Chordomas: diagnosis and management.

Six patients with chordomas, five in the sacral and one in the craniocervical region, are reported along with review of the literature. Two of the patients treated with radiation for macroscopic tumor had palliation of their symptoms and an apparent prolongation of survival. Two other patients with sacral chordomas had resection of the gross tumor and radiation due to inadequate proximal margins.

Symptomatic gastrointestinal metastases from malignant melanoma.

Twenty-two patients with symptomatic metastases to the gastrointestinal tract from malignant melanoma who presented to the Roswell Park Memorial Institute during the past 12 years were reviewed. Sixteen of 22 patients underwent abdominal surgery and most received satisfactory palliation. Of the six patients who were considered unsuitable for surgery, two died from perforation of the small bowel.

The surgical treatment and outcome of soft-tissue sarcoma.

Cases of 251 patients with soft-tissue sarcoma of the extremities, trunk, head and neck, and retroperitoneum were reviewed. The overall five-, ten-, and 15-year survival rates were 45%, 30%, and 24%, respectively. The five-year survival rates after wide soft-tissue resections, local excision, and amputation were 59%, 42%, and 39%, respectively.

Axillary node dissection in malignant melanoma.

Axillary node dissection for nonmammary malignant lesions can be performed easily through an incision in the medial wall of the axilla. In patients with clinical involvement of the axilla with melanoma, positive nodes above the level of the axillary vein may occasionally be found.

Characterization of cells obtained by mechanical and enzymatic means from human melanoma, sarcoma, and lung tumors.

Characterization of cells comprising solid tumors will facilitate the rational design of cancer chemotherapy for individual patients. We have prepared cell suspensions from human melanoma, sarcoma, and lung tumors by thinly slicing the tissue with a microtome and scalpels (mechanical release), followed by treatment with a mixture of collagenase II and DNase I (enzymatic release). This method of disaggregation resulted in two cell suspensions for each tumor specimen, and we characterized these suspensions by assessing their dye exclusion capability, ribonucleoside triphosphate pools, cytological profile and clonogenicity in soft agar.

Phase II study--intra-arterial BCNU therapy for metastatic brain tumors.

Thirty-one patients with metastatic brain tumors (MBT) from lung cancer and ten patients with MBT from melanoma received BCNU, 100 mg/m2, every four weeks by intracarotid and/or vertebral artery infusion into each involved site. Twenty-five patients with lung cancer and all melanoma patients are currently evaluable. Twelve patients with lung cancer had complete and partial responses lasting from 1 to 14 months.

Surgical management of metastases to the lung.

Our experience with 234 patients having resection of metastatic lesions of lung is reviewed. Most bilateral lung metastases were removed though a median sternotomy. Exploration of the contralateral lung with simultaneous removal of all lesions is possible through such an incision, and moreover, it appears to give less pain postoperatively.

Regional chemotherapy via the pulmonary artery for pulmonary metastases.

Regional chemotherapy with Adriamycin via the pulmonary artery produces significantly higher tissue levels in the infused canine lobe than systemic administration. Seven patients with soft tissue sarcomas who had received the maximum dose of Adriamycin and had shown metastatic tumor recurrence to the lungs, received small doses of 10 to 20 mg of Adriamycin in the lobar arteries supplying areas with tumor via a Swan-Ganz catheter, temporarily occluding with its inflated balloon the infused artery. One partial objective regression was noted.

Adrenal adenocarcinomas: diagnosis and management.

Thirty-two patients with adrenal adenocarcinoma are reviewed. Eleven of them had symptoms suggestive of a hormonally functional tumor. The median survival in 17 patients who had the primary tumor removed was 13.

High incidence and characterization of glucocorticoid receptors in human malignant melanoma.

The glucocorticoid receptor was characterized in biopsy samples from patients with recurrent malignant melanoma. Glucocorticoid receptors were measured by the charcoal-adsorption technique. Tumor cytosol from approximately 86% (25/29) of the patients contained large quantities of receptors (20-324 fmol/mg protein).

Cyclic nucleotide phosphodiesterases in normal and malignant human tissues.

Biopsy samples were obtained from tumor tissue and surrounding normal tissue from the same organs of the same patients in 25 patients. Adequate studies could be performed on all parameters in 18 tissue pairs: 12 malignant melanomas, 4 sarcomas, and 2 others. Significantly higher levels of cAMP low affinity phosphodiesterases were found in the tumors as compared to the controls.

High-dose methotrexate as secondary chemotherapy in metastatic soft-tissue sarcomas.

High-dose methotrexate in a dose of 2-4 g/m2 every four weeks was given as secondary chemotherapy to 22 patients with metastatic soft-tissue sarcoma; toxic reactions included 1 death and 2 instances of moderate hematopoietic toxicity. The remaining patients tolerated this treatment without difficulty. Of 18 patients with measurable evaluable disease, 17 demonstrated progression.

Anorectal melanoma: clinical features, recurrence and patient survival.

In this study, 20 cases of anorectal melanoma seen over a 50-year period were analyzed. It is common to mistake this tumor for other benign conditions because of its similar clinical presentation and the frequent absence of pigmentation. Patients with anal lesions had a significantly longer mean survival than those with rectal lesions.

The technique of popliteal lymph node dissection.

Popliteal node dissection may be indicated when in continuity dissection is performed along with the excision of a primary malignant tumor adjacent to the popliteal fossa or when actual or potential metastatic disease to the popliteal nodes is suspected. The technique involves removal of fatty tissue and nodes of the popliteal fossa with proper identification and preservation of the common peroneal and tibial nerves and popliteal vessels.

Colony growth in soft agar of human melanoma, sarcoma, and lung carcinoma cells disaggregated by mechanical and enzymatic methods.

The effect of mechanical and enzymatic disaggregation on human malignant melanoma, soft-tissue sarcoma and lung carcinoma colony growth in soft agar was studied. The enzymatic disaggregation was advantageous in most cases of melanoma and sarcoma, giving a larger number of colonies and increasing the probability of achieving growth in soft agar. Enzymatically treated pulmonary carcinoma cell populations had lower clonogeneic potential, especially in the case of anaplastic carcinomas.

Estrogen and progesterone receptors and tamoxifen in malignant melanoma.

Tumor biopsies from 68 patients with malignant melanoma were assessed for estrogen receptor (ERc) binding, and 32 of these for progesterone receptor (PRc) binding. Twenty-five patients (37%) had ERc greater than or equal to 5 fmols/mg protein; 14 patients (44%) had PRc greater than or equal to 10 fmols/mg of protein. There was no significant difference between the sexes in relation to the presence or absence of ERc or PRc.

Prognostic value of lymph node dissection in malignant melanoma.

Retrospective review of 199 patients with malignant melanoma who had regional node dissection showed that the median survival rates of patients with histologically negative nodes was more than threefold higher than that of patients with histologically positive regional nodes. In the patients with positive nodes, survival was related to the number of nodes involved. Patients with one, two, and three or more positive lymph nodes had a tumor-free five-year survival rate of 41%, 30%, and 18%.

Treatment of adult neuroblastoma.

Twelve patients, all over 17 years of age, with adult neuroblastomas, an entity recently described, were seen at Roswell Park Memorial Institute for the period from 1950 to 1977. Four of these patients who were treated by multimodality therapy constitute the bulk of this report. One patient had a complete response and showed no evidence of disease 23 months after treatment with surgery and combination chemotherapy (CYVADIC); she also had maturation of established metastases.

One layer closure of the abdominal wall.

A one layer closure of the abdominal wall with a far-near, near-far suture has been used in 34 patients. This technique allows approximation of the fascia without pressure on the skin and leads to firm uncomplicated wound healing.