Comparison of clinico-epidemiological features of lung cancer patients with and without a history of smoking

In order to study the characteristics of lung cancer in smokersand non-smokers, clinico-epidemiological features of 943 lungcancer patients treated in the Aichi Cancer Center Hospitalfrom 1964–77 were analyzed according to their smokinghistories. About 70% of both male and female patients who smokedfell in Group I (squamous cell, small cell and large cell carcinomas),while of those who did not smoke, 50% of the male and 36% ofthe female patients fell in Group I. The mean age of the patientswho smoked was about 60 yr and that of the nonsmokers was 55yr in both men and women. It was estimated that about 70% ofthe Group I tumors originated from main, segmental or subsegmentalbronchi, but half of the Group 11 tumors (adenocarcinoma) originatedfrom peripheral bronchi in both smokers and nonsmokers. One-thirdof the tumors were seen in the apical and subapical segmentsof the upper lobes regardless of the smoking history. Therewas no difference between the survival rates for the patientswith and without a history of smoking. ^* Present Address: Department of Public Health, Tohoku UniversitySchool of Medicine, Sendai.     

Intensive therapy and autotransplant for patients with an incomplete response to front-line therapy for lymphoma

BACKGROUND:: Patients with Hodgkin's disease (HD) and intermediate or high-gradenon-Hodgkin's lymphoma (NHL) who fail to achieve a completeremission (CR) with standard induction therapy have a poor prognosiswith conventional-dose salvage therapy alone. We examined therole of subsequent intensive therapy and autologous bone marrowtransplantation (ABMT) in patients who demonstrated a responseto conventional-dose salvage therapy. PATIENTS AND METHODS:: Sixty-six patients with either HD (n = 30) or NHL (n = 36) underwentintensive therapy with etoposide (60 mg/kg), intravenous melphalan(160–180 mg/m²) followed by infusion of unpurged autologousbone marrow and/or blood cells. All patients had advanced stageor bulky disease at diagnosis and failed to achieve a CR afteran anthracycline-containing front-line chemotherapy regimen(NHL) or ABVD or equivalent regimen (HD). Patients who achieveda CR after involved-field radiotherapy were excluded. All patientsdemonstrated sensitivity to conventionaldose salvage treatmentbefore advancing to intensive therapy and ABMT. RESULTS:: The CR, partial response (PR) and overall response rate (RR)following ABMT for HD patients was 48%, 17% and 65%, respectively.At a median follow-up of 35 months, the predicted three-yearoverall survival (OS) is 51% (95% CI: 44%–60%) and event-freesurvival (EFS) is 34% (95% CI: 26%–54%). For patientswith NHL, the CR, PR and RR were 68%, 9% and 77%, respectively.At a median follow-up of 28 months, the predicted three-yearOS is 51% (95% CI: 35%–66%) and EFS is 39%(95% CI: 21%–57%). CONCLUSIONS:: Intensive therapy with etoposide and melphalan followed by ABMTresults in prolonged survival in selected patients with lymphomawho fail to achieve a complete remission to front-line chemotherapy.Based on our previous studies of outcome to conventionaldosesalvage chemotherapy, we estimate that of all patients failinginduction therapy, 28% with HD and 15% with NHL will be eventfreeat three years after ABMT. induction failure, Hodglun's disease, non-Hodgkin's lymphoma, refractory lymphoma     

Results of Radiotherapy in the National Cancer Center Hospital--Second Report of the National Cancer Center Radiotherapy Computer System

Results of radiotherapy in the National Cancer Center Hospitalduring 1962–1970 were analysed by using the National CancerCenter Radiotherapy Computer System which had been developedby the authors. More than a half of the total cancer cases treatedin the hospital were given some kind of radiotherapy. The overallfive-year survival rate of radiotherapy cases corrected witha life table method were 38.4% for total cases, 44.6% for radicallytreated cases and 14.6% for palliatively treated cases. Combinedtreatment by radiation and surgery showed better results suchas 48.3% for preoperative and 57.8% for postoperative radiotherapycases. The following factors were analysed in terms of the five-yearsurvival rate: age, sex, stage, histology and double-primarycancer. In general, female cases showed much better prognosis than thatof male cases. Five-year survival rate showed its peak at 30–40years of age and was low at lower or higher ages. Inverse correlationshipsby age were observed between the incidence of cancer and thesurvival rate after treatment, and the value of correlationcoefficient was larger in males and smaller in females. The age dependency of incidence and prognosis of cancer stronglysuggested the important role of host resistance in the treatmentand prevention of cancer. ^*Present address: National Institute of Radiological SciencesChiba ^**Present address: Chiba Cancer Center Hospital hiba     

Effect of granulocyte colony-stimulating factor administration in elderly patients with aggressive non-Hodgkin's lymphoma treated with a pirarubicin-combination chemotherapy regimen

PURPOSE:: Results of a multidrug chemotherapy regimen consisting of cyclophosphamide,pirarubicin, teniposide, and prednisolone (CTVP) plus subcutaneousgranulocyte colonystimulating factor (G-CSF) in elderly patientswith aggressive non-Hodgkin's lymphoma (NHL) are reported. PATIENTS AND METHODS:: Between January and December 1992, 46 previously untreated patientsolder than 69 years with intermediate- and high-grade NHL receivedcyclophosphamide 750 mg/m², teniposide 75 mg/m², pirarubicin50 mg/m² day 1, and prednisolone 40 mg/m² days 1 to 3. G-CSF,5 µg/kg/day, was administered from day 4 up to day 14or when the absolute neutrophil count reached 5 x 10⁹/1. Sixcycles were scheduled every 3 weeks. RESULTS:: Grade 3 or grade 4 neutropenia complicated 22% and 26% of chemotherapycycles, respectively. Fever or/and clinical infection were observedin 4% and 14% of cycles. One toxic death related to a septicshock occurred. Eight cycles (4%) were delayed with a medianduration of 7 days. Administered median dose intensity was 93.5%.Objective response rate was 74% and 46% of the patients achieveda complete response. The 2-year overall survival and eventfreesurvival rates were 47% and 28%. CONCLUSION:: In comparison with a previous group of patients treated withCTVP, G-CSF allows delivery of chemotherapy with a reduced neutropenia-inducedmorbidity in an outpatient setting in elderly patients withaggressive NHL without modifying response rate or survival. chemotherapy, elderly, G-CSF, lymphoma     

Oil-Depot Type Bleomycin in the Treatment of Malignant Lymphoma in Comparison with Regular Bleomycin

Oil-depot type bleomycin was originally intended to take advantageof not only concentration-dependent action, but also the time-dependentaction of bleomycin to obtain more efficient tumor cell kill.In this study, the effects of oil-depot type bleomycin and regularbleomycin on 81 patients with malignant lymphoma were compared.Both oil-depot type bleomycin and regular bleomycin were equallyeffective against Hodgkin's disease, with a complete remissionrate of 60% (6/10) and 54.5% (6/11), respectively. Non-Hodgkin's lymphoma in advanced stages responded better tooil-depot type bleomycin [complete remission (CR); 35.2% (6/17)]than to regular bleomycin [CR: 10.5% (2/19)]. In addition, thepatients were more responsive to smaller doses of oil-depottype bleomycin than regular bleomycin. Eleven out of 12 (91.6%)patients who responded to oil-depot type bleomycin, went intocomplete remission before receiving 45 mg in total dosage ofbleomycin, while five out of 10 (50%) patients who respondedto regular bleomycin reached complete remission after 60 mgin total dosage was administered. The toxic manifestations of oil-depot type bleomycin were almostthe same in quality and quantity as regular bleomycin. However,the average total dose of oil-depot type bleomycin used wasalmost half of that of regular bleomycin. ^* Present address: Cancer Chemotherapy Center, Cancer ResearchInstitute, Tokyo, Japan. ^** Present address: National Nagoya Hospital, Nagoya, Japan.     

Levels of proteins C and S do not decline subsequent to first line chemotherapy in lymphoma patients

Thromboembolic complications and decrease in protein C and S have been observed in patients while receiving combination chemotherapy for breast cancer. We investigated whether initial cytotoxic treatment of non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) is also associated with changes in these anticoagulant parameters. For this purpose 25 patients with intermediate to high grade NHL and seven with HD, undergoing primary treatment with cytotoxic drugs were evaluated at three time-points: pre-therapy, mid-therapy and post-therapy. In contrast to the breast cancer patients, no significant changes in protein C, protein S and antithrombin III levels were observed in the NHL patients during the various stages of therapy. However in HD patients, the mean protein C values had a tendency to be higher at mid-therapy compared to pre-therapy and protein S levels had a tendency to be higher at mid-therapy compared to post-therapy. In lymphoma patients receiving primary cytotoxic treatment we did not find changes in anticoagulant parameters that can explain a chemotherapy-induced hypercoagulable state, as has been reported in breast cancer patients. © 1997 John Wiley & Sons, Ltd.     

Second Primary Malignancies in Lymphoma Patients

We evaluated the occurrence and the type of second malignanciesamong 74 patients with Hodgkin's disease (HD) and 407 patientswith non-Hodgkin's lymphoma (NHL) who were treated at the NationalCancer Center Hospital for more than one year. Fifteen patients developed a second malignancy. In 10 of thesepatients the second cancer was gastric cancer, but no casesof acute nonlymphocytic leukemia were encountered. The observed number of second cancers in females among the HDpatients was significantly (p < 0.005) greater than the expectedincidence based upon the number of age-adjusted person-yearsboth for all cancers and for stomach cancer. However, no significantdifferences between males and females in the NHL patients werefound. Furthermore, no significant differences were seen inany of the groups between the observed and expected numbersof second malignancies according to the treatment.     

Clinical and Pathological Analyses of Patients with a Family History of Colorectal Cancer

Patients who were registered by the Japanese Society for Cancerof the Colon and Rectum between 1978 and 1983 were examinedclinically and pathologically, in terms of colorectal cancerwith familial accumulation. The incidence of patients with afamily history of colorectal cancer (FH⁺ group)—patientswith adenomatosis coli were excluded—was 6.5% in 15,369colorectal cancer patients. The incidence of patients with afamily history of malignant tumors other than colorectal cancerwas 27.7%. Comparison of the FH⁺ group with the FH^– group(patients without a family history of colorectal cancer) revealedthe incidence of colonic cancer to be significantly higher thanthat of rectal cancer in the FH⁺ group (P<0.01). The patientswith colonic cancer in the FH⁺ group were significantly youngerthan those in the FH^– group (P<0.01), but there wasno age-dependent difference between patients with rectal cancerin the two groups. There was no difference in sex ratio andthere was little difference in the subsite of the primary lesionin the colon between the FH⁺ and FH^– groups. The incidenceof multiple primary colorectal cancer was significantly higherin patients with colonic cancer in the FH⁺ group than in theFH^– group (P<0.01). The incidence of multiple primarycancer in sites other than the colon and rectum was significantlyhigher in the FH⁺ group (P<0.01), but no significant differencewas found in the site of lesions. The prognosis of patientsin the FH⁺ group was significantly better than that of thosein the FH^– group; however, there were no differences inbackground factors such as findings of the primary lesion, statusof metastasis, clinical stage and rate of curative resectionbetween the groups.     

Risk of second cancer after lymphohematopoietic neoplasm

People living with lymphohematopoietic neoplasms (LHNs) are known to have increased risks of second cancer; however, the incidence of second cancers after LHNs has not been studied extensively in Australia. The Australian Cancer Database was used to analyze site-specific risk of second primary cancer after LHNs in 127,707 patients diagnosed between 1983 and 2005. Standardized incidence ratios (SIRs) were calculated using population rates. Overall, patients with an LHN had nearly twice the risk of developing a second cancer compared to the Australian population. Among 40,321 patients with non-Hodgkin's lymphoma (NHL), there was over a fourfold significant increase in melanoma, Kaposi sarcoma, cancer of the lip, connective tissue and peripheral nerves, eye, thyroid, Hodgkin's disease (HD) and myeloid leukemia. Among 6,396 patients with HD, there was over a fourfold significant increase in melanoma, Kaposi sarcoma, cancer of the lip, oral cavity and pharynx, female breast, uterine cervix, testis, thyroid, NHL and myeloid leukemia. Among the 33,025 patients with lymphoid and myeloid leukemia, significant excess were seen for cancers of the lip, eye, connective tissue and peripheral nerves, NHL and HD. Among the 13,856 patients with plasma cell tumors, there was over fourfold significant increase for melanoma, cancer of the connective tissue and peripheral nerves and myeloid leukemia. Our findings provide evidence of an increased risk of cancer, particularly ultraviolet radiation- and immunosuppression-related cancers, after an LHN in Australia.     

Endoscopic treatment of early gastric cancer: polypectomy and laser treatment

With the tremendous development of gastroenterological endoscopy,it has become possible to treat some types of early gastriccancer by endoscopy. There are two principal methods for thispurpose, endoscopic polypectomy using a high frequency electriccurrent and laser endoscopy. We developed the technic and instrumentsof endoscopic polypectomy, in 1972. Since then, we have experienced358 cases of gastric polypoid lesions treated by endoscopicpolypectomy. Nineteen patients with the elevated type of earlygastric cancer were treated by endoscopic polypectomy. Sevenpatients were operated on after polypectomy and 12 were followedwithout surgery. Out of the 12 patients, nine are alive aftermore than five years. On the other hand, we started researchto apply lasers for treating early gastric cancer in 1978. Sincethen, 18 patients have been treated by laser endoscopy, withNd-YAG laser, argon dye laser or a combination of both lasers.We have established criteria for these treatments for earlygastric cancer. ¹Present address: Department of Internal Medicine, Tokyo MetropolitanToshima Hospital, 33-1, Sakae-cho, Itabashi-ku, Tokyo I 73,Japan.     

Phase II Study of Oral Administration of 5'-Deoxy-5-Fluorouridine (5'-DFUR) for Solid Tumors

A phase II trial of 5'-deoxy-5-fluorouridine (5'-DFUR), a newfluorinated pyrimidine analog which has been demonstrated tohave potential superiority over 5-FU and tegafur for chemotherapyof murine tumors, was performed in patients with advanced non-smallcell carcinoma of the lung and metastatic pulmonary tumors.5'-DFUR at a dose of 800 mg/m² was given per os every day formore than four weeks. None of 15 evaluable patients with non-smallcell carcinoma of the lung and 15 evaluable patients with metastaticpulmonary tumors showed a complete or partial response. Toxiceffects of 5'-DFUR included anorexia (29%), diarrhea (26%),nausea (23%), vomiting (10%), leukocytopenia (10%), generalfatigue (10%), liver disorder (6%) and thrombocytopenia (6%). ^**Present address: Third Department of Internal Medicine, Schoolof Medicine, Toku-shima University, Kuramoto-cho 3-chome, Tokushima770, Japan.     

Results of a randomized trial with or without 5-FU-based preoperative chemotherapy followed by postoperative chemotherapy in resected colon and rectal carcinoma

Background: Our previous study confirmed the efficacy of postoperativetreatment with mitomycin C (MMC) and oral 5-fluorouracil (5-FU)for colorectal cancer. The 2nd trial was designed to evaluatethe effectiveness of additional preoperative chemotherapy topostoperative treatment with MMC and oral 5-FU for curativelyresected colorectal cancer patients. Patients and Methods: 1355 patients (colon 755; rectum 600)were enrolled in this study. The pre- and postoperative chemotherapy(PPC) group was treated preoperatively with 5-FU (320 mg/m²/day)by continuous intravenous infusion for 5 days beginning on day6 before surgery and postoperatively with MMC (6 mg/m²) on days7 and 14 and in months 2, 4 and 6, by bolus injection and oral5-FU (200 mg/day) for 6 months. The postoperative chemotherapy(PC) group received postoperative chemotherapy only. Results: In an intent-to-treat analysis, the 5-year survivalrate in the PPC group and the PC group was 77.3% and 75.7% forcolon cancer and 67.2% and 69.2% for rectal cancer, respectively.In a per-protocol analysis, the 5-year DFS rate in the PPC groupand the PC group was 76.0% and 80.7% for colon cancer and 60.5%and 63.0% for rectal cancer, respectively, indicating no significantdifferences between the two groups. Adverse reactions were generallymild, confirming the safety of this preoperative chemotherapeuticregimen. Conclusion: In the PC group, the 5-year survival rate was nearlyidentical with that seen in our earlier research using the sameregimen, reaffirming the clinical effectiveness of postoperativeMMC by protracted intravenous infusion and oral 5-FU. However,our findings did not support additional preoperative chemotherapyfor curative resection in patients with colorectal cancer. ⁺ For participating physicians and institutions, see Appendix.      

A phase II study of ifosfamide, carboplatin and cisplatin in advanced and recurrent squamous cell carcinoma of the uterine cervix

BACKGROUND:: Discouraging response durations and long-time survivals haveso far been the result of cisplatin-containing combination chemotherapyagainst advanced or recurrent squamous cell carcinoma of theuterine cervix. In order to increase the platinum-based effectupon this tumor without an increase in the specific toxicityof cisplatin, we combined it with carboplatin, added ifosfamide,which has been shown to possess a comparable degree of single-agentactivity. PATIENTS AND METHODS:: Thirty-six patients with advanced or recurrent squamous cellcarcinoma of the uterine cervix not curable by radiation orsurgery were treated with a combination of ifosfamide 1.5 gr/m²i.v. days 1–3, carboplatin 200 mg/m² i.v. day 1, and cisplatin50 mg/ml² Thirty-one patients were evaluable for response and34 patients for toxicity. RESULTS:: Twenty-three patients responded (64%), 11 (31%) of them completely,and 12 (33%) partially. Median response duration was 23 weeks(range 8–107 weeks), reaching 27 weeks and 21 weeks patientswith and without disease in previously irradiated areas, respectively.Median survival is 40 weeks (range 1–114 weeks). Toxicityconsisted mainly of moderate to severe myelosuppression, resultingin 2 toxic deaths. CONCLUSION:: The response rate, also for earlier irradiated areas, comparesfavorably with other known cisplatin-containing regimens. Thecombination deserves investigation in a randomized setting. Uterine cervical cancer, advanced, recurrent, chemotherapy     

The natural history of thyroid function abnormalities after treatment for childhood cancer

The aim of the study was to find out which of childhood cancer survivors are at higher risk of thyroid dysfunction, and the timeframe for its development. The consequences of different treatments, particularly chemotherapy, were of interest. Follow-up data for 291 patients from a cohort of 360 patients were available and analysed in this retrospective study. Impaired thyroid function occurred in 71/291 (24%) patients: brain tumours 30/65 (46%), Hodgkin's disease (HD) 10/21 (48%), leukaemia/non Hodgkin's lymphoma (NHL) 19/140 (14%) and others 12/65 (18%). Patients with brain tumours had a higher hazard ratio (HR) over leukaemia/NHL (HR 7.47) but not over HD (HR 1.57). These patients also developed thyroid hypofunction earlier than patients with HD or leukaemia/NHL. Age at diagnosis did not have an effect on the occurrence or timeframe of development of thyroid hypofunction. Radiotherapy (HR 4.68) and radiotherapy combined with chemotherapy (HR 2.90) were associated with a higher risk than chemotherapy alone. Chemotherapy added to radiotherapy tended to increase risk (HR 2.42 95% confidence interval (CI) 1.00-5.87). Craniospinal irradiation did not differ significantly from total body irradiation (TBI) (HR 1.09 95%CI 0.25-4.76) or direct thyroid irradiation (HR 0.81 95%CI 0.32-2.06), but cranial irradiation (CIR) (HR 0.18 95%CI 0.08-0.38) was less harmful to thyroid function. Girls were more prone to effects of irradiation (HR 2.10 95%CI 1.15-3.82). All treatments, excluding surgery, predispose to thyroid dysfunction. Suggestions for follow-up of thyroid function are made.     

CHOP-Bleo plus interferon for stage IV low-grade lymphoma

BACKGROUND: Alpha interferon (IFN) is an effective single agent for patientswith low-grade lymphoma, but until 1982 had not been integratedwith standard chemotherapy for these patients. Since relapsefrom complete remission (CR) is the rule for patients with advancedstage low-grade lymphoma, a maintenance IFN schedule was exploredfor patients in CR. PATIENTS AND METHODS: From 1982–1987, 127 patients with stage IV low-grade lymphomawere treated with cyclophosphamide, doxorubicin, vincristine,prednisone, and bleomycin (CHOP-Bleo) for 9–18 mo. (median13 mo.), followed by interferon alfa-n-1 (Wellferon^®) maintenancetherapy for 24 mo. for CRs. RESULTS: The overall response rate for the entire treatment program was73% CR and 23% partial remission. The median follow up was 59months. At 5 years, survival was 74%, failure-free survival(FFS) 47%, and FFS of CRs 60%. Compared to a group of 96 patientswith similar pretreatment clinical features treated with CHOP-Bleofrom 1972–1982, this represents a significant improvementfor both overall FFS (p – 0.01) and FFS of CRs (P <0.01). Toxicity from the IFN maintenance was generally acceptable,but even at the modest dose employed in this trial (3 x 10⁶U/m² three times weekly), dose modification was required inmore than 30% of patients, usually because of fatigue. CONCLUSIONS: The integration of IFN and conventional chemotherapy is feasibleand effective. Maintenance IFN prolongs remission duration forpatients with stage IV low-grade lymphoma.     

Intensive Chemotherapy for Anaplastic Thyroid Carcinoma: Combination of Cisplatin, Doxorubicin, Etoposide and Peplomycin with Granulocyte Colonystimulating Factor Support

The Japanese Society of Thyroid Surgery undertook a pilot studyof treatment for anaplastic thyroid carcinoma in a cooperativesetting. The treatment consisted of cisplatin 40 mg/m² dripintravenous infusion (div), day 1, adriamycin 60 mg/m² iv, day1, etoposide 100 mg/m²/day div, days 1–3, peplomycin 5mg/body/day sc, days 1–5 and granulocyte colony-stimulatingfactor (GCSF) 2 µg/kg/day sc, days 6–14. This wasscheduled to be repeated every 3 weeks. Local radiation therapywas added for patients in whom it was indicated. A total of17 patients (mean age, 66 yr) were enrolled. Ten patients hadadvanced disease with measurable lesions and 2 patients experiencedpartial remission lasting 2 and 3 months, respectively. Sixof 7 patients were treated with the same modality of treatmentas an adjuvant. Three died of progressive disease after 3–7months and three others have survived for 3–11 months.The toxicities of the chemotherapy were mainly bonemarrow suppression,despite G-CSF support. Transient liver dysfunction was alsonoticed. These results indicate that this combined a treatmentcan be given to patients with acceptable toxicity. The degreeof leukopenia was greater than expected, partly due to the advancedage of the patients and the low dose of G-CSF. In addition,8 available thyroid specimens were examined for the mdr 1 geneand P-glycoprotein, but all were negative. Further study ofanaplastic thyroid carcinoma by this cooperative group willbe carried out.     

A Retrospective Histological Study of 9,009 Cases of Malignant Lymphoma in China Using the NLPCG Classification

A total of 9,009 cases of malignant lymphoma from 13 provincesin China were reviewed in a retrospective study covering the10-year period from 1972 to 1981. Of these 9,009 cases, 8,572 were of non-Hodgkin's lymphomas(NHL), of which 67% were of B-cell type and 28.5% were of T-celltype. Of the NHL, 5.2% showed a follicular pattern, and 30.1%were extranodal upon presentation, the most frequent site beingWaldeyer's ring. Hodgkin's disease accounted for 7.9% of thelymphomas in the regions where the cases of this disease wereincluded in the review. Within China, there was a higher incidenceof B-cell types in the middle and western parts of the countryas well as in Hainan Island (around 83%), while the T-cell typesshowed a higher incidence (34–45%) in the eastern part(Nanjing, Suzhou-Wuxi and Hangzhou). A few cases of Burkitt'slymphoma were found in the subtropical island of Hainan. Thetwo cities of southwestern China (Chongqing and Chengdu) hada relatively higher frequency of the small lymphocytic type. The data indicate that the lymphomas in China, unlike thosein the U.S.A. and Europe, are fairly similar to those in Japanin distribution of their subtypes, with the exception of thewestern part of China, where there is a tendency to approximatethose in the Western countries. ^*This study was directed by Prof. Sui-yu Gu     

Treatment of human immunodeficiency virus-associated hodgkin disease is there a clue regarding the cause of hodgkin disease?

Background. The occurrence of human immunodeficiency virus (HIV)-associated Hodgkin disease (HD) offers a unique opportunity to study the cause of HD and compare HIV–HD with the well-characterized HIV–non-Hodgkin lymphoma (NHL). Methods. Eight patients with HIV–HD and 17 with HIV–NHL were treated. Results. The complete remission (CR) rate in HIV–HD was 100% with mechlorethamine, vincristine, procarbazine, and prednisone or doxorubicin, bleomycin, vinblastine, and dacarbazine (median survival, > 38.0 months). HIV–NHL patients were treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CR, 80%; median survival, 13.0±1.3 months). Durable CR was achieved with one to six cycles of chemotherapy (median, 4). There were no late relapses. The difference between the survival rate associated with chemotherapy-treated HIV–HD and chemotherapy-treated HIV–NHL approached statistical significance (P = 0.06). Analysis indicated that all patients with HIV–HD (n = 8) may have acquired HIV through intravenous drug abuse (IVDA) compared with 1 of 17 patients with HIV–NHL (P = 0.0001). A combined analysis (metaanalysis) of 157 patients with chemotherapy-treated HIV–NHL and 51 with chemotherapy-treated HIV–HD confirmed the significantly better survival of those with HIV–HD (P < 0.0001). Conclusions. Standard combination chemotherapy, truncated as necessary, offers survival outcomes that are at least equivalent and, perhaps, superior to previously published experimental approaches for HIV–NHL and HIV–HD. HIV–HD has a significantly better prognosis than HIV–NHL and is associated with IVDA. These data suggest that the etiologic agents of HIV–HD and HIV–NHL may be transmissible, identifiable, and unique.     

Acute ovarian failure underestimates age-specific reproductive impairment for young women undergoing chemotherapy for cancer

BACKGROUND:

The authors sought to describe the age‐specific impact of infertility and early menopause after chemotherapy among reproductive age women with cancer.

METHODS:

A total of 1041 women diagnosed with cancer between the ages of 18 and 40 years responded to a retrospective survey on reproductive health history. Five cancer types were included: leukemia, Hodgkin disease (HD), non‐Hodgkin lymphoma (NHL), breast cancer, and gastrointestinal(GI) cancer. Survey questions addressed acute ovarian failure (cessation of menses after treatment), early menopause (menopause before 45 years old), and infertility (failed conception). Logistic regression was used to determine the proportions of acute ovarian failure and infertility based on age at diagnosis. Censored data methods were used to determine the probability of early menopause.

RESULTS:

Six hundred twenty women received chemotherapy alone. The percentage reporting acute ovarian failure was 8%, 10%, 9%, and 5% for HD, NHL, breast cancer, and GI cancer, respectively. Acute ovarian failure increased significantly with age at diagnosis (P < .05). In subjects not reporting acute ovarian failure, the incidence of infertility was at least 40% at age 35 years and increased significantly with age at diagnosis in HD and breast cancer (P < .05). The estimated probability of early menopause was at least 25% at age 30 years and increased significantly with younger age at diagnosis in HD, NHL, and GI cancer (P < .05).

CONCLUSIONS:

For patients to receive appropriate counseling, it is important that they understand the potential increased risk of infertility and early menopause beyond that of acute ovarian failure. These findings can provide improved, age‐specific counseling regarding reproductive impairment for young women diagnosed with cancer. Cancer 2012;. © 2011 American Cancer Society.     

Lymphoma Cases Referred to the Radiation Oncology Service of a Tertiary Referral University Hospital in Karachi,Pakistan: a Retrospective Study

Introduction: Radiation therapy is an important component of curative therapy for Lymphoma [Hodgkin’sdisease (HD) and non Hodgkin’s Lymphoma (NHL)]. The current study was conducted to give us an overview oflymphoma patients presenting to a tertiary care hospital for complementary adjuvant RT. Method: Data oflymphoma patients who underwent radiotherapy during February 2006 till August 2009 at the department ofradiation oncology, Aga Khan University, Hospital, Karachi was retrieved from the medical records and analyzedusing SPSS (version 16.0). Results: A total of 1,678 cancer patients were registered, 75 (0.45%) were lymphomapatients (25.3% HD; 74.7% NHL). HD and NHL were both seen predominantly in males, with a male:femaleratio of 2 and 3 respectively. Nodal HD comprised 94.7% and nodal NHL comprised 41.1%. Extranodal NHL(EN-NHL) comprised 53.6% whereas 5.4% cases had both nodal and EN-NHL; 6.7% of EN-NHL were primaryCNS lymphomas. Stages of presentation for HD were IIA (52.6%), 1A (21.1%), IIB (10.5%) and IB, IIIB andIVA collectively 15.9%. The ages of HD patients ranged from 11 to 54 years (median 23.5 years ± 13.2 SD).Response to therapy for HD was 52.6% complete remission, 36.8% partial response, and 5.3% each with stableand progressive disease. Almost all patients (94.7%) received radical treatment with radiation doses (between1950 cG to 5404 cGy) with a median of 40 Grays.Stages at presentation for NHL were II (23.2%), IV (21.4%)and IE (17.9%); I, IIE, and III were found to be 12.5 %. NHL patients ranged from 15 to 88 years. It was morecommonly observed amongst the elderly with 25% diagnosed in the fifth decade of life; 50% patients aged at orabove 50 years, 41.1% belonged to the 25-49 years age group and 8.9% below 25 years of age. Majority of thecases were diffuse NHL (82.1%), follicular NHL (7.1%), ‘Primary CNS unclassified type (8.9%), and unclassifiedother than CNS variety (1.8%). Response to chemotherapy for NHL was 51.8% complete remission, 25.9%progressive disease, 20.4% partial response. Forty (71.4%) with NHL received radical treatment with radiationdoses between 2340 cG to 6600 cGy; 28.6% received palliative RT. Conclusion: Radiation therapy, thoughimportant for cure of lymphoma, is relatively underutilized in our population, despite encouraging outcomes.