Response rates in relapsed Wilms' tumor: a need for new effective agents

Article Abstract:

Wilms' tumor is a kidney tumor of embryological origin. Modern therapy, involving both chemotherapy and radiotherapy, has achieved a cure rate in excess of 85 percent. However, for many of the patients who do suffer relapse, the prognosis is poor. The majority of recurrences of Wilms' tumor occur within two years of diagnosis, although there are reports of metastatic disease occurring as long as 11 years after initial treatment. The chances for successful treatment of a recurrence are greater if the metastatic disease occurs in the lungs, or if an isolated metastasis occurs in the liver or brain. Prognosis, where there is recurrent disease in a previously irradiated abdomen, is poor. Researchers have now reported the results of a study of Wilms' tumor treatment which began in 1980 and ultimately involved 381 patients. A total of 71 patients experienced relapse after initial treatment, and they were treated with a combination of chemotherapy, radiation, and/or surgery. Among the 51 relapsed patients with disease showing favorable histological (cell structures) characteristics, 15 survived. Six of 9 patients with Stage I disease survived, as did 5 of 10 with Stage II disease. None of the 11 patients with Stage III disease survived. Three of 16, and 1 of 5 patients survived stages IV and V disease, respectively. Among the 20 patients with unfavorable histologic signs, 2 patients survived after relapse. The results reveal that barely half the patients with early stage disease survived after relapse, and that the prospects for patients with more advanced disease are grim. Relapsed patients with unfavorable histologic indications have poor prospects for survival, regardless of the stage of disease. Despite the advances in the initial treatment of Wilms' tumor, the treatment of relapsed disease is in need of further developments. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Cancer in children, Childhood cancer, Kidney cancer, Nephroblastoma, Nephrectomy

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Combination therapy for anaplastic giant cell thyroid carcinoma

Article Abstract:

The most common form of thyroid cancer is papillary carcinoma, an indolent (slowly developing) cancer that rarely kills. Another form of thyroid cancer, however, the anaplastic (showing unclear cell development) carcinoma, is among the most malignant of all cancers in the body and is invariably fatal, usually within a year. Anaplastic thyroid carcinomas are always undifferentiated and highly malignant, but still show a spectrum of different histological characteristics. One form, with highly unusual cell forms, including giant multinucleated cells, is called the anaplastic giant cell thyroid carcinoma. Like other anaplastic thyroid cancers, the giant cell carcinoma most commonly occurs in the elderly, who are more susceptible to the adverse effects of aggressive chemotherapy, particularly chemotherapy including doxorubicin. Researchers have evaluated the combination of radiotherapy and chemotherapy in 20 patients with anaplastic giant cell thyroid carcinoma. All patients received 17.5 Gy (a Gy, or Gary, is one Joule of energy absorbed per kilogram of tissue), and patients under 65 years of age received doxorubicin and cisplatin. Patients over 65 received mitoxantrone. The majority of patients relapsed in eight months or less. However, longer survival was achieved in three patients. Two patients receiving doxorubicin sustained responses for 22 and 34 months, while one patient receiving mitoxantrone sustained a response for 40 months. The authors emphasize that the initiation of radiation and chemotherapy must not be delayed for patients with anaplastic giant cell thyroid carcinoma, even when surgical treatment is used. Unfortunately, the toxicity observed with the present treatments was severe, and remains a major barrier to improving the effectiveness of therapy for anaplastic thyroid carcinoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Giant cell tumors, Thyroid cancer

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Congenital malignant melanoma of the eye

Article Abstract:

The authors present the case of a newborn baby with a large tumor obliterating the left eye. Pathologic study revealed the tumor to be a malignant melanoma. The case is striking since congenital malignant melanoma is very rare, and this seems to be the only case of congenital melanoma of the eye ever to have been reported. In a review of the medical literature, the authors were able to identify only 23 previously reported cases of congenital malignant melanoma. In nine of the reported cases, the melanoma was associated with a giant congenital melanocytic nevus, that is, a very large, dark birth mark or "mole". Only two of these infants survived past six months of age. In five of the reported cases, the hapless infant was invaded by cancer cells which crossed the placenta from the mother; only one of these infants survived. It is worth noting that the cancerous lesions of this one surviving infant disappeared on their own, presumably the result of an immune attack on the "foreign" cells which had invaded from the mother's tissues. In the present case, however, there was neither a giant congenital melanocytic nevus nor any indication of malignant melanoma in the mother. There were, however, many raised nevi which varied in their pigmentation. The nevi were two to four millimeters in diameter and were located primarily on the scalp and back. The large mass in the eye socket was surgically removed and the infant was treated for widespread metastases with vincristine, dactinomycin, and cyclophosphamide. The patient is now alive and well at almost three years of age. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Melanoma, Eye cancer

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