Bilateral bronchial stenting and esophageal intubation for advanced bronchial carcinoma with esophageal invasion.

Successive bilateral bronchial stenting (Dumon type) and minimally invasive pull-through esophageal intubation for accompanying malignant bronchial and esophageal involvement was undertaken. External radiation and afterloading brachytherapy for localized endobronchial overgrowth was used. A 13-month survival was achieved using mainly out-patient facilities. During such esophageal intubation, bronchoscopic control is mandatory. Extended complex palliation was obtained using this combined treatment, even in the high-risk stage of advanced tracheobronchial carcinoma with associated esophageal stricture.

The efficacy of a combination of etoposide, ifosfamide, and cisplatin in the treatment of patients with soft tissue sarcoma.

BACKGROUND: Successful chemotherapy for patients with soft tissue sarcoma (STS) has been limited by a lack of active drugs. The most effective single agents are doxorubicin, dacarbazine, and, more recently, ifosfamide. Previously the most widely used combination has been CYVADIC (cyclophosphamide, vincristine, doxorubicin, and dacarbazine). In one randomized trial, ifosfamide was superior to cyclophosphamide; two nonrandomized studies also reported favorable results. Etoposide monotherapy was successful in 8%; the effectiveness of cisplatin was 5-23%. In view of these findings, the authors treated STS patients with an etoposide, cisplatin, and ifosfamide (VIP) combination. METHODS: The eligibility criteria included histologically confirmed, inoperable, metastatic or locally recurrent STS; a World Health Organization (WHO) performance status of 0-2; a maximum age of 75 years; and progressive, measurable disease. A total of 104 patients were treated from January 1990 to June 1997. The median age of the patients was 42.4 years. The patients were treated with a combination of etoposide (100mg/m(2) for 5 days), ifosfamide (2000 mg/m(2) for 2 days), and cisplatin (20mg/m(2) for 5 days) once a month via a peripheral vein. The treatment response and the toxicity were assessed according to WHO criteria. RESULTS: Of 104 evaluable patients, 47 responded. The overall response rate was 46% (complete response: 10%; partial response: 36%). In 43 patients the disease remained stable (41%). Remission duration was 4.6 months. Toxicity was moderate. The main adverse events were alopecia (100%), nausea and vomiting (73%), and leukopenia (29%). CONCLUSIONS: This new combination is promising for the treatment of patients with advanced STS.

[Multiple endocrine neoplasia-type medullary thyroid carcinoma in three generations of a family]. / Multiplex endokrin neoplasia típusú medullaris pajzsmirigy-carcinoma egy család három generációjában.

The familial accumulation of a multiple endocrine neoplasia (MEN) type 2a medullary thyroid carcinoma, is described based on the retrospective analysis of a family history. The proband was characterized by medullary carcinoma (MC) combined with phaeochromocytoma, her child had been shown to suffer from MC. In the third generation of the family C-cell hyperplasia and bilateral adrenal hyperplasia occurred. It is shown that in order to arrive at a correct decision as regards the therapy to be used, modern laboratory tests (serum calcitonin, CEA-analysis) and diagnostic imaging methods (ultrasound, computer tomography, magnetic resonance imaging, positron emission tomography, metaiodobenzylguanidine scintigraphy) should be used. It is emphasized that the available therapeutic means (surgery, radiotherapy, nuclear medicine) have to be carefully selected and, if necessary, combined. In medullary thyroid carcinoma associated tumours in other endocrine organs should be expected to occur. Family screening using blood chemical and genetic tests are recommended in asymptomatic cases, since their surgical treatment can in this way lead to complete recovery.

[Merkel cell tumor]. / Merkel-sejtes daganat.

Merkel cell cancer is a rare carcinoma arising from the neuroendocrin cells of the skin. The diagnosis is based on the clinical behaviour, histopathologic and ultrastructural findings and immunohistochemical results. An unusual case of Merkel cell carcinoma is presented. Mass from the umbiculus and a right inguinal lymph node was excised in a 63-year-old female. The histologic features of a typical, primitive small cell tumor combined with the immunohistochemical evaluations established the diagnosis. Rare polynuclear giant cells were focally present in our case. Patient was treated with combination of chemotherapy (Cisplatin, Etoposid) and radiotherapy. Control examinations showed complete respond. One year later metastasis developed. Resection of all known metastasis were performed. Two months after the laparotomy she died of metastatic disease. The autopsy did not reveal any other primary tumor. The capricious nature of the clinical course and the differences between this tumor and other carcinomas is emphasized.

[Spinal metastasis from ovarian granulosa cell tumor--after 23 years]. / Granulosasejtes ováriumtumor spinális metastasisa--23 év után.

On admission, the 63-year-old patient suffered from spinal chord compression at the level of D. IV. vertebra. 23 years earlier she had undergone a total uterus exstirpation for ovarian tumor, with bilateral adnexectomy. The microcellular granular cell tumor potentially regarded as malignant, gave a spinal metastasis after 23 years of "dormancy". Half a year after the second spinal surgery, the growth again reached compression-size, requiring reoperation. On discussing the case, the authors also deal with the clinical signs of ovarian tumors as well as their prognosis and treatment modalities.

[The brachytherapy of carcinoma of the external auditory canal]. / Die Brachytherapie des äusseren Gehörgangskarzinoms.

Brachytherapy is advantageous in the initial carcinomas of external auditory canal. The radiation charge of the surrounding tissues is much lower in spite of millivoltage irradiation because of its higher dosage gradient. It is stated according to the recent experiences and results on seven treated patients, that with LDR treatment of 5 x 10 Gy on consecutive days and with HDR treatment of 6 x 6 Gy on weekly interruptions (in both cases the dose means a depth of 5 mm). It is impossible to give the analysis because of the small number of cases. On base of our own patients it could be proved that lasting recovery of bone involving tumours is due to radical surgery and postoperative millivoltage irradiation.

[Laryngo-pharygo-esophagectomy in the surgical excision of multicentric esophageal-laryngeal cancer]. / Laryngo-pharyngo-oesophagectomia multicentricus megjelenésü nyelöcsö-gégerák sebészi eltávolítására.

The occurrence of esophageal cancer and lethality show rising tendency in Hungary. Despite of the improving operative technique and decreasing rate of mortality in the hospitals the late survival is low. The main cause of this fact is the late recognition of the esophageal tumors in the majority of the cases. In the patient material of the authors 80% of the cases were in stage III-IV and were from oncological viewpoint practically inoperable tumors. The sad late results may be due also to the lack of a uniform consideration concerning the complex therapy of the esophageal cancer (surgical + cytostatic and/or radiotherapy). A case is presented where the surgical and radiological treatment brought success. The location of the tumor was unusual and the applied surgical technique is new in the Hungarian literature.