Treatment of malignant pericardial effusion with 32P-colloid.

Malignant pericardial effusion is usually treated only when signs of cardiac tamponade develop. Several methods of treatment have been reported with an overall response rate of approximately 75%. Since our initial study using intrapericardial 32P-colloid instillation as a treatment modality for pericardial effusion demonstrated a significant higher response rate, this study was conducted to further evaluate the efficacy of intrapericardial 32P-colloid in terms of response rates and duration of remissions. Intrapericardial instillation of 185-370 MBq (5-10 mCi) 32P-colloid in 36 patients with malignant pericardial effusion resulted in a complete remission rate of 94.5% (34 patients) whereas two patients did not respond to treatment due to a foudroyant formation of pericardial fluid. The median duration time was 8 months. No side-effects were observed. These results suggest that intrapericardial instillation of 32P-colloid is a simple, reliable and safe treatment strategy for patients with malignant pericardial effusions. Therefore, since further evidence is provided that 32P-colloid is significantly more effective than external radiation or non-radioactive sclerosing agents, this treatment modality should be considered for the management of malignant pericardial effusion.

An early phase II study of intratumoral P-32 chromic phosphate injection therapy for patients with refractory solid tumors and solitary metastases.

BACKGROUND: In this early Phase II study, the authors investigated the efficacy of intratumoral injection of P-32 chromic phosphate in 17 patients with refractory solid tumors or solitary metastases in terms of response rates and overall survival. METHODS: Seventeen patients (median age, 60 years) with either cytostatic drug-resistant tumors or tumors known to be primarily chemotherapy-resistant were entered into the study. After sonographic determination of the tumor volume, P-32 chromic phosphate (74-555 MBq) was injected into the central part of the tumor under sonographic guidance. Follow-up investigations included serial scintigraphy, sonographic examinations, and hematologic studies. RESULTS: Injection of P-32 chromic phosphate into refractory tumors resulted in remarkable regression. The median survival of all patients was 13 months (range, 8-25 months). The response rate was 71% (12 patients). A complete remission was seen in 7 patients (41%), and the rate of partial remissions was 29% (5 patients). However, 5 patients (30%) did not respond to the treatment. In one patient thrombocytopenia was observed, but no other side effects were apparent. Important pathologic and anatomic changes within the tumor tissue were demonstrated in solitary liver metastases of gastrointestinal malignancies excised in second-look operations. In all cases examined, formation of a cyst within the area of central activity, surrounded by a centrifugal necrotic ring and a marginal fibrotic structure, was found. CONCLUSIONS: Lack of persistent systemic or local side effects, as well as noteworthy efficacy, are properties of this optimal regional treatment modality with P-32 chromic phosphate. This modality deserves consideration for further clinical trials.

[Unusual course of hemangiopericytoma]. / Ungewöhnlicher Verlauf eines Hämangioperizytoms.

BACKGROUND: Hemangiopericytomas, rare perivascular tumors, normally tend to be well circumscribed, however, since some have a malignant behavior they are recognized to be potentially malignant. CASE REPORT: In the case presented here, we report the medical history of a 46-year-old man with a hemangiopericytoma of the nose. In 1983, the tumor was surgically removed, and histological examination revealed no signs of malignancy. In 1987, a local recurrence was removed followed by X-irradiation. In March 1995, the patient presented with multiple hepatic and bone metastases. Chemotherapy with ifosfamide (5 g/m2, day 1) and epirubicin (50 mg/m2, day 1) was performed. After three courses of chemotherapy a tumor stabilization was achieved. In November 1995, however, a massive progression of the hepatic lesions was found. Therefore, six courses of a second-line chemotherapy with dacarbazine (200 mg/m2, day 1 to 5) and adriamycin (60 mg/m2, day 1) were applied. A partial remission was achieved lasting until November 1996. A couple of weeks later the patient died due to hepatic failure. CONCLUSION: Despite of unacceptably low survival rates in patients with advanced soft tissue sarcomas (especially after pretreatment with ionizing radiation) our report demonstrates that it is also possible to induce long lasting remissions without altered quality of life.

The role of bronchoscopy in pulmonary complications due to mustard gas inhalation.

Over the last five years we have repetitively treated a group of 21 Iranian soldiers who developed pulmonary complications as a result of severe inhalation injury due to mustard gas during the Iran-Iraq war. Early respiratory manifestations included hemorrhagic inflammation of the tracheobronchial tree accompanied by severe erosions. Secondary complications consisted of chronic infections, suppurative bronchitis, and extensive stenotic process of the entire tracheobronchial tree with life-threatening sequelae. After a delay of up to 15 months, scars, ulcers, and strictures developed in the central airways. Progressive deterioration of gas exchange was common. At this point, bronchoscopy, both diagnostic and therapeutic, was invaluable in evaluating the conditions in these patients since many required multiple therapeutic bronchoscopies. Repeated bougienage of the stenotic tracheobronchial lesions and laser photoresection of scarring tissue was life-saving. The recurrence rate of stenosis was very high, with intervals of less than six months on the average. One pneumonectomy was necessary, with the excised lung showing bronchiectasis and chronic pneumonia. To this date we have performed 146 therapeutic bronchoscopies. In four patients, silicone stents had to be implanted. One patient received brachytherapy and external beam radiation therapy in an effort to prevent continued scarring and life-threatening stenoses of the tracheobronchial tree. Our experience demonstrates the extreme usefulness of bronchoscopy in the diagnosis and treatment of pulmonary complications due to inhalation of poisonous gases.

[Chemo- and laser therapy of advanced tumors of the upper gastrointestinal tract]. / Chemo- und Lasertherapie der fortgeschrittenen Tumoren des oberen Gastrointestinaltraktes.

Results of combined modality treatment of space occupying tumors of the upper gastrointestinal tract consisting in combined chemotherapy and endoscopically guided topical laser therapy have been presented. A majority of patients achieved complete relief of nutritional distress and a remarkable survival duration. Further development of such treatment by additional after loading treatment has been discussed.

[High-dosed gestagen therapy of the metastatic mammary carcinoma (author's transl)]. / Hochdosierte Gestagentherapie des metastasierenden Mammakarzinoms. Vorläufige Ergebnisse einer Phase-II-Studie.

Thirty patients with histologically proven metastatic mammary carcinoma were treated, after exhaustion of hormonal and cytostatic therapeutic means, with high-dosed medroxyprogesterone acetate (MPA) during a ten-day induction phase with 1000 mg MPAi.m. per day and then with 600 mg oral MPA per day. In eleven patients a complete or partial remission was achieved. The median period of remission comprised ten months. A positive relationship was found between the response to high-dosed MPA therapy and the length of free intervals. Side effects were tolerable.

[Chemotherapy in advanced sarcomas (author's transl)]. / Chemotherapeutische Behandlungsmöglichkeiten bei fortgeschrittenen Sarkomen.

43 patients with metastasizing sarcomas were treated with a combination of either vincristin, adriamycin and cis-platinum (n = 21) or ifosfamide and cis-platinum at three weeks' intervals in each case. Ten patients responded to the first combination and nine to the second combination with objective tumor regression. Particularly the latter result is remarkable since 16 of the 22 patients had already been pretreated with combinations containing adriamycin. Obviously the combination of ifosfamide and cis-platinum is a promising alternative in metastasizing sarcomas of the bones and soft tissue, especially if the CYVADIC combination--which is often regarded as standard treatment--remained unsuccessful. This has no bearing on additional surgical measures or on radiotherapy which may be necessary in some patients.

[Therapeutical aspects of the neuroblastoma (author's transl)]. / Therapeutische Aspekte des Neuroblastoms.

Formation of the neuroblastoma, primary locations of the tumor, its mode of spreading and the incidence dependent on age are reported from 2055 cases. The prognosis, dependent on an early diagnosis, and the problems related to it are discussed. The actual therapeutic concepts as operation, radiation and chemical therapy for children and adults are represented. A well-differentiated combined schedule is recommended.

[32P therapy of malignant pericardial effusions]. / 32P-Therapie des malignen Perikardergusses.

Treatment of 11 patients with malignant pericardial effusion was performed by instillation of radioactive phosphorus. All of these patients had clinical evidence of tamponade. Only 2 patients had further problems with effusion after radioisotope therapy. Remarkable long-lasting remission could be observed in the rest of patients.

[Results of emission computerised axial tomography of the liver in 113 patients (author's transl)]. / Ergebnisse der Emissions-Computer-Tomographie der Leber bei 113 bioptisch untersuchten Patienten.

Transversal emission computerised axial tomography (ECAT) was performed in addition to bioptic examination in 113 patients with solid tumours and lyphomas. In 69/113 (61%) patients the results of conventional scintigraphy and ECAT were in agreement. In 44/113 (39%) patients additional information was obtained. Correct positive and correct negative results were found in 86.3% (63.6% and 22.7%, respectively), while in 13.6% the results were false positive or false negative (6.8% both).

[Anabolic effects of steroid hormones in rabbits (author's transl)]. / Zur Frage der anabolen Eigenschaften der Steroid-Hormone im Tierexperiment.

The anabolic effect of steroid hormones was investigated in rabbits by measuring the skeletal accumulation rate of 85Sr following the continuous administration of estrogens, androgens and corticosteroids over a period of eight weeks. Androgenic hormones did not influence the accumulation rate of 85Sr, whereas following castration and prolonged administration of estrogens an increase of 85Sr accumulation was found. There was no correlation of the changes observed with serum calcium levels, since the latter remained stable throughout the observation period during long-term administration of various hormones.

Microangiopathic haemolytic anaemia in cancer patients with bone marrow infiltration.

Eight patients suffering from wide-spread malignancies presented with a severe microangiopathic haemolytic anaemia (MHA) without gross evidence for coagulation abnormalities. The common feature in these patients was bone marrow infiltration with malignant cells, suggesting a pathogenic link between bone marrow carcinosis and red cell destruction. Furthermore, it is concluded that MHA is a rare complication of malignancy and a terminal syndrome rather than an early manifestation of the disease.

[Chemotherapy as an adjuvant treatment in breast cancer (author's transl)]. / Adjuvante Chemotherapie des Mamma-Ca.

Prolonged L-Phenylalanin mustard Administration and combination chemotherapy as on adjuvant to mastectomy in the management of patients with primary breast cancer and pathologically axillary nods. Lead to improvement of results. L-PAM and CMF have been demonstrated to be effective in the treatment of women with primary breast cancer, particularly those who are premenopausal. In our trial no improvement of results could be observed by administration of Chlorambucil, Cyclophosphamide and 5-FU. Experience with both single-drug and combination chemotherapy has shown that the benefit of these treatments, as judged by the disease-free intervall, is restricted largely to premenopausal patients. This suggest that the therapeutic effect is due, at least to cytotoxic suppression of endocrine function. Therefore further prospective trial in this field are necessary.

[The relatinship between prognosis and "Kiel" classification of malignant non-Hodgkin lymphoma. A study of 201 patients (author's transl)]. / Der Zusammenhang zwischen Prognose und Kieler Klassifikation der malignen Non-Hodgkin-Lymphome Eine katamnestische Studie über 201 Patienten.

The clinical course of 201 patients with malignant non-Hodgkin-lymphomas was analysed according to the Kiel classification. The five-year survival rate of 133 patients with lymphomas of low grade malignancy was 63% in comparison to 23% out of 68 patients with lymphomas of high grade malignancy. Radio- and chemotherapy were used in a different way. Patients with centrocytic-centroblastic lymphomas had the best porgnosis, which was not influenced by the stage of the disease. The poorest prognosis was observered in patients with lymphoblastic lymphomas. These results support the importance of a classification of malignant non-Hodgkin-lymphomas which is not only based on morphological criteria.

[Endo-osseous isotope therapy of malignant skeletal disease (author's transl)]. / Endoossale Isotopen-Therapie maligner Skeleterkrankungen.

The intravenous application of 89-strontium for the relief of pain in 43 patients with breast cancer, bronchogenic cancer, carcinoma of the prostate, hypernephroma and lymphoma with generalized bone metastases is reported. A remarkable clinical improvement was achieved in 33 (76.7%) patients. In four patients a transient analgesic effect was observed. In six cases no response could be achieved. The therapeutic effect usually was long-lasting. At the same time, an increase of alkaline phosphatase was observed, which was interpreted as an indication for the stimulation of osteoblasts and osteoid peripheral zones owing to beta-emission of the radioisotope in the affected areas. There was a significant correlation between the concentration of 85Sr in the bone scan and the therapeutic result of 89Sr-therapy. The indication for such therapy and possible late adverse effects of bone-seeking isotopes are discussed.