Initial Site Of Failure Research Articles

Uterine papillary serous carcinoma

A review of 256 cases of pathologic Stage I uterine adenocarcinoma treated at Stanford University Hospital revealed 26 cases of uterine papillary serous carcinoma (UPSC), a clinically aggressive and morphologically distinct variant of adenocarcinoma which closely resembles ovarian papillary serous carcinoma. These lesions are easily recognized by microscopic examination and typically feature a high degree of cytologic anaplasia and a papillary growth pattern. Invasion of the lymphatics has been a frequent finding. The relapse rate among patients with pathologic Stage I UPSC was 50% (13/26), five times the rate which would have been predicted by the incidence of UPSC. Patients with Stage I UPSC fared significantly worse than the group of nonpapillary grade II or grade III adenocarcinomas (p less than 0.0001). Forty percent of Stage I UPSC patients had deep myometrial invasion, as compared with 12% of those with all other histologic types of adenocarcinoma (p = 0.001). Women with UPSC deeply invading the myometrium tended to do worse than those with deeply invasive lesions of the more usual endometrioid type as reflected by relapse rates (after surgery alone) of 63% and 30%, respectively. Of seven Stage I corpus carcinoma patients whose initial site of failure was in the upper abdomen, six had UPSC. Thus, UPSC shares the tendency of its ovarian counterpart to spread over peritoneal surfaces. In addition to the original study group of 26 Stage I patients, 34 patients with more advanced stages of UPSC were also reviewed. Of these, 26 have been followed and four survive. Eleven of these women presented or relapsed with abdominal carcinomatosis. UPSC is a clinically aggressive neoplasm which should be distinguished from other types of primary endometrial adenocarcinoma. In cases of invasive UPSC the mode of spread, similar to that of ovarian surface epithelial carcinomas, suggests the need for adjuvant upper abdominal and pelvic irradiation or effective chemotherapy.

Treatment of small cell carcinoma of lung with combined high dose mediastinal irradiation, whole brain prophylaxis and chemotherapy

Survival of patients with small cell carcinoma of lung, treated on a new combined radiotherapy-chemotherapy protocol, compares favorably with other regimens in the literature and our own previous combined approaches. Radiation, given after induction chemotherapy, consisted of whole brain prophylaxis in all 44 evaluable patients. Patients with limited disease were also treated to the primary and mediastinum to a high dose (5000 rad equivalent) using multiple fields. The new chemotherapy regimen consisted of induction with cyclophosphamide, doxorubicin, and vincristine alternated with cis-platinum and VP-16 (an epipodophyllotoxin) for two cycles, followed by consolidation with low dose cyclophosphamide and vincristine concurrent with irradiation. Patients with limited disease who achieved less than complete response, and all patients with extensive disease were not continued on maintenance chemotherapy. Out of 24 evaluable patients with limited disease, there was 73 % survival at 1 year by life-table analysis, measured from treatment initiation. After induction, 16 24 of these limited disease patients were CR (complete responders): 20 24 were CR at completion of their irradiation. Out of 20 evaluable patients with extensive disease, there was 59% survival at 1 year by life-table analysis. Only 4 44 (9%) brain parenchymal relapses occurred, one at 3 months and one at 6 months after local failure and two in patients who did not become CRs, implicating a possible re-seeding mechanism. Five patients had central nervous system relapses outside of brain parenchyma (spinal epidural and leptomeningeal); in three patients this was the initial site of failure. Significant complications included leukopenia (50% ) and thrombocytopenia (24% ) primarily during induction, and chronic pulmonary fibrosis (25% ), possibly contributing to two deaths.

Liver metastases (LM) as initial site of failure in wilms' tumor: A report from the national wilms tumor study (NWTS)

Liver metastases (LM) as initial site of failure in wilms' tumor: A report from the national wilms tumor study (NWTS)

Extra-hepatic biliary tract metastases from breast cancer

A retrospective review was conducted of 49 breast cancer patients who were seen at the Massachusetts General Hospital from 1962 to 1978 and who developed biliary tract metastases. Although these findings were incidental at autopsy in 21 patients, clinical evidence of extra-hepatic biliary involvement developed in 28. This was documented radiographically, surgically, and/or confirmed at autopsy. Although most patients had previous or concurrent nonbiliary tract metastases, in 6 patients the initial site of failure was in the extra-hepatic biliary system. Analysis of the 28 patients in the clinical group revealed that initial management with radiation therapy alone produced a response in 3 of 6 patients. However, when radiation was coupled with bypass surgery and/or adjuvant chemotherapy, a response occurred in 3 of 3; the total radiation therapy response rate was 6/9. Chemotherapy given either alone or in combination with surgery produced a response in only one of 7 patients. All 4 irradiated patients who were treated with a time-dose-fractionation (TDF) > 40 had a complete response compared to a complete response in only 2 of 8 with a TDF ≤ 40. The median survival of the irradiated group was 6 months compared to 3.3 months in the treated-unirradiated patients and 0.7 months in the untreated patients. The onset of jaundice in a breast cancer patient does not necessarily indicate progressive hepatic involvement. Patients with extrahepatic metastatic obstruction are being recognized increasingly and should be treated vigorously, especially since such patients with no liver parenchymal involvement have a greater survival (median 6 months) than those with liver involvement (median 1.8 months).

Non-Hodgkin's lymphoma: involvement of Waldeyer's ring.

From 1963 through 1976,59 patients with non-Hodgkin’s lymphoma involving Waldeyer’s ring were evaluated in the Division of Radiation Therapy at Stanford University. Fifty-one patients had clinical stage 1-111 disease. Most were staged with a lymphangiogram and percutaneous needle marrow biopsy. Lymphangiograms were positive in 12% of clinical stage I or I1 patients. Although the bone marrow biopsy was not positive in any of the patients with clinical stage I or I1 disease, 67% of patients with clinical stage I11 disease had bone marrow involvement. Fourteen patients also underwent a staging laparotomy and splenectomy and this procedure influenced the final stage in 36% of the patients submitted to the operation. The histologic pattern of the biopsies in 90% of the cases was diffuse and in 55% the cell type was histiocytic. Six patients had lymphoblastic lymphoma. Most patients with stage I or I1 disease were treated with involved field or extended field irradiation. This often consisted of an enlarged Waldeyer’s field matched to a mantle or “mini-mantle” field. Several patients with stage I or I1 disease and most patients with stage I11 disease were treated with total lymphoid irradiation, usually modified to treat the entire abdominal mesentery. The long-term freedom from relapse among patients with stage I disease was significantly better than among patients with stage I1 or I11 disease (50% vs. 25% and 17%). All patients with lymphoblastic lymphoma died with active disease. Stage I or I1 patients treated with total lymphoid irradiation seemed to enjoy a better freedom from relapse than those treated with involved or extended field irradiation, but variations in staging techniques may account for some of the observed differences. The most frequently recognized site of initial failure was in lymph nodes, primarily untreated nodes; the bone marrow was the second most common site of relapse. Comparisons with our overall lymphoma experience are made and justification is given for consideration of Waldeyer’s ring as a separate lymphoid region. Cancer 42:1096-1104, 1978.

The effectiveness of prophylactic brain irradiation in small cell carcinoma of the lung. A Southwest Oncology Group Study

Brain involvement in small cell carcinoma of the lung is a common phenomenon occurring in from 29 to 45% of patients. Because of this, it was suggested that prophylactic brain irradiation be made a part of treatment plans for small cell carcinoma. In December 1974, the Southwest Oncology Group (SWOG) began treating patients with combination chemotherapy and irradiation of both the primary lesion and whole brain. In two years, there were 390 patients entered into the study. In patients with extensive disease only 6 of 152 prophylactically irradiated patients developed CNS signs or symptoms of CNS recurrence. In limited disease, 6 of 88 prophylactically treated patients had CNS recurrence and in only 4 was this the site of initial failure. We feel prophylactic brain irradiation in small cell carcinoma of the lung is of benefit.