Safety and effectiveness of vascular endoprosthesis for malignant superior vena cava syndrome.

BACKGROUND: Superior vena cava syndrome management has been traditionally radiation therapy, chemotherapy or chemoradiation, depending on the underlying malignancy involved and individual clinicopathological features of the case. Recent emergence of endovascular stents offer the opportunity for immediate relief of the venous stenosis. This review examines findings from the published series which used endovascular prosthesis for this syndrome with regards to efficacy and safety. METHODS: Literature search identified studies using endovascular stents as initial therapy or for recurrence of malignant superior vena cava syndrome. Effectiveness and toxicity from stent placement was assessed. RESULTS: Endovascular stent placement provides immediate haemodynamic relief of venous compression either before or after definitive therapy in the majority of cancer patients. Severe bleedings, cardiopulmonary complications and stent migrations remain significant problems for patient management. CONCLUSIONS: Endovascular prosthesis is an effective modality for malignant superior vena cava syndrome with acceptable morbidity. Prospective studies should be performed to determine the optimal anticoagulation regimen.

Role of ionizing irradiation for 393 keloids.

Between 1928 and 1986, 393 keloid sites on 250 patients were presented. Three hundred seventy-five sites received superficial quality therapeutic irradiation. Etiologies were determined. The majority were excised prior to irradiation, and in these, histologic confirmation was obtained. Recurrence rate after irradiation was low, 9/375 (2.4%). When 7 of 9 recurrences are eliminated for post-irradiation ear lobe repiercing, true recurrence is only 2/375 (0.53%). Cosmetic result was considered excellent without recurrence in 92%; favorably improved with hypertrophic scar, nodule or altered pigment in 5.6%; and marginally improved with smaller, less symptomatic keloid in 2.4%. Significant complications were limited to persistent pigment disturbance in only 1 patient, and pre-irradiation hemorrhage in 1 patient (unrelated to radiotherapy). There was no wound dehiscence nor failure to heal irradiated incision site. Transient hyperpigmentation occurred in 91/375 (24%). Recurrence after irradiation was too rare to associate with etiology, specific technical factors, keloid configuration or velocity of initiating the post-operative radiotherapy. An unexpected finding was that 22/250 (9%) were Caucasian subjects. Our null (0%) carcinogenicity rate to date and the one-half of one percent true recurrence rate supports continued use of post-operative irradiation to prevent keloid formation in this group of documented troublesome keloid formers. Configuration subtypes are proposed, post-operative irradiation protocol is listed, and mechanism of action is explained in accordance with the dynamic pathophysiology of keloid.

Microwave hyperthermia radiosensitized iridium-192 for recurrent brain malignancy.

Twenty-one patients whose solitary detectable biopsy proven recurrent brain malignancies produced Central Nervous System (CNS) symptoms warranting further intervention received 60-minute 43 degrees C (180 degree-minute) interstitial 2450 MHz microwave hyperthermia fractions. All received brain teletherapy prior to recurrence. The first 15 received no brachytherapy and served as a toxicity pilot. All 15 enjoyed neurologic improvement, 12 symptomatic improvement, and 12 objective response as mass reduction and/or tumor necrosis. The next 6 patients were selected with more favorable Karnofsky performance status, no known active malignancy elsewhere, and received afterloading Ir-192 interstitial implantation juxtaposed to radiosensitizing hyperthermia. Volume dose varied from 1000 to 2245 rad, and dose rate from 40 to 100 rad/hr. Dose selected varied as a function of pre-recurrence teletherapy dose, general condition, histologic type, and volume. Neurosurgical debulking, if technically indicated through no additional aperture or trauma, was permitted if consistent with preservation of neurological function. Six enjoyed neurologic improvement, symptom reduction, and objective tumor response; three remain alive, and one experienced transient improvement. Complications, histologic subtypes, autopsy findings, stereotactic approach, thermal monitoring methods and CT follow-up of objective response are presented along with computer dosimetry and isotherm chart. Our microtraumatic universal catheter technique for CT guided stereotactic biopsy, aspiration, decompression, thermal sensory loop, thermalization antennae, and brachytherapy without multiple trauma nor changing catheters is stressed. The rationale for combined modes peculiar to the CNS will be outlined.2+ Proposal for incorporating controlled-release ARA-C chemotherapy polymer micro-rods into the interstitial format will be offered. The preceeding is an FDA-approved controlled clinical trial.(ABSTRACT TRUNCATED AT 250 WORDS)

Time course and significance of acute hyperamylasemia in patients receiving fractionated therapeutic radiation to the parotid gland region.

To improve our understanding of hyperamylasemia secondary to parotid gland irradiation, serial serum amylase levels were measured from 12 consecutive patients who received incidental parotid irradiation during radiotherapy of their head and neck tumors. Rapid transient increases in enzyme activity, limited to the first days of radiotherapy, were consistently found. Awareness of the frequency and nature of this response may avoid unnecessary investigation and concern for abdominal pathology in this clinical setting.

Malignant glioma. Results of combined modality therapy.

Multimodal treatment of malignant gliomas is routinely used at New York University Medical Center. Overall, our treatment program has resulted in survival rates of 78% at six months, 51% at one year, and 7% at five years for these high-grade brain tumors. However, various subgroups (based on tumor or host factors, or both) fared significantly better or worse than others. Particularly limited survival rates were found in patients who experienced paresis/paralysis or impaired mental function, who had tumors that were markedly anaplastic, who were elderly, or who for a variety of reasons did not receive the multimodal treatment we consider optimal.

Mycosis fungoides: retrospect, current understanding, and prospect.

After a brief historical view of mycosis fungoides from Alibert's time to the present, the authors go on to detail the average biologic course of mycosis fungoides, give a protocol for investigating patients with disease as extensively as modern means permit, review past and present staging schemes, and finally, review treatment as practiced today and speculate upon what may yet be practiced to the better in the future.