Hypothesis. The importance of a histological diagnosis when diagnosing and treating advanced cancer. Famous patient recovery may not have been from metastatic disease.

Over the past 33 years, mystery has surrounded the diagnosis and treatment of a very influential Australian patient. In the long gap between amputation of his leg for osteogenic sarcoma and successful treatment for widespread tuberculosis, he was told he had advanced and incurable metastatic sarcoma. Details of his recovery and the treatments used have been extensively described. An alternative hypothesis is advanced to explain his recovery. This hypothesis is advanced for two reasons. The first is to underline the modern recognition of the need to consider diagnostic investigations, including biopsy, before assigning the diagnosis of advanced cancer to any patient. This principle is especially vital in cases where two diseases can present in the same way. The second is that there a risk that if diseases are incorrectly labelled, incorrect treatments may be given. This can lead to misleading interpretations being made about non-traditional treatments providing 'cures', which can influence the decision-making of patients seeking answers and even lead them away from potentially curative traditional treatments.

Are guidelines on use of colony-stimulating factors in solid cancers flawed?

In cancer care in Australia, we are very reliant on an array of expensive pharmaceuticals. Our use of these treatments is often based on multinational or foreign clinical studies. Oncologists are, to varying degrees, reliant on how the studies are interpreted by the writers of journal editorials, clinical guidelines and opinion pieces. Therefore it is important that these guidelines are balanced and evidence based. We have examined in detail one of the most influential and wide ranging clinical guidelines used in oncology, The American Society of Clinical Oncology (ASCO) 2006 Update of Recommendations for the use of White Blood Cell Factors: An Evidence-Based Clinical Practice Guideline. We have discussed in detail some of the controversial recommendations in this guideline and have exposed what we believe are some flaws in these recommendations. We would urge that we continue to be rigorous in our oversight of international research agendas and international clinical guidelines in the future.

Larynx preservation with combined chemotherapy and radiation therapy in advanced but resectable head and neck cancer.

Forty patients with advanced, resectable squamous cell carcinoma of the larynx, oropharynx, or hypopharynx whose surgery would have required total laryngectomy (TL), were treated with one to three cycles of cisplatin-based chemotherapy before local therapy with the goal of larynx preservation. Clinical complete responses (CRs) or partial responses (PRs) to chemotherapy were seen in 26 of 40 patients (65%). Three patients with primary-site disease unresponsive to chemotherapy underwent resection of the primary lesion and neck dissection followed by radiation therapy (RT). Thirty-seven patients were referred after chemotherapy for RT +/- neck dissection. Thirty-one of 40 patient (78%) were rendered disease-free (no evidence of disease [NED]). With a median follow-up of 49 months (range, 31 to 76), the overall actuarial survival rate for the group was 58% at 2 years and 33% at 5 years. The failure-free survival rate was 42% and 33% at 2 and 5 years, respectively. Seven patients refused recommended TL throughout their course. This may have adversely affected survival results. A greater proportion of patients who achieved a CR or PR to chemotherapy remained disease-free compared with those who achieved less than a PR (P less than .001). Sixteen patients relapsed, 10 with locoregional disease. Six patients underwent TL, either for initial induction failure or at relapse, for an actual larynx-preservation rate of 34 of 40 patients (85%). If the seven patients who refused TL are included, the anticipated preservation rate is 27 of 40 patients (68%). Larynx preservation with combined chemotherapy and radiation is feasible and effective in patients with advanced, resectable squamous cell carcinoma of the head and neck (SCHN). This treatment approach requires a motivated patient, careful patient monitoring, and close interdisciplinary cooperation among oncologists.

A rare opportunity to observe aspects of the natural history of untreated Hodgkin's disease.

We report here a case of Hodgkin's disease that progressed untreated for almost four years by virtue of a delayed diagnosis before constitutional symptoms developed. Data that relate to series of untreated patients with Hodgkin's disease are reviewed and the possible role of pregnancy in accelerating the disease is discussed.

Recurrent dysgerminoma after 33 years.

Surgery with or without radiotherapy produces a high cure rate in localized pure dysgerminoma of the ovary. Recurrence rates are low, and usually occur within 2 years. We report the case of a 58-year-old para 1 who developed recurrent pure dysgerminoma 33 years after initial surgery. The need for long-term follow-up of these patients is emphasized.

Rhabdomyosarcoma in a patient treated for metastatic germ cell tumour of the testis containing teratoma--a case report.

A patient who developed a rhabdomyosarcoma following apparently successful chemotherapy for metastatic germ cell testicular carcinoma is presented. This newly recognized association may be seen particularly in patients whose initial germ cell malignancy contains immature teratoma. Possible reasons for this are discussed. The findings in this patient suggest that re-biopsy of recurrent disease be undertaken wherever possible, particularly where immature teratoma was a feature of the initial histopathology. A proportion of relapsing patients as described may not in fact have recurrent germ cell malignancy, but may have developed high grade, and often chemoresistant sarcomas. These second tumours appear to have an extremely poor prognosis, unless amenable to complete surgical resection.

Recurrent nasopharyngeal carcinoma--two long term disease-free remissions with non-cisplatinum based combination chemotherapy.

Two cases of locally recurrent nasopharyngeal carcinoma following maximal radiotherapy are presented. Both patients had complete resolution of disease with outpatient combination chemotherapy using Vincristine, Adriamycin and Cyclophosphamide (VAC), and are disease free, and working full time, 3 and 4 years later, respectively. The significant relapse rate of nasopharyngeal carcinoma after initial radiotherapy is outlined, and the reported limitations of radiotherapy and chemotherapy in this situation are discussed. The survival curve for this disease appears to plateau at 2-3 years. This appears to be the first reported outpatient combination chemotherapy programme to produce long term disease-free remission in recurrent disease.