Non-haematological toxicity limiting the application of sequential high dose chemotherapy in patients with advanced breast cancer.

A programme of repeated high dose chemotherapy for advanced breast cancer was developed using (1) cyclophosphamide 4 g/m2 followed by autologous peripheral blood stem cell (PBSC) collection; (2) three cycles of conventional dose chemotherapy; (3) high dose cyclophosphamide, cisplatin, and carmustine with PBSC rescue; and (4) high dose etoposide and melphalan with PBSC rescue. Fifteen eligible patients had advanced poor prognosis breast cancer either at initial diagnosis (one patient) or at relapse (14 patients). During the course of the protocol, there were three treatment related deaths, two patient withdrawals due to debilitating toxicity, five patient withdrawals due to disease progression, and one patient withdrawal due to inadequate collection of PBSC. The remaining four patients did not complete the planned protocol as the programme was terminated because of the unacceptable morbidity and mortality. They were treated with an alternative high dose chemotherapy protocol which was well tolerated. This study highlights the significant problems associated with a complex sequential high dose chemotherapy regimen. Cyclophosphamide mobilized PBSC infused following high dose chemotherapy enables rapid haematological recovery. However the non-haematological toxicity following high dose chemotherapy regimens is often severe and may limit the application of certain sequential high dose chemotherapy combinations in patients with breast cancer.

The value and need of more attention to end-results and follow-up in hospitals today. October 23, 1923.

Dr. George Ward, in a long-forgotten paper presented at a meeting of the American College of Surgeons on October 22, 1923, describes a hospital with a massive commitment to the continuous improvement of the quality of care.

Radiation therapy in hyperbaric oxygen for head and neck cancer at Royal Adelaide Hospital--1964 to 1980.

This report describes experience with radiation therapy in hyperbaric oxygen in 201 patients with squamous carcinoma arising in the mobile portion of tongue (anterior 2/3), oropharynx, hypopharynx, and supraglottic larynx, treated between the years 1964 and 1980. Although not statistically different, the overall 5-year determinate survival figures of 35% for all patients with tumors arising in the hypopharynx, 87.5% for Stage I and II, 55% for Stage III, and 27.1% for Stage IV supraglottic carcinoma were perceptibly better than those obtained in a contemporary but not randomly controlled series of patients treated in air at Royal Adelaide Hospital from 1970 to 1980. The results obtained for tumors arising in the oropharynx and mobile portion of tongue however were found to be very similar to those achieved in air. The results achieved in this series are discussed in the context of experience at other centers and the role of randomly controlled clinical studies in evaluating new treatment modalities is emphasized.

Ammonia inhalation.

Because of the widespread use of ammonia in industry and agriculture there is a growing opportunity for ammonia burns to occur. Two fatal cases are presented. The injury is thermal as well as chemical, to skin, eyes, airway and lungs. Prompt (5-10 seconds) irrigation of the eyes is required, and immediate treatment of airway and pulmonary injuries. Fluid resuscitation and skin wound care are similar to that of other burns. Presence or absence of abnormal chest findings on admission is the best prognostic factor.

Organochlorine and Organophosphorus Insecticides and Industrial Pollutants in the Milk Supplies of Ontario - 1983.

During the spring of 1983, fluid milk samples were collected from 359 bulk transporters representing 16 counties, municipalities and districts of Ontario, and were analyzed for organochlorine and organophosphorus insecticides plus selected halogenated industrial pollutants. Dieldrin, p,p'-DDE, heptachlor epoxide, and α-BHC were found in over 90% of samples, but none exceeded the accepted maximum residue limits. Polychlorinated biphenyls (PCB), lindane and pentachlorophenol (PCP) were found in 83, 68 and 57% of samples, respectively, with four samples exceeding the permissable PCB limit and one sample exceeding the permissable PCP limit. Residues of chlordane, endosulfan, p,p'-TDE, and p,p'-DDT were identified in only 1.9 to 4.7% of samples, and were present at levels only slightly above the detection limits. Hexachlorobenzene (HCB) was found at low levels in 40% of samples. Mean residues of organochlorines found were as follows (µg/kg butterfat): ∑DDT - 12; α-BHC - 5.3; lindane - 4.0; heptachlor epoxide - 3.9; dieldrin - 6.2; HCB - 0.67; PCB - 24; and PCP - 29. No residues of six organophosphorus insecticides, endrin, methoxychlor or mirex were detected in any samples. This survey was the sixth in a series beginning in 1967. Half-residue disappearance rates were calculated at 3.5, 5.4, 5.6 and 3.0 years for ∑DDT, dieldrin, PCB and HCB, respectively. A case history is included involving the misapplication of fenthion to a dairy herd which revealed a half-residue elimination from milk in approximately 3 d.

Chemotherapy of squamous cell cancer of the head and neck.

Forty patients with advanced squamous cell cancer of the head and neck were treated with methotrexate, cisplatin, and bleomycin. Major regression of disease occurred in 69%; 30% of patients achieved complete remission. Fifteen patients received chemotherapy as the initial treatment, followed by either radiotherapy or surgery or both. Subsequent therapy was not prejudiced by this approach. The results demonstrate the marked sensitivity of these tumors to these three agents, and the need for further assessment of their use in optimal patient care.