Chemotherapy with cisplatin and 5‐fluorouracil for penile and urethral squamous cell carcinomas

Six men with either recurrent (n = 4) or unresectable (n = 2) squamous cell carcinoma of the penis (n = 5) and urethra (n = 1) received chemotherapy with cisplatin intravenously at a dose of 100 mg/m2. This was followed 24 hours later by a continuous intravenous infusion of 5‐fluorouracil (5‐FU) at a dose of 960 mg/m2/d for five days every 3 to 4 weeks. There was universal alopecia. The other toxicities were mild and consisted of mucositis, nausea, vomiting, reversible creatininemia, and transient azotemia. After chemotherapy, five patients had a clinical partial response and one had a complete response. Of the five patients with no metastases, three had residual unresectable tumors. These three patients received radiation and survived for 6,8, and 20 months after the start of chemotherapy. The other two patients were rendered disease‐free by surgery. The first patient, who was a partial responder to chemotherapy, survived for 26 months. The second patient, who was a clinical complete responder, had excision of microscopic disease and is disease‐free at 32+ months after the start of chemotherapy. This is the first article to report that the combination of cisplatin and 5‐FU is active in penile and urethral carcinomas. After chemotherapy, surgery may be useful in selected patients to accurately assess response and excise localized residual tumors. Patients rendered tumor‐free may achieve long‐term survival

Evolving role of surgical treatment in limited‐disease small cell lung carcinoma

The diagnostic role of surgical procedures in small cell lung carcinoma (SCLC) is well established. The therapeutic role of surgery has changed over the years. At present, curative resection is the treatment of choice in peripheral T1‐2 NoMo SCLC, and adjuvant chemotherapy may be beneficial. Surgery is also indicated in SCLC patients diagnosed by a limited pathologic sample in whom the clinical course suggests nonsmall cell lung carcinoma (NSCLC). The resection may reveal either a mixed tumor or an alternate diagnosis and may be potentially curative. Surgery, at the time of maximal response to chemotherapy in T3NoMo SCLC, may be curative and reveal the presence of NSCLC elements. The best survival is in patients found to be tumor‐free at surgery, and the worst survival is in N2 patients

Digital Clubbing and Lung Cancer

To determine the relative frequency of clubbing in small cell lung carcinoma (SCLC) versus non-small cell lung carcinoma (NSCLC). Examine patients with lung cancer for digital clubbing and relate the findings to the histopathologic subtype of lung cancer. Cancer center at a tertiary teaching hospital. One hundred and eleven consecutive patients with a pathological diagnosis of lung cancer examined by one physician (KSS). None. Clubbing was present in 32 (29%) of the 111 patients with lung cancer. Clubbing was more common in women (40%) than in men (19%; χ2 test p = 0.011), and was more common in patients with NSCLC (35%) than those with SCLC (4%; χ2 test p = 0.0036). In a prospective study, digital clubbing was less frequently observed in men than women and in patients with SCLC than NSCLC. These clinical observations may assist in the initial evaluation of patients for planning workup and therapy

Primary choriocarcinoma of the lung: Report of a case treated with intensive multimodality therapy and review of the literature

Primary choriocarcinomas of the lung are extremely rare. Like choriocarcinomas elsewhere, they possess rapid growth ability and a high propensity to metastasize. There is minimal information available on the treatment of lung choriocarcinoma. In the case reported herein, neoadjuvant chemotherapy with 5‐fluorouracil (5‐FU) infusion, etoposide, and cisplatin induced a partial response permitting complete excision of a massive tumor of the right upper lobe involving the chest wall and superior vena cava. The patient relapsed with a metastasis to the brain that was surgically excised. Contralateral lung metastases were soon noted and responded well to systemic chemotherapy; yet the patient died of a new brain metastasis. To our knowledge, this is the first example of a primary choriocarcinoma of the lung treated with intensive multimodality therapy. The latter seems to offer a potential benefit if certain guidelines are followed

Activity of pirarubicin (4′‐o‐tetrahydropyranyladriamycin) in malignant mesothelioma

Eight patients with diffuse malignant mesothelioma of the pleura or peritoneum, previously untreated with chemotherapy, were treated with a new anthracycline 4′‐O‐tetrahydropyranyladriamycin (pirarubicin). Pirarubicin was given intravenously at the rate of 5 mg per minute, at doses ranging from 35 to 70 mg/m2 once every 21 days. On clinical evaluation, one patient had complete response lasting 4 months. On second‐look laparotomy residual tumor was found and she was labelled a partial responder and changed to alternate chemotherapy. Another patient had a partial response of recurrent chest wall tumors lasting 11 months. A third patient had a partial response lasting 4+ months of a pleural‐based tumor and resolution of pleural effusion. After the fifth course of chemotherapy, he developed severe granulocytopenia, pseudomonas sepsis, shock, and renal failure. Despite recovery of blood counts to normal within 3 days, renal failure proved fatal. Autopsy revealed only fibrosis and no gross or microscopic evidence of malignant mesothelioma. A fourth patient had improvement in evaluable disease lasting about 4 months; and the remaining four had stable disease for at least 2 months each. The authors conclude that, whenever feasible, noninvasive clinical assessment of tumor response should be supplemented by surgical‐pathologic evaluation. Pirarubicin is active in malignant mesothelioma. This is the first report documenting complete tumor eradication after chemotherapy in an adult with malignant mesothelioma

New strategies are needed in diffuse malignant mesothelioma

Background. Medical records of 50 patients with malignant mesothelioma were reviewed to determine the clinical features and factors influencing survival. Methods. Charts of all patients whose conditions were diagnosed as malignant mesothelioma were ed and analyzed by statistical software. Results. The male‐to‐female ratio was 4:l. The age distribution was younger than 45 years of age, 10%; 45–54 years of age, 12%; 55–64 years of age, 37%; 65–74 years of age, 33%; and 75 years of age or older, 8%. Both mean and median ages were 58 years. Among the 32 patients in whom asbestos exposure was recorded, 24 had documented exposure. The sites were pleura, 73%; peritoneum, 20%; and both, 6%. The histologic types were epithelial, 51%; sarcomatous, 10%; mixed, 15%; and not specified, 24%. The stage at presentation was Stage I, 37%; 11, 39%; 111, 12%; IV, 6%; and unknown, 6%. The common symptoms in pleural disease were dyspnea and pain; in peritoneal disease, abdominal distension and pain were common. The median time from first symptom to diagnosis was 3 months (range, 0–23 months). The median survival after the appearance of symptoms, the diagnosis, and the treatment were 13,10, and 8 months, respectively. Conclusions. The survival was independent of age, sex, and smoking behavior. It was longer in patients with earlier‐stage disease, a good performance status, a longer duration of symptoms, an absence of pain, and who were treated with combined surgery and chemotherapy. Chemotherapy using anthracyclines yielded more remissions (9 of 21) than that using nonanthracyclines (0 of 13). The remission rate after primary chemotherapy with anthracyclines (7 of 16) may be higher than in recurrent tumor (2 of 14). In future trials, stratifization into primary chemotherapy and chemotherapy of recurrent cancer is suggested. There is a need for multi technique trials incorporating primary Chemotherapy