Role of radiotherapy in soft tissue sarcoma

OBJECTIVE: To determine if the ammonia produced by Helicobacter pylori affects the phagocytic ability of human polymorphonuclear leucocytes as measured by the oxidative burst. METHODS: Interactions between opsonized urease-positive and -negative strains of H. pylori with polymorphonuclear leucocytes were studied in two series of experiments. In the first series of experiments, concentrations from 0 to 50 mM of NH4Cl were added to polymorphonuclear leucocytes. In the second series of experiments, bacteria were pre-incubated for 1 h with urea (0 to 50 mM) before addition of phagocytes. Luminol-dependent chemiluminescence was measured every 5 min over a 50-min period. The pH was verified in each treatment. RESULTS: Inhibition of chemiluminescence, increasing with concentration, was noted in all treatments when NH4Cl was added. When urea was added to urease-positive strains, chemiluminescence was significantly reduced when compared to the urease-negative strain and the zymosan control. This effect could not be attributed to a change in pH in the experiments using NH4Cl or urea at a concentration of 5 mM and 10 mM. CONCLUSION: Ammonia generated by H. pylori may contribute to the decreased activity of polymorphonuclear leucocytes in vivo.     

Chemotherapy of metastatic soft tissue sarcoma

The chemosensitivity of bone sarcomas contrasts sharply with the comparative initial chemoresistance of soft tissue sarcomas. The lack of new effective cytotoxic agents, delayed treatment due to a clinical presentation which is often innocuous and the absence of a consensus about the role of adjuvant chemotherapy after adequate surgery account for the slow progress achieved in the treatment of these tumours and for such an appalling prognosis. Chemotherapy is still purely palliative except for certain specific metastatic lesions, and median overall survival is more often than not below 12 months. However, the optimization of the therapeutic index of the most active antimitotic drugs, the ever-increasing acceptance of the concept of a dose-effect for the majority of these lesions, the particularly promising objective response rates with intensive drug combinations and a better understanding of the development process of certain lesions and histologic subtypes make it possible to envisage a rapid improvement in their still far too dismal prognosis.     

Locally recurrent soft tissue sarcoma of the extremities

BACKGROUND: The management of locally recurrent extremity soft tissue sarcoma remains challenging. This study was undertaken to evaluate the long-term outcome after therapy for isolated locally recurrent soft tissue sarcoma (STS) of the extremity. METHODS: Between January 1, 1980, and December 31, 1990, 52 patients were treated at The University of Texas M. D. Anderson Cancer Center for locally recurrent extremity STS. The records of the subset of these patients (n = 36) with isolated local recurrence were examined to document clinicopathologic and treatment factors and to evaluate outcome using the end points of local recurrence-free, recurrence-free, and overall survival. RESULTS: Limb-sparing conservative surgery was possible in 24 patients (75%). Twelve (33%) of 36 patients were treated by surgery alone, 23 patients (64%) were treated with combined modality therapy (surgery plus radiation and/or chemotherapy), and 1 patient had radiotherapy only. Sixteen (44%) of 36 patients had no further recurrence of any type at a median follow-up of 58 months (range, 4 to 173 months). The 5-year actuarial local recurrence-free, recurrence-free, and overall survival rates were 72%, 45%, and 77%, respectively. CONCLUSIONS: Limb-sparing conservative surgery is possible in the majority of patients with isolated locally recurrent STS. Durable local control can be established with individualized local treatment strategies. These results support aggressive multimodality limb-sparing treatment approaches for these patients.     

Sarcoma botryoides in the pediatric vagina--a soft tissue sarcoma with good prognosis

Although rare, sarcoma botryoides of the vagina in infants is a highly aggressive soft tissue tumour. Former opinions suggesting exenterative surgery and radiation to improve the dismal outcome in these young children, are outdated. Due to balanced therapies (topical tumourectomy, chemotherapy and radiation adjusted to tumour stage) cure of these sarcomas may be expected dependent on tumour stage, localisation and response to chemotherapy. The rate of complete remissions has increased in recent years. We report on an eighteen-month old girl with complete remission of tumour stage IIA who had been treated according to the CWS 91 protocol. Diagnosis and treatment were performed in March 1994 at the age of six months. We observed the patient in complete remission for 8 months (till September 1995).     

Morphological changes in the articular capsule tissue after preliminary synoviorthesis

Synovial tissues, surgically removed after synoviorthesis, were investigated microscopically. 198Au metallic desposits were seen until five years after the intraarticular injection. Light fibrotic changes were present, however these tissues exhibited also necrotic changes. 90Y could not be detected microscopically. Inclusions of necrotic cartilage in the synovial membrane may indicate cartilage disturbances due to 90Y. Osmium acid was identified by Xray-microanalysis.     

Li-Fraumeni syndrome in pediatric patients with soft tissue sarcoma or osteosarcoma

Family history of cancer and features of the Li-Fraumeni syndrome (LFS) were investigated in 42 patients with soft tissue sarcoma or osteosarcoma in a pediatric hospital in Mexico City, and compared with 42 non-cancer children. Six subjects with cancer were found among 204 first-degree relatives of cancer patients while there were none among 183 first-degree relatives of non-cancer children. In three families, the proband had two affected relatives, and the type of neoplasia as well as the age of onset suggested the clinical diagnosis of LFS. Our results show that 7.1% of our pediatric patients with soft tissue sarcoma or osteosarcoma may belong to LFS families. The authors encourage pediatric and adult oncologists to pay more attention to the history of cancer in nuclear families for eventual hereditary cancer syndrome identification and cancer prevention.     

Surgery of soft tissue sarcoma (with the exception of the retroperitoneum)

The place of surgery in the treatment of soft-tissue sarcoma is defined in the light of a review of the recent litterature. Usual treatment combines conservative surgery and radiotherapy. The essential risk factor of local recurrence is the quality of surgical resection, defined by the definitive resection margins. The addition of radiotherapy after inadequate surgery can improve local control, but cannot ensure that obtained after adequate surgery. Some limited tumours can be treated by surgery alone, but radiotherapy remains essential in more advanced tumours. Under these conditions, local recurrence rates after surgery alone, surgery and systematic radiotherapy and surgery with radiotherapy, as required are 27%, 28% and 30% respectively. The development of a local recurrence appears to affect survival in tumour with a good initial prognosis, early recurrence determining unfavourable outcome. Serious postoperative morbidity is observed in 14% of the cases and is responsible for delayed treatment and functional disorders. The use of muscle flaps to fill the surgical defects can reduce these complications. Evaluation of the functional results must be based on predefined objective criteria.     

Multivariate analysis of prognostic factors in 75 patients with soft tissue sarcoma

Traditionally, patients who received minor gynecology surgery remained in the hospital for a few days, during which time post-operative care was given by nurses. However, since patients are now often discharged the same day, the responsibility for this care has been transferred to the patients and their families. Because the nursing staff of the Gynecology Day Surgery Unit at the Royal Victoria Hospital believes there is a need for patient-monitoring after discharge and CLSCs do not offer services for this generally healthy clientele, they developed, with the head nurse and the assistant head nurse, a post-operative telephone follow-up program. This idea stemmed from the general need to adapt care as a result of the increase in day surgery. In addition to extending care beyond the hospital walls and improving its quality, this program has increased the job satisfaction of the nurses involved.     

Morphological changes of clefts in Plasmodium-infected erythrocytes under adverse conditions

Blood infected with human or rodent malaria parasites, Plasmodium falciparum or Plasmodium berghei, was exposed to higher pH, higher PO2, and lower temperature than those used in standard cultivation conditions. Parasitized blood was incubated for 20, 25, and 30 min with RPMI 1640 medium, 10% (vol/vol) serum, pH 8.0, at 20 degrees C in the air, conditions which are ultimately lethal to the asexual stages of malarial parasites. Markedly dilated clefts were observed in the cytoplasm of the malaria-infected erythrocytes so treated. These clefts can take up colloidal gold particles and macromolecules such as Protein A, rhodamine-dextran, and lucifer yellow-dextran. Such dilated clefts were not seen in the cytoplasm of infected erythrocytes that were incubated under normal cultivation conditions before fixation. These had slender clefts of the usual sort that did not take up colloidal gold particles and macromolecules.     

Buttockectomy as a limbsaving procedure for locally advanced soft tissue sarcoma of the buttock region

Cord blood was obtained from 164 neonates at birth and investigated for the presence of aflatoxins. 14 of the samples were neonates without jaundice and 150 from neonates with jaundice. There was significant reduction (P > 0.05) in birth weight of jaundiced neonates with aflatoxin. Neonates with jaundice have high mean concentration of aflatoxin B1 (32.3 ng/ml and 35.6 ng/ml). Aflatoxin G1 was not detected in any of the groups. The rate of detection was higher in wet (81.8%) than dry season (50.0%). These findings show that neonates are exposed to aflatoxin prenatally and that high incidence of jaundice occurred in the wet warm months.     

The metal/tissue interface effect in irradiation of the oral cavity

Bovine ligamentum nuchae elastin that had been partially digested by porcine pancreatic elastase and then thoroughly washed with 0.2 M-NaC1/0.05 M-sodium borate solution continued to release peptide fragments in solution. Complete removal of elastase from the elastin surface required extraction with dilute alkali, a procedure that does not irreversibly inactivate the enzyme or hydrolyse elastin.     

Mutant p53 expression: a marker of diminished survival in well-differentiated soft tissue sarcoma

The aim of this study was to assess the translational value of the quantitative assay of mutant p53 protein expression as both a prognostic indicator and a tool to determine appropriate therapy in a group of relatively innocuous and morphologically similar soft tissue sarcomas (STSs). Using a quantitative ELISA, we analyzed mutant p53 protein expression in 47 well-differentiated (grade I) STSs from patients treated in our Department of Surgical Oncology. Sixteen of 47 tumors expressed up to 42.6 ng mutant p53 protein/mg total protein. After a mean follow-up of 112 months, 63% of the patients with mutant p53+ tumors but only 16% of the patients with mutant p53- tumors had died (P < 0.01). Mutant p53 expression of >/=4.5 ng predicted even greater reduction in survival. These data show that mutant p53 expression identifies biologically aggressive grade I STSs. This molecular marker should have translational value as a tool to select those patients likely to benefit from aggressive multimodal therapy and intense surveillance.     

Mobilization of peripheral blood progenitor cells by disease-specific chemotherapy in patients with soft tissue sarcoma

We investigated peripheral blood progenitor cell (PBPC) mobilization by disease-specific chemotherapy in patients with metastatic soft tissue sarcoma (STS). Nine patients, five females and four males, aged 12-51 years, pretreated by one to nine courses of cytotoxic chemotherapy, underwent STS-specific mobilization followed by G-CSF at 5 microg/kg/day. PBPC were collected by 19 conventional-volume aphereses (8-12 l) with one to four procedures in individual patients. Leukaphereses started on median day 15 (range 13-18) from the first day of mobilization chemotherapy at medians of 25.8 x 10(3) WBC/microl (6.8-46.9), 3.5 x 10(3) MNC/microl (1.1-8.8), 122 x 10(3) platelets/microl (72-293) and 30.7 CD34+ cells/microl (6.7-207.8). Cumulative harvests resulted in medians of 4.6 x 10(8) MNC/kg (3.0-6.4), 2.9 x 10(6) CD34+ cells/kg (1.1-11.1) and 12.0 x 10(4) CFU-GM/kg (2.0-37.8). Eight patients underwent high-dose chemotherapy (HDCT) followed by PBPC rescue. Seven patients recovered hematopoiesis at medians of 12 days (8-15) for ANC >0.5 x 10(3)/microl and 14 days (8-27) for platelets >20 x 10(3)/microl. One patient, who received 1.6 x 10(6) CD34+ cells/kg, exhibited delayed ANC recovery on day +37 and failed to recover platelets until hospital discharge on day +55. We conclude that in patients with metastatic STS, who are pretreated by standard chemotherapy, PBPC can be mobilized by a further course of STS-specific chemotherapy plus G-CSF. One to four conventional-volume aphereses result in PBPC autografts that can serve as hematopoietic rescue for patients scheduled for HDCT.