Palliation in malignant pleural effusion.

Experience with thoracostomy and intrapleural chemotherapy in the management of malignant pleural effsion is presented. Of 19 patients not requiring further thoracentesis, five died within one month. The surviving 14 patients all responded, 11 completely and three partially, with good palliation, for periods of from one to 28 months. Indications for the procedure and technical problems are discussed, and the results evaluated. This would seem ot be the method of choice for recurring malignant pleural effusion.     

Adjuvant chemotherapy for operable breast cancer with positive axillary nodes: A comparison of CMFVP versus L-PAM

This 5-year update of a study by the Southwest Oncology Group continues to show that combination chemotherapy utilizing cyclophosphamide, methotrexate, 5-fluorouracil, vincristine, and prednisone (CMFVP) is superior to melphalan (L-PAM) used alone. Adjuvant chemotherapy for patients with operable breast cancer and positive axillary nodes treated with continuous CMFVP confers a significantly longer disease-free and total survival compared to those treated with intermittent L-PAM. This significant decrease in recurrence and prolongation of survival are demonstrated for the entire CMFVP group and in the following subgroups: premenopausal, postmenopausal, and women with 4 or more axillary nodes. Women with 1 to 3 axillary nodes have a significantly longer disease-free interval, but a total survival advantage is not statistically significant.

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Resumen La presente actualización a 5 años continúa demostrando que la combinación CMFVP (ciclofosfamida, metotrexato, 5-fluorouracil, vincristina, y prednisona) es superior al L-PAM (melfalán). La quimioterapia adyuvante para pacientes con cáncer mamario operable con ganglios axilares positivos tratados con CMFVP continua demuestra un intervalo libre de enfermedad significativamente más prolongado y una mejor tasa de supervivencia total que la observada en pacientes tratados con regimenes intermitentes de L-PAM. Estos significativos descensos en la recurrencia y prolongación de la supervivencia pueden ser demostrados en la totalidad del grupo tratado con CMFVP y en los siguientes subgrupos: premenopáusico, postmenopáusico y mujeres con 4 o más ganglios axilares afectados. Las mujeres con 1–3 ganglios afectados exhibieron una supervivencia libre de enfermedad significativamente más prolongada, pero la ventaja en cuanto a supervivencia total no es estadísticamente significativa.

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Résumé Cette étude portant sur 5 ans montre que les résultats de la chimiothérapie par le CMFVP (cyclophosphamide, methotrexate, 5 FU, vincristine, prednisone) est supérieure à la chimiothérapie par le L-PAM (melphalan). La chimiothérapie associée pour traiter les malades atteints de cancer du sein opérable avec envahissement ganglionnaire donne un intervalle de temps entre l'opération et la reprise de l'affection, et une survie plus longues quand elle est assurée par le traitement continu avec les CMFVP par rapport au traitement discontinu avec le L-PAM.La diminution significative de la récidive et le prolongement de la survie sont manifestes pour la totalité du groupe traité par le protocole CMFVP et les sous-groupes suivants: femmes avant la ménopause, après la ménopause, avec envahissement ganglionnaire supérieur à 4 ganglions. Lorsque l'envahissement ganglionnaire concerne 1–3 ganglions, la récidive survient plus tardivement mais la durée de la survie au total n'est pas augmentée.

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Supported by grant CA 20319-09.     

Phase II trial of R115777 (NSC #70818) in patients with advanced colorectal cancer: A Southwest Oncology Group study

Summary Purpose: The purpose of this Phase II multi-institutional trial was to determine the efficacy and toxicity of R115777 in previously untreated patients with metastatic colorectal carcinoma. Patients and methods: Patients were required to have histologically confirmed colorectal cancer with distant metastatic disease that was not surgically curable. They could not have received prior chemotherapy for metastatic disease. R115777 was given at a dose of 300 mg p.o. twice a day for 21days every 28 days until tumor progression or toxicity or other reason for discontinuation occurred. The primary endpoint was to determine the confirmed response probability with this treatment. Results: There were 55 eligible patients accrued to the study. There were no complete responses, but one confirmed partial response for a confirmed response probability of 2% (95%CI 0–10%). Three additional patients had an unconfirmed partial response for an overall response probability of 7%. The time to treatment failure was 1.7 months and the estimated median survival was 8.1 months. One patient died of treatment related infection and there were 7 other patients with grade 4 toxicities consisting of neutropenia, leukopenia, febrile neutropenia and thrombocytopenia, depression, increased bilirubin, anemia, and pneumonitis/infiltrates. Conclusion: R115777 given as a single agent by this dose and schedule is ineffective in patients with metastatic colorectal cancer.     

Neural correlates of the object-recall process in semantic memory

The recall of an object from features is a specific operation in semantic memory in which the thalamus and pre-supplementary motor area (pre-SMA) are integrally involved. Other higher-order semantic cortices are also likely to be involved. We used the object-recall-from-features paradigm, with more sensitive scanning techniques and larger sample size, to replicate and extend our previous results. Eighteen right-handed healthy participants performed an object-recall task and an association semantic task, while undergoing functional magnetic resonance imaging. During object-recall, subjects determined whether words pairs describing object features combined to recall an object; during the association task they decided if two words were related. Of brain areas specifically involved in object recall, in addition to the thalamus and pre-SMA, other regions included the left dorsolateral prefrontal cortex, inferior parietal lobule, and middle temporal gyrus, and bilateral rostral anterior cingulate and inferior frontal gyri. These regions are involved in semantic processing, verbal working memory and response-conflict detection and monitoring. The thalamus likely helps to coordinate activity of these different brain areas. Understanding the circuit that normally mediates this process is relevant for schizophrenia, where many regions in this circuit are functionally abnormal and semantic memory is impaired.