Partial remission of pulmonary metastasis of malignant gonadal stromal tumor by salvage chemotherapy

Fourteen malignant cases of gonadal stromal tumor were found among the cases reported in literature, but the roles of chemotherapy and radiotherapy have not been defined. We treated a malignant case and achieved 98.9 per-cent remission of lung metastases by salvage chemotherapy (cis-platinum + VP-16). A 34 year-old desk-worker, underwent left orchiectomy for testicular tumor on March 20, 1984. Histologic examination showed a malignant gonadal stromal tumor invading into the epididymis. Three course of adjuvant chemotherapy with cis-platinum, vinblastine, and peplomycin (PVP) were performed. However, chest X-ray films 13 months later revealed multiple lung metastases. Although 3 courses of combination chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP) were given, no remission was obtained. However following 4 courses of combination chemotherapy with cis-platinum and VP-16, 98.9 per-cent remission of lung metastases was achieved. Subsequent bilateral residual lung tumors were resected. However, lung metastases recurred 3 months later, and the patient died on February 29, 1988. The autopsy revealed extensive lung, liver and pancreas metastases, but no lymph node metastases.     

Treatment of pulmonary disease caused by opportunist mycobacteria.

Opportunist mycobacterial infections localised to the chest may be treated with combinations of standard antimycobacterial drugs. The combination of rifampicin and ethambutol seems to be particularly effective, both in vivo and in vitro. In vitro sensitivity testing with single drugs may have a role in the future when the levels of in vitro resistance compatible with the clinical response to treatment are eventually established. Sensitivity testing against drugs in combination may prove useful for modifying treatment regimens in those patients who either fail to respond to initial chemotherapy or relapse. Further evidence on this will, it is hoped, emerge from the prospective studies currently in progress.     

Radical resection of a pulmonary blastoma involving the pulmonary artery.

Pulmonary blastoma is a rare malignant lesion with a poor prognosis. We described a case of a 47-year-old woman with a large biphasic pulmonary blastoma, involving the left pulmonary artery. Under cardiopulmonary bypass, it was treated with radical left intrapericardial pneumonectomy and pulmonary thromboendarterectomy. Subsequent chemotherapy and radiotherapy was used. Three years postoperatively, the patient was clinically and radiologically free of tumor.     

Multidrug chemotherapy in pulmonary treatment of osteosarcoma.

Forty-three patients with osteosarcoma were treated with amputation and adjuvant chemotherapy utilizing a four-drug combination of cyclophosphamide, vincristine, phenylalanine mustard, and adriamycin (CONPADRI-I regimen). Twenty-four patients (56 per cent) remained free of metastases twelve to sixty-one months after diagnosis. Ten of the twenty-four have been disease-free for more than three years. Another group of thirty patients was treated with amputation and a five-drug adjuvant chemotherapy program which included the administration of massive doses of methotrexate with citrovorum factor (COMPADRI-II regimen). Twenty of the thirty (67 per cent) remained free of metastases from twelve to twenty-six months after amputation (median, sixteen months). Two deaths related to methotrexate toxicity occurred. Late metastases developed in three patients (at sixteen, nineteen, and twenty-six months after operation) in the group treated with the COMPADRI-II regimen.     

Giant-cell tumor of bone with pulmonary metastases

We reviewed the cases of seven patients with histologically benign primary giant-cell tumor of bone and histologically proved metastases to the lung. All seven had a Stage-3, aggressive, benign lesion with interruption of the cortex and soft-tissue extension. The main histological features of the primary lesion were identical to those of the pulmonary metastases. In only one of the seven patients were the metastases detected simultaneously with the primary lesion. All seven patients were treated by surgical resection of the lung nodules and chemotherapy. Of the seven patients, four were alive and free of disease after an average follow-up of nine years; two were receiving chemotherapy; and one, who had had immunosuppression for an allograft transplant, died less than one year after the discovery of the pulmonary lesions. Based on this small series, we concluded that patients with a Stage-3 giant-cell tumor of bone may be at risk for pulmonary spread of the disease. This lesion, with its benign histological picture even in lung lesions, has a favorable prognosis when treated with pulmonary resection of the nodules. However, the role for chemotherapy after pulmonary surgery is still unclear.     

Clinical review of pulmonary disease caused by Mycobacterium xenopi.

Mycobacterium xenopi comprised 56% of all non-tuberculous mycobacteria isolated in the Brompton Hospital laboratory during six years. M xenopi alone was cultured from the sputum of 23 patients, whose clinical and bacteriological features are reviewed. Pulmonary disease was considered to be due to the organism present in 15 of these patients on the basis of strict criteria for a causal relationship. Radiographs of all these patients were consistent with mycobacterial disease, showing pulmonary cavitation in 11, apical shadowing in three, and upper lobe fibrosis in one. In nine patients the disease was chronic, progressing very slowly with longstanding respiratory symptoms and extensive radiographic abnormalities developing over many years (mean 19 years). In six patients the disease was subacute, being of recent onset with radiographic shadowing of limited extent. M xenopi was isolated as a saprophyte from four patients who had lung disease of known cause and single isolates were obtained from four patients who had no lung disease attributable to this organism. In vitro drug sensitivity tests showed the sputum cultures of 17 of 22 patients to be sensitive to two or more of the drugs rifampicin, isoniazid, and ethambutol. Response to chemotherapy was unpredictable and did not always correlate with the results of sensitivity tests. Of 11 patients treated with at least two drugs to which their organisms were sensitive, two remained sputum positive, one relapsed after 18 months of chemotherapy, and eight have remained sputum negative during a minimum of three years' follow-up.     

Video-assisted thoracoscopic epicardial ablation of left pulmonary veins for lone permanent atrial fibrillation

Permanent atrial fibrillation necessitating oral anticoagulation may lead to deleterious consequences in patients with severe comorbidity factors. We present the case of a 68-year-old female patient with a lone permanent atrial fibrillation disclosed five years earlier, necessitating anticoagulation with coumadin and treated for a lymphoma by chemotherapy. Due to hematological consequences resulting from chemotherapy and oral anticoagulation, the patient presented with regular hemothorax and anemia. The need to suppress oral anticoagulation became obvious and the decision to treat the atrial fibrillation was discussed through a video-assisted thoracoscopic radiofrequency epicardial isolation of pulmonary veins.     

Evaluation of surgical resection of pulmonary metastasis of trophoblastic tumor

Objective: To evaluate the role of the lung lobectomy in gestational trophoblastic tumor patients with lung metastases. Methods: A total of 45 cases of trophoblastic tumor with pulmonary metastases treated by lung lobectomy from 1985~2002 at PUMC hospital were retrospectively analyzed. Seven cases were diagnosed as invasive mole and thirty-eight as choriocarcinoma. Results: Lung lobectomy was performed in all of these patients after several courses of chemotherapy. Seven cases of invasive mole reached complete remission. Eleven cases of choriocarcinoma with stage Ⅲa had received average 13 courses of chemotherapy, 10 of them reached complete remission. Seventeen cases of choriocarcinoma with stage Ⅲb had received average 14.3 courses of chemotherapy, 11 of them reached complete remission. Ten cases of choriocarcinoma with stage Ⅳ had received average 15 courses of chemotherapy, six of them reached complete remission. In the 45 patients, histologic examination disclosed haemorrhagic necrotic tissue in 27 patients, 17 of them reached complete remission(63%). Histologic examination also revealed fibrosis around the focus in 16 patients, 14 of them reached complete remission(88%). Tuberculosis was found in 2 patients.Conclusions: Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, lung lobectomy remains an important adjunct treatment in a selected subset of patients. Pathological examinations can help to estimate the prognosis.     

An unusual successfully treated case of pulmonary yolk sac tumor

Extragonadal germ cell tumors are relatively rare, particularly malignant yolk sac tumors arising in the lung parenchyma. We report a case of a huge malignant yolk sac tumor in the right middle lobe. The patient was successfully treated with neoadjuvant chemotherapy followed by complete resection of the tumor.     

The alteration in the pattern of pulmonary metastasis with adjuvant chemotherapy in osteosarcoma

Summary Alterations in the pattern of pulmonary metastasis of patients with osteosarcoma treated with adjuvant chemotherapy were studied. Thirty two patients who were treated with both radical surgery and adjuvant chemotherapy were observed (chemotherapy group). As a control, sixty two patients treated with radical surgery alone were also assessed (non-chemotherapy group). The chemotherapy group demonstrated a reduction in the number and a delay in the appearance of metastases. The tumour doubling time did not differ between the chemotherapy and non-chemotherapy groups. The initial site of metastasis among the chemotherapy group was most commonly in the lower lung field, whereas among the non-chemotherapy group it was usually to the middle lung field. The chemotherapy group survived longer than the non-chemotherapy group after developing pulmonary metastases. Histological examination showed that the metastatic foci simulated the primary sites.

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Résumé On a étudié les modifications de l'aspect des métastases pulmonaires chez des malades porteurs d'un ostéosarcome et traités par chimiothérapie complémentaire. Trente-deux malades traités à la fois par chirurgie radicale et chimiothérapie ont été examinés (groupe avec chimiothérapie). Soixante-deux malades traités seulement par chirurgie radicale (groupe sans chimiothérapie) ont également été suivis, constituant un groupe de contrôle. Le groupe avec chimiothérapie a présenté une diminution du nombre ainsi qu'un retard à l'apparition des métastases. Le temps de doublement de ces tumeurs ne diffère pas entre les deux groupes. La localisation initiale des métastases dans le groupe avec chimiothérapie est le plus souvent la base du poumon, tandis que dans le groupe sans chimiothérapie c'est habituellement la partie moyenne du poumon. Après apparition des métastases pulmonaires la durée de survie est plus importante dans le groupe avec chimiothérapie que dans l'autre. L'examen histologique montre que les foyers métastatiques sont identiques à la localisation initiale de la tumeur.

     

Primary malignant non-seminomatous germ cell tumour of the mediastinum treated by surgery and chemotherapy

Primary malignant germ cell tumours of the mediastinum are rare and are associated with poor survival when treated with surgery alone or with surgery when chemotherapy has failed. Recent improvements in combination chemotherapy have given some prospect of cure. A patient treated with primary surgical excision and postoperative chemotherapy, who remains free of disease 24 months after completion of treatment is reported here.     

Malignant gliomas treated after surgery by combination chemotherapy and delayed irradiation

Summary Forty-six patients with gliomas were introduced after surgery into a therapeutic programme of six cycles of combination chemotherapy with VM₂₆ and CCNU, followed by delayed irradiation six months after surgery with an average dose of 5,800 rads. After irradiation the same preradiation chemotherapy was readministered for an average of four cycles. The results were compared to those from another group of 28 patients treated only by the same chemotherapy (CRC and C groups successively).Twelve patients (26%) died before irradiation in the CRC group, six patients (13%) had recurrences at the time of irradiation, and 28 patients (61%) had no clinical or radiological signs of recurrence at the time of irradiation. For the total of treated patients the median survival after surgery was 17 months, and 46% of the patients were surviving at 18 months. The percentage of survivors at 18 months was significantly more elevated in the group treated by combination chemotherapy and delayed irradiation than in a control group treated by the same combination chemotherapy alone. This result suggests that in approximately 50% of cases combination chemotherapy after surgery, and delayed irradiation six months after surgery, cumulated their effects on survival time.     

Successful treatment of chemo-refractory pulmonary metastases of renal pelvic cancer by second-line chemotherapy including gemcitabine followed by salvage surgery

A 51-year-old woman developed multiple pulmonary metastases after receiving nephroureterectomy and two cycles of adjuvant chemotherapy for the treatment of renal pelvic transitional cell carcinoma. All metastases disappeared after four cycles of methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) chemotherapy followed by radiotherapy; however, 8 months later two pulmonary metastases recurred. The patient was entered into a phase I study of combination chemotherapy with gemcitabine, etoposide and cisplatin, designed for chemorefractory urothelial cancer. The lung masses showed significant reduction after two cycles of this chemotherapy; following salvage surgery, the patient has been well with no evidence of recurrence for more than 3 years.     

Therapy on pulmonary metastasis of renal cell carcinoma

We reviewed the results of therapy on pulmonary metastasis of renal cell carcinoma performed in our hospital between 1979 and 1988. Eighty patients of renal cell carcinoma were treated during the period. Of those patients 13 (10 males and 3 females) had pulmonary metastasis and their ages were between 52 and 74 (average 61.6). The therapies we performed were surgical resection, cytotoxic chemotherapy, BRM (biological response modifier) therapy, hormone therapy and irradiation therapy. Four patients became tumor free by administration of medroxyprogesterone acetate, interferon-alpha, UFT (a compound combining tegafur and uracil) and surgical resection respectively. In 1 patient, administration of UFT resulted in partial remission. Cytotoxic chemotherapy using cisplatin, vinblastine and doxorubicin, and irradiation therapy were not effective. These findings suggest that BRM therapy, UFT therapy and hormone therapy are effective in eliminating pulmonary metastasis of renal cell carcinoma, particularly in the patients with excellent performance status whose original lesions had been resected.     

Coexistent bronchogenic carcinoma and active pulmonary tuberculosis.

Sixty-four cases of coexistent bronchogenic carcinoma and active pulmonary tuberculosis were diagnosed between 1969 and 1976. The majority were male chronic cigarette smokers in their fifth and sixth decades. Human bacilli were isolated in 48 patients (88.9 percent) and atypical bacilli in six patients (11.1 percent). All of the atypical bacilli and 8.3 percent of the human bacilli were found to be resistant to the first line antituberculous drugs. All patients, except two who died following resection, were given a course of antituberculous drugs with 93.8 percent successful sputum conversion. Uncontrolled or disseminated tuberculous infection was not observed. Forty-five patients (70.3 percent) underwent pulmonary resection. Median survival time of those who had curative resection was 14.3 months with a 5 year survival rate of 13.2 percent. Median survival times of those treated by palliative resection plus anticancer chemotherapy and by anticancer chemotherapy alone were 8.3 months and 11.1 months, respectively. None of these patients survived more than 30 months. It appears that, clinically, each disease runs its own course with little effect on the other.     

Surgical treatment and chemotherapy for pulmonary metastases from osteosarcoma.

Between 1971 and 1991, 247 patients with stage I osteosarcoma were treated at UCLA. Patients were treated in four sequential groups, with group 1 receiving surgery alone, and groups 2 through 4 receiving various adjuvant chemotherapeutic regimens. The incidence of lung metastases in these patients decreased from 92% (group 1) to 31% (group 4), while the proportion of patients undergoing pulmonary resection increased (17% vs 82%). Overall 5-year survival rate among patients with pulmonary metastases increased from 0 in group 1 to 41% (actuarial) in group 4. No clinical factor correlated significantly with outcome using univariate analysis, although there was a trend toward prolonged survival in those with longer disease-free intervals. Adjuvant chemotherapy and resection of pulmonary metastases have transformed a uniformly fatal condition into one with a reasonable expectation of long-term survival.     

Lung cancer accompanied by active pulmonary tuberculosis

We report 2 patients with lung cancer accompanied by active pulmonary tuberculosis. Case1 was a 82-year-old woman with stage I A bronchioloalveolar carcinoma and tuberculosis in right upper lobe. Right upper lobectomy was performed after the histological diagnosis of lung cancer by intraoperative frozen section. Case2 was a 69-year-old man with papillary adenocarcinoma in right lower lobe and tuberculosis in bilateral upper lobe. Partial resection in right lower lobe was performed for diagnosis of lung cancer. Smear-positive tuberculosis was diagnosed by sputum examination after the operation. Post-operative anti-tuberculosis chemotherapy was added in both patients.     

Chemotherapy of embryonal carcinoma of the testis with lymph node invasion and/or pulmonary metastases. Results of a VBP type protocol

Fourteen patients with histologically proven embryonal carcinoma of the testis with pulmonary metastasis (10 pts) or para-aortic nodal involvement (4 pts) were treated by a chemotherapy regimen including vinblastine, bleomycin and cisplatin. Extreme ages were 19 and 51 years with a median age of 32 years. Median duration of treatment was 6 months (6 cycles of chemotherapy) without maintenance treatment. After completion of chemotherapy, 6 patients in complete remission received para-aortic node irradiation (45 Grays in 25 fractions). One patient had a para-aortic node dissection, histologically negative. With a median follow-up of 47 months (maximum 92 months, minimum 12 months), eleven patients are in complete remission (78.6%). Three patients are dead from the disease, in spite of salvage chemotherapy. There were no toxic deaths. Disease-free actuarial survival is 74% at 4 years. Our results confirm the excellent therapeutic results of this chemotherapy regimen in embryonal carcinoma of the testis with pulmonary metastasis and/or para-aortic nodal involvement.     

Neoadjuvant Chemotherapy Followed by Radical Surgery in Patients Affected by FIGO Stage IVA Cervical Cancer

Background Concomitant chemoradiotherapy represents the standard treatment for patients affected by locally advanced cervical cancer. Survival rates in patients affected by FIGO stage IVA disease remain poor. Some authors have suggested that neoadjuvant chemotherapy followed by radical surgery might be a valid alternative to standard treatment. The objective of this study was to analyze the feasibility and results obtained by neoadjuvant chemotherapy in patients affected by stage IVA disease. Methods Eighteen patients affected by FIGO stage IVA cervical cancer were treated with 175 mg/m² paclitaxel and 75 mg/m² cisplatin every 21 days for three courses followed by radical surgery when feasible. Results All patients were subjected to the three planned chemotherapy courses. Two patients achieved a complete clinical response, and 10 patients achieved a partial clinical response. Ten patients were subjected to anterior pelvic exenteration, whereas the remaining eight patients were treated with chemotherapy, radiotherapy, and concomitant chemoradiotherapy. The estimated 3-year and 5-year overall survival rates were 47.4% and 31.6%, respectively. Patients eligible for surgery benefited from significantly longer survival rates. Conclusions Neoadjuvant chemotherapy followed by radical surgery is feasible in approximately half of patients affected by FIGO stage IVA cervical cancer. Overall survival rates appear similar to those reported with concomitant chemoradiotherapy. Patients who are amenable to radical surgery after chemotherapy may benefit from long-term survival rates.     

Results of chemotherapy in 30 AIDS patients with symptomatic pulmonary Kaposi's sarcoma.

BACKGROUND--The aim of this study was to report the effects of a three-drug chemotherapy regimen in patients with symptomatic AIDS-related pulmonary Kaposi's sarcoma and to analyse prognostic factors for survival. METHODS--Thirty consecutive HIV seropositive patients with respiratory symptoms and proven pulmonary Kaposi's sarcoma were treated with the same therapeutic regimen comprising adriamycin (30 mg/m2), bleomycin (10 mg/m2), and vincristine (2 mg) administered intravenously once every four weeks. RESULTS--Two patients died during the first course of chemotherapy. In the other 28 cases dyspnoea improved and Pao2 rose despite minimal (n = 17) or no (n = 11) improvement in the chest radiographic appearance. The median survival from the beginning of chemotherapy was 6.5 months. Poor prognostic factors for survival were: (1) absence of cutaneous Kaposi's sarcoma; (2) previous opportunistic infection; (3) CD4 cell count < 100/microliters; (4) leucocytes < 3500/microliters; (5) haemoglobin < 10 g/dl; and (6) absence of radiological response. Of the 28 patients 24 experienced at least one episode of neutropenia which was associated with bacterial infection in 16 cases. CONCLUSIONS--Chemotherapy may improve respiratory impairment in patients with extensive pulmonary Kaposi's sarcoma but the outcome remains poor. The efficacy of chemotherapy may be limited by neutropenia.