Induction chemotherapy for advanced head and neck cancer: modification of response to chemotherapy by antiemetics.

Forty Stage IV head and neck cancer patients were entered on a multimodality trial of induction chemotherapy (cisplatin + infusional 5-fluorouracil), surgery, and radiation. During chemotherapy, the patients of Group A (the first 19 patients) were medicated with metoclopramide. The patients of Group B (the next 21 patients) were medicated with droperidol. The groups were comparable. The response rate (complete + partial) was 32% for Group A and 52% for Group B (p = 0.16). Primary site (p = 0.08) and surgical margin (p = 0.005) clearance of tumor were better in Group B. Nodal disease responded poorly to chemotherapy in both groups. Tumor necrosis (p = 0.006) and granulation tissue (p = 0.07) were reduced in surgical specimens after chemotherapy in Group B. The drugs were well tolerated with reversible toxicity; nausea/vomiting (p = 0.01) and weight loss (p = 0.07) after chemotherapy, were increased in Group B. The 2-year survival was 26% for Group A and 62% for Group B (p = 0.027). The median survival was 15 months for Group A and 33 months for Group B (p = 0.05). Progression-free survival improved in Group B (p greater than 0.17). These improvements in response and survival did not appear to reflect changes in surgical or radiotherapy management, but may have reflected an uninhibited effect of cisplatin in Group B. It is theorized that the metabisulfite formulated with metoclopramide altered the pharmacokinetics or pharmacodynamics of cisplatin. This resulted in the poor response to chemotherapy and poor survival in Group A. An analysis of a randomized trial comparing metoclopramide (formulated with metabisulfite) versus a control antiemetic can confirm the data presented in this pilot study. Overall, our patients survived as well as others in comparable multimodality studies in Europe and the United States.

Intrapulmonary thymoma.

A 50-year-old man presented with a lung mass in the left upper lobe, which was shown by electron microscopy to be a thymoma. There was no evidence of a mediastinal mass. The lymphocytes of the tumor reacted with monoclonal antibody T101, a pan T-cell marker, and with OKT8. B1 and B2 surface antigens characteristic of B lymphocytes were not detected. Tumors of thymic epithelial cells completely covered by pleura without mediastinal involvement are rare.

Granular cell tumor in black patients.

A 12-year review of granular cell tumors at Howard University Hospital is reported. Sixty-one cases were studied (56 patients). A female preponderance was clearly established and multicentricity of lesions constituted a higher percentage than previously reported in other series. Malignant transformation was not found. Electron microscopic studies tended to support the Schwann cell origin theory for the tumor but no conclusion could be drawn as to whether or not the lesion is neoplastic, degenerative, or metabolic in nature.

Congenital diverticula of the right ventricle of the heart: a case report.

The authors present a case of a rare cardiac anomaly, diverticula of the right ventricle, associated with a persistent truncus arteriosus. The literature is reviewed and the presence of systemic pressure at the level of the right ventricle is underlined.