Current management of cystic neoplasms of the pancreas.

Over the last decade there has been a dramatic increase in the number of patients identified with pancreatic cysts. This increase has been largely attributed to advances in imaging. The majority of these cysts represent benign neoplasms; however, a significant fraction of these are pre-malignant or malignant. Because the majority of these neoplasms are benign, many reports have advocated a selective approach to surgical resection. Here we review the literature that has contributed to the development of our approach to the management of these cystic neoplasms. We provide an overview of the key features in diagnosis and in predicting malignancy. Particular attention is given to the natural history and management of intraductal papillary mucinous neoplasms (IPMN).

[Radiotherapy for cystadenoma of the trachea]. / Luchevaia terapiia adenokistoznogo raka trakhei.

Radiation as a method of treatment was carried out in 16 (25.0%) out of 64 patients with tracheal adenocystoma (radical dosage of 50-70 Gy (12) and palliative--40-48 Gy (4). The dosimetric profile consisted of the cervical, cervico-thoracic, thoracic and bifurcation sections of the trachea. Complete resorption of tumor was registered in 12, partial--3, no effect in 1 cases. Three-, five- and ten-year survival was 65.2 +/- 12.6; 55.9 +/- 13.5 and 10.4 +/- 13.1%, respectively.

[Studies on serum protein fractions of patients with maxillary sinus cancer undergoing a combination of radiotherapy and chemotherapy: II. Relationship between changes in serum protein fractions and prognosis].

We examined the correlations between changes in serum protein fractions and the prognosis of the patients. The levels of 21 protein components of the sera of 36 patients with maxillary sinus cancer were determined by a single radial immunodiffusion method before and after radiation therapy. The patients with maxillary sinus cancer were treated with combined intra-arterial infusion of bleomycin and external irradiation of 60 Co gamma-rays, and were concurrently treated with 5-fluorouracil at 200 mg/day p.o. The levels of the same protein components were also measured in 34 normal adult as a control. All patients were observed 5 years and 12 years after radiation therapy. In patients who had survived at least 5 years after radiation therapy, the Alb, Tf, Hx, IgG and IgM levels measured before radiation therapy were elevated significantly compared with those who had died within 5 years. In those who had survived at least 5 years, the Alb, Tf, Hx, IgG, IgM, IgA and I alpha I levels measured after radiation therapy were elevated significantly compared with those who had died within 5 years, and AT III was reduced. In cases of maxillary sinus cancer following a period of 5 to 12 years after radiation therapy, multiple regression analysis was used to determine whether increased concentrations of serum protein fractions were associated with good prognosis for the original disease, alpha 2HS. IgM, HX, alpha 1AT and alpha 1X before radiation therapy were positively correlated with survival, whereas AT III, Pmg, Cp, IgA, and alpha 1AG showed negative correlations. After radiation therapy, Pmg, Hx, Cp, Cl inh and Fib were found to be positive factors of survival rate, whereas alpha 2M, alpha 2Pl, I alpha 1, IgA, alpha 1AG and C3 were negative factors.

The treatment of intraperitoneal malignant disease with monoclonal antibody guided 131I radiotherapy.

Seven patients with small volume ovarian carcinoma, remaining after conventional therapy with surgery and a platinum containing chemotherapy regimen, were treated with intraperitoneal monoclonal antibody guided radiotherapy. 100 mCi131I conjugated to 10 mg of monoclonal antibody were injected i.p. in 2,000 ml peritoneal dialysis fluid. Patients were evaluated 3 months later; 3 had clinical progressive disease while third look laparotomy demonstrated progressive disease in 3 of the remaining 4 patients. The seventh patient did not have a third look laparotomy and is currently inevaluable for response. Five patients with recurrent malignant ascites not controlled by diuretics or repeated paracentesis were similarly treated with 75-170 mCi131I conjugated to 10 mg monoclonal antibody. In three patients the ascites was controlled for a mean of 4 months. One patient died too early to assess the control of his ascites but tumour cells disappeared from the ascitic fluid after therapy. In the patient whose ascites were not controlled, a subpopulation of antigen-negative tumour cells was demonstrated. This study was unable to demonstrate a therapeutic benefit for i.p. injected monoclonal antibody guided radiotherapy for solid intraperitoneal tumour but suggests that it may be capable of controlling the accumulation of antigen positive malignant ascites.

Malignant tumours of the paranasal sinuses and nasal cavity. A series of 180 patients.

In a series of 180 malignant tumours in the paranasal sinuses and nasal cavity the largest groups comprised 90 epidermoid carcinomas, 25 adenocarcinomas, and 19 adenocystic carcinomas. The epidermoid carcinomas were classified according to various proposed methods. The planned treatment schedule for carcinoma was 57 to 60 Gy in 30 fractions over 42 days, followed 8 to 12 weeks later by radical surgery. In the group of 80 patients with epidermoid carcinomas treated with radical intention, the 5-year corrected survival was 42 per cent. The prognosis has been analysed against a number of parameters, and it is found that sex, tumour size, and histologic score are important but neither totally independent nor evenly distributed parameters.

[Radiotherapeutic methods in the management of ovarian cancer (author's transl)]. / Methodik der strahlentherapeutischen Massnahmen beim Ovarialkarzinom.

A report is given of the therapeutic strategy and the stage-adjusted methods of irradiation in the treatment of ovarian cancer. The influence of radical surgery, irradiation and chemotherapy on survival rates is discussed and the results achieved in this unit, especially in patients admitted at a more advanced tumour stage, are presented.

Pseudomyxoma peritonei.

Thirty-eight patients with pseudomyxoma peritonei were treated at the M. D. Anderson Hospital, Houston, from 1954 to 1978. The various treatment regimens used have provided actuarial survival rates of 54% at five years and 18% at ten years. Local or regional disease was the cause of death in 68% of patients, and no patient died of metastatic disease. Initial definitive surgery should consist of effective tumor reduction, omentectomy, appendectomy, and, in the female subject, bilateral oophorectomy. Most patients have been treated adjunctively with either fluorouracil or melphalan (L-phenylalanine mustard) depending on the presumed site of origin, but results in a small number of patients treated with either whole abdominal or strip abdominal radiotherapy suggest that this modality may offer improved survival. Treatment with adjunctive radiotherapy alone has provided a five-year survival rate of 75%, compared with 44% for chemotherapy.

Radiation therapy in stage II ovarian carcinoma: the influence of histologic grade.

Between September 1968, and December 1975, 40 patients with Stage II epithelial tumors of the ovary were treated at the Joint Center for Radiation Therapy. Thirty-six patients had undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy (BSOH) with attempted total removal of disease, and all patients received postoperative pelvic irradiation. The five-year actuarial relapse-free survival rate is 66% and the overall survival rate 70% for the entire group of patients. The histology was reviewed in all cases and graded for the percentage of solid vs. papillary or glandular in the specimen. Of the 36 patients treated with a BSOH, 18 had well-differentiated tumors defined as containing less than a 10% solid architectural pattern. There have been no relapses in this group of patients. In contrast, 9 of 18 patients with moderately or poorly differentiated tumors containing a 10% or more solid pattern have relapsed; five diffusely in the abdomen, two in the pelvis, and two in the lungs or pleura. It appears that a BSOH followed by pelvic irradiation is sufficient treatment for Stage II patients with well-differentiated tumors showing less than a 10% solid pattern. In contrast, patients with less well-differentiated tumors have a high risk of relapse outside of the pelvis and need additional treatment. Alternative treatment options are discussed.

Limited epithelial carcinoma of the ovary treated with curative intent by the intraperitoneal installation of radiocolloids.

Between January 1960 and September 1972, 104 patients with limited epithelial carcinoma of the ovary received intraperitoneal radiocolloid. Fifty-six of these patients also received external beam radiation therapy to the pelvis (pelvic RT). Five-year actuarial no-evidence-of-disease survival rates were 95% for stage Iai, 82% for Iaii, 73% for Ib, 67% for Ic, 67% for IIa, 67% for IIb without gross residual tumor (GRT), 25% for IIb with GRT, and 50% for III with minimal or no GRT. The addition of pelvic RT following radiocolloid could not be shown to affect survival of patients with Stage I and IIa tumors. Small bowel complications were related to the use of pelvic RT, however, occurring in 2.2% of patients treated with radiocolloid alone and 24% of patients treated with colloid and pelvic RT (p less than 0.005). In patients who underwent abdominal surgery following treatment of ovarian cancer, no excessive complication rate was observed. We conclude that for patients with stages Iaii through IIa, postoperative radiocolloid appears to provide the greatest chance of survival with the least chance of complication. For patients with Stage IIb and III lesions in whom there is minimal or no GRT, radiocolloid followed by pelvic RT produced survival rates comparable or superior to any other form of postoperative therapy.

[Pseudomyxoma peritonei. Effect of radiogold therapy]. / Pseudomyxoma peritonei. Effekt der Radio-Gold-Behandlung.

Five female patients with pseudomyxoma peritonaei in various stages of disease received one or more applications of 198Au intraperitoneally. In all cases the origin of the disease was the ovary. In these patients radioactive gold was given four weeks after the diagnosis was made at laparotomy. Results with this group of patients in gratifying since no recurrence has occured in two patients who were treated one year ago and in a third patient treated five years ago. -- In two other cases 198Au was administered after a recurrence after one year, the other patient had no response at all.

[Application of the Moving Strip Technique of Fletcher in the radiation treatment of primary malignant tumours of the ovary (author's transl)]. / Application de la technique d'irradiation en bandes de l'abdomen (Moving Strip Technique de Fletcher) au traitement des tumeurs malignes primitives de l'ovaire.

The moving Strip Technique for irradiation of the abdomen perfected by Fletcher and Delclos represents considerable progress in terms of radiotherapy for carcinomas of the ovary by virtue of its simplicity, good tolerance, the homogeneous dose delivered to the entire abdominal cavity and the absence of sequelae. It is possible to deliver a dose of the order of 2.500 rads in 10 days to each abdominal segment, this being equivalent of 3,500 rads in 3,5 weeks. This moderate dose is aimed only at dealing with micronodular invasion and the superimposition of added local doses is required for residual tumour, marked using clips. Of 18 cases treated, including. 15 et stages III and IV, overall survival at 4 years is 52.5%. Two patients at stage III survived for more than 2 years with radiotherapy alone, whilst all at stages I and II are still alive. Have survived for more than two years with radiotherapy alone, whilst all at stages I and II are still alive. From a histological standpoint, the worst group seems to be adenocarcinomas (all dead). Systematic sequential surgery for excision or reduction, chemotherapy to dry out ascites, moving strip irradiation with superimposed doses locally and long term chemotherapy should make it possible to improve the prognostic results of this tumour, for which the outlook remains poor.

Intraabdominal calcification in treated disseminated carcinoma of the ovary.

The presence of diffuse abdominal calcification in patients with known carcinoma is usually a sign of metastatic involvement. This finding in some patients who have been treated with high dosage radiation therapy may represent areas of tumor necrosis and subsequent healing without evidence of active malignancy.

[Healing results of pseudomucinous ovarian carcinoma depending on therapy]. / Heilungsergebnisse beim Carcinoma pseudomucinosum ovarii in Abhängigkeit von der Therapie

A report is given on 57 patients with pseudomucinous ovarian carcinomas. The prognosis of the disease depends on two decisive factors, if the FIGO stages are not taken into consideration: 1. the operation which should be executed as radically as possible, 2. the intraperitoneal instillation of radiogold which shall be repeated two times. The following therapeutic results were realized under this treatment: a five-year survival rate of 76,9% and a ten-year survival rate of 72.7%. There were no serious side-effects of the radiogold therapy since the introduction of routine peritoneographies before instillation of 198Au.

Peritoneal osteosarcoma following irradiation therapy of ovarian cancer.

A peritoneal osteosarcoma occurring after irradiation therapy for cystadenocarcinoma of ovary is described. Only 6 cases of postradiation extraosseous osteosarcomas have been reported and none of them have arisen within the peritoneum. The clinical presentation and histopathology of this unusual tumor is presented with a review of the literature.

Radiocolloid scans in evaluating splenic response to external radiation.

By use of 99mTc-sulfur colloid, splenic size as well as liver/spleen ratio of ratioactivity was determined after external radiation of the abdomen. In six patients receiving about 2,000 R whole-abdominal radiation, there was no atrophy of the spleen or abnormal distribution in the liver/spleen ratio of radioactivity (that is, the spleen was still functional). Serial studies in a 7-year-old boy with acute lymphoblastic leukemia in remission showed that 1,450 R splenic radiation did not result in any appreciable change in the length of the organ. In a woman with lymphosarcoma, a change in spleen size did not occur until a dose of 1,800 R was delivered. Another patient had apparently normal uptake of radiocolloid 5 years after 3,600 R. Hence the normal spleen and the spleen affected by other diseases may be far more resistant to external radiation than the spleen diseased with chronic myelocytic leukemia. Spleen scans can be useful in documenting the response of the organ to radiation.