Initial chemotherapy followed by surgery in malignant thymoma.

Initial combination chemotherapy with cisplatinum, adriamycin and cyclophosphamide was given prior to surgery in a young woman with an unresectable malignant thymoma. Complete remission was achieved following three cycles of chemotherapy. Subsequent thymectomy revealed no evidence of residual malignancy. Prolonged remissions following cisplatin-based chemotherapy have recently been achieved in metastatic thymoma. Initial chemotherapy should now be considered prior to surgery or radiotherapy in those patients presenting with very bulky or unresectable disease.

Management of patients with advanced breast cancer.

Although patients with recurrent breast cancer are not curable with presently available treatments, the duration of survival after the development of metastases has increased to about three years. This has been due to optimal supportive care as well as the use of endocrine therapy, chemotherapy and radiotherapy for symptom control. With these methods quality of life can usually be maintained for much of this period.

Cisplatinum-based chemotherapy in malignant mediastinal teratoma.

Five patients with primary malignant mediastinal non-seminomatous germ cell tumours have been treated with a multimodality approach, including cisplatinum-containing chemotherapy, at this institution over the past 7 years. All patients had bulky disease (greater than 10 cm maximum diameter) at presentation and showed raised serum concentrations of human chorionic gonadotrophin or alpha-fetoprotein. Two patients are alive with no evidence of disease at 22 months and 6 years, respectively, from initial diagnosis; two patients have died from progressive disease and one from acute non-lymphocytic leukaemia without evidence of residual germ cell tumour. Long-term survival is achievable for these poor risk patients with a combined modality approach.

Prognostic factors in stage I and II high and intermediate grade non-Hodgkin's lymphoma.

Between 1975 and 1986, the Manchester Lymphoma Group treated 127 patients with localized (Stages I/II) high and intermediate grade non-Hodgkin's lymphoma (NHL) on one of three protocols of combined involved field radiotherapy and chemotherapy. The study included patients with widespread bulky abdominal disease providing there was no apparent spread outside the abdomen and the liver was not involved with metastatic disease. The median duration of follow-up was 70 months. The complete response rate was 86% and the overall 5-year survival was 70%. The 5-year relapse-free survival of the complete responders was 80%. Cox model multivariate analysis showed that bulk disease (greater than 5 cm), low serum albumin and gut involvement were the pretreatment factors associated with shorter survival. When remission status was included in the model the attainment of a complete response was the major determinant of long-term survival but bulk disease and gut involvement were still significant adverse predictors for survival. These factors need to be assessed when analysing results of therapy in NHL and in the design of future treatment strategies.

Chemotherapy of advanced head and neck cancer: updated results of a randomized trial of the order of administration of sequential methotrexate and 5-fluorouracil.

One hundred and twenty-seven patients with advanced or recurrent squamous cell carcinoma of the head and neck (HNC) were randomized to treatment with methotrexate (MTX) followed 1 hour later by 5-fluorouracil (5-FU) (sequence MF), or 5-fluorouracil followed after 1 hour by methotrexate (sequence FM). One hundred and seventeen patients were evaluable for response. There was no significant difference in response rates between the MF and FM sequences. Overall, 8 patients (6.8%) achieved complete response (CR) and 46 (39.3%) partial response (PR). In 95 previously untreated patients, the overall response rate (CR + PR) was 50%, compared with 31% for previously treated patients (P = 0.02). Survival duration significantly favored the FM sequence in univariate analyses (P = 0.04). Stepwise multivariate Cox model analysis showed that poor performance status (Eastern Cooperative Oncology Group) at study entry (P less than 0.001) and prior radiotherapy (P = 0.03) were significant adverse predictors for survival. When allowance was made for these factors, a survival difference in favor of the FM sequence remained (P = 0.003). Sequential MTX followed 1 hour later by 5-FU is not recommended for treatment of HNC.

Improved survival after brain metastases in non-seminomatous germ cell tumours with combined modality treatment.

Long-term disease-free survival (78 + and 31 + months) has been achieved in two of four patients treated for brain metastases from non-seminomatous germ cell tumours between 1980 and 1984. The incidence of cerebral metastases among 101 patients seen over the 5-year period was 4%. The encouraging results from the use of combined modality treatment, incorporating cisplatin-based chemotherapy, whole brain irradiation and surgery, are reviewed.

Prolonged survival with conventional cisplatinum/vinblastine/bleomycin therapy alone for mediastinal endodermal sinus tumour.

Combination chemotherapy with cisplatin, vinblastine, and bleomycin (PVB) is considered to be the best treatment for disseminated non-seminomatous germ cell tumours, with a 70% long term disease-free survival rate. For one subgroup of patients, those with primary mediastinal endodermal sinus tumours, results with PVB have been disappointing and more intensive regimens with major toxicity have recently been proposed. We report a patient who, following standard PVB chemotherapy, is one of the longest reported survivors of mediastinal endodermal sinus tumours. Optimal chemotherapy for endodermal sinus tumours is yet to be determined.