Clinical and laboratory characteristics at diagnosis, and long-term (up to 7 years) evolution, were analysed in 156 patients (66 adults and 90 children) with acute lymphoblastic leukemia (ALL), ...according to the expression of CD34. Eighty-three patients had CD34+ and 73 patients CD34- blasts at diagnosis. In adults, CD34+ ALL was more often of B-lineage (p =. 003). White blood cell counts were higher both in children with CD34- B-lineage ALL (p =. 02) and adults with CD34- T-lineage ALL (p =. 05). Adult patients with CD34- T-lineage ALL were older (p =. 04) and had more frequent splenic or liver enlargement (p =. 02). Children with CD34+ ALL had a significantly (p =. 04) longer event-free follow-up than CD34- children. Survival curves showed that after induction of remission, relapses were less frequent during the first 2 years for patients with CD34+ B-lineage ALL. After 2 years, however, event-free survival curves of CD34+ and CD34- patients merged. Thus it seems that CD34+ has no significant benefit for ALL patients.
In a 72 year-old woman with microcytic anemia, small bowel study showed tumoral lesions. Malignant melanoma was histologically proved. Clinical and radiological aspects of metastatic malignant ...melanoma of the small bowel are discussed and hypothesis advanced to explain absence of an identifiable primary lesion.
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IJS, IMTLJ, KILJ, KISLJ, NUK, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Between 1972 and 1986, 37 patients with lower genital tract malignancies were treated with intracavitary or interstitial brachytherapy. Thirteen patients presented with clear cell adenocarcinoma, 14 ...patients with embryonal rhabdomyosarcoma, 6 patients with endodermal sinus tumor, 3 patients with sarcoma, and 1 patient with an undifferentiated tumor. FIGO classification was: Stage I, 16%; Stage II, 47%; and Stage III, 37%. Treatment policy included initial exploratory laparotomy with lymph node biopsy and ovarian transposition, chemotherapy (except in clear cell adenocarcinoma) and/or external radiotherapy prior to interstitial brachytherapy. Chemotherapy consisted of a combination of VAC-Ad (V = vincristine, A = D actinomycin, C = cyclophosphamide, Ad = adriamycin) in rhabdomyosarcoma and sarcomas, and MAC-Ad (M = methotrexate) in endodermal sinus tumor. External radiotherapy was used in seven patients: in one to reduce a bulky clear cell adenocarcinoma (20 Gy) and in six for pelvic nodal involvement (45 Gy). Brachytherapy techniques depended on tumor site and extent, and on the anatomy of the patients. Vulvar tumors were implanted with iridium-192 wires by an afterloading plastic tube technique. Cervical and vaginal tumors were treated with individually tailored moulded vaginal applicators loaded with either cesium-137 or iridium-192, with or without interstitial implants by plastic tube or guide gutter technique. Computerized dosimetry allowed calculation of treatment volumes and doses delivered on the tumor and adjacent critical organs. The prescribed dose (including external radiotherapy) was 60-75 Gy with 1-3 brachytherapy applications of a low dose rate (0.2 Gy/hr). Six patients are dead: one from chemotherapy complication, three of metastases (two sarcomas, one endodermal sinus tumor) and two of pelvic failures and metastases (two clear cell adenocarcinoma). The overall disease free 5-year survival is 72%. Actuarial 5-year local control is 84%, but including salvage is 94%: three (two rhabdomyosarcoma, one clear cell adenocarcinoma) of the five local failures were salvaged by surgery, chemotherapy and/or brachytherapy. Metastases occurred in six patients, one (sarcoma) salvaged by chemotherapy and external radiotherapy. Complications requiring surgery occurred in five patients: two hydronephroses, one urethral stricture, one ileo-cecal obstruction, and one vesicovaginal fistula. Twelve of the 17 patients (71%) over 12 years of age are normally menstruating. Two patients have produced three normal children. This multidisciplinary management of lower gynecological tract tumors including brachytherapy is both conservative and effective.
