[Lymphomas originating in the otorhinolaryngeal region: 10 years' experience]. / Linfomas originados en el área otorrinolaringológica: experiencia de 10 años.

BACKGROUND: Non-Hodgkin's lymphomas (NHL) originated in the otorhinolaryngological (ORL) area are rare diseases and its therapy is poorly established. METHODS: The diagnostic features, treatment and outcome based on therapy of 34 NHLs originated in the ORL area and seen in the Oncology Service from the Hospital de la Santa Creu i Sant Pau during a ten year period were reviewed. RESULTS: The predominant primary localization was the tonsil (17 patients), followed by rhinopharynx (8), massive involvement of Waldeyer's ring (4), and oropharynx, maxillary sinus and larynx in the remaining cases. In 26 patients the diagnosis was high-grade lymphoma. The stage distribution was 8 patients (24%) in stage I, 16 in stage II (47%), 3 in stage III (9%), and 5 in stage IV (16%). The treatment was heterogeneous and consisted in chemotherapy in 29 patients (38%), radiotherapy in 5 (15%) or the combination of both in 16 (47%). Eleven patients relapsed (38%), more commonly those treated with radiotherapy. The specific actuarial survival was 69%. CONCLUSIONS: NHL originated in the ORL area are uncommon neoplastic diseases, with a commonly dramatic response to chemotherapy. This should be the initial therapeutic modality in all cases.

[The modification of the toxicity produced by chemotherapy in testicular cancer by adapting its intensity to prognostic groups]. / Modificación de la toxicidad producida por la quimioterapia en el cáncer de testículo al adecuar su intensidad a los grupos pronósticos.

BACKGROUND: The reduction of iatrogenesis is fundamental in the treatment of germ-cell testicular tumors (GTT) because of the high incidence of cures achieved. On the other hand, the tumoral mass and the serum concentration of the beta fraction of the gonadotropin hormone (CGH) and of alphafetoprotein allow the differentiation of 2 clear prognostic groups; those for which the intensity of chemotherapy may be adapted to reduce its collateral effects and improve the results. METHODS: In the Oncology Department of the Hospital de la Santa Creu i Sant Pau 23 patients with GTT of good prognosis were treated between 1984-1990. These patients were given the combination of etoposide-cisplatin (EP) over the same period. Twenty patients with a bad prognosis received the alternative scheme of bleomycin-vincristine-methotrexate-cisplatin/etoposide-cisplatin- phosphamide (BOMP/EPI). RESULTS: In comparison to the classical treatment with cisplatin-vinblastine-bleomycin (PVB) the EP association demonstrated less iatrogenesis except in regards to the formation of granulocytopenia which was higher. The BOM/EPI combination conditioned greater hematological toxicity during the acute phase and the first observations suggested a diminution of chronic iatrogenesis. CONCLUSIONS: These results indicate that chemotherapy in testicular cancer may be adapted to the aggressiveness of the with the aim to thereby reduce global toxicity.

Intensive chemotherapy in poor-prognosis nonseminomatous germ cell tumors of the testis.

Forty-one patients with poor-prognosis nonseminomatous germ cell tumors (NSGCT) of the testis were treated between 1980 and 1989. This group was defined by the presence of one of the following features: multiple large lung metastases, bone, liver or brain metastases, abdominal mass greater than 10 cm, abdominal mass greater than 5 cm with high serum concentration of the tumor markers [alpha-fetoprotein (alpha FP) greater than 500 kU/l or beta-subunit of human chorionic gonadotropin (beta HCG) greater than 1,000 IU/l) or very high serum tumor marker concentrations (alpha FP greater than 5,000 kU/l or beta HCG greater than 10,000 IU/l). The first 21 patients were treated with cisplatin, vinblastine, bleomycin (PVB) chemotherapy and the following 20 with an intense, alternating 6-drug chemotherapy consisting of cisplatin, bleomycin, vincristine, methotrexate, etoposide and ifosfamide (BOMP/EPI). Surgery of residual masses was performed when tumor markers were negative. Fifteen patients (71.4%) in the PVB group and 18 patients (85%) in the BOMP/EPI group remained disease-free at a median follow-up of 67 and 41 months, respectively. None of the resected masses in the BOMP/EPI group contained malignant disease whereas viable carcinoma was found in 5 of 14 (26.4%) patients in the PVB group. The toxicity of the BOMP/EPI regimen was severe but tolerable. Intensive chemotherapy regimen seems to be useful in this subset of patients, but randomised prospective trials comparing these with standard chemotherapy are necessary.

[The clinico-mammographic follow-up of breast cancer after conservative treatment]. / Seguimiento clínico-mamográfico del cáncer de mama tras tratamiento conservador.

Clinical and mammographic follow-up of 149 patients diagnosed of stage I and II breast neoplasm and treated with conservative surgery and irradiation between January 1986 and December 1988 was reviewed to determine clinical and radiographic recurrence pattern. Follow-up controls included a clinical examination and a mammogram at 6-9 months, a second at 10-16, a third at 17-22, a fourth at 23-24 and a mammogram yearly and a clinical examination every 6 months thereafter. To December 1991 18 patients recurred. 12 had a metastatic spread, 3 a unique local recurrence and 3 a local recurrence with a metastasis spread. Clinical recurrence was as a carcinomatous mastitis in three patients and a solid nodule in two. Radiologic recurrence was as an augmented skin thickness in three patients. Mammogram was not performed in one patient because an associated poor prognostic metastatic spread. Mammographic skin thickness secondary to irradiation appeared in 93% of the patients at 6-9 first control, 62% at second, 50% at third and 35% at fourth. The number of recurrences is scarce to achieve any clinical, pathological or treatment factor associated with greater risk of recurrence. We suggest that first mammogram should be delayed after 12 months of treatment because we would not obtain any relevant clinical information before, once observed skin thickness persistence at 6 months and most frequent recurrence radiologic pattern.