Catalytic effects of ruthenium and osmium spontaneous deposition on platinum surfaces toward methanol oxidation.

The influence of ruthenium and osmium spontaneous deposition on polycrystalline platinum in sulfuric acid was studied by conventional electrochemical techniques. The inhibition of the hydrogen adatom voltammetric profile by the foreign adatoms was used to calculate the degree of surface coverage of ruthenium, osmium, and a mixture of both metal ions from solutions of different composition. Methanol adsorption and oxidation were compared on bare platinum, platinum/ruthenium, platinum/osmium, and ternary compounds, considering the efficiency of methanol oxidation per hydrogen adatom displaced by the foreign metal on platinum.

Multimodality preoperative treatment for advanced stage IV (MO) cancer of the head and neck.

Sixty-three patients with advanced unresectable squamous cell carcinoma of the head and neck were treated with a combination of chemotherapy, radiation, and surgery. We observed a 75% response to neoadjuvant chemotherapy. The 5-year survival rate for all 63 patients was 20%, and only 3 patients were alive at 8 years. The 5-year survival rate for patients who completed the treatment plan and received chemotherapy, radiation, and surgery was 43% compared with 20% for those who had chemotherapy and radiation but refused surgery. Development of a second primary cancer was the cause of death in 62% of the patients who survived more than 24 months.

Impact of esophageal screening in patients with head and neck cancer.

We have reviewed the records of 1,982 patients who were treated for head and neck cancer or esophageal cancer from 1962 to 1986. Forty-one patients had primary cancer at both sites. Twenty-one cases of these multiple primaries occurred synchronously and twenty were metachronous. The overall incidence of esophageal cancer in our head- and neck-cancer patients was 2.5 per cent and the incidence of head and neck cancer in our esophageal cancer patients was 7.1 per cent. From 1980 to 1986, 574 cases with a diagnosis of head and neck or esophageal cancer were routinely screened for other aerodigestive malignancies at the time of initial diagnosis. From this group, only six patients had simultaneous lesions of the head and neck and esophagus with only one asymptomatic esophageal carcinoma. Median survival of all 41 multiple primary patients after diagnosis of esophageal cancer was 5.3 months. Two- and three-year survivals were 6.7 per cent and 0 per cent, respectively. There was no significant survival difference for lesions diagnosed simultaneously, synchronously, and metachronously before 1980 or after 1980. All patients died with uncontrolled esophageal cancer except for one patient who died of head- and neck-cancer recurrence. Our experience indicates that active screening of head- and neck-cancer patients for simultaneous esophageal cancer has a low yield and there appears to be no survival advantage for these patients compared with those with subsequently diagnosed esophageal tumors.

Use of the 90Sr applicator for intraoperative radiation therapy in a mouse tumor model.

Intraoperative radiation therapy (IORT) research is limited by the lack of small-animal models. We have implanted B16 melanoma into mouse kidneys, which we subsequently operated upon and irradiated with beta rays from a 90Sr ophthalmic applicator. The IORT has effectively prolonged survival and produced some cures. The strategy should be applicable to other murine tumors and to other internal implantation sites.

Management of squamous cell carcinoma of unknown origin in cervical lymph nodes.

Forty-three patients with the diagnosis of metastatic squamous cell carcinoma from unknown primary to the cervical lymph nodes were treated in EOVAMC between 1962-1982. Six of these patients were N1, 19 N2, and 18 N3. Five-year survival was 41 per cent for N1, 15 per cent for N2, and 6 per cent for N3 nodes. There was no significant difference in the treatment failure of those patients treated with unimodality versus multimodality. A subsequent primary was detected in the head and neck in 23 per cent of these patients (10/43), and eight of these patients had received previous radiotherapy. The most common site for these subsequent primaries was hypopharynx. Nine of the 43 patients developed distant metastasis with no correlation to stage of disease or treatment modality. These data show that the survival of these patients correlates with the stage of nodal disease, and that radiotherapy did not decrease the subsequent appearance of the primary lesions.

Cancer of the tonsil. Improved survival with combination therapy.

One hundred seventy-four cases of squamous cell cancer of the tonsil (SCCT) were reviewed. Radiation therapy (RT) alone was used in 81 patients, surgery alone (S) in 19 patients, preoperative RT + S in 49 patients, and chemotherapy [( C] methotrexate plus bleomycin plus cisplatin) in 25 patients. The 5-year survival was 83% in Stage I (n = 21), 72% in Stage II (n = 19), 23% in Stage III (n = 34), and 15% in Stage IV (n = 100). RT and S were equally effective in Stages I and II. In Stage III, the 5-year survival for RT + S was 31% versus 11% for RT alone; and in Stage IV, the respective 3- and 5-year survivals for RT + S were 24% and 15% versus 6% and 0%, respectively, for RT alone. There was an 84% response rate to C, and the patients who completed C + RT + S had 3- and 5-year survival rates of 41.7% and 32%, respectively. Our results indicate that RT + S appears to offer better survival in Stage III and IV SCCT. The high response rate in early survival data seen with C + RT + S suggests a promising role for this approach.

Advanced carcinoma of the nasopharynx. 2. Pattern of failure in 256 patients.

Of 256 patients with advanced carcinoma of the nasopharynx, 82% presented with Stage IV disease. The 5-year survival was 15% with 83% failing within 2 years. Prognosis was related to stage (p less than 0.03), neck status (p less than 0.03), initial performance status (p less than 0.001) and radiation dose (p less than 0.003). With no pathological neck glands (N0), less than 5% failed radiotherapy. Overall, 36% had distant metastases, correlating with the N Stage (p less than 0.001) but not with the T Stage. The most frequent site of metastasis was lung, then bone and liver. Radical neck dissection failed to increase tumor control, contributing to three fatal complications. New radiotherapeutic regimens have so far failed to substantially improve the results.

The incidence of metastases after multimodal therapy for cancer of the head and neck.

Combined therapeutic regimens integrating chemotherapy, radiation therapy, and surgery are reported to be effective in treating advanced squamous cell carcinomas of the head and neck. The current study evaluates 58 consecutive patients with advanced (T4, N3) head and neck cancers. Forty patients (multimodal group) were treated with 2 courses of chemotherapy (cisplatin 2 mg/kg; methotrexate 280-560 mg/m2 with leucovorin rescue; bleomycin 30 mu X 3) followed by radiation therapy and surgery. Eighteen patients (combined group) were treated with preoperative radiation therapy followed by surgery. In the multimodal group there were 27 (67.5%) partial responses and nine (22.5%) complete responses, for an overall response rate of 90%. Response rates by site of primary lesion were: oral cavity, 11 of 11; oropharynx, 13 of 17; hypopharynx, 5 of 5; and larynx 7 of 7. Distant metastases (skin, lung, bone, central nervous system [CNS]) appeared in 16 patients (40%) (P less than 0.05 versus combined) at a median time of 8.5 months after diagnosis, 15 in patients having a partial (11) or complete (4) response. Thirteen patients (33%) developed distant metastases within 1 year of diagnosis (P less than 0.05 versus combined). In 11 of these patients, the primary lesion and neck disease were resectable. Two thoracotomies were performed for solitary pulmonary metastases; one was resected for cure. Fifteen patients (38%) underwent curative resection; 11 (73%) were alive at 1 year, and ten (67%) were free of disease. Overall survival was 20 of 40 (50%) at 1 year. In the combined group, there were 14 partial responses (78%) and no complete responses. Early distant metastases appeared in two patients (12.5%), at 2 and 6 months after diagnosis. Seven patients (38%) underwent curative resection; six of seven (86%) were alive at 1 year, four of seven (57%) were disease-free. Six of 16 patients at risk (37.5%) survived 1 year. After combined therapy, six of ten patients (60%) with responses to therapy survived 1 year versus 12 of 20 responders (57%) without distant metastases in the multimodal group. It is concluded that multimodal therapy for advanced head and neck cancer results in a higher response rate than with conventional combined therapy. The incidence of early and postoperative distant metastases was increased after the multimodal regimen. At 1 year there were no differences in survival between the combined and multimodal groups for responders without early metastases. Further observation is needed to determine the net long-term effects of this regimen. A prospective randomized comparison of combined and multimodal therapy for advanced lesions is indicated.

Multimodality preoperative treatment for advanced cancer of the head and neck.

Neoadjuvant induction chemotherapy with cisplatin, methotrexate, and bleomycin appears to improve the results of treatment of advanced stage IV head and neck cancer, compared with results in historical control subjects. Patients treated with induction chemotherapy and radiation therapy had a 29 percent overall survival rate at 3 years, which represents approximately a twofold improvement in the survival rate. Patients who were treated with chemotherapy and radiation therapy followed by surgery had more than a threefold increase in the survival rate (49 percent at 3 years), compared with historical data from our institution and elsewhere for such patients [9-11]. Distant metastases developed in 25 percent of the patients, and it thus appears that long-term, effective consolidation and maintenance chemotherapy [12,13] need to be developed for patients who receive combination therapy before surgery for head and neck cancer.

Advanced carcinoma of the nasopharynx. A clinical study of 274 patients.

A total of 274 patients with a diagnosis of nasopharyngeal carcinoma was treated in eight Veterans Administration Hospitals over a period of 22 years. Of the 274 patients, 256 (93%) had squamous-cell carcinoma, while 18 (7%) had other tumors. Most of the squamous-cell carcinoma patients (82%) had Stage IV disease; cervical lymph node metastases were found in 193 (75%), and distant metastases were present in 22 (9%). The actuarial 5-, 10-, and 15-year survival rates for the 256 squamous-cell carcinoma patients were 15%, 10%, and 7%, while they were 49%, 42%, and 35% for the 18 patients with other tumors (p = 0.006). There was a progressive decrease in 5-year survival with the increase in the stage of tumor. The survival of the 63 patients without metastases was better than the survival of the 193 patients with cervical metastases (24% vs. 12% at 5 years, p = 0.03). The presence of T4 disease or Initial Performance Status of less than 80 on the Karnofsky Scale indicated a poor prognosis (p = 0.0001). Treatment failure occurred in 83% of the patients by 2 years after therapy and was due to the lack of tumor control at the primary site. Advanced (N3) cervical lymph node metastases indicated that systemic tumor dissemination of the nasopharynx is an uncommon malignancy.

Combined therapy in advanced squamous cell carcinoma of the head and neck.

The charts of 102 patients with stage IV squamous cell carcinoma of the head and neck, seen at the East Orange Veterans Administration Hospital between 1975 and 1979, were reviewed. Ninety-one of these patients were submitted to a protocol of high-dose preoperative radiotherapy, followed by surgery. Five-year actuarial survival in patients completing the protocol was 31.6 per cent. All patients who completed radiotherapy and were eligible for surgery, but refusing operation, died of their disease within three years. Historical controls for stage IV head and neck cancer have five-year survival rates of 0-16 per cent, depending on site. A recent review of the literature shows stage IV lesions treated with surgery alone have a five-year survival rate of 6 per cent.

A siting policy for an acceptable nuclear future.

A nuclear siting policy leading to a few, large concentrated sites, it is argued, is preferable in the long run to the present policy which could lead to many dispersed sites. Such a policy could be implemented incrementally if requirements for new nuclear generating capacity were met by adding reactors to the existing 100-odd sites. Such a concentrated nuclear siting policy would, to some extent, isolate nuclear activities while augmenting the strengths of the institutions responsible for managing them. Additionally, it would confer an element of permanence on the sites and thereby open new options fer managing low level wastes and reactor decommissioning. These actions may improve the public acceptability of nuclear energy in the United States as well as lead to a more rational contained nuclear system in the long run.

Malignant melanoma metastatic to the mandible.

Metastatic malignant melanoma to the jaws is uncommon and is usually accompanied by generalized involvement. Hematogenous dissemination with deposition and growth in areas of hematopoietic marrow (that is, the mandibular molar region) is the accepted mechanism for involvement of the jaw. Clinical and radiographic findings are nonspecific. Comprehensive history, physical examination, and tissue microscopy are essential to accurate diagnosis and management of the patient. Radiotherapy for palliation is the accepted mode of therapy for symptomatic metastatic melanoma. Prognosis in cases with secondary jaw involvement is grave. A case of malignant melanoma with metastases to the mandible is presented and the literature is reviewed.

Clinical report of the treatment of locally advanced lung cancer.

This paper discusses the results of the treatment of 345 patients entered in the Veterans Administration Lung Group Protocol 13L. The study was activated March 1972, and closed for the patient accesion March 1975. All patients had a histological diagnosis of primary lung cancer considered clinically non-resectable or inoperable. Patients were equally randomized into two groups, radiotherapy alone or radiotherapy with chemotherapy. The analysis of the data included: treatment regimen, radiation dose, initial performance status, performance status change, cell type, duration of survival, quality of survival and age. The strongest influence on median survival was the level of radiation dose. The small cell carcinoma patients treated with radiotherapy and chemotherapy showed significant improvement in the median survival (38.2 weeks) over the patients treated with radiotherapy alone (20.6 weeks). The patients treated with radiotherapy and chemotherapy also showed improvement in performance status more frequently than the patients treated with radiotherapy alone. Other parameters of the analysis will be presented.

Radiation-Induced Cardiomyopathy: II. An Electron Microscopic Study of Myocardial Microvasculature.

Sequential ultrastructural lesions of rabbit myocardial microvasculature after a single dose (1008 or 1300 rads) of local x-irradiation are described. Vascular permeability status was assessed through use of ferritin and colloidal carbon. Endothelial cell swelling and increased vascular permeability were the most conspicuous lesions during the first week following irradiation. Increased vascular permeability, as indicated by the observed ferritin and carbon distribution, appears to be a result of altered pinocytotic transport and widening of endothelial junctional gaps. These lesions, on day 14 and later, were followed by basement membrane thickening, endothelial cell extrusions and bleb formation, platelet sequestration, abnormal endothelial cell phagocytosis and appearance of myelin-like figures within the endothelial cells.