RESUMEN
BACKGROUND: 1994 marked a decade since the inception of a prospective population-based study on the value of neoadjuvant approach for soft tissue sarcomas of head, neck, and limbs at the Tom Baker Cancer Centre, Calgary, Alberta. To date, 42 patients have been followed for a minimum of 5 years or until death. METHODS: Each patient received a protocol of 60 mg to 90 mg of Adriamycin infused intra-arterially or intravenously over 3 days into a vessel feeding the involved area, 30 Gy of radiotherapy given over 10 days, and complete resection of the sarcoma 4 to 6 weeks later. The lower dose was used empirically for smaller limbs (e.g., arm). RESULTS: Two of the 42 patients were immediate failures of protocol, with one requiring amputation and one requiring later reexcision. In the 38 appendicular lesions, the ultimate limb salvage rate was 97.5%. All tumors were associated with a high risk of local recurrence with 15 being previous local failures. The rest were deep and grade 2 or 3 lesions. Serious local complications were seen in one patient (2.5%) who had wound necrosis requiring reoperation. Minor wound complications were seen in five patients (12.5%) (one wound infection, one resolved edema, three long-term drainage). There was one local recurrence; thus 5-year local control was 97%. No patient had long-term morbidity related to the treatment. No effect on systemic control was suggested. CONCLUSION: Our report demonstrates that this combined modality approach provides superior local control of soft tissue sarcomas with low postoperative morbidity.
Asunto(s)
Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/cirugía , Adolescente , Adulto , Anciano , Antibióticos Antineoplásicos/administración & dosificación , Estudios de Cohortes , Terapia Combinada , Doxorrubicina/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intraarteriales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dosificación Radioterapéutica , Sarcoma/tratamiento farmacológico , Sarcoma/radioterapia , Neoplasias de los Tejidos Blandos/tratamiento farmacológico , Neoplasias de los Tejidos Blandos/radioterapia , Factores de Tiempo , Resultado del TratamientoRESUMEN
Twenty-five patients with soft-tissue and bony sarcomas of the head and neck and limbs were treated by local neoadjuvant therapy. It consisted of 90 mg of Adriamycin infused intra-arterially over 3 days into a vessel feeding the involved area and 30 Gy of radiotherapy given over 10 days; this was followed by a complete resection of the sarcoma 4 to 6 weeks later. All the tumors were associated with a high risk of local recurrence; eight were locally recurrent and the remainder were stage II to stage IV tumours. Serious local complications were seen in 4% of the patients. This rate compares well with other higher dose neoadjuvant regimens (35 Gy over 10 days), which are associated with a 35% local complication rate. Follow-up at a mean of 30 months demonstrated no local recurrence. All limbs were spared. Long-term morbidity was negligible. No effect on systemic control is suggested; only 63% of the patients were free of systemic disease. This report substantiates other similar experiences supporting neoadjuvant therapy followed by resection as the treatment of choice for local control of sarcomas.
Asunto(s)
Neoplasias Óseas/tratamiento farmacológico , Doxorrubicina/administración & dosificación , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Sarcoma/tratamiento farmacológico , Neoplasias de los Tejidos Blandos/tratamiento farmacológico , Terapia Combinada , Doxorrubicina/efectos adversos , Humanos , Infusiones Intraarteriales , Recurrencia Local de Neoplasia , Estudios Prospectivos , Sarcoma/cirugíaRESUMEN
A 79-year-old woman with the clinical presentation of polymyalgia rheumatica (PMR) also had breast cancer. Histopathologic evidence of arteritis was found in mastectomy tissue and in a temporal artery, neither of which had produced symptoms before surgery. Previously reported cases are reviewed in the context that breast vasculitis may be more common than in generally recognized in patients with PMR.
Asunto(s)
Arteritis/complicaciones , Mama/irrigación sanguínea , Polimialgia Reumática/complicaciones , Anciano , Arterias/patología , Arteritis/patología , Neoplasias de la Mama/complicaciones , Femenino , Humanos , Polimialgia Reumática/patologíaRESUMEN
A 72-year-old man with choledocholithiasis, demonstrated radiologically, was treated by constant perfusion through the gallbladder of monooctanoin (glyceryl-1-monooctanoate) following cholecystostomy for a perforated gallbladder. The monooctanoin was given at a rate of 7.5 ml/h and monitored to ensure that delivery pressure did not rise above 20 cm H2O. Perfusion was carried out for 60 hours, but could not be continued because of abdominal pain, nausea and vomiting. This was followed by progressive jaundice, anorexia and fever. The patient was treated with penicillin G and cefoxitin intravenously and metronidazole orally, but he died 5 weeks after the perfusion. Autopsy showed acute pancreatitis and cholangitis, and a biliary tree filled with pus and a black biliary cast. No calculi were present. The authors consider the possible causes for this patient's death.