An institutional review of sarcomas of the large and small intestine.

BACKGROUND: This study was done to review the institutional experience with the treatment of sarcoma of the small or large intestine. STUDY DESIGN: Thirty-nine patients admitted between the years 1959 and 1987, with a diagnosis of sarcoma of the small or large bowel form the basis of this review. RESULTS: At referral, 74 percent of the patients presented with peritoneal sarcomatosis. Only six patients underwent complete resection. The overall five-year survival rate was 20 percent. Patients with low grade tumors had median and five-year survival rates of 33.3 months and 44 percent, respectively, while patients with high grade tumors had median and five-year survival rates of 22.4 months and zero percent, respectively, p = 0.01. Patients undergoing complete resection had a median survival period of 33.3 months, while patients receiving less than complete resection had a median survival period of 15.4 months, p = 0.003. Factors found to be significant by multifactorial analysis included tumor size, grade, stage at presentation, and invasion of adjacent organs. CONCLUSIONS: Sarcoma of the small and large bowel is an uncommon entity. Survival rates are relatively poor. Aggressive surgical intervention is the mainstay of therapy.

Thick cutaneous melanoma of the trunk and extremities: an institutional review.

The objective of this study was to review our experience with thick cutaneous melanoma of the trunk and extremities and to identify subgroups of long-term survivors. Ninety-one patients admitted between the years 1977 and 1987, with cutaneous melanoma of the trunk or extremities, Breslow thickness > or = 4.0 mm, or a Clark's level V lesion form the basis of this review. Node positive clinical stage II patients had a 5-year survival rate of 32%. Five-year survival for node positive clinical stage III patients was 0% (P < 0.0001). Node negative clinical stage II patients, and those found to be histologically node positive, had no survival difference, P = 0.88. Sixty per cent of node negative patients with an extremity primary survived 5 years, while patients with a node positive truncal primary had a survival of 14%, P = 0.005. In conclusion, most patients present with local-regional disease. Patients with node negative extremity lesions have the best chance for cure.

Cytokine production by human soft tissue sarcomas: implications for immunosuppression within the tumour bed.

The local immune response to the presence of tumour is affected by the pattern of cytokine production within the tumour bed. The purpose of this study was to define the pattern of cytokine production in human soft tissue sarcomas, attempting to identify potential immune suppression. Total RNA was extracted from six human soft tissue sarcomas from which cDNA was generated. PCR was carried out in the presence of primer pairs for G3PDH, TGF-beta1, TGF-beta2, TNF-alpha, INF-gamma, IL-2 and IL-10. TGF-beta1 and IL-10 mRNA was detected in all tumours, however, mRNA for IL-2 and INF-gamma was detected in only two out of six sarcomas. Paraffin sections were incubated with alpha-hu-TGF-beta1 or alpha-hu-IL-10 antibodies to localize protein production. TGF-beta1 and IL-10 protein expression was only associated with the tumour cells. These findings suggest potential local immune suppression within the tumour bed.

The technique of sentinel node biopsy.

Fifty-five consecutive patients with localized melanoma and clinically definable regional nodal basin who had undergone sentinel node biopsy were reviewed. The technique described by Morton et al was applied with the following modifications: (1) injection of a larger amount of isosulfan blue dye initially, i.e. 3 ml, on the side of the primary lesion facing the nodal group; (2) elevation of the primary site, for 5 min; (3) incision over the regional nodal group and exposure of the nodes with sharp dissection; (4) identification of either the blue-stained node(s) or adjacent colored lymphatics first and demonstration of their continuity. The sentinel node was identified in 51/55 (93%); specifically 33/36 (92%) in the axilla, 17/18 (93%) in the groin, and 1/1 in the supraclavicular area. It was positive in 12/51 (24%). Morton's technique of sentinel node biopsy is reproducible and can provide correct identification of the sentinel node in over 90% of the patients without the aid of radiolabelled materials.

Role of sentinel node biopsy in the management of malignant melanoma.

The use of elective lymph node dissection for intermediate-thickness melanoma has remained controversial. The technique of sentinel node biopsy (intraoperative lymphatic mapping and selective lymphadenectomy) has been developed in an attempt to identify patients who may benefit from an elective node dissection while sparing patients without occult metastases the morbidity of an elective lymphadenectomy. Current methods of performing a sentinel node biopsy include both a dye and radiolabeled technique. Although the accuracy of sentinel node biopsy for identifying nodes at risk for occult metastases has been demonstrated, a survival benefit from dissection of nodal basins that contain occult metastases remains to be determined. This article reviews the basis for, technical considerations of, and surgical results with selective lymphadenectomy in an attempt to clarify the role of this modality in the management of patients with cutaneous melanoma.

Primary renal sarcoma.

Primary renal sarcoma represents approximately 1 per cent of all primary tumors of the kidney. The purpose of this study is to review the experience at Roswell Park Cancer Institute with the treatment of primary renal sarcoma. Four patients with a diagnosis of primary renal sarcoma admitted from 1976 to 1983 form the basis of this review. All patients underwent radical nephrectomy. The tumor was localized in two patients, and locally invasive in two patients. All patients had recurrence of metastatic disease. Patients with localized disease recurred at 19.0 and 25.0 months respectively. Patients with invasive disease recurred at 4.0 and 5.0 months respectively. Patients presenting with localized disease survived a mean of 34.0 months. Patients presenting with invasive disease died at 6.0 and 10.0 months from time of diagnosis. Primary renal sarcoma is a rare entity. Only patients presenting with localized disease have a reasonable chance for prolonged survival.

Malignant melanoma of the gallbladder: report of a case and review of the literature.

A case of primary melanoma of the gallbladder is presented and review of the literature. Eighteen cases have been previously reported. The diagnosis is usually not made preoperatively. Metastatic melanoma to the gallbladder as an isolated site is also rare.

Clonal interactions in a human squamous cell carcinoma.

F.2a and B.2, cell clones of the human squamous cell carcinoma SCC-12, were examined to characterize their interactions through the expression of growth factors. F.2a was nontumorigenic yet B.2 was fully tumorigenic when injected into the flanks of athymic nude mice. Combination injections of F.2a and a subtumorigenic level of B.2 produced tumors. F.2a and B.2 overexpressed the 4.8-kb transcript for transforming growth factor-alpha (TGF-alpha) as well as the 10.5- and 5.8- kb transcripts for the epidermal growth factor receptor. Neither clone expressed the transcript for epidermal growth factor, while both expressed transcripts for insulin-like growth factor-I (IGF-I) of 8.15, 4.9, and 1.6 kb and transcripts for its receptor of 8.5 and 6.5 kb. Conditioned medium (CM) from either clone stimulated the growth of itself and the other clone in tissue culture. Both clones produced intracellular TGF-alpha detectable by immunohistochemical staining, but not detectable in CM by enzyme-linked immunosorption assay. IGF-I was detected at low levels in CM by radioimmunoassay. Neutralizing antibodies to TGF-alpha but not IGF-I partially inhibit the growth of both clones in tissue culture. These results suggest that (1) TGF-alpha is active in autocrine signaling (2) IGF-I is not directly stimulatory, and (3) additional factors, as yet unidentified, are present in CM and enhance tumor growth. It is concluded that human squamous cell carcinoma SCC-12 is composed of tumorigenic and nontumorigenic clones which interact to enhance growth.

Advanced cutaneous squamous cell carcinoma of the trunk and extremity: analysis of prognostic factors.

BACKGROUND: Patients with squamous cell carcinoma (SCC) of the skin may exhibit locally advanced or metastatic disease and present a challenging management problem. METHODS: A retrospective review of 40 patients with advanced SCC of the trunk or extremity managed at Roswell Park Cancer Institute from 1982 through 1992 was performed to identify clinical and pathologic factors that influenced outcome. RESULTS: There were 27 males and 13 females with a median age of 61 years. Median follow-up was 24 months. Surgical resection to control the primary tumor was often extensive. Amputation was required in nine patients, hemipelvectomy in three patients, and hemicorporectomy in one patient. Median survival was 28 months, and 5-year survival was 43%. Univariate analysis identified stage (P = 0.04), size (P = 0.0001), type of surgical procedure (P = 0.009), and margins of resection (P = 0.005) as having prognostic significance. On multivariate analysis, stage (P = 0.04) and size (P = 0.02) were found to be significant. CONCLUSIONS: Optimum treatment for advanced SCC of the trunk and extremity involves surgical resection with uninvolved margins. The role of elective node dissection remains undefined. Investigation is needed to define the role of neoadjuvant therapy that may improve functional and cosmetic results.

Complications and outcome of external hemipelvectomy in the management of pelvic tumors.

BACKGROUND: Although the technique of external hemipelvectomy has been adequately described, little is known about its complications and late results. DESIGN: Retrospective review of 68 external hemipelvectomies performed at our Institute between 1973 and 1994. MATERIALS AND METHODS: Eleven patients had bone tumor; 39 patients, soft-tissue sarcoma; seven patients, melanoma; 10 patients, squamous cell carcinoma; and one patient, giant neurofibroma. In 48 (71%) patients, the intent was curative. In 17 cases, the hemipelvectomy was extended. RESULTS: Postoperative complications occurred in 36 (53%) patients, including flap necrosis in 11 (16%), wound infection in 24 (35%), and other complications in 12 (18%). Four (6%) patients died postoperatively. The average hospital stay after curative versus palliative resection was 39 versus 24 days. Only three (5%) patients were able to use a prosthesis, whereas 55 (81%) used crutches, six (9%) remained wheelchair bound, and four patients (6%) spent most of the time in bed. Local recurrence occurred in 35% of the patients. The estimated 5-year survival for curatively resected patients was 21%. CONCLUSIONS: External hemipelvectomy is a procedure with considerable morbidity and is indicated for only a minority of far-advanced tumors. It offers a chance of palliation and possibly cure when lesser surgical options have been exhausted.