Chemosensitivity correlation between primary tumors and simultaneous metastatic lymph nodes of patients evaluated by DNA synthesis inhibition assay

Article Abstract:

A tissue culture test to evaluate the sensitivity of a patient's cancer cells to chemotherapy may result not only in an improvement in therapy, but an avoidance of therapies which are likely to fail in a particular individual. Such assays have not proved particularly successful; this probably results from the great difference between the environment in a tissue culture plate and that within a cancer patient. Another factor which may also affect the validity of in vitro assays, however, is the heterogeneity of the cancers themselves. This heterogeneity, which is becoming increasingly appreciated by researchers, is reflected in the fact that even within the same tumor, some cells may be affected by a particular chemotherapeutic agent and others remain unaffected. This heterogeneity may make it impossible to predict the response of tumor metastases to chemotherapeutic agents based on in vitro chemosensitivity tests performed on the primary cancer. To examine the relative chemosensitivities of primary tumors and lymph node metastases, in vitro assays were performed on cells obtained from 29 patients whose diagnoses included stomach cancer, colorectal cancer, breast cancer, and others. The effect of chemotherapeutic agents was measured by determining the amount of radioactive thymidine incorporated into the cancer cell's DNA. Radioactive thymidine, which can be converted into thymine by reproducing cells and used as a DNA building block, will be incorporated in greater quantities in a culture of actively growing cells than in a culture of cells that has been inhibited or killed by a chemotherapeutic agent. The measured DNA synthesis was always higher in the metastatic nodes than the primary tumors. In addition, the metastatic nodes were always more sensitive to anti-cancer drugs than the primary tumor. The drug sensitivities of the primary tumor correlated with the sensitivities of the metastatic tumor for some drugs but not for others. If the primary tumor was sensitive to Adriamycin (doxorubicin) or carboquone, the metastatic node was also likely to be. Curiously, if the primary tumor was sensitive to 5-fluorouracil, the metastatic node was likely to be sensitive to carboquone, and carboquone sensitivity of the primary correlated not only with carboquone sensitivity in the metastatic node, but Adriamycin and mitomycin C sensitivity as well. No correlations were observed for cisplatin sensitivity. The DNA synthesis inhibition assay may provide useful information to guide the choice of chemotherapy in patients with metastatic cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Case studies, Evaluation, Antineoplastic agents, Chemotherapy, Tissue culture

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Ultrasound and ultrasound-guided fine needle aspiration biopsy of supraclavicular lymph nodes in patients with esophageal carcinoma

Article Abstract:

Cancer of the esophagus has a poor prognosis, since the disease is generally not detected until it has developed into more advanced stages. Surgical treatment for esophageal cancer results in considerable illness and death, and is generally not considered if the patient's disease is already sufficiently advanced that the chances for success are nil. A straightforward and relatively noninvasive method for the detection of advanced disease would be useful, not in terms of improving the survival rate, but in terms of sparing terminally ill patients the pain and morbidity associated with surgery. Unfortunately, although computed tomography is the most accurate noninvasive method available for the preoperative staging of esophageal cancer, it is not sufficiently reliable to exclude patients from surgery without corroborating biopsy. Since the spread of esophageal cancer to the supraclavicular lymph nodes is an indication of advanced Stage IV disease, biopsy of these nodes may be one method that would exclude some patients with advanced disease from surgery. Since the supraclavicular lymph nodes are relatively close to the surface, they can be detected by ultrasound imaging, which could be used to guide a needle for precise aspiration biopsy of the nodes. To determine if this minimally invasive procedure would be useful in excluding patients from surgery, ultrasound-guided fine-needle biopsy was performed on the supraclavicular lymph nodes of 37 patients with esophageal cancer. Metastatic tumor cells were observed in 7 (19 percent) of the specimens obtained; this result is in keeping with proportions of supraclavicular lymph node involvement ranging from 18 to 27 percent, as reported in the medical literature. Ultrasound-guided fine-needle biopsy may be a useful addition to computed tomography in the staging of esophageal cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Ultrasound imaging, Diagnosis, Identification and classification, Tumors, Lymph nodes, Esophageal cancer, Biopsy, Needle, Needle biopsy, Lymph node biopsy

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Can internal mammary chain treatment decrease the risk of death for patients with medial breast cancers and positive axillary lymph nodes?

Article Abstract:

Previously, the authors reported achieving improved outcomes of breast cancer through the treatment of the internal mammary chain. Among women whose cancer had already spread to the lymph nodes in the armpits, the treatment of the internal mammary chain, which runs down the medial portion of the chest, was associated with improved long-term survival. However, these results have not been confirmed by other researchers. To resolve this apparent disparity, the authors reviewed the cases of 1,060 women whose treatment included internal mammary chain dissection or radiation therapy, along with the cases of 135 women whose treatment for breast cancer did not include treatment of the internal mammary chain. A multivariate analysis of the factors affecting the likelihood of distant metastases (spread) and recurrent breast cancer revealed that there was a difference between the women whose breast cancer occurred laterally (to the side) and those in whom the cancer was medial (in the center). For women with medial breast cancer, the treatment of the internal mammary chain conferred a significant benefit. The risk of breast cancer recurrence was 2.9 times greater among the women who did not receive treatment of the internal mammary chain, and the risk of distant metastases was 1.6 times greater than women who were so treated. However, a similar trend was not observed among women whose breast cancer was more laterally located. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Risk factors, Physiological aspects, Development and progression, Breast cancer, Radiotherapy, Cancer invasiveness, Mammary glands

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