[Synchronous renal carcinoma and urothelioma of the contralateral renal pelvis]. / Carcinoma renale e urotelioma della pelvi controlaterale, sincroni.

A case characterized by a rare synchronous occurrence of transitional cell carcinoma of the renal pelvis and renal cell carcinoma in the contralateral kidney is presented. The simultaneous occurrence of renal adenocarcinoma and transitional cell carcinoma of the renal pelvis in the opposite kidney is unusual.

Comparison of nutritional status after total or subtotal gastrectomy.

Forty-four disease-free patients were evaluated a mean of three years after total gastrectomy (TG) or subtotal gastrectomy (SG) for cancer. The investigation encompassed nutritional assessment by standard anthropometric and biochemical indices; evaluation of the nutritional intake based on 24 h recall and of appetite status on a visual analogue scale; and anamnestic analysis of postcibal symptoms and syndromes. Body weight had declined progressively until the 15th postoperative month after both TG and SG. Weight loss, as well as the general nutritional status index (actual body weight/usual body weight +/- actual body weight/desirable body weight + measured arm muscle circumference/reference arm muscle circumference x 33), had dropped more significantly in patients undergoing TG than those having SG (p less than 0.05). The principal body compartment change was observed in the fat content which was severely depleted, whereas the somatic proteins were relatively spared and the visceral proteins and remaining biochemical variables were in the normal range. Protein intake was not significantly different in the two groups, but caloric intake was significantly lower and the number of meals significantly higher after TG (p less than 0.05). These data suggest that malnutrition after TG is relatively mild and that this operation causes only a limited impairment of the nutritional state, and spares most of the nutritional variables of clinical interest in comparison with SG. These findings argue in favor of TG when clinically indicated without excessive concern about postoperative nutrition.

Plasma retinol level reduction by the synthetic retinoid fenretinide: a one year follow-up study of breast cancer patients.

Fenretinide (HPR) is a synthetic retinoid which has been shown to cause a reduction in the incidence of carcinogen-induced epithelial tumors in experimental animals, and it has been chosen to be tested as a chemopreventive agent in humans. A study on plasma concentrations of HPR, of its metabolite N-(4-methoxyphenyl)retinamide (MPR), and on its effects on endogenous retinol was performed in groups of 14 to 18 breast cancer patients who received p.o. daily doses of placebo or 100, 200, and 300 mg of HPR for 6 mo and subsequently 200 mg for an additional 6 mo. After the first 5 mo of treatment, there was a linear relationship between doses of HPR administered and HPR, MPR, and retinol levels. HPR and MPR levels increased with the increase in dose, whereas retinol levels decreased, and the reduction was statistically significant compared with the placebo group after all the doses tested. Plasma retinol binding proteins (RBP) decreased proportionally to retinol (r = 0.96). The effect of HPR on retinol and RBP occurred early, since retinol and RBP levels had already been decreased, compared with the initial levels, by 38% and 26%, respectively, 24 h after a 200-mg HPR dose. After 12 mo of treatment, in patients treated with 200 mg daily, the dose chosen for a chemopreventive trial, HPR and retinol levels were similar to those found at 5 mo, suggesting no drug accumulation and no further retinol reduction, whereas MPR levels were higher. Following interruption of treatment, as HPR decreased, retinol increased with a linear relationship between log levels (r = 0.78); after about 50 days, HPR was present in trace amounts, and retinol levels were in the range of those of the placebo group. These data show that HPR treatment lowers retinol and RBP plasma concentrations. This effect is related to HPR levels and is reversible on cessation of HPR administration.

Tolerability of the synthetic retinoid Fenretinide (HPR).

Fenretinide, N-(4-hydroxyphenyl)retinamide (HPR), is a synthetic retinoid which has been proven effective in inducing cell differentiation and in inhibiting carcinogen induced mammary tumors in rodents. Because of its efficacy and low toxicity in animals, HPR has been proposed for chemopreventive evaluation in humans. Thus, a randomized trial has been conducted to select a dose which can be administered over a lengthy period of time and with acceptable toxicity. The retinoid was administered orally to patients already operated on for breast cancer in daily doses of 100, 200 and 300 mg for 6 months and subsequently at 200 mg for another 6 months. No acute toxicity was found. Dermatological toxicity was minimal and no liver function abnormalities were observed. Nausea and headaches were infrequent and always mild. Menstrual irregularities were recorded with similar frequency in the treatment and placebo groups and appeared to be more age related than drug dependent. After 6 months of treatment one of 25 patients taking 300 mg HPR daily experienced impaired night vision, confirmed by the electroretinogram, and resolved by interruption of treatment. Because the 300 mg daily dose is possibly associated with impaired dark adaptation, the recommended dose for chemoprevention trials of HPR is 200 mg per day.

Psychologic aspects of patients participating in a phase I study with the synthetic retinoid 4-hydroxyphenyl retinamide.

One hundred and one patients participating in a phase I study with the synthetic retinoid 4-HPR (4-hydroxyphenyl retinamide) were evaluated. The study was set up by Veronesi et al. during 1986 at the National Cancer Institute of Milan. The patients were randomized into 4 groups of therapy: 25 in the placebo group, 25 in the group receiving a daily dose of 100 mg of HPR, 26 in the group receiving 200 mg/day of HPR, and 25 in the group receiving 300 mg/day of HPR. All patients were previously treated at our Institute for breast cancer. None had received adjuvant therapy, chemotherapy or hormone therapy. After 4-5 months from the beginning of treatment, all patients received a series of tests to evaluate anxiety, depression and sexual life. Moreover, during one the follow-up checkups after 4-5 months, the patients filled-out a self-scoring mood questionnaire. The results did not show any particular differences between the groups, although we found that the administered drug and experimental setting do not interfere with the psychologic state of the participating patients.

Kaposi's sarcoma: malignant tumor or proliferative disorder?

UNLABELLED: In order to provide information on the response to treatments and clinico-pathological pattern, the clinical course of 41 patients with classic Kaposi's sarcoma (KS) was reconsidered. Twenty-six cases presented a single nodular lesion, and 15 multiple, pluricentric lesions. Surgery was the first treatment for patients with single lesions, 14 of 26 (54%) patients had recurrences: the disease-free interval ranged from a few months to 11 years. Five cases had disseminated disease, three of these were preceded by local recurrence. Cases with multiple lesions were treated by a combination of surgery, chemo- and radiation therapy (RT). In three cases spontaneous regression of disease was observed and two of these are presently disease-free. After chemotherapy and RT, many patients had complete remission of disseminated disease for up to 40 months. The drugs of first choice were vinblastine and bleomycin. Over all, only one patient died of KS, 10 years after diagnosis, nevertheless the cure rate was very poor and the final overall disease-free rate was around 30%. Proper treatment for nodular or disseminated lesions provides a fair disease-free period. FINAL CONSIDERATIONS: mortality of disease is exceptional despite the 80% risk of recurrence or dissemination. Data from our series do not provide proof that adequate control of the primary single lesion could screen against recurrence: the interval between treatment of the first lesion and recurrence is sometimes exceptionally long, up to more than 10 years, and for that it is not easy to state when disease is really cured. These considerations and other analogies between KS and lymphoproliferative disorders in immunodepressed people strongly suggests the possibility of a non-malignant or even non-tumoral pattern to this disease, with implications for therapeutic strategies.

Chordoma: natural history and treatment results in 33 cases.

Thirty-three chordomas were observed at the Istituto Nazionale Tumori of Milan from 1933 to 1983: 27 sacrococcygeal, 3 spheno-occipital, and 3 vertebral. The male:female ratio was 2.7, and the median age was 63 yr for patients with sacrococcygeal and 35.2 yr for those with nonsacral chordomas. After pathologic reassessment, distinct cytologic patterns were found: physaliphorous, syncytial, and mixed subtypes, with variable degrees of cytologic atypia. However, no evident difference in survival was documented in relation to these cytohistologic features. Four cases had a prior traumatic fracture, and the pathogenetic role of trauma is stressed. Eight cases were operated with adequate surgery and only three recurred, whereas of 11 inadequate operations, 10 developed local relapse. However, follow-up for recent adequate operations is short. Radiation therapy seemed to be effective with adjuvant or palliative aims. No chemotherapeutic regimen achieved any result; one case had a short complete remission after cis-dichlorodiammineplatinum + vinblastine + bleomycin (PVB). This analysis confirms the possibility of achieving radicality with high resection of the sacrum for lesions confined below the second sacral vertebra. Nonsacral chordomas were all unresectable. The best treatment for unresectable lesions seems to be palliative surgery plus radiotherapy.

Prognosis of patients after palliative surgical procedures for carcinoma of the stomach.

From 1965 to 1980, 294 (33 per cent) of 885 patients admitted to the Istituto Nazionale Tumori of Milan with carcinoma of the stomach did not undergo a radical operation. Forty-eight patients were not considered suitable for operation due to their poor general status and spread of disease. One hundred and five patients underwent simple exploratory laparotomy, 80 underwent bypass procedure and 61, noncurative resection, and the operative mortality rate was 4.7, 10.0 and 11.5 per cent, respectively. Median survival time was 2.4 months for patients who did not undergo an operation, 2.8 months after exploratory laparotomy and 3.5 months after bypass procedures. Median survival time after nonradical resections was 8.0 months and 6 per cent of these patients survived for more than five years. To perform the analysis within relatively homogeneous groups, patients with different treatments were further stratified into three groups according to the spread of disease: local, distant and local plus distant spread. It is noteworthy that the benefit after bypass procedures in comparison to exploratory laparotomy was limited to those patients with local spread of disease; the advantage of nonradical resection was apparent in all groups. Survival time was finally analyzed with reference to the extent of liver involvement in patients with metastatic disease confined to the liver. The data suggest that a limited sporadic survival time is possible only after gastric resection in patients with liver involvement of less than 50 per cent.