Recalcitrant facial pemphigus vulgaris: correlation of skin lesions with the ratio of antidesmoglein antibodies 1 and 3.

Pemphigus vulgaris (PV) is an autoimmune bullous disease characterized by autoantibodies against desmogleins. We report a case of recalcitrant PV, which progressed from the mucosal to the mucocutaneous type, with a corresponding increase in anti-desmoglein (Dsg)1 and decrease in anti-Dsg3 antibody titres. Thus, the clinical features seemed to correlate with the ratio of anti-Dsg1 and 3. The patient also had anti-Dsg4 antibodies, which might be related to the nonscarring diffuse hair loss and marked facial involvement she also had. The patient did not respond to treatment with systemic steroid, ciclosporin, azathioprine, cyclophosphamide or double filtration plasmapheresis, and eventually died from fulminant thrombotic thrombocytopenic purpura of unknown cause.

Epoxomicin, a new antitumor agent of microbial origin.

An actinomycete strain No. Q996-17 produced a novel compound, epoxomicin, which exhibited in vivo antitumor activity against B16 melanoma. Structural studies indicated that it is a new member of the epoxy-beta-aminoketone group, and is closely related to eponemycin.

Hydramycin, a new antitumor antibiotic. Taxonomy, isolation, physico-chemical properties, structure and biological activity.

A new antitumor antibiotic hydramycin was isolated from the fermentation broth of Streptomyces violaceus P950-4 (ATCC 53807). It showed potent antibacterial and cytotoxic activity and increased the survival time of mice inoculated with P388 leukemia. A new structure related to the pluramycin group antibiotics was assigned by its spectroscopic experiments.

Nodular histiocytic lymphoma, emphasizing results of stage I disease treated by radiotherapy. A report of the Japan Lymphoma Radiation Therapy Study Group (JLRTG).

The records of 49 patients with nodular histiocytic lymphomas (NH) who were treated from 1972 to 1985 in hospitals belonging to the JLRTG were retrospectively reviewed. The actuarial survival rate and relapse-free survival rate of all patients after 5 years were 55.0 and 51.3%, respectively. Twenty-one patients with stage I disease had a significantly better survival rate than did 12 patients with stage II disease (P less than 0.01). Without combination chemotherapy, all 15 patients with stage I NH treated by radiation therapy were in complete remission, and 14 of them remained alive and well. Among these 15 patients, no difference in relapse was observed between patients who received involved field irradiation (1 of 6) and those who received extended field irradiation (2 of 9). Patients with stage II or more NH should be treated with intensive chemotherapy and radiotherapy, as are patients with diffuse histiocytic lymphoma (DH). However, involved field radiotherapy with careful follow-up observation may be the treatment of choice for patients with stage I NH, provided their tumors are not bulky.

[Preoperative radiotherapy of bone and soft tissue sarcomas].

UNLABELLED: The role of preoperative radiotherapy was evaluated in 16 cases with soft tissue sarcoma and 13 cases with osteosarcoma. Nine osteosarcoma cases underwent radiotherapy of whole lesion, and 4 cases had radiotherapy only of the surgically incurable portion. There were no local recurrences in M0 cases, but skin necrosis occurred in the whole radiation group. As for the soft tissue sarcomas, local recurrence was not seen in virgin cases, but two cases which had received previous treatment showed local recurrence. There were no cases with severe side effects. CONCLUSION: 1. Partial radiotherapy was effective as preoperative treatment for osteosarcoma. 2. preoperative radiotherapy is better than postoperative radiotherapy from many standpoints.

[Radiation therapy in brain metastases].

From 1980 to 1985, 126 patients with a brain metastases from various malignant tumors were treated by hypervoltage irradiation with conventional fractionation at the Department of Radiotherapy at the Cancer Institute Hospital. The patients without an extracranial metastases or without neurological symptoms had a longer survival than did the other patients. Radiotherapy of more than 30 Gy improved the neurological functions and reduced the risk of death from the brain metastases. For long-term local control of brain metastases, whole brain irradiation with boost therapy for localized lesions may be a better treatment than other radiation methods and the total radiation dose required may be more than 50 Gy.

[Radiation therapy of choroidal metastases].

A retrospective study was performed on 30 cases with choroidal metastases referred to the Cancer Institute Hospital between July 1975 and June 1986. Of these 30 cases, 32 eyes of 26 patients were treated with irradiation of 4.3 MV X-rays or 12 MeV electron beam therapy in the range of 20-60 Gy to restore vision and prevent blindness. The tumor response to radiation therapy confirmed by ophthalmoscopic examination was described as complete, partial or no response. Of the 32 eyes, 31% had complete response, and 47% showed partial response. The overall response rate was 78%. A visual response as defined by marked or partial improvement of visual acuity and/or subjective symptoms was obtained in 16 out of 26 patients (62%). All of these patients were free of recurrence of symptoms in their quality of life. This proved radiotherapy to be a useful modality of treatment for choroidal metastases. No obvious radiation injuries were encountered in this series.

[Clinical research of radiotherapy in brain metastasis].

One hundred and four patients with brain metastasis were received the conventional radiotherapy from 1980 to 1985 at 3 hospitals. Results were as follows. 1. Primary sites were lung (41 cases), breast (34) and others (29). 2. Tumor was 3.15 cm in mean size (0.6-8.2 cm) and 2.6 in number of average (1-15) 3. Radiation dose was 46.5 Gy in average (30-66 Gy) and almost of all cases were irradiated with whole brain field. 4. Over all response rate on CT findings was 65.4% (CR rate: 23.1%) and 63.4% for lung and 73.5% for breast cancer. 5. Survival rate were 25.5% in 1 year, 8.8% in 2 year, 5.4% in 3 year and 3.6% in 5 year. 6. The longer interval was between onset of brain metastasis and primary treatment, the longer survival after brain irradiation. 7. No significant differences of survival rate were seen in size and in number of brain metastasis and with on without improvement of neurological symptoms. 8. The better response was on CT, the better prognosis after radiotherapy. 9. Identification of treatment for brain metastasis according to patient's characteristics and tumor factors were important.

[Progress of radiation therapy in malignant lymphomas].

Radiation therapy is keeping an important role on treating stage I, II and III A Hodgkin's disease. Several prognostic factors influencing treatment result were discovered recently even though patients conditions belong to the same stage. Owing to rapid progress of multi-anticancer drug chemotherapy, indication of radiotherapy of non-Hodgkin's lymphoma has become narrower than 10 years ago. However, radiotherapy is important to cure both stage I and early stage II non-Hodgkin's lymphoma with low or intermediate grade histological malignancy.

[Results of radiation therapy of stage II non-Hodgkin's lymphoma of the Waldeyer's ring: a report of the Japanese Lymphoma Radiation Therapy Study Group].

A retrospective analysis of 245 patients with stage II non-Hodgkin's lymphoma of the Waldeyer's ring treated between 1972 and 1985 was performed. Treatment consisted of radiation therapy alone in 96 patients and 149 patients were treated with chemotherapy combined. Five-year survival and relapse-free survival rates were 57% and 50%, respectively. For cases with DH, they were 64% and 55% respectively, and for DLPD 31% and 27%, respectively. Of the cases with relapse, 21% were seen in stomach or intestine. There were no difference on survival rates between radiation therapy alone and chemotherapy combined with radiation therapy.

[Results of radiation therapy in extranodal non-Hodgkin's lymphoma of the head and neck--a study of the Japan Lymphoma Radiation Therapy Study Group].

Extranodal non-Hodgkin's lymphoma (NHL) in the head and neck except Waldeyer's ring treated with radiation were analyzed. No definite difference was observed both in actuarial and relapse-free five-year survival rate between stage I and II. There was a high survival rate with orbital NHL in which most of the patients occupied with favorable histology. Prognosis of the disease was highly influenced by the histologic subtype; five-year survival was 91.4% in DWDL, 77.2% in the DM, 52.0% in DPDL and 51.7% in DH. Application of histologic classification with the Working Formulation was also recommended. There was a high incidence of extranodal relapses to bone and/or soft tissue from the lesions with nasal cavity, paranasal sinus and oral cavity.

[Results of radiation therapy of stage I and II nodal non-Hodgkin's lymphoma originated in the cervical lymph nodes--a study of the Japan Lymphoma Radiation Therapy Study Group].

During the years 1972-81, 118 patients with stage I (78 cases) and II (40) nodal non-Hodgkin's lymphoma originated in the neck were treated with radiation. 5 year survival rates were 74% for stage I and 40% for stage II. Favorable histology group showed better prognosis than unfavorable one. Among stage I patients with unfavorable histology group, prognostic factors were studied and tumor size larger than 4 cm is found to be a sole prognostic factor.

[Results of the radiotherapy of Hodgkin's disease (a JLRTG report). Japan Lymphoma Radiation Therapy Group].

A total of 234 patients of Hodgkin's disease treated at 7 institutions from 1972 through 1985 were analyzed. Male to female ratio was 157: 77, mean age was 39.8 years, and overall 5- and 10-year survival were 67% and 56%, respectively. Of 126 patients treated by radiotherapy with more than 36 Gy, alone or preceded to other treatments, 5- and 10-year survival rates were 84% and 80% for Stage I (43 patients), 79% and 69% for Stage II (71 pts.), and 52% and none for Stage III (12 pts.), respectively. Survival rate was better for LP, NS and MC histologies as compared to LD, better for patients without constitutional symptoms, as compared to patients with B, and better for patients with ages younger than 59 years as compared to those with ages over 60 years. Relapse was observed in 57 out of 126 patients. Relapse within the irradiation field was observed in only 4, and nodal areas outside the field, especially of abdomen (1/3), were the most common sites. Half of the relapses occurred within 20 months, and 80%, 40 months. Five-year survival of patients after relapse to lower torso lymph nodes (19 patients) was 37%, which was worse than patients after relapse to upper torso lymph nodes (15 patients: 63%) (z = 1.507, N.S.).

[Analysis of non-Hodgkin's lymphomas of 210 patients with nodular and favorable histologies--report of the Japanese Lymphoma Radiation Therapy Study Group].

Between 1972 and 1985, 210 patients with nodular poorly differentiated lymphocytic (NPDL), nodular mixed lymphocytic and histiocytic (NM), nodular histiocytic (NH), or diffuse well differentiated lymphocytic (DWDL) lymphoma according to Rappaport classification were treated among the 7 hospitals belonging to JLRTG (Japanese Lymphoma Radiation Therapy Study Group). Age greater than 50 years adversely affected overall survival. But no obvious survival differences were seen by sex and the primary site. Patients with NH had a significantly poorer survival (P less than 0.01), while there were no differences among the other histologic groups. Aggressive combination chemotherapy is advisable for patients with stages II, II and IV NH. But radiotherapy along may be treatment choice for patients with stage I NH. Because among stage I, over all survival and relapse-free survival of patients with NH were similar to those with the other histologic types. Five-year and 10-year relapse-free survival of stage I patients with the other 3 histologic types by radiotherapy alone were 85% and 67%, respectively. Those of stage II patients were both 58%. These data suggest cure of more than 50% of stages I and II patients with favorable lymphoma by radiotherapy alone.

[Histopathological changes in the brain after radiotherapy of brain metastasis].

This is the histopathological analysis of 18 post-irradiated brains with metastases of breast cancers. There was no evidence of radiation necrosis, except for one with demyelinization and one with degeneration of nerve cells. There was no radiation damage in re-irradiated group. Whole brain irradiation of about 40 Gy may be safe, but that of 60 Gy or more may be not so safe. It may be more useful for preventing of radiation damage to take split-course-method or shrinking-technique at doses of 40 Gy or more. The combination of chemotherapy and radiation therapy seems to aggravate the course of radiation damage.

[The criteria of radiotherapy for treating carcinoma of the esophagus].

The criteria of radiation therapy is given for the treatment of a carcinoma of the esophagus, said criteria decided by a committee of the Japanese Association for Radiotherapy Systems at the request of the Japan Radiological Society. The indication for radiation therapy is described and adapted to the new TNM Classification, based on the depth of the invasion of the tumor. The depth of the tumor invasion is divided into 4 stages and the radiological images for each are shown. To evaluate the effect of radiotherapy, cases are divided into curable and non-curable groups, according to the degree of changes of the radiological findings after irradiation, and each group is further subdivided into absolute and relative categories.

[Thyroid dysfunction following external irradiation of the neck].

Thyroid function after radiation therapy to the neck was studied in 120 patients, 110 of whom were suffered from malignant lymphomas. No patients had clinical symptoms from thyroid dysfunction, but 9 patients were given thyroid hormone after examination of thyroid function test. TSH elevation rate for 95 patients irradiated to the hole neck by dosage was 0%, 24%, 47% and 47%, for less than 30 Gy, 30-39 Gy, 40-49 Gy and 50 Gy or more, respectively. The effects of lymphangiography and systemic combination chemotherapy on the thyroid function were also discussed.

[Radiation tolerance dose of the spinal cord following conventionally fractionated irradiation].

409 patients whose spinal cord were irradiated over 30 Gy with conventionally fractionated method were surveyed to study the relation between the dose of spinal cord and the incidence of radiation myelitis. Radiation myelitis was observed in 26 cases including 3 transverse myelitis ones. 5 year incidences of transverse myelitis calculated with life table method were approximately 0% at 40 Gy, 5% at 50 Gy, 10% at 60 Gy and 20% at 70 Gy. The radiation tolerance dose of the spinal cord was considered to be 50 Gy.

[Results of radiation therapy of extranodal non-Hodgkin's lymphoma of the head and neck--a study of the Japan Lymphoma Radiation Therapy Study Group].

During the years 1972-81, 168 patients with extranodal Non-Hodgkin's lymphoma localized in the head and neck were treated with radiation. Five-year survival rates were 62% in stage I, 56% in stage II, and 91% in diffuse well-differentiated lymphocytic, 77% in diffuse mixed, 52% in diffuse poorly-differentiated lymphocytic and diffuse histiocytic each. Marginal relapse was rare after radiation therapy, but relapses were not infrequently noticed in distant extranodal sites. Bone and/or soft tissue relapses were frequently noticed in patients with lesions initially located in the nasal cavity, paranasal sinus and oral cavity.