Extracorporeal whole body hyperthermia treatment of HIV patients, a feasibility study.

The literature supports that the retrovirus, Human Immunodeficiency Virus (HIV), which is thought to cause Acquired Immunodeficiency Syndrome (AIDS), is heat sensitive at temperatures which can be achieved in man. Invasive or non-invasive induction of whole body hyperthermia (WBH) has been used to treat an array of illnesses, primarily in the field of oncology, until recently. Non-invasive methods have proven to be less toxic than invasive means. However, new technology and refined patient management have shown a dramatic decrease in the side effects with extracorporeal whole body hyperthermia (EWBH). The Food and Drug Administration granted a prospective trial for six HIV positive/AIDS patients to undergo a single treatment of EWBH, with patients randomized to a core temperature of either 41 or 42 degrees C. All patients had failed antiretrovirals and experienced at least one episode of an opportunistic infection. Organetics, Ltd., PS-1 extracorporeal, centrifugal pump device was used to induce EWBH. Results of this feasibility study demonstrated the ability of this equipment and technique to induce EWBH with acceptable toxicity. It was not possible to assess efficacy in this small study.

Stage II adenocarcinoma of the endometrium treated by two standard regimens of combined preoperative irradiation and surgery.

We retrospectively analyzed 77 patients with stage II endometrial carcinoma treated with standard regimens of preoperative radiotherapy (RT) and surgery (S). The age range was 31-74 years with a median of 56.3 years. Thirty-three patients received 40 Gy whole pelvis RT followed by either radical or modified radical hysterectomy. Forty-four patients received 50 Gy whole pelvis RT and sequential intrauterine and intravaginal cesium-137 brachytherapy followed by a simple hysterectomy. Median follow-up was 111 months. No patient was lost to follow-up. The overall 5-year actuarial survival was 78%. There was no significant difference between the two treatment groups. Several prognostic variables were analyzed. Those with histologic grade I and II had 5-year survival of 89% and 83%, respectively, compared to 62% for grade III (P =0.045). The 5-year survival for microscopic cervical involvement was 87% compared to 59% for gross involvement (P= 0.008). Patients with negative or microscopic residual tumor in the surgical specimen and those with negative lymph nodes had less risk of treatment failure. Local failure occurred in only 9%. Major complications (3%) were seen only in the radical surgery group. Combined preoperative RT and S provide high cure rates with minimal complications for patients with stage II endometrial carcinoma. Patients with adverse prognostic factors are candidates for trials of more aggressive local and systemic therapy.

Pure seminoma arising in androgen insensitivity syndrome (testicular feminization syndrome): a case report and review of the literature.

This is a case of a young woman who had testicular feminization syndrome and developed a seminoma in an undescended intrapelvic testis. Androgen insensitivity (testicular feminization) syndrome is a rare inherited form of male pseudohermaphroditism that occurs in phenotypically normal women with adequate breast development, normal external genitalia, a vagina of variable depth, absent uterus, and sparse or absent pubic and axillary hair. The gonad (undescended testes) may be intraabdominal, inguinal, or labial. These patients characteristically have male karyotype (XY) and negative sex chromatin and are at increased risk of undergoing malignant transformation of the undescended gonad. We review the literature emphasizing the biochemical and endocrinologic abnormalities leading to the syndrome, as well as the morphologic abnormalities (light microscopic) of the undescended testes, diagnosis, and therapeutic management.

Electron beam therapy for skin cancer of the head and neck.

We retrospectively analyzed 99 patients with 115 sites of skin cancer, predominantly involving the head and neck, treated with electron beam therapy. Our objective was to determine the local control rate, radiotherapy reactions, cosmesis, and salvage treatment. Forty-three percent of patients received radiotherapy after biopsy, 41% were treated for recurrence following other modalities of treatment, and 16% had positive margins after surgical excision. With minimum and mean follow-up of 24 and 47 months, respectively, local control was achieved in 88% of patients. Six of 14 local recurrences were salvaged by surgery (five patients) and radiotherapy (one patient) for a total local control of 93%. Serial photographs and data were available to analyze cosmesis in 56 patients. Excellent or good cosmesis was achieved in 91%. Side effects were mild and self-limiting. EBT is highly efficacious and offers excellent cosmesis.

Radiotherapy T1 glottic carcinoma.

From 1970 to 1985, curative radiotherapy was administered to 63 patients with stage I carcinoma of the true vocal cords. Precision radiotherapeutic technique yields cure rates comparable to surgical results. Good voice quality was preserved in a high percentage of patients.

Early stage pure seminoma testis.

Forty-three patients with early stage pure seminoma of the testis were analyzed retrospectively. All patients were treated with orchiectomy and radiation therapy. Overall survival was 97.7 percent, with followup ranging from 4.3 to 17.4 years.