Outcome of surgical versus medical treatment of dogs with beta cell neoplasia: 39 cases (1990-1997).

OBJECTIVE: To compare outcome of surgical versus medical treatment of dogs with beta cell neoplasia. DESIGN: Retrospective study. ANIMALS: 39 dogs with clinical signs of hypoglycemia and serum glucose and insulin concentrations consistent with a diagnosis of beta cell neoplasia. PROCEDURE: Information on signalment; clinical history; physical examination findings; results of CBC, serum biochemical analyses, and urinalysis; serum glucose and insulin concentrations; results of thoracic radiography and abdominal ultrasonography; treatment and treatment complications; survival time; and cause of death were obtained from medical records. RESULTS: 26 dogs underwent exploratory celiotomy and partial pancreatectomy; 13 dogs were treated medically (i.e., dietary change and prednisone). Median survival time was significantly longer for dogs treated surgically than for dogs treated medically. Significant differences were not found in mean age, body weight, duration of clinical signs prior to diagnosis, serum glucose and insulin concentration, or results of other serum biochemical tests between dogs treated surgically and dogs treated medically; also, there was no significant correlation between any of these parameters and survival time for either group of dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that exploratory celiotomy and partial pancreatectomy are indicated once a tentative diagnosis of beta cell neoplasia is established in dogs.

Preoperative irradiation for cancer of the rectum with extrarectal fixation.

Tumor mobility of rectal cancer is well known to have prognostic significance for operative resection, local recurrence, and survival. Between 1976-1988, 220 patients have been consecutively treated with high dose preoperative radiotherapy at Thomas Jefferson University Hospital. During this time period, 134 patients were clinically determined by the surgeon and radiotherapist to have extrarectal tumor fixation as a primary indication for preoperative irradiation and are the subject of this review. The patient population can be further divided into two subgroups which include 49 patients with clinical tethering/partial fixation, and 85 patients with completely fixed tumors. Patients were treated with 4-field pelvic radiotherapy to 45 Gy in 25 fractions. Depending on location and degree of fixation, a localized boost dose was frequently delivered to the tumor for an additional 4.8-9.6 Gy using opposed high-energy lateral fields. Surgical resection was instituted 4-6 weeks post completion of radiotherapy. Significant tumor regression permitted sphincter preserving surgery in 105/134 (78%) of these patients. With a median follow-up of 37 months, the overall 5-year actuarial survival for our postradiation Stage A/B1 patients was 92% (n = 28), and 63% for Stage B2/C patients (n = 91). Local recurrence occurred in only 7% of the Stage A/B1 patients, and 18% in the Stage B2/C patients. Analyzed by pre-treatment clinical evaluation, the 5-year actuarial survival of these patients was 68% and 60% in the clinically tethered and fixed tumor subgroups, respectively (p = .51). Pelvic control was demonstrated in 86% of the patients in the tethered subgroup, and in 80% of the preoperative fixed patients. The combined treatment was well tolerated, with complications limited to 6% of the patient population. We conclude that preoperative radiotherapy for rectal carcinomas with clinical extrarectal fixation provides optimal presurgical cytoreduction and excellent survival. Furthermore, sphincter function can be maintained in a majority of patients with appropriate attention to patient selection.

Wilms' tumor: reduced-dose radiotherapy in advanced-stage Wilms' tumor with favorable histology.

Fifty-two children with favorable histology Wilms' tumor who had residual abdominal disease (Surgical Stages III and IV) were treated from 1979 to 1988 on a protocol designed to assess the effectiveness of reduced radiation doses. All patients received three-agent chemotherapy, beginning within 1 week after surgery. To permit assessment of disease response to initial chemotherapy, radiation therapy was delayed for a median of 28 days after surgery (range, 14-71 days). Total doses of abdominal radiation were limited to 12 Gy, given as 150 cGy daily fractions; 18 patients with Stage IV disease received 12 Gy bilateral pulmonary irradiation. Two year disease-free survival was 85% and 71% for Stage III and IV, respectively (p = .24). Abdominal relapses occurred in 3 cases (5.7%). The interval between surgery and initiation of irradiation was not related to disease-free survival. Of several patient and disease-related factors analyzed, only patient age was related to outcome. Disease-free survival was 100% at 3 years for children under the age of 3 versus 78% for children greater than age 3 (p = .05). Reduced-dose abdominal radiotherapy in conjunction with multi-agent chemotherapy and surgery provided excellent disease control with minimal toxicity in advanced-stage, favorable histology Wilms' tumor.