International advances in surgical oncology最新文献

Nonmelanomatous skin cancer usually occurs in fair-skinned persons on sites chronically exposed to sunlight. In a series of 35,000 patients with skin cancer seen at M. D. Anderson Hospital and Tumor Institute, 1,208 patients (13%) had squamous cell skin cancer of the extremities. Forty-one of these patients had a clear history of a preexisting thermal burn or irradiation dermatitis (Marjolin's ulcer). The average lesion was over 2 cm in diameter, and the average Marjolin's ulcer was over 5 cm. The treatment of choice in this series of relatively large lesions was surgical excision with or without skin grafting and with histologic evaluation of the surgical margins. The local recurrence rate was less than 10%. Regional metastasis developed in 1.4% of the patients and in 44% of those with Marjolin's ulcer. Even with prompt nodal dissection, the five-year survival rate for patients with nodal metastasis was only 35%. The presence of extracapsular spread of nodal disease is of grave significance, and adjunctive radiation therapy should be considered. Careful follow-up of all patients with squamous cell skin cancer is important.

Conventional pancreatic resections have proved unsatisfactory in the treatment of pancreatic cancer. A new operative approach that includes resection of the pancreas en bloc with the regional nodes and pertinent vascular structures has been developed. The procedure was carried out in 27 patients, the majority of whom had advanced neoplasms. The two-year actuarial survival of those who escaped complications of the procedure and lived was 46%. The technical details, postoperative problems, and the benefits of this operation are discussed.

The mutilating effect of surgery for cancer of the breast has left many women needful of reconstruction to restore the body contour and self-image. Reconstruction involves replacement of the three elements that have been lost: breast mass, skin, muscle and nipple-areolar complex. Methods for accomplishing this have been devised and are in common use. Because of the increased predisposition to malignancy in the remaining breast and the difficulty in achieving symmetry in both breasts, the remaining breast must be considered, with subcutaneous mastectomy being the most appropriate course in most cases. Patient acceptance has been excellent.

In recent years there has been considerable interest in exploration of surgical speech rehabilitation (SSR) for the laryngectomee as an alternative to conventional management. The history of the evolution of present pneumatic and electronic methods is traced. The details of the various methods are analyzed including the phonatory neoglottis method reported by Staffieri. Algorithms are offered for the patient who is about to undergo laryngectomy, for the patient who has had laryngectomy in the past, and for the patient facing total pharyngolaryngectomy. The prospects for future developments in the field of SSR are analyzed, acknowledging that none of the present methods provides an ideal solution to the problem of laryngeal aphonia.

The cell populations derived from normal tissues and solid tumors comprised many different cell types. Within each cell type there is a distribution of cells in different phases of the cell cycle and/or metabolic states (ie, differing rates of protein, RNA, and other macromolecular syntheses). Flow cytometry and companion instrumentation now promise to aid in rapid quantitative analyses of heterogeneous cell populations, thus finding broad applicability in many areas of cancer research and treatment. Since it is projected that this analytical technique will greatly expend our knowledge in tumor biology, it seems appropriate to review the basis principles of the methodology and to demonstrate recent applications in several areas of current research. After reviewing basis principles, a detailed description of one specific flow cytometer, the PHYWE-ICP-22, with its computer interface as developed in this laboratory is described. Subsequently, applications of this methodology to analyses of tumor cell kinetics, assays of blastogenesis, and studies of human colon cancer are presented as specific, current applications of flow cytometry. It is anticipated that this overview of flow cytometry along with some current applications will provide a background understanding for the inevitable rapid future developments in this area of research.

The term osteogenic sarcoma (osteosarcoma) is applied to malignant bone-forming tumors, identifiable by the matrix produced, though the histologic pattern may differ greatly. Ths more cellular (osteolytic) forms of the tumor have the poorer prognosis. Other prognostic factors are 1) site of the primary tumor; 2) duration of symptoms; and 3) extent of disease and tumor size. The site of tumor origin is the metaphyseal side of the epiphyseal line. The histogenesis of the tumors accounts for this distribution. Following a diagnostic biopsy, amputation of the extremities remains the treatment of choice. In selected cases, a limb-saving radical en bloc resection may surface. Radiotherapy plays a lesser but important role as adjunctive treatment, and as primary definitive treatment in certain types of bone sarcoma (Ewing sarcoma and primary reticulum cell sarcoma of bone). Until recently, chemotherapeutic agents have been used for late palliation only. Advances in treatment, however, have resulted from the application of innovative postsurgical adjuvant chemotherapy in children. The various chemotherapeutic regimens following amputation in adults and in children are discussed. In most such series of cases following amputation alone, five-year survivals have not exceeded 15-20%, with recurrent disease appearing within 18 months in fatal cases. Current studies reflect more effective regimens of adjuvant chemotherapy, with improved palliative results in metastatic osteogenic sarcoma. Although survival is much prolonged, however, many patients show a recurrence of the disease after long intervals of control, suggesting that five-year survival may not indicate a complete cure. At M.D. Anderson Hospital, th projected overall survival rate at three years is 79% of all patients with nonmetastatic disease. These results have accrued from the use of Compadri-I and Compadri-II regimens of chemotherapy. More intensive therapy may yield higher survival rates. It is known that the immunologic status of a patient definitely relates to prognosis. Although most of the investigations with immunotherapy are preliminary, emphasis is placed on improving the immune system in immunodeficient patients.