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Histopathology peer review of high-grade soft tissue sarcoma: the Scandinavian Sarcoma Group experience. The prognosis of clinically localized primary melanoma may be estimated rather precisely by the Breslow depth of primary tumor invasion (in millimeters) at the site of origin, the presence or absence of ulceration, and sentinel lymph node status. In addition, other national and regional cooperative groups have conducted controlled chemotherapy trials. In patients whose diagnoses were based on immunoperoxidase staining with tumors other than lymphoma, only limited data exist concerning treatment outcome. Despite normally resting, melanocytes maintain a lifelong proliferation potential. First, longitudinal studies have shown a high risk of colorectal cancer development in individuals whose adenomas are not removed, 23,24 and polypectomy decreases colorectal cancer risk. A pilot study of the combination of interleukin-2-based immunotherapy and radiation therapy. Discrete nodules and plaques of firm, grayish tumor coalesce, eventually obliterating the parietal and visceral surfaces. Inferior venacavography may be performed when a large renal tumor is present or when there is uncertainty about tumor involvement of the vena cava. As breast tissue undergoes differentiation as a result of hormonal changes of a full-term pregnancy, these fully differentiated cells may be less likely to undergo malignant transformation. This would be particularly useful if it permitted the identification of the small percentage of otherwise low-risk patients who are destined to develop recurrent disease. Pathogenesis of generalized dermal pigmentation secondary to malignant melanoma and melanuria. Antitumor activity of sequential treatment with topotecan and antiepidermal growth factor receptor monoclonal antibody C225. All patients in the series underwent ovarian hyperstimulation for the treatment of infertility. Chemoprevention of colon carcinogenesis by dietary administration of piroxicam a-difluoromethylornithine, 16-fluoro-5-androsten-17-one, and ellagic acid individually and in combination. For example, if one takes patients with lymph node metastasis only or lymph nodes plus other metastasis and contrasts those to other systemic metastasis, then the disease-specific survival is essentially the same (. In addition to singlet oxygen, carotenoids are also thought to quench oxygen free radicals. Osseous sites of involvement, in decreasing order of frequency, include the lumbar spine, proximal femur, pelvis, thoracic spine, ribs, sternum, and skull. Development of a biochemotherapy regimen with concurrent administration of cisplatin, vinblastine, dacarbazine, interferon alfa, and interleukin-2 for patients with metastatic melanoma. This vein can be accessed percutaneously in a similar fashion by using the bellies of the sternocleidomastoid muscle as landmarks. The prognosis for these patients may improve with a more aggressive surgical approach and more effective chemotherapy. The microtubule polymer is in a dynamic equilibrium with the intracellular pool of tubulin dimers, which results in the simultaneous incorporation of free dimers into the polymerized structures and release of dimers into the soluble tubulin pool. The use of molecular techniques has led to remarkable progress in the understanding of cell growth, differentiation, maintenance of genomic integrity, and programmed cell death, these being key issues in tumor development and progression. Careful hydration and emptying of the bladder are crucial to avoiding this toxicity, which has produced massive and even fatal hemorrhage. Bc12 and p53 protein expression in metastatic carcinoma of unknown primary origin: biological and clinical implications. The first decade of the twenty-first century will probably bring such approaches into mainstream oncology, driven both by technological and cost issues. Considering that so few drugs have demonstrable activity against macroscopic osteosarcoma, the results reported in adjuvant trials are remarkable. Interestingly, the two most impressive responses were those patients who had experienced a flutamide withdrawal response. The staging portion of the operation is performed endoscopically followed by a transvaginal hysterectomy.

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No prospective study has proven that this tumor stabilization results in increased survival. Selected biopsy specimens from the "apparently" normal transitional cell epithelium and prostatic urethra are also performed to assess whether a field change has occurred. The prevalence of panurothelial tumor diathesis suggests that chemoprevention strategies will be needed as an adjunct to active therapy directed against the primary bladder tumors. For 9 of 12 schoolteachers with mesothelioma, the only potential asbestos exposure was that derived from asbestos-containing building materials in schools. Subsequent studies suggested that large stationary megavoltage fields could be tolerated, and they were technically less difficult to deliver. They are often incidentally discovered on various abdominal imaging studies and must be distinguished from malignant lesions. Women and patients younger than 50 years of age seem to have a more favorable outcome. Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. In evaluating a patient with hyponatremia and cancer, other causes of hyponatremia need to be considered. Altered expression of the cyclin D1 and retinoblastoma genes in human esophageal cancer. The resulting specimen is of adequate size and lacks burn artifact caused by the use of electrocautery to obtain the specimen. Some recommend low-dose ablation with less than 30 mCi given on an outpatient basis. As plasma cells contain cytoplasmic immunoglobulins with a constant heavy and light chain, its frequency can be evaluated by flow cytometric analysis using immunohistochemical staining of the plasma cells. Temporal lobe syndromes, like frontal lobe syndromes, can range from symptoms that are detectable only on careful testing of perception and spatial judgment to severe impairment of recent memory. Rectosigmoid colectomy and reanastamosis to facilitate resection of primary and recurrent gynecologic cancer. Despite this uncertainty, most large trial groups include some radiotherapy as an integral part of their advanced-stage treatment strategy. Therefore, it has been recommended that surveillance colonoscopy be performed on gene carriers starting at age 20 and be repeated every 1 to 2 years. Palliative and remittive properties of oral bexarotene in the management of erythrodermic cutaneous T-cell lymphoma. The intestinal variety represents a differentiated cancer with a tendency to form glands. Randomised trial of targeted chemotherapy with lipiodol and 5-epidoxorubicin compared with symptomatic treatment of hepatoma. It is appropriate to electively harvest the first echelon nodes in high-risk patients as a means of staging the neck. Ekbom and Gleysteen 299 have reviewed the results of palliative resection versus intestinal bypass (gastrojejunostomy) in 75 patients with advanced gastric cancer. When the involved pleural thickness was over 6 mm, gallium 67 uptake correlated with the macroscopic thickness of mesothelioma in resected specimens. New methods of tissue extraction include a sleeve system and an extracorporeal pneumoperitoneal access bubble. The patient should be well hydrated and in a reclining position, with frequent blood pressure monitoring. Unresected teratomas in males with testicular cancer have been known to progress and lead to significant morbidity unless completely resected. For example, the patient with verrucous carcinoma can demonstrate enlarged adjacent cervical lymph nodes that are worrisome when in fact the adenopathy is only secondary to the inflammatory process. Long-term survival after resection of pulmonary metastases from carcinoma of the breast. Patients with synchronous pulmonary metastases with their primary tumor have a worse survival rate, even with chemotherapy and complete resection. Intraoperative irradiation combined with radical resection for cancer of the head of the pancreas. The majority of venous blood drains directly into the prostatic and inferior vesical veins to the internal iliac veins. Germline mutations of the p53 tumor suppressor gene in children with osteosarcoma.

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These results suggest that if all the lesions can be removed surgically in patients with multiple brain metastases, the outcome is significantly improved, and comparable to the outcome of patients who underwent surgery for a single lesion. The fascia and overlying dorsal vein complex generally are gathered and suture-ligated to facilitate exposure and prevent bleeding from the complex once it is cut to allow access to the urethra. The result of the therapeutic equivalence trial is summarized by a value y, which estimates the effectiveness of E relative to C. An unusual problem of laparoscopic resection can be an inability to localize a small lesion due to loss of ability to palpate the bowel. Four published prospective randomized trials have not shown a survival advantage for the D2 lymph node dissection and do not support the routine use of extended D2 gastrectomy. A characteristic maculopapular skin eruption over the neck and torso occasionally occurs that resolves on discontinuation of the drug. Reluctance to use radiation therapy in paragangliomas probably stems from a historic bias against radiating benign tumors. Published data will be available when reliable 5-year survival estimates are known. This is accomplished by expanding the lateral cranial fields and moving the posterior spine fields caudally without changing their dimensions. Similarly, the routine use of bone scans despite the absence of clinical or biochemical abnormalities is probably not cost-effective. In addition to repeating standard front-line regimen, purine analogues such as fludarabine 329 and cladribine 330 are often used. Like tamoxifen, raloxifene increased the risk of thromboembolic disease (relative risk, 3. Using a two-stage method of implant reconstruction allows for maximum control of the implant pocket and optimal symmetry with the contralateral breast (. Staging laparoscopy for pancreatic cancer should be used to select the best means of palliation and not only to maximize the resectability rate. However, the anticoagulation effects can be effectively reversed with protamine sulfate and thawed fresh frozen plasma. Liver transplantation is associated with substantial morbidity and mortality (Table 33. Multiple scalp nodules consistent with internal malignancy metastatic to the scalp. The steepness of the curve in the effective range emphasizes the importance of small increases in dose. The plasma protein binding for the anthracyclines is probably not clinically relevant, with the exception of idarubicin and idarubicinol, as hypoalbuminemia may increase systemic exposure to unbound idarubicin and idarubicinol. The items in the American diet often linked to cancer are red meat especially when charred, 50 animal fats51 and "pesticide residues" ingested on over-treated and under-washed fruits and vegetables. Numbness and paresthesias are typically noticed later in the history than motor dysfunction. The obturator also serves to lower the palate to allow for appropriate contact with the remaining tongue base. A somatic mutation in a single retinal cell causes loss of function of the remaining normal allele, leading to tumor formation. In selected patients, the superior border of the field was at L2-3 and the incidence of small bowel obstruction requiring surgery was 17. Because of the relative rarity of this clinical entity, it is generally poorly understood by oncologists. Massive hemorrhage from the lesion is rare but can be avoided by the judicious use of coagulative techniques. Telomerase reverse transcriptase gene is a direct target of c-myc but is not functionally equivalent in cellular transformation. Larynx preservation with induction chemotherapy plus radiation as alternative to laryngectomy. Chemotherapy has been used successfully to delay the initiation of radiation therapy in young children.

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Interstitial radiation therapy for carcinoma of the penis using iridium 192 wires. Selected Randomized Trials of Concurrent Single-Agent Chemotherapy and Radiotherapy versusRadiotherapy Alone the results of four trials with bleomycin and radiotherapy are conflicting. High-dose recombinant interleukin-2 therapy in patients with metastatic melanoma: long-term survival update. Current clinical trials are evaluating the use of alternative chemotherapy combinations, shortened courses of chemotherapy, chemotherapy with smaller radiation fields or lower radiation doses, and chemotherapy without radiotherapy. Inoperable recurrent rectal cancer: results of a prospective trial with radiation therapy and razoxane. In contrast to sarcoma, myositis ossificans is rarely attached to the underlying bone. All patients should receive intravenous hydration to correct preexisting deficits of intravascular volume and to ensure continued urinary output. Experimental tumor therapy in mice using the cyclophosphamide-activating cytochrome P450 2B1 gene. The extent and multicentricity of high-grade prostatic intraepithelial neoplasia in clinically localized prostatic adenocarcinoma. After a persistent effort at removing individual lesions, it was determined that the continued growth rate necessitated complete removal of the scalp tissue. Migration along this paravertebral gonadal ridge proceeds in a caudal to cranial direction. In studies of risk of renal carcinoma, cigarette smoking has been found to be a definite risk factor. A comprehensive review of the effect of chemotherapeutic agents on wound healing 310 emphasized the importance of the agents used and the timing of delivery. Preoperative radiation has the advantages of sterilizing cells at the edges of the resection, sterilizing cells that perhaps would be dislodged and seeded at the time of surgery and, in the special circumstance of unresectable tumors, reducing the tumor volume sufficiently to allow resection. This reduction in local recurrence rate has been reported as the reason for a high survival rate for these patients. It is just meant to draw attention to the lack of specific criteria for such an exercise and the need to reach some generally approved system if it is thought that such applications deserve to be translated to the routine clinical practice. Large trials evaluating the role of multiagent chemotherapy in advanced carcinoma of the penis are uncommon. A large clinical experience in radiation use has resulted in certain principles of treatment. Germline mutations in a chromosome 19 gene have been found in Peutz-Jeghers syndrome families. This reflected the gradually increasing use of estrogens, particularly conjugated equine estrogens, to manage symptoms of menopause. Recommendation for follow-up care for individuals with an inherited predisposition to cancer. Both preoperative and postoperative radiation appear to be valuable, and the choice of the method, the dose of radiation, and time between radiation and surgery should be considered in terms of the goals planned. Although such biopsies have been described as relatively safe, particularly in large tumors, there is a risk that tissue sampling of these heterogenous tumors may not depict accurately the correct histologic nature of the tumor. Excess water is reabsorbed and increased sodium is delivered to the distal nephron. Cure following resection has often been considered a chance phenomenon dependent more on the biologic behavior of the tumor than on the surgical strategy pursued. Kindblom 176 performed a study of 18 soft tissue tumors, 5 bone tumors, and 3 metastatic carcinomas thought to be primary soft tissue tumors to examine the relative advantages of a technique using both light and electron microscopy rather than conventional light microscopic aspiration cytology. These patients usually present with maldescended testes, ambiguous genitalia, and an abnormal karyotype. In contrast, certain nodal chains (mesenteric, hypogastric, presacral, epitrochlear, popliteal) seldom are involved. In traditional cancer thinking, sustained complete response after radiation is the criterion by which local control is usually judged. No studies to date have carefully compared this technique with its open counterpart. Insulin-like growth factor I is a growth and survival factor in human multiple myeloma cell lines.

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Left frontal lobe tumors can cause right hemiplegia and nonfluent dysphasia with or without some apraxia of lip, tongue, or hand movements. Local determinants of response to endobronchial high-dose rate brachytherapy in bronchogenic carcinoma. The use of primary radiation may be associated with improved functional outcome as compared with surgery, but this requires more investigation. Ipsilateral (N2) mediastinal lymph node involvement, despite being potentially resectable, remains a contentious issue when indications for surgery are discussed. High-dose dexamethasone was evaluated in combination with vincristine and Adriamycin. A similar sigmoid relation is seen when plotting the likelihood for complications against tumor control. The superiority of high-dose therapy was also confirmed in a pair-mate analysis comparing 116 patients treated on the tandem transplant arm with a similar number of patients selected from 1123 patients treated with standard therapy on various Southwest Oncology Group studies and selected for important prognostic factors. Better exposure to early cancers of this region may also be obtained through a combined lip-splitting incision coupled with an anterior midline or lateral mandibulotomy. Inherent cellular radiosensitivity as a basic concept for human tumor radiotherapy. Randomized comparison of cis-diamminedichloro platinum versus cis-diamminedichloro platinum, methotrexate, and bleomycin in recurrent squamous cell carcinoma of the head and neck. The Arbeitsgemeinschaft Gynaekologische Onkologie trial 138 incorporated the quality-of-life instrument in its comparison of cisplatin plus paclitaxel versus carboplatin plus paclitaxel and demonstrated the superiority of the carboplatin combination. Although these investigators recommended the administration of craniospinal irradiation to prevent meningeal recurrence, others reported isolated meningeal relapse in 5. In particular, induction chemotherapy appears to improve systemic disease control, while concomitant chemoradiotherapy leads to higher locoregional control. Cranial nerve length predicts the risk of delayed facial and trigeminal neuropathies after acoustiv tumor stereotactic radiosurgery. Despite the extensive anastomosis of lymphatics in the region, metastasis of vulvar carcinoma to contralateral lymph nodes is uncommon in patients with well-lateralized T1 lesions. The rationale for standard fractionation is that small-dose fractions preferentially spare late reacting normal tissues with lower alpha to beta ratios (1. In fact, percutaneous drainage of the kidney or percutaneous nephrostomy is the treatment of choice for malignant obstruction of the urinary tract and has completely replaced surgical nephrostomy. Once the abdomen has been cleared of disease, or the maximum residual disease is less than 1 cm, the fat pad overlying and surrounding the aorta and vena cava is removed, as are lymph nodes involved with metastatic disease in this area. Presumably the normal function of this gene is to negatively regulate cell stimulation by the ras gene product or similar growth-promoting proteins. Surgical management of the neck is similar to that of other sites in the upper aerodigestive tract. Just as linkage studies in families with multiple members affected with these diseases were critical to the identification of colon and breast cancer susceptibility genes. Note how the dark pigmentation is different from surrounding pigmented lesions in this fair-skinned individual. The potential of a high-fiber diet, or fiber supplementation, to modulate cancer risk in at-risk or high-risk individuals who have a genetic predisposition to colorectal cancer has been studied and further investigations are under way. In fact, the only long-term survivors were among the group in which the tumor was small enough not to be recognized at the time of cholecystectomy. Primary radiotherapy with delayed amputation gained acceptance in 1955, when Cade 286 advocated initial therapy with radiation and delayed amputation for patients in whom there was no evidence of metastasis 4 to 6 months after radiotherapy. The p53 gene mutation is of prognostic value in esophageal squamous cell carcinoma patients in unified stages of curability. Active immunotherapy of human melanoma exploiting the immunopotentiating effects of cyclophosphamide. The evidence appears to support the use of smaller target volumes to deliver higher doses without compromise of the regional outcome.

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Now possible is defining more reliably the histology and, at least in selected patients, the origin and biology of neoplasms. Plasma sex steroid hormone levels and risk of breast cancer in postmenopausal women. The use of carbon dioxide laser therapy to remove tumors of the mouth, oropharynx, and larynx has been reported to result in immediate improved oral intake and with less toxicity than is sometimes seen with radiation to the oral cavity. Staley and colleagues 156 have demonstrated that the number of lymph nodes identified in the surgical specimen is increased by the use of a standardized system of specimen analysis. The use of charged particle irradiation as well as stereotactic radiosurgery 432 and combining chemotherapy with radiotherapy has been reported. The positive detection rate in peripheral blood samples increased with advancing stage of disease. Surgical management of small bowel leiomyomas includes adequate segmental resection with grossly negative serosal margins. The larynx and hypopharynx are regions that are readily accessed by clinical examination, which makes possible the diagnosis of malignancy through endoscopy and biopsy. For postoperative radiation, the total doses recommended to the primary site and involved areas of the neck are between 6000 and 6500 cGy in 6. Extending the indications for breast-conserving treatment to patients with locally advanced breast cancer. The most prominent deleterious one, endometrial cancer, is increased approximately threefold in incidence over the general population. Agents so tested have included acetic acid, hot saline, glass microspheres containing 90Y, and various chemotherapeutic drugs. In pediatric series, adolescent patients typically have the worst prognosis, though in adult series this is almost always the most favorable group. As with major salivary gland tumors, the incidence of nodal metastases is related to grade and tumor size. One additional patient required a percutaneous gastrostomy tube for poor gastric emptying during the terminal phase of his disease. Randomized controlled trial of post-operative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. The mechanism for induction of radiation-induced instability is not known, but it does not appear to be a result of the induction of a mutation in a specific gene or set of genes. Advanced epithelial ovarian cancer: salvage whole abdominal irradiation for patients with recurrent or persistent disease after combination chemotherapy. Lymph nodes lateral to the jugular vein are sampled and, if there is any evidence of metastatic spread in this area, a formal modified radical neck dissection is performed. Gentle percussion over the spine can confirm the site of involvement and help elucidate other sites of vertebral metastases. The murine interleukin-4 receptor: molecular cloning and characterization of secreted and membrane bound forms. Acute elevations in hepatic enzyme levels, as well as hyperbilirubinemia, are often observed during high-dose therapy, but these usually return to normal within 10 days. Pulmonary toxicity, in the form of interstitial pneumonitis, can develop after multiple courses of treatment. Lymphangiography Historically, lymphangiography was used to determine the extent of retroperitoneal involvement in both seminoma and nonseminoma. Larger tumor size (more than 8 cm) or volume (more than 100 cm 3) has correlated with decreased success in achieving durable local control. When total parenteral nutrition is necessary, these same formulas are used for determining calorie protein and lipid intake. The development of soft tissue and bone sarcoma as a result of exposure to radiation has been known since 1922. Ultrastructural studies, however, cannot always document Schwann cells in these tumors derived from nerve sheaths, and therefore the terms malignant nerve sheath tumor, neurogenic sarcoma, and neurofibrosarcoma are sometimes used. In many cases, recurrent basal cell cancer may develop squamoid features and demonstrate more aggressive behavior with recurrence. Since sarcoma may be radiocurable in terms of cell killing but not radioresponsive in terms of shrinkage of the mass, this can be perplexing, as such masses could give the false impression that little has been accomplished, whereas in reality the mass is mainly made up of sterilized tumor cells and debris.


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In the future, advances in molecular genetics may enable the diagnosis of most neoplasms with a specific genetic fingerprint. Chemotherapy Combined with Interferon in Renal Cell Cancer Interferon, one of two immunotherapeutic agents widely used in the treatment of renal cell cancer (as discussed later, in Biologic Therapy), has a modest response rate and confers a survival advantage as a single agent. Point A was originally developed as part of the Manchester treatment system (a modification of the earlier Paris system). Retrospective data suggest that there may be subsets of patients with T3N0 disease who may not require adjuvant therapy and that there may be patients with stage I disease who should be considered for adjuvant therapy. The frequency of micronuclei (an indicator of genotoxic damage) in exfoliated cells from buccal mucosa is another premalignant end point that has been used in head and neck chemoprevention trials. At present, we prefer to use simple particle embolization for treatment of symptomatic or favorable tumors. Specifically, mesenteric, portal, iliac, pelvic, peri-aortic, and celiac lymph nodes can be biopsied. Alendronate has also been studied by the intravenous route in hypercalcemia, 89,90 but this formulation is not widely available. An important feature interpreting any histologic diagnosis of a cutaneous lymphoma is to remember that the clinical behavior may be different than when the same diagnosis is identified in nodal or other extranodal sites. Interstitial implantation essential for successful radiotherapeutic treatment of base of tongue carcinoma? Fumonisin contamination of food: progress in development of biomarkers to better assess human health risks. Some studies include only patients with recurrent or metastatic disease undergoing palliative treatment, whereas others include varying proportions of patients with locally advanced, untreated disease who received two to four cycles before proceeding to radiotherapy, surgery, or both. Comparative genomic hybridization analysis of sporadic neuroendocrine tumors of the digestive system. A history of five or more sunburns as an adolescent has been found to double the risk for melanoma. The substantial body of knowledge showing the effectiveness of postoperative radiation therapy has in large part been responsible for this more conservative approach to dealing with the facial nerve in parotid gland surgery. Additionally, the electronic approach permits front-end validation processes, such as range checking, simple edit checks, and cross-validation between variables measured on repeated occasions. They are also relatively uniform in histologic appearance, and thus there is greater concordance of pathologists in the diagnosis of leiomyosarcoma than other forms of soft tissue sarcoma. In contrast, a multiinstitutional study of 407 patients aged 20 to 29 at the time of cancer diagnosis found a relative risk of cancer death of 2. For those who have undergone radical prostatectomy, several models have been proposed to identify patients at very high risk for relapse. Conservative management of rectal cancer with local excision and post-operative radiation therapy. Several investigators have reported the likelihood of local and distant tumor progression in patients who were untreated or who were treated with noncurative intent. The main branches pierce the prostatic capsule, then travel along the fibromuscular trabeculae as acinar branches before reaching their terminals at muscular and glandular cells. Certainly, this practice allows for reimbursement for some drug costs by a system that otherwise has not even recognized unknown primary cancer. A definition of tumor dormancy is nonexpanding tumor that can be detected only microscopically. Expression of the E7 protein apparently occurs both within cells from patients with cervical carcinoma and from cell lines derived from this malignancy. The authors concluded that attention to the management of depression, treatment of substance abuse, and help with financial difficulties could contribute to the quality of life of patients who underwent limb-sparing surgery or amputation. Sample size considerations for studies comparing survival curves using historical controls. Making comparisons among retrospective reports is difficult because of differences in patient populations, lack of standardization of surgical and radiotherapeutic techniques, and changes in treatment practice over time. The pattern is infiltrative rather than destructive, with partial preservation of the subcapsular sinus and germinal centers.

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Even with this surveillance system, underreporting is common as numerous thin melanomas are treated in an office setting and not reported in this hospital-based system. The primary site and both upper necks were then treated with 5400 cGy, including the retropharyngeal nodes. The spleen is then removed intact, within the plastic bag, through a small midline incision incorporating the umbilical port site. Total mesorectal excision has been associated with a high rate of anastomotic leak when used for upper rectal tumors. For mammographic abnormalities that are benign, core biopsy is clearly less traumatic and more cost effective than needle localization and excision. In contrast to the promising results reported by others, of the 123 evaluable randomized patients, complete and partial response rates were 9. A randomized trial of levamisole versus placebo as adjuvant therapy in malignant melanoma. For patients not eligible for radiosurgery or systemic therapy, treatment with whole or partial brain radiation may be indicated. Depending on the age at onset of the cancer and the number of relatives involved, lifetime risk can increase from 1. Phase I evaluation of sequential doxorubicin gemcitabine then ifosfamide paclitaxel cisplatin for patients with unresectable or metastatic transitional-cell carcinoma of the urothelial tract. A syndrome resembling idiopathic thrombocytopenic purpura in 10 patients with diverse forms of cancer. Penile erection is a neurovascular phenomenon, and the nerves and arterial blood supply (neurovascular bundles) crucial to potency run posterolaterally along either side of the prostate. Although early studies suggested an unusually aggressive, incurable tumor, others have reported cure rates similar to those for other large cell lymphomas with aggressive therapy, usually combining chemotherapy with mediastinal irradiation. The sequencing of radiation and chemotherapy remains controversial and is more fully discussed later in this chapter (see Sequencing of Radiation with Chemotherapy). The authors emphasized that the meaningful survival interval should be considered 10 or 15 years. Separable growth and migration factors for large-cell lymphoma cells secreted by microvascular endothelial cells derived from target organs for metastasis. Prophylactic removal of the ovaries at the time of colorectal cancer resection has been considered in order to reduce the risks of poor survival from metachronous metastases. A novel hypothesis: specific oncogenes and tumor suppression genes are involved in the expression of the proopiomelanocortin gene by small cell lung cancer. The histological response to chemotherapy as a predictor of the oncological outcome of operative treatment of Ewing sarcoma. Survival was significantly changed in the old N2 group by applying the new N stage classification. Evaluation of optimal duration of chemotherapy in favorable-prognosis disseminated germ cell tumors: a Southeastern Cancer Study Group protocol. Gasparini and Harris 79 analyzed the variables in quantitation of tumor angiogenesis in histologic sections, and they have summarized the reports up to 1999. Radiotherapy of gastric cancer with a three field combination: feasibility, tolerance, and survival. The monomorphic centroblastic (large noncleaved cell) type is composed of medium to large lymphoid cells with oval to round vesicular nuclei with fine chromatin and two to four membrane-bound nucleoli. The age-adjusted cancer death rates for selected sites in males (A) and females (B) in the United States from 1930 to 1996. Esophageal strictures were due to squamous cell carcinoma in 43 patients, adenocarcinoma in 18, anastomotic recurrence in 14, or extrinsic compression from mediastinal tumor in 14 individuals. However, in the setting of abnormal p53 function, whether through the acquisition of point mutations in the p53 gene, posttranslation inactivation of p53 through binding to other protein partners. If there is tumor extension into the vena cava, the vena cava may need to be partially resected.

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In general, sites with a high degree of variability in the position, size, or shape of the target require more individualized modification of constraints. Feasibility of concurrent radiation therapy and paclitaxel or docetaxel chemotherapy in the management of locally advanced breast cancer. These data are frequently collected using questionnaires, abstracting occupational or medical records, or examining participants. Ultrasonographic three-dimensional scanning for determination of intraocular tumour volume. A randomized clinical trial of moving strip versus open field whole abdominal irradiation in patients with invasive epithelial cancer of ovary. Both patient and physician bias may play a strong role in treatment selection, inasmuch as precise guidelines for treatment are not available for the majority of patients. Although each of the sarcomas has distinguishing histologic characteristics, the different types of sarcoma have many common clinical and pathologic features. One series has reported that the detrimental effect on sphincter function associated with postoperative therapy 153,154 may not be as problematic with preoperative therapy. Heroic operations attempted in patients with no chance for long-term survival are pointless. The tumor is an irregularly lobulated reddish mass, which on histopathologic examination is apparently normal choroid plexus. If criterion number 1 is absent but numbers 2 and 3 are present, primary pigmented nodular adrenocortical disease should be ruled out by iodocholesterol scan (see. Administration of R24 monoclonal antibody and low-dose interleukin 2 for malignant melanoma. Salvage therapy in recurrent germ cell cancer: ifosfamide and cisplatin plus either vinblastine or etoposide. A correlation of pathologic characteristics with human papillomavirus detection by in situ hybridization and polymerase chain reaction. Furthermore, the results support the use of systemic cytotoxic chemotherapy as part of multimodality therapy in patients with less-advanced but high-risk cancers. Although pelvic irradiation was routinely added to early treatments with single alkylating agents, it generally has been abandoned since platinum-containing regimens became standard. Numerous reports have shown malignant tissue to contain higher levels of top I than its normal counterpart. Interpretation of results is also hampered by lack of standardized histologic classification. Overall it is thought that lung cancers produce factors that stimulate angiogenesis and stop producing others that would inhibit this process. The Scandinavian randomized trial is similar in design to that of the Italian study. A relative disadvantage of cohort studies is that they are usually large, long-term, complex, and very expensive endeavors. Fourteen of the 18 patients had pathologically negative second-look results, four patients had a partial response, 14 patients had stable disease, and two patients had progression of disease among the 55 patients evaluable for response. These tumors also are highly resistant to chemotherapy, limiting options for palliative treatment. Loss of heterozygosity suggests multiple genetic alterations in pheochromocytomas and medullary thyroid carcinomas. Primary radiotherapy of T1 and T2 glottic carcinomaanalysis of treatment results and prognostic factors in 223 patients. Anorectal melanoma: clinical characteristics and results of surgical management in twenty-four patients. Cell and environment interactions in tumor microregions: the multicell spheroid model. The most common side effects from radioiodine therapy include sialadenitis, nausea, and temporary bone marrow suppression. Most clinicians follow this with vaginal intracavitary therapy, delivering an additional vaginal surface dose of 30 to 50 Gy. Modern techniques of immunohistochemical and morphologic analysis will almost certainly lead to the recognition and accrual of more of these tumors in the future, and as a result, they will make up a higher relative percentage of laryngeal malignancies.

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Vaginal recurrences of endometrial carcinoma: the prognostic value of staging by a primary vaginal carcinoma system. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Five days of oral topotecan (Hycamtin), a phase I and pharmacological study in adult patients with solid tumours. Because of inconsistencies in pathologic diagnosis as well as different philosophies with regard to aggressiveness of surgery, it is difficult to define the prognosis and the best treatment strategies. Because the pace of the disease is usually rapid, diagnostic studies and institution of therapy should proceed quickly. Wide pelvic lymphadenectomy including lateral pelvic lymph nodes has been proposed for the treatment of rectal cancer. Combination chemotherapy, often used with surgery or radiation therapy, has proved to be potentially curative for selected patients with several metastatic tumors. Gastrointestinal toxicities, aside from those caused by autonomic dysfunction, may be caused by all the vinca alkaloids. Fludarabine-related autoimmune haemolytic anaemia in patients with chronic lymphocytic leukaemia. Kalish and Begg 35 have also studied analytic aspects of adaptive stratification methods. Phase I study of suramin combined with doxorubicin in the treatment of androgen-independent prostate cancer. Bearzi and Ranaldi 77 have correlated the degree of histologic differentiation with the gross appearance of 41 primary gastric cancers seen on endoscopy. Natural history of untreated breast cancer (18041933): comparison of treated and untreated cases according to histologic grade of malignancy. The largest series of mucinous appendiceal tumors with peritoneal spread has been reported by Sugarbaker and Chang. Mitomycin C and cisplatin in human malignant mesothelioma xenografts in nude mice: clinical correlation. Because of external compression, dorsal column involvement occurs with paresthesia and abnormalities of pain and temperature on the side contralateral to the motor weakness. The predictive values were low and the study was too small to deduce prognostic significance. Early deaths due to hemorrhage and leukostasis in childhood acute myelogenous leukemia. Activities of the microtubule-stabilizing agents epothilones A and B with purified tubulin and in cells resistant to paclitaxel (Taxol). Twelve patients received a reduced dose (20 mCi) due to bone marrow involvement or unsuccessful marrow harvest. All involve the creation of a low-pressure reservoir from a detubularized segment of bowel that is then anastomosed to either abdominal wall (Indiana pouch) or the urethra (neobladder) (. The incidence of unknown primary neuroendocrine tumors is not known, but an estimate suggests approximately 4000 U. Spongy vacuolization and pallor of the white matter as well as spinal cord edema were also described. Now, more that two decades since the first randomized trial evaluated induction cisplatin and bleomycin before surgery, 216 we can conclude from many such trials that the induction strategy confers no survival advantage. However, they concluded that in patients with cytologically negative pleural effusions, unresectability must be documented surgically. Assessment of prehospital admission American Urological Association voiding symptom score in all these patients is helpful in identifying patients who may require treatment of prostate obstruction. Treatment options for such a tumor are altered significantly because of paraglottic space involvement. Second-look operations only are routinely recommended for women participating in clinical trials. Biopsy of ampullary tumors is facilitated by endoscopic sphincterotomy, and the associated obstructive jaundice may be temporarily relieved by this procedure. Relatives of such patients, whether with a family history or not, are also at risk of developing malignant tumors. Use of intraoperative electron beam radiation therapy in the management of soft tissue sarcomas.