Courses Of Multiagent Chemotherapy Research Articles

Multicenter Pilot Trial of Intrathecal Liposomal Cytarabine Combined with FAB Chemoimmunotherapy with Reduced Doxorubicin in CAYA with Mature De-Novo B-NHL

Background: Children, adolescents, and young adults (C-AYA) with newly diagnosed advanced Mature B Non-Hodgkin Lymphoma (MB-NHL), specifically Burkitt Lymphoma (BL) and Diffuse Large B Cell Lymphoma (DLBCL), have achieved ≥ 90% overall survival with multi-agent chemotherapy and intrathecal chemotherapy (IT) without central nervous system (CNS) radiation (Cairo et al., Blood 2007; Goldman/Cairo et al., BJH 2014; Frazier/Cairo, et al., BJH 2014; Minard-Colin, et al., NEJM 2020). Standard therapy includes short but intensive courses of multiagent chemotherapy including CNS-penetrating high dose methotrexate and cytarabine for CNS penetration as well as vincristine, prednisone, doxorubicin, and cyclophosphamide with or without etoposide. Patients also receive 9, 10 and 13 IT doses of intrathecal chemotherapy when treated according to FAB Group B, FAB Group C (CNS -) and FAB Group C (CNS +) protocols, respectively. While this approach has effectively eliminated need for CNS radiation for disease control, the need for sedation of patients during these procedures results in the need for repeated episodes of patient fasting, increased healthcare costs, and most importantly, general anesthesia is associated with long-term late effects in cognitive development (Banerjee et al., JAMA Oncol, 2019). Liposomal cytarabine (LC) is a formulation of cytarabine encapsulated in spherical multivesicular, biodegradable particles known as DepoCyt® which has a maximum-tolerated intrathecal dose of 35 mg in patients between the ages of 3 and 21 years (Bomgaars et al., JCO, 2004). This liposomal formulation has a half-life of 100-263 hours compared with only 3.4 hours of standard cytarabine. As an s-phase specific agent, prolonged exposure may increase its efficacy in controlling CNS disease while decreasing the total number of intraventricular doses required for treatment. Objective: To determine the safety and efficacy of reduction of IT therapy and substitution of LC within modified FAB group B and C backbones of systemic immunochemotherapy. Methods: LC was incorporated into the multiagent chemotherapy regimen in a unique manner to mitigate the risk of possible CNS toxicity. A total of 2 doses of LC were administered as part of the prophylaxis IT therapy for Group B and CNS negative group C patients. A total of 4 doses of LC were administered as part of the treatment of Group C CNS + patients (Table 1). The LC was given only in phases of therapy in which no systemic cytarabine was administered. When Methotrexate was given, the LC was only given after clearance. Dexamethasone replaced prednisone for all patients to mitigate potential CNS toxicities from LC. Results: This trial enrolled 33 patients with newly diagnosed MB-NHL (25 Group B, 8 Group C with 7 CNS+). Median age was 12 (Range 3-25). Males comprised 64% of patients and 52% had Burkitt Lymphoma/Leukemia. The CNS was involved in 21% of patients, and a total of 78 doses of LC was given. Twenty-six patients received 2 prophylactic doses (25 Group B and 1 Group C CNS negative). Six of seven CNS + patients received all 4 planned doses of LC. The median days from the start of the induction cycles until LC administration (post methotrexate clearance) was 3 days. Of the 33 patients, only 1 (3%) had a transient Grade 3 adverse event (facial nerve palsy). With dexamethasone prophylaxis, there were minimal adverse events and no toxic deaths reported. There were no other serious adverse events, such as seizure, headaches, nausea, vomiting, fever, somnolence, confusion, or asthenia that have been previously reported. The 2-year EFS and OS of LC when added to an FAB backbone for MB-NHL, was 94.5% and 97.2%, respectively (Figure 1). Conclusions: By utilizing dexamethasone prophylaxis and waiting for systemic methotrexate clearance, we were able to demonstrate that IT LC in C-AYAs with MB-NHL who received FAB chemoimmunotherapy with HD MTX was feasible, safe, and did not compromise event free and overall survival. We were also able to reduce the total number of IT injections without apparent compromise to CNS prophylaxis and treatment.

Timing of Surgery and Pathologic Complete Response (pCR) after Completing Total Neoadjuvant Therapy for Rectal Adenocarcinoma: A Retrospective Study of the National Cancer Database

Total neoadjuvant therapy (TNT) is a treatment strategy for rectal cancer that includes a course of multiagent chemotherapy and a separate course of radiation +/- concurrent chemotherapy before definitive surgery. The use of TNT has increased in recent years and carries the potential for improved sphincter preservation and a significant risk reduction of locoregional recurrence. However, the influence of rest period from end of radiation to surgery after TNT is unclear. The objective of this study was to evaluate the relationship between rest period and pCR using data from the National Cancer Database. We hypothesized that longer duration of rest period before surgery will be positively associated with pCR. Patients aged 18 years and older diagnosed with primary rectal cancer between 2016 and 2020, who underwent an NCCN-recommended TNT regimen followed by definitive surgery at a Commission on Cancer-accredited facility were retrospectively analyzed in the current study. We included 5,997 patients who met the following inclusion criteria: clinical stage T2 and above, any N stage, M0, adenocarcinoma histology, and not receiving any adjuvant therapy. Logistic regression methods were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between duration of rest period and pCR. Restricted cubic splines were used to evaluate potential non-linear relationship between duration of rest period and pCR. The median age of the study sample was 57 years old (interquartile range: 49 - 65), with majority of them being males (62.3%) and reporting Non-Hispanic White race and ethnicity (75.5%). The overall pCR rate was 18.6%. The majority received long-course radiation (76.7%) and induction chemotherapy (86.3%). In multivariable adjusted models, there was a non-linear relationship between duration of rest period and pCR (p = 0.036). Rest periods of 8-24 weeks were significantly associated with elevated odds of pCR with the odds highest at 14 weeks (OR = 2.86, 95% CI: 1.20 - 6.84) when compared to rest periods of less than a week. There was no difference in pCR between long-course vs. short course radiation and no difference between those who received induction chemotherapy vs. consolidative chemotherapy. Although the rest period is inherently longer when radiation therapy precedes consolidative chemotherapy, the order of chemotherapy to radiation itself did not impact pCR but rather the duration of rest period. These data demonstrate an ideal window for surgery to achieve pCR in rectal cancer in the TNT era and the need for further prospective investigations of optimal rest period before surgery to achieve maximal pCR with homogenous TNT treatment regimens.

Atrial fibrillation in a patient with lung cancer: a case report

Introduction. Cancer remains one of the most common causes of death in the world, second only to cardiovascular diseases. The use of novel chemotherapeutic and targeted agents has significantly improved the prognosis of this group of patients. However, this significantly increased the number of cardiotoxic complications of anticancer therapy, including arrhythmias, in particular atrial fibrillation (AF), which negatively affects the prognosis.Brief description. The purpose of this article was to describe the case of a 64-yearold woman with central right lung lower lobe cancer. Upon admission to the chemotherapy department, the patient was first diagnosed with paroxysmal AF. After chemical cardioversion, the first course of multiagent chemotherapy (MAC) was performed as follows: paclitaxel 280 mg and carboplatin 450 mg, which was complicated by the development of recurrent AF episode. During subsequent MAC courses, arrhythmia episodes regularly occurred. During the next AF episode, the patient was hospitalized at the City Clinical Hospital № 51, where she died despite intensive therapy. Postmortem examination ruled out tumor invasion into the left atrium.Discussion. For the AF development, the patient had prerequisites in the form of a significantly remodeled left atrial myocardium. Chemotherapy agents used as antitumor therapy are characterized by the common development of cardiotoxicity, including variety of arrhythmias. The occurrence of AF episodes coincided with the course of MAC, which suggested its cardiotoxic manifestations. Postmortem examination confirmed the high probability of an association between AF episodes and MAC.Conclusion. The presented case illustrates the difficulties encountered by oncologists and cardiologists in determining the genesis and treatment of complex arrhythmias in cancer patients.

Early echocardiographic alterations in cancer patients during chemotherapy

Aim. To evaluate the early manifestation of cardiotoxicity after the first course of multiagent chemotherapy (MAC) using echocardiography with an assessment of the left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS).Material and methods. The study included 49 cancer patients with elective MAC.Results. After the first administration of a therapeutic dose of chemotherapy, a decrease in LVEF ≥10 and GLS >15 was demonstrated in more than 6,1% of patients, as well as a subclinical decrease in LVEF ≥5% in 22,4% and a decrease in GLS ≥12% in 24,5%.Conclusion. In cancer patients, after the first course of chemotherapy, GLS dynamics should be assessed during echocardiography as a marker of myocardial dysfunction.

Choriocarcinoma with spinal metastasis: a case report

Choriocarcinoma is a highly malignant trophoblastic neoplasia, arising following any type of pregnancy. Even though choriocarcinoma has an early haematogenous metastasis to multiple organs, spinal metastasis is extremely rare. A 28-year-old woman presented with a two-week history of progressive numbness and weakness of the lower limbs and difficulty in walking. In magnetic resonance imaging of the spine, soft tissue components were noted adjacent to the spinal cord. She underwent laminectomy to remove the extramedullary located tumour mass, which was compressing the spinal cord. Although there was a significant improvement in tactile stimulation in the lower limb following six courses of multi-agent chemotherapy, she continued to have leg weakness. Despite improvements in treatment modality and the use of combined modality treatment with chemotherapy, surgery, and radiation, the prognosis for this choriocarcinoma with spinal metastasis is unfavourable. Earlier diagnosis and multimodality treatment is crucial for a significant reduction in mortality and morbidity.

Efficacy of High-Dose Chemotherapy and Three-Dimensional Conformal Radiation for Atypical Teratoid/Rhabdoid Tumor: A Report From the Children's Oncology Group Trial ACNS0333.

Atypical teratoid/rhabdoid tumor (AT/RT) is an aggressive, early-childhood brain tumor without standard effective treatment. To our knowledge, we conducted the first AT/RT-specific cooperative group trial, ACNS0333, to examine the efficacy and safety of intensive postoperative chemotherapy and focal radiation to treat AT/RT. Patients from birth to 22 years of age with AT/RT were eligible. After surgery, they received 2 courses of multiagent chemotherapy, followed by 3 courses of high-dose chemotherapy with peripheral blood stem cell rescue and involved-field radiation therapy. Timing of radiation was based on patient age and disease location and extent. Central testing of tumor and blood for SMARCB1 status was mandated. Tumor molecular subclassification was performed retrospectively. The primary analysis was event-free survival (EFS) for patients < 36 months of age compared with a cooperative groups' historical cohort. Although accrual was based on the therapeutic question, potential prognostic factors, including age, tumor location, M stage, surgical resection, order of therapy, germline status, and molecular subtype, were explored. Of 65 evaluable patients, 54 were < 36 months of age. ACNS0333 therapy significantly reduced the risk of EFS events in patients < 36 months of age compared with the historical cohort (P < .0005; hazard rate, 0.43; 95% CI, 0.28 to 0.66). Four-year EFS and overall survival for the entire cohort were 37% (95% CI, 25% to 49%) and 43% (95% CI, 31% to 55%), respectively. Timing of radiation did not affect survival, and 91% of relapses occurred by 2 years from enrollment. Treatment-related deaths occurred in 4 patients. The ACNS0333 regimen dramatically improved survival compared with historical therapies for patients with AT/RT. Clinical characteristics and molecular subgrouping suggest prognostic differences. ACNS0333 results lay a foundation on which to build future studies and incorporate testing of new therapeutic agents.

Recurrent biphasic pulmonary blastoma in a young patient: a case report

Background: Biphasic pulmonary blastoma (BPB) is an uncommon and aggressive malignancy of the lung. Herein, we report a recurrent BPB in a young patient. Case Presentation: A 26-year-old female patient presented with respiratory distress and cough. Radiological workup illustrated well-circumscribed mass lesion (size ~ 6 cm) in the lateral basal segment of the lower lobe of the right lung, for which the patient underwent lobectomy. Histopathology revealed BPB. The patient was kept on close follow-up without any oncological intervention and remained disease-free for 3 years. Afterward, the patient presented with recurrent disease (i.e., a pulmonary oval nodule of size ~ 1.4 ×1.2 cm) and metastasis in the right renal region with infiltration into the right T12-LV1 and LV2 vertebrae. The patient was given three courses of multi-agent chemotherapy (i.e., ifosfamide, carboplatin, and etoposide), which resolved the pulmonary lesion only. Conclusion: Ultimately, our study indicates that BPB is an aggressive disease and demands multimodality treatment toward favorable prognosis.s.

A case of long-term survival of metastatic desmoplastic small round cell tumor treated with multimodal therapy

Desmoplastic small round cell tumor (DSRCT) is a rare, aggressive and malignant tumor that predominantly affects young males. No standard therapy is currently available for patients with DSRCT and the prognosis remains extremely poor. In this study, we report a thought-provoking DSRCT case. A 24-year-old male was admitted to our hospital with a chief complaint of hematemesis. Computed tomography revealed a retrovesical mass with a splenic hilar tumor, multiple lung and liver tumors and marked lymph node swellings. The source of hematemesis was gastric varices caused by the compression of the splenic vein by a splenic hilar tumor. The patient was provided with a histological diagnosis of DSRCT based on needle biopsy from the liver tumors and the pelvic mass was thought to be the primary lesion. This is a long-term survival case of metastatic DSRCT treated with multimodal therapy including 15 courses of multiagent chemotherapy, radiation therapy for the hepatic portal region using 42.5 Gy, and four instances of therapeutic endoscopy. The prolonged progression-free survival period (15 months) obtained following chemotherapy suggests the chemosensitive feature of the disease. We used a modified P6 regimen (cyclophosphamide, pirarubicin, vincristine, ifosfamide and etoposide) and a modified PAVEP regimen (cyclophosphamide, pirarubicin, etoposide and cisplatin) to decrease severe adverse events and to improve the completion rate of chemotherapy. DSRCT is an aggressive but chemo-sensitive disease, and continuous chemotherapy using an appropriate regimen with possible supportive care is essential for long-term survival. This case report may represent a treatment option for this rare disease.

Sonographic appearance of gestational trophoblastic disease evolving into epithelioid trophoblastic tumor

Epithelioid trophoblastic tumor is a distinctive but rare trophoblastic tumor. It derives from intermediate trophoblastic cells of the chorion laeve and is usually associated with a previous gestational event. We report the case of a patient who had undergone dilatation and curettage for a missed miscarriage. Three months later gestational trophoblastic disease was suspected because of persistent vaginal bleeding and high levels of beta-human chorionic gonadotropin (beta-hCG). Transvaginal ultrasound revealed irregular echolucent lacunae within the myometrium, some of them filled with low-resistance, turbulent blood flow on Doppler examination, emphasizing the diagnosis of gestational trophoblastic disease. The patient was treated with 12 courses of multiagent chemotherapy. After a 2-year remission, a low rise in serum beta-hCG was observed. Transvaginal ultrasound revealed a well-circumscribed echogenic lesion with a diameter of 1.8 cm in the uterine fundus, with no detectable blood flow on Doppler imaging. A diagnosis of tumor of intermediate trophoblastic cells was suspected and total hysterectomy was performed. On pathological examination, the histological and immunohistochemical features were characteristic of epithelioid trophoblastic tumor. Most reported cases of epithelioid trophoblastic tumor have solitary nodules with sharp margins, which is consistent with our ultrasound findings. Ultrasound may be helpful in differentiating epithelioid trophoblastic tumor from placental-site trophoblastic tumor, another tumor of intermediate trophoblastic cells, which shows infiltrative growth insinuating between muscle fibers.

A case of ATLL (adult T-cell leukemia/lymphoma) mimicking odontogenic infection

A case of adult T-cell leukemia/lymphoma (ATLL) in which cheek swelling was the initial symptom is presented. A 44-year-old man referred to our hospital with swelling in his right cheek, and a dental infection was suspected by a previous physician. Computerized tomographic scans and magnetic resonance imaging revealed tumorous lesions from the right alveolus of the maxilla to the anterior and posterior walls of the maxillary sinus. Anti-HTLV-1 antibodies were positive, and the level of sIL-2R was high; other laboratory test results were normal., based on immunohistochemical results on a specimen biopsy, the patient was diagnosed with a lymphoma-type ATLL. Immediately, the patient was treated in the department of hematologic medicine. After several courses of multiagent chemotherapy, 27 Gy radiation therapy was directed to the maxilla. However, remission was not achieved. Cord blood transplantation was subsequently performed, but his general condition gradually worsened until he died 7 months after his initial visit.

Oxaliplatin-induced immune mediated thrombocytopenia

Oxaliplatin is a third generation platinum compound used in patients with advanced colorectal carcinoma. Recently, the mechanism of a rare drug-induced immune thrombocytopenia in patients receiving oxaliplatin has been described. This complication is caused by oxaliplatin-dependent antibodies directed against platelet surface glycoproteins, and is unrelated to myelosuppression. In this report, we describe two patients who developed thrombocytopenia immediately soon after receiving oxaliplatin. Sensitization presumably had occurred after receiving oxaliplatin during preceding courses of multiagent chemotherapy that included oxaliplatin.

Lower Extremity Swelling after Treatment for Thigh Synovial Sarcoma

Lower Extremity Swelling after Treatment for Thigh Synovial Sarcoma

Hyperfractionated craniospinal radiotherapy and adjuvant chemotherapy for children with newly diagnosed medulloblastoma and other primitive neuroectodermal tumors

Purpose: This single-institution Phase I/II study conducted from 1989 to 1995 evaluates the feasibility of a multimodality protocol combining hyperfractionated craniospinal radiotherapy (HFRT) followed by adjuvant chemotherapy in 23 patients with newly diagnosed primitive neuroectodermal tumors (PNET) arising in the central nervous system.Methods and Materials: All 23 patients had a histogically confirmed PNET and were over 3 years of age at diagnosis. The eligibility criteria for PNET patients with cerebellar primaries (medulloblastoma) included either a high T stage (T3b or 4) or high M stage (M1-3). All patients with noncerebellar primaries were eligible regardless of T or M stage. The median age of the 23 patients was 9 years (mean 3–25); 11 were female. The primary tumor arose in the cerebellum in 19. Of these medulloblastoma patients, 15 had high T stages (T3b or T4) with large locally invasive tumors and no evidence of metastases (M0), constituting Group 1. Thirteen (86%) of these patients had gross total resections. Four other medulloblastoma patients had both high T and high M stages, constituting Group 2. Group 3 consisted of four other patients with exocerebellar primaries (two brain, one brain stem, and one cauda equina), three of whom were M3. Hyperfractionated radiotherapy was administered within 4 weeks of surgery. Twice-daily 1-Gy fractions were administered separated by 4–6 h. The total dose to the primary intracranial tumor and other areas of measurable intracranial disease was 72 Gy. The prophylactic craniospinal axis dose was 36 Gy, and boosts of 44–56 Gy were administed to metastatic spinal deposits. Following radiotherapy, monthly courses of multiagent chemotherapy were administered sequentially (cyclophosphamide-vincristine followed by cisplatin-etoposide followed by carboplatin-vincristine) for a total of 9 months.Results: All patients completed radiotherapy as planned. Only three patients lost > 10% of their body weight. One patient had clinically apparent radiation-induced esophagitis. The mean white blood count (WBC) nadir was 2.5/dl, and hematologic recovery occurred in all within 4 weeks of completing HFRT without the need of granulocyte-colony-stimulating factor. Two patients refused adjuvant chemotherapy, 3 patients experienced tumor progression during chemotherapy, and 2 of 18 remaining patients could not tolerate the full 9 months owing to hematologic toxicity. Of the 15 patients (93%) in Group 1, 14 remain in continuous remission for a median of 78 months, and more have died. Two of the four patients in Group 2 are in continuous remission at 67 and 35 months, and two died at 18 and 30 months. One of the two patients in Group 2 who died refused adjuvant chemotherapy and developed tumor progression in the bone marrow. None of the three patients in Group 3 with evaluable disease (M3) had a complete response to therapy, and eventually all four died of progressive or recurrent disease.Conclusion: This multimodality protocol is feasible in the short term, and long-term monitoring of neurocognitive and neuroendocrine effects are in progress. Excellent long-term disease control has been achieved for medulloblastoma patients with high T stages who were M0 at diagnosis (Group 1), the majority of whom had gross total resections. This group has a progression-free survival of 95% after a median period of follow-up of 6.5 years. Alternative treatment strategies must be developed for patients with high M stages, as five of seven patients died of progressive or recurrent disease.

Predictive value of serum CA125 following optimal cytoreductive surgery during weekly cisplatin induction therapy for advanced ovarian cancer

One hundred seventy-one patients with epithelial ovarian cancer were treated on a prospective protocol of weekly cisplatin induction (1 mg/kg weekly for four courses) followed by monthly cisplatin (50 mg/m2), Adriamycin (50 mg/m2), and cyclophosphamide (750 mg/m2). Seventy-five patients with FIGO stage III or IV disease who underwent optimal cytoreductive surgery (<2 cm residual disease) were treated on this protocol and had weekly as well as monthly serum CA125 levels measured. A retrospective analysis was performed in order to determine if a > or = 50% fall in elevated serum CA125 levels during weekly cisplatin induction therapy would be predictive of findings at second look operation, normalization of serum CA125 levels (< 35 u/ml) immediately prior to the third course of multiagent chemotherapy, and to determine the impact of such a decline on median progression-free interval. Positive predictive values for this parameter with respect to findings at second look operation ranged between 38% and 50% (P > 0.05). Positive predictive values for this parameter with respect to normalization of serum CA125 levels immediately prior to the third course of multiagent chemotherapy ranged between 64.2% and 89.6% (P > 0.05). Logistic regression analysis demonstrated that a > or = 50% fall observed in CA125 levels during four weekly courses of chemotherapy served as an independent predictor of normalization of serum CA125 levels (<35 u/ml) following two courses of multiagent chemotherapy (P = 0.009) and improved median progression-free interval (P = 0.04). Eighteen patients demonstrated a rise in serum CA125 levels during weekly induction cisplatin chemotherapy. Only one of these patients (5.5%) demonstrated a surgical complete response at the end of standard therapy.

Choriocarcinoma in a Term Placenta

A clinically unsuspected choriocarcinoma arose in a term placenta. The patient was hospitalized for 3 weeks antepartum with preterm labor. She was delivered of a normal female infant at 36 weeks' gestation. Mother and infant were discharged after 3 days. The placenta, 465 g, contained multiple white nodules, a single infarct, and retroplacental hemorrhage. By microscopy, there was multifocal choriocarcinoma. No villous stromal invasion was found. The patient was readmitted 6 days postpartum with a serum beta human chorionic gonadotropin (hCG) value of 741,640 mIU/ml and lung metastases. She received 9 courses of multiagent chemotherapy and is currently free of tumor 1 year after diagnosis. The infant, 46,XX, remained clinically free of tumor although she had a serum beta hCG of 37 mIU/ml at 1 week of life. This placenta provides evidence of choriocarcinoma developing directly from mature placental villi in a chromosomally normal gestation and depicts a situation wherein choriocarcinoma is diagnosed correctly in the presence of villous tissue. It also demonstrates the utility of placental examination in clinically abnormal gestations.

Radiation therapy as local treatment in ewing's sarcoma. Results of the cooperative ewing's sarcoma studies cess 81 and cess 86

The Cooperative Ewing's Sarcoma Studies, CESS 81 and CESS 86, are multiinstitutional trials with more than 80 participating institutions from Germany, the Netherlands, Austria, and Switzerland. Treatment consists of four courses of multiagent chemotherapy and local therapy. Local therapy was not randomized and was either radical surgery or resection plus postoperative irradiation or definitive radiation therapy. Here results according to local therapy have been analyzed for 93 protocol patients with localized Ewing's sarcoma (ES) who have been recruited in CESS 81 from January 1981 to February 1985 and 122 protocol patients recruited in CESS 86 from January 1986 to November 1989. The 3-year relapse-free survival (RFS) was 55% in CESS 81 and 62% in CESS 86. In CESS 81, the RFS was better for surgically treated than for irradiated patients. In this study there was an extremely high incidence of local failures (50%) after definitive irradiation. In CESS 86, however, the results after radiation therapy have been improved markedly (3-year RFS 67% after radiation therapy, 65% after surgery, and 62% after resection plus irradiation). Possible explanations for the improvement of radiotherapeutic results are as follows: selections for patients for radiation therapy, start of local therapy, and quality of radiation therapy. In CESS 86, irradiated patients were randomized to receive either conventionally fractionated irradiation with less intense chemotherapy or hyperfractionated irradiation with simultaneous chemotherapy. There was no difference in treatment results at the time of analysis. The authors conclude that selection of patients for local treatment modalities and quality of treatment performance has an impact on local and overall treatment results in ES.

Delivery of a normal infant following cisplatin, vinblastine, and bleomycin (PVB) chemotherapy for malignant teratoma of the ovary during pregnancy

Pregnancy complicated by an immature teratoma is rare, with a reported incidence of 0.07%. A case report of a grade 3 immature teratoma measuring 18 × 20 cm, with operative intraabdominal rupture (FIGO stage IC), is reported. The poor prognosis of malignant germ cell tumors treated by surgery alone seems to indicate a need for adjunctive chemotherapy. One course of multiagent chemotherapy consisting of cisplatin, vinblastine, and bleomycin (PVB) was initiated during the midtrimester. After an uncomplicated vaginal delivery at term of a normal infant, the planned regimen of chemotherapy was resumed. Subsequent “second-look” laparotomy was negative for malignant disease. The actual risk of PVB chemotherapy in pregnancy cannot be assessed by a single case report. The delivery of a normal infant is encouraging.

Hodgkinʼs disease complicated by nephrotic syndrome

The clinical course of a 14-year-old boy who developed biopsy-proven minimal change nephrotic syndrome (MCNS) prior to institution of therapy for Hodgkin's disease (HD), mixed cellularity histologic subtype, is presented. In the first week of radiotherapy to the major site of disease in the neck, BUN and creatinine levels rose to 98 mg% and 8.4 mg%, respectively. During the second week of treatment, levels gradually decreased becoming normal in the third week. Body weight gradually decreased in the second week of radiotherapy, falling rapidly in the third and fourth week when diuresis was greatest. Although urine protein concentration fell initially, the concentration remained 1 + or more for 10 weeks following radiotherapy. Following radiotherapy to the neck, staging laparotomy demonstrated a single focus of Hodgkin's disease in the spleen. Radiotherapy was given to the splenic pedicle: six courses of multiagent chemotherapy (MOPP) followed. The boy remains free of any evidence of either HD or MCNS 33 + months from the time of the diagnosis. Circulating lymphocytes showed normal responses to stimulation by phytohemaglutinin, Concanavalin A, and pokeweed mitogens. The patient's monocyte-macrophage-mediated antibody-dependent cellular cytotoxicity (ADCC) was low both prior to and following radiotherapy. Lymphocyte-mediated ADCC was normal at both of these times.

Chemotherapy--radiotherapy association in Hodgkin's disease, clinical stages IA, II2A: results of a prospective clinical trial with 166 patients.

One hundred sixty-six patients with clinical stages IA, II2A Hodgkin's disease were treated between April 1972 and December 1976 with three courses of multiagent chemotherapy (methylchlorethamine, vincristine, procarbazine, prednisone) followed by mantle irradiation--excluding mediastinum for those with initial upper cervical presentation and absence of mediastinal involvement--or inverted Y radiotherapy. None had staging laparotomy. With a follow-up of 12--84 months, median 40 months, the overall survival is 93.5% and the overall relapse-free survival 89.9%. Eight patients died, three of them with evident disease. Ten patients relapsed; four are now free of disease after retreatment. With chemotherapy-radiotherapy sequence, staging laparotomy is not indicated. Results and side effects of this treatment strategy are compared with those of other treatment policies.