Late intensification therapy in adult acute lymphoid leukemia. The Southeastern Cancer Study Group Experience.

One hundred ninety-two evaluable patients were treated on a multicenter protocol for adult acute lymphoid leukemia to determine in a prospective randomized fashion if late intensification chemotherapy beginning after about six months of treatment would improve remission duration and survival. The complete remission rate was 60%. The median remission duration was 13.5 versus 25.9 months (P = 0.31) for standard maintenance therapy and late intensification, respectively, and the median survival was 17.5 versus 34.7 months (P = 0.19) respectively. Although there was a suggestion that the late intensification strategy was helpful, relapse proved to be common during the early phases of treatment; thus, insufficient numbers of patients were available at the randomization point to conclusively address the possible value of late intensification. Intensive therapy earlier in remission should be evaluated.     

Synovial sarcoma in young people: background, prognostic factors, and therapeutic questions

Synovial sarcoma represents 5% to 10% of all soft tissue sarcomas, with an estimated total of 800 new cases annually in the United States. The median age is 30 years; males and females are almost equally affected. About 70% of cases occur in patients more than 20 years old. Young people less than 20 years of age are mainly affected in the second decade of life. The majority of the tumors occur in para-articular structures in the extremities, and most of them are localized at diagnosis. A recent meta-analysis of 219 patients younger than 21 years old treated by the University of Texas M. D. Anderson Cancer Center's Division of Pediatrics, St. Jude Children's Research Hospital, the German Cooperative Group, and Istituto Nazionale dei Tumori, Milan, found that, as in older people, tumor size larger than 5 cm, residual local tumor or metastases at diagnosis, and progressive or recurrent disease all portended a poor outcome. There are currently no randomized studies of therapy for patients with synovial sarcoma, but such are needed to provide answers to the following questions: Is adjuvant chemotherapy useful in preventing recurrence in patients without visible residual disease after apparently complete surgical removal of localized tumor? Should local radiation therapy be given to all patients who have had complete removal of the primary tumor with clear margins at the time of diagnosis?     

Prognostic factors and surgical treatment guidelines for children with rhabdomyosarcoma of the perineum or anus: a report of Intergroup Rhabdomyosarcoma Studies I through IV, 1972 through 1997

Background/Purpose: Rhabdomyosarcoma (RMS) of the perineum or anus is a rare sarcoma of childhood with a poor prognosis. This study reviews the Intergroup Rhabdomyosarcoma Study Group (IRSG) studies I through IV to identify determinants of patient outcome and to refine surgical treatment guidelines. Methods: From 1972 through 1997, 71 eligible patients were treated and studied. The median patient age was 6 years. The majority (64%) were at an advanced stage (clinical group III and IV) at initial presentation and 50% had positive regional lymph node (LN) involvement. Results: The 5-year failure-free survival rate (FFS) for all patients was 45% and the overall survival rate (OS) was 49%. Characteristics that were associated with significantly improved survival rate were primary tumor size less than 5 cm, lower (less advanced) clinical group and stage, negative regional lymph node status, and age less than 10 years. When the extent of disease was controlled for in multivariate analysis, only age less than 10 predicted an improved outcome. The 5-year overall survival rate for patients less than 10 years of age was 71% versus 20% in older patients (P [lt ] .001). Histology (alveolar versus embryonal) and primary site (perineal versus anal) did not significantly affect outcome. Conclusions: Because of the high incidence of regional LN involvement in these patients, a strategy of routine surgical evaluation of ilioinguinal lymph nodes in all patients with perineal or anal RMS is recommended. J Pediatr Surg 38:347-353.     

CT myelography for outpatients. An inpatient/outpatient pilot study to assess methodology

The diagnostic usefulness, limitations, and adverse reactions associated with computed tomographic myelography using metrizamide were assessed for broad outpatient application. The initial approach was to examine inpatients (n = 38) with low-dose metrizamide (100 mgI/ml). This low dose was believed less likely to be associated with side effects. They were then treated as if they were outpatients, with the liberties this entailed. The consequences of needle puncture were minimized by using a 25-gauge disposable needle. Thirty-four (89%) patients remained free of side effects after the procedure. Subsequently, this technique was extended to 42 outpatients, 38 (90.5%) of whom remained asymptomatic. For comparison, 170 mgI/ml was used in another 25 outpatients, who evidenced more symptoms. The potential medical, economic, and therapeutic benefits of obviating hospitalization by safer outpatient CT myelography seem clear.