotemporal degeneration of the motor neuron disease-type (FTD-MND-type). To date, 2 reports have described intranuclear ubiquitinated inclusions (Ub-INIs) in 9 cases of familial FTD-MND-type (without clinical or pathologic motor neuron disease, MND). In the current study we found an additional 11 cases with Ub-INIs. We have identified for the first time among these cases 2 with a negative family history and 3 that have concomitant amyotrophic lateral sclerosis (ALS). The results of the present study i) confirm a previous report of significantly lower average brain weight and longer duration in cases with Ub-INIs, ii) reveal significantly greater striatal neuronal loss and gliosis in cases with intranuclear inclusions, and iii) demonstrate that intranuclear inclusions correlate with cytoplasmic inclusions and dystrophic neurites in frontal cortex and striatum but not in dentate gyrus. In addition, the current study confirms that Ub-INIs are found in familial FTD-MND-type, but also extends the presence of Ub-INIs to familial FTD-MND (with concomitant ALS), and probably also to non-familial FTD-MND-type.

Comparison of selective retinoic acid receptor- and retinoic X receptor-mediated efficacy, tolerance, and survival in cutaneous t-cell lymphoma.

Primary cutaneous T-cell lymphomas are non-Hodgkin's lymphomas with varied clinical presentation and prognosis. The most common subtypes of cutaneous T-cell lymphomas are the epidermotropic variants mycosis fungoides and Sézary syndrome. Treatment of mycosis fungoides has encompassed a variety of modalities including the use of retinoids with several studies evaluating their efficacy. The reported benefits and duration of response have varied in published data. The biological effect of retinoids is mediated by specific receptor families, retinoic acid receptor (RAR) and retinoic X receptor (RXR), with subsequently altered gene expression. There are no data available on cutaneous T-cell lymphomas that compare RAR and RXR retinoids. The objective of our retrospective, nonrandomized, single-center study was to compare the response, survival outcomes, and toxic effects in our phase II trial of the RAR-specific retinoid, all-trans retinoic acid, with clinical use of the RXR-specific retinoid, bexarotene, in patients with mycosis fungoides/Sézary syndrome who have relapsed. There was no statistical difference in response rates (12% vs 21%), response duration (20.5 vs 7.3 months), event-free survival time (4 vs 5 months), or median survival when corrected for length of follow-up. Both have favorable toxicity profiles that can be managed with medications. The toxicity profile caused by bexarotene seems to be more limited to laboratory values and better tolerated, although generally associated with more severe grades of toxicity. In conclusion, both retinoids have modest objective response rates and, therefore, most likely will have limited impact as monotherapeutic agents. However, the immunomodulatory effects of RAR and RXR retinoids provide a rational basis for using retinoids in combination with other biologic immune response modifiers, phototherapy, or cytotoxic chemotherapy.

Predictive formula for calculating the probability of LASIK enhancement.

PURPOSE: To develop a formula to predict a patient's need for laser in situ keratomileusis (LASIK) enhancement. SETTING: Northwestern Laser Vision Center, Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. METHODS: In this retrospective study, charts of patients who received LASIK with the Visx Star excimer laser for myopia and myopic astigmatism were reviewed. Laser in situ keratomileusis enhancement was performed in 130 of 720 eyes. Variables such as age, keratometry, spherical power, power and axis of astigmatism, and surgeon factor were compared in patients who required retreatment and those who did not. Multivariate logistic regression analysis was used to determine a formula for the probability of enhancement surgery. RESULTS: Age (P<.0001), preoperative cycloplegic sphere (P<.0001), and surgeon (P<.0001) were the statistically significant factors for predicting retreatment. The predictive formula derived from these factors had a sensitivity of 79%, a specificity of 61%, and positive and negative predictive values of 31% and 93%, respectively. CONCLUSIONS: Older age, higher preoperative cycloplegic sphere, and surgeon significantly influenced a patient's likelihood for LASIK retreatment. A formula based on these predisposing factors helps to more accurately predict the need for retreatment.

The effect of ipsilateral whole breast ultrasonography on the surgical management of breast carcinoma.

BACKGROUND: Patients can be selected for breast conservation therapy using mammography and physical examination. Whole breast ultrasonography has been shown to identify lesions not seen on mammography. This study sought to determine how often whole breast ultrasonography changes the surgical management of breast cancer. METHODS: All patients with stage 1 and 2 breast cancer undergoing whole breast ultrasonography were identified. A change in surgical management was defined as the identification by ultrasonography alone of foci of carcinoma greater than 1 cm from the primary tumor site or in another quadrant of the breast. RESULTS: There were 1385 breast cancer patients; 31% had ultrasonography. Eighteen percent of patients had abnormalities identified by ultrasonography alone. Changes in management occurred in 2.8%. The additional lesions led to four wider resections and eight mastectomies. Patients with ultrasonography abnormalities were significantly younger, and more likely to have histologic grade 2 or 3 disease. CONCLUSIONS: These findings do not support the routine use of ultrasonography in all breast cancer patients. Significant abnormalities were more commonly seen among younger patients with higher grade lesions.