Adjuvant chemotherapy in renal leiomyosarcoma.

Our encounter with a patient with renal leiomyosarcoma prompted a survey of the world literature in which 84 cases were found. The use of chemotherapy after nephrectomy is advocated since our patient survived more than four years without metastases. The rationale for our chemotherapeutic protocol is discussed.

Long-term nutritional support as an adjunct to chemotherapy for breast cancer.

In recent years, the concept of nutritional support as a part of a comprehensive cancer management program has gained increasing acceptability. However, little data is available in regard to the effect of nutritional support programs on the chronic disease state represented by recurrent or persistent cancer that characterizes patients undergoing systemic chemotherapy. In 1977 we undertook to study this problem in a randomized prospective study designed to evaluate the effects of long-term (12 months) enteral nutritional support in a group of ambulatory breast cancer patients undergoing a standard cytotoxic chemotherapy treatment program, in an adjuvant or therapeutic setting. The results of this study suggest that patients with breast cancer are overweight as compared to the general population and that any significant change in initial body weight, either a gain or a loss, is associated with an increased risk of recurrent disease. Data are presented which show little or no correlation between standard parameters of nutritional assessment and risk of disease recurrence and/or response to chemotherapy. These data also suggest that until we better understand the relationship between tumor and host in breast cancer patients, we offer nutritional support programs only in situations where there are specific clinical indications for such interventions.

Preneoplastic changes in rabbit pancreatic duct cells produced by dimethylhydrazine.

Permeation catheters containing 40% dimethylhydrazine (DMH) were implanted into the main pancreatic duct of New Zealand white rabbits. The catheters were constructed of silicone polycarbonate with a 4- to 10-day carcinogen release rate. Rabbits implanted with catheters containing DMH showed pancreatic ductal cell hyperplasia, metaplasia and dysplasia with periductal cell infiltration, adenosis and adenoma formation. These changes began approximately 9 to 12 weeks after implantation and persisted for 75 to 80 weeks. Specificity of the delivery system appeared to be excellent in that pathologic effects were observed only in the pancreatic and peripancreatic tissues. Moreover, these effects were probably directly related to the implanted carcinogen since similar maintained effects were not observed in control animals.

A combined treatment program for the management of locally recurrent breast cancer following chest wall irradiation.

Locally recurrent breast cancer involving the previously irradiated chest wall and skin is a difficult but manageable problem. A detailed oncological evaluation is initially undertaken to determine the extent of local and systemic disease. Local infection, if present, is controlled by topical therapy with 0.5% silver nitrate in conjunction with well-planned, aggressive radiotherapy to the areas of tumor recurrence. Concomitant, hormonal, and/or cytotoxic chemotherapy is administered if evidence of systemic involvement is detected. Biopsies of the ulcer margin are performed with surgical excision and débridement as indicated, followed by sequential skin grafting. Seven patients are presented in whom circumferential ulcer biopsies, radiation therapy, skin grafting, and topical silver nitrate therapy were carried out with control and resolution of local symptoms in all cases. It is not essential to have initial tumor control in order to insure graft take. This program has particular application to the poor risk surgical patient, with or without evidence of systemic disease.