Use of saline-filled tissue expanders to protect the small bowel from radiation.
Hoffman JP. Sigurdson ER. Eisenberg BL.
Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
Over the past 7 years, 58 saline-filled tissues expanders (TEs) have been temporarily placed in 57 patients. The indications for TE placement were: small bowel exclusion from external-beam radiation therapy (N = 25), interstitial RT (N = 16), or both (N = 13) when there was insufficient omentum to provide adequate exclusion. Of the 57 patients, 24 had primary tumors (4 colon, 4 endometrial, and 11 rectal cancer; 3 sarcomas, 1 schwannoma; and 1 vaginal cancer). The remaining 33 patients (58%) had recurrent cancers (3 anal, 8 colon, and 16 rectal cancers; and 6 sarcomas), of whom 26 (79%) had received prior RT. Of the 58 TEs, 15 were placed superior to the iliac vessels and 43 were placed in the pelvis. Complications included post-withdrawal enterocutaneous fistulae in four patients, TE deflation in three patients, and TE extrusion in one patient. Improvements in TE design and removal techniques have reduced the incidence of these complications. When no native tissue is available for small bowel exclusion, the saline-filled TE is a safe, effective substitute.
Problems in lymphoma management: special sites of presentation.
Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada.
The staging and treatment of the common presentations of malignant lymphoma are readily familiar to experienced medical oncologists and hematologists. However, because of their rarity and variable and unusual behavior, certain special sites of lymphoma present a major challenge even to experienced clinicians. This article focuses on five such special sites of presentation: the eye, paranasal sinuses, central nervous system (CNS), testicle, and stomach. In each case, an appreciation of the usual histologic types, unique mode of metastatic spread, special patterns of resistance to systemic treatment, and, in the stomach, the remarkable association with a causative organism, Helicobacter pylori, is needed to optimize management. Only if these special characteristics are understood can the clinician plan a multiphase treatment course that offers each patient the best chance of disease control or cure.
Combined radiation and chemotherapy for carcinoma of the anal canal.
Stafford SL. Martenson JA.
Division of Radiation Oncology, Mayo Clinic and Mayo Foundation, Mayo Medical School, Rochester, Minnesota, USA.
Sphincter-preserving treatment with combined radiation and chemotherapy has replaced abdominoperineal resection as the standard of care for patients with carcinoma of the anal canal. Randomized studies have shown that the combination of radiation therapy, fluorouracil (5-FU), and mitomycin (Mutamycin) is superior to radiation alone or to radiation combined with 5-FU in these patients and that the colostomy-free survival rate is 71%. Research is underway to determine whether other combinations, such as higher doses of radiation with 5-FU and cisplatin (Platinol), will result in lower or equivalent toxicity or better locoregional control and potentially improved survival. Currently, radiation combined with 5-FU and mitomycin remains the treatment of choice in most patients with carcinoma of the anal canal.
Initial control of chemotherapy-induced nausea and vomiting in patient quality of life.
Morrow GR. Roscoe JA. Hickok JT. Stern RM. Pierce HI. King DB. Banerjee TK. Weiden P.
University of Rochester Cancer Center, New York, USA.
The side effects commonly experienced by patients receiving chemotherapy for the treatment of cancer can challenge many aspects of daily life. Nausea and vomiting, the most common side effects reported by patients, affect the ability to continue with usual life activities and, thus have a pronounced impact on quality of life. This paper reviews studies of the impact of nausea and emesis on quality of life, and highlights the importance of prevention of these side effects by presenting new data on how persistent uncontrolled nausea and vomiting can be. The Morrow Assessment of Nausea and Emesis (MANE) was used to collect information on symptoms experienced by consecutive patients starting chemotherapy between September 1987 and December 1995 at any of 18 geographically diverse member sites of the University of Rochester Cancer Center Community Clinical Oncology Program. Data from 1,413 patients were collected after each of four successive chemotherapy treatments. Reported incidences of posttreatment nausea and posttreatment vomiting after the first treatment were 59.4% and 28.6%, respectively. Occurrence of nausea/vomiting at the first treatment was a strong predictor of nausea/vomiting at later treatments. Of the 839 patients reporting initial nausea, 763 (90.9%) reported nausea at at least one subsequent treatment, and approximately 59% reported nausea after all three subsequent treatments. Fewer than half (45.6%) of the patients who had no nausea at the first treatment developed it later. The majority (72.0%) of patients reporting vomiting at the first treatment also reported subsequent vomiting, 30.7% of whom experienced emesis at all remaining treatments. Conversely, 76.2% of patients who were emesis-free at the first treatment remained so for all later treatments. These findings show a continuing need for further progress in controlling nausea and vomiting, and demonstrate the importance of aggressive nausea/vomiting control at the first treatment. In addition, more emphasis on controlling chemotherapy-induced nausea after its initial occurrence is necessary.