Nutritional factors as predictors of response to radio-chemotherapy and survival in unresectable squamous head and neck carcinoma

BACKGROUND AND PURPOSE: This study sought to evaluate nutritional prognostic factors before treatment in patients with unresectable head and neck cancer treated by concomitant radio-chemotherapy. METHODS AND MATERIALS: Seventy-two consecutive patients were treated. We studied the potential effects of CRP, Alb, preAlb, orosomucoid, weight, weight history, BMI, PINI, OPR and NRI on response to treatment, Event-Free Survival (EFS) and Overall Survival (OS). Effects of potential risk factors on OS and on EFS were analyzed by computing Kaplan-Meier estimates, and curves were compared using the log-rank test. RESULTS: All biological nutritional factors were statistically correlated with the response to radio-chemotherapy. In multivariate analysis, only CRP (p=0.004) remained statistically significant. A statistical correlation was found between Alb and EFS in multivariate analysis (p=0.04). The factors influencing OS in univariate analysis were Alb (p=0.008), CRP (p=0.004), orosomucoid (p=0.01) and NRI (p=0.01), response to radio-chemotherapy (p<0.001) and staging (p=0.04). In multivariate analysis, only the response to radio-chemotherapy (p<0.001) remained significant. CONCLUSIONS: This study illustrates the prognostic value of nutritional status. CRP and Alb may be useful in the assessment of advanced head and neck cancer patients at diagnosis and for stratifying patients taking part in randomized trials.     

Pancreatoblastoma: Response to chemotherapy

Two cases of pancreatoblastoma in children are reported here. Only biopsies were made at laparotomy as surgical resection by duodeno-pancreatectomy was not possible. In both children a dramatic response was observed with chemotherapy: doxorubicin plus cisplatin for one, cyclophosphamide, actinomycin D, bleomycin, vinblastin sulfate, and cisplatin for the other. After completion of the chemotherapy the first patient had a local resection; then he had radiotherapy. He is alive in first remission 40 months after the end of the treatment. In the second patient, regional recurrence occurred 8 months after chemotherapy was ended. A transient second remission was obtained with ifosfamide plus etoposide alternating with epirubicin plus vincristine. The patient died 36 months after the diagnosis. Therefore, these two cases suggest that chemo therapy may be proposed before any attempt at surgical excision. Nevertheless, early consolidation by radical resection or irradiation must be considered.     

Clinical development of beta-thalassemia-sickle cell anemia apropos of 36 cases]

Hematological and clinical features of 36 mainly Algerian patients with S-beta thalassemia are reported. These data, compared with those reported in the literature, showed a higher prevalence of aseptic necrosis and gall stones, probably related to the large predominance of S-beta zero-thalassemia (30 cases) and a long (14 years) median follow-up period.     

Association of distal displacement of the left subclavian artery and coarctation of the aorta

Summary Previously noted but undocumented observation of distal displacement of the left subclavian artery in patients with discrete coarctation of the aorta was verified by an objective two-dimensional echocardiographic method in 28 patients with aortic coarctation and in 43 control subjects.Relative position of brachiocephalic arteries to one another was evaluated by the ratio of the distance between the left common carotid and the left subclavian artery to the distance between the innominate and the left common carotid artery.Large distance between the left common carotid and the left subclavian artery was reflected by high value of the derived ratio. In neonates with aortic coarctation, the ratio was 1.69, SD±0.66, compared to 1.04, SD±0.40 in the control group. In older children this ratio was less discriminatory.We also observed that the left subclavian artery formed an acute angle (<90°) with the proximal (upstream) segment of the aortic arch in infants with aortic coarctation. In all control infants, this angle was equal to or greater than 90°.A corresponding necropsy study confirmed the echocardiographic findings.We conclude that distal displacement of the left subclavian artery is associated with coarctation of the aorta. It can be accurately visualized and objectively assessed by the two-dimensional echocardiographic technique proposed.     

Phase I study of RP 49532A,a new protein-synthesis inhibitor,in patients with advanced refractory solid tumors

Giroline (RP 49532A) is a new protein-synthesis inhibitor with broad antitumor activity in experimental models. In the present phase I study, Giroline was given by 24-h i.v. infusion every 3 weeks at doses ranging from 3 to 15 mg/m² to 12 patients with advanced refractory solid tumors. The dose-limiting toxic effects were delayed hypotension and severe asthenia. The maximum tolerated dose (MTD) was 15 mg/m². Transient nausea and vomiting during infusion were reported at all dose levels. Mild reversible prolongation of prothrombin time and activated partial thromboplastin time was observed in most patients at dose levels above 3 mg/m². No antitumor activity was observed. The toxicity profile of Giroline precludes further evaluation in cancer patients.This work is dedicated to the memory of Prof. Michel Clavel     

Hypodiploidy, Ki-67 growth fraction and prognosis of surgically resected lung cancers.

One hundred and thirty-seven lung cancer patients (123 non-small-cell lung cancers (NSCLC), 10 small-cell lung cancers (SCLC) and four carcinoid tumours) who underwent surgery in an attempt at complete resection were prospectively entered in a study whose aim was to determine the prognostic significance of a hypodiploidy or a multiploidy pattern of tumour cell DNA content and a high immunohistochemical reactivity of Ki-67, a nuclear antigen related to the cell cycle. Indirect immunoperoxidase reactivity of Ki-67 on frozen tumour tissue sections was evaluated both visually, using a classical semiquantitative scale, and by means of a computer-assisted image processor. Cell DNA content analysis was done using static computer-assisted cytometry on tumour cytological prints stained by the pararosaline Feulgen-Schiff technique. The ploidy was characterised for each tumour by DNA index (DI), percentage of hypodiploid cells and type of DNA content histogram (near diploid, hyperdiploid, hypodiploid and multiploid). Ki-67 immunostaining was negative in 64 tumours (48%) and positive in 69 (52%). DNA histogram classification disclosed 57 (42%) near diploid tumours. Among the 80 (58%) aneuploid tumours, 16 were hypodiploid, 44 hyperdiploid and 20 multiploid. The prevalence of both a positive Ki-67 immunostaining and an aneuploid DNA histogram differed according to histology as SCLC demonstrated a higher frequency of both features when compared with NSCLC and carcinoid tumours. On the other hand, Ki-67 immunostaining and ploidy did not significantly differ according to degree of differentiation, nodal status and Mountain''s stage grouping. The percentage of cells in the hypodiploid modal DNA was significantly higher for tumours which demonstrated a high Ki-67 immunostaining, suggesting a link between growth fraction and DNA content abnormalities. In univariate analysis, survival did not differ significantly according to either the Ki-67 immunohistochemical reactivity or the DNA index. Patients with a hypodiploid tumour had a shorter survival than patients with other DNA histogram patterns but, owing to the low frequency of hypodiploidy, this difference did not reach statistical significance. In Cox''s proportional hazard model, an SCLC histology, an advanced tumour status, a positive nodal status and a hypodiploid tumour (hazard ratio: 2.070; 95% confidence interval 1.041-4.116) were significant determinants of survival. We conclude that hypodiploidy in lung cancer is a distinct DNA content abnormality as it contributes significantly to prognosis. Neither visually assessed nor computer-generated Ki-67 immunostaining measurements significantly determine prognosis.     

Long term results after portal disconnection of the esophagus using an anastomotic button for bleeding esophageal varices in cirrhosis

From 1968 to 1984, 250 patients with cirrhosis and bleeding esophageal varices underwent portal disconnection of the esophagus using either Murphy's button (before 1974) or an esophageal device developed by one of the authors (after 1974). One hundred and thirty-four patients underwent operation on an elective basis and 116 underwent emergency procedures. With the use of Child's classification, 62 patients were class A, 125 were class B and 63, class C. The over-all operative mortality rate was 24.4 per cent but this varied with the hepatic functional status and whether or not the operation was done on an elective or emergency basis. The long term survival rates were 53 per cent at one year, 36 per cent at three years, 24 per cent at five years and 8 per cent at ten years. Ninety-six per cent of the patients were without proved recurrent esophageal bleeding at one year, 88 per cent at three years, 79 per cent at five years and 66 per cent at ten years. Portal disconnection of the esophagus using an anastomotic button is a simple and effective procedure which can benefit many patients with cirrhosis who undergo an operation for bleeding varices on an elective or emergency basis. It constitutes an efficacious prophylactic means for preventing recurrent bleeding from esophageal varices.     

Value of ultrasonics in the diagnosis of acute intestinal invagination in infants and children. Apropos of a series of 60 cases

Sixty cases hospitalized between May and October 1985 for suspicion of acute intestinal intussusception in whom emergency ultrasonography was performed are reported. The diagnostic reliability of this non-invasive technique reduces the indication for performing barium enemas to treatment only.     

Prenatal diagnosis of classical phenylketonuria by linked restriction fragment length polymorphism analysis

Since the isolation of a recombinant containing a cDNA sequence for human phenylalanine hydroxylase (hPH) (Woo et al., 1983; Speer et al., 1986) prenatal diagnosis by linked restriction fragment length polymorphism (RFLPs) has become possible for families in which phenylketonuria (PKU) occurs (Lidsky et al., 1985a). We describe here the application of a Hind III three-allele RFLP in a single family, which allowed the prenatal diagnosis of an affected fetus.