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BACKGROUND. To assess the toxicity, local response, and survival associated with multimodality therapy in a cooperative group setting, patients with biopsy-proven clinical Stage I or II adenocarcinoma of the esophagus (staged according to 1983 American Joint Committee on Cancer criteria) or gastroesophageal junction were treated with concomitant radiation and chemotherapy followed by esophagectomy. METHODS. Radiotherapy was administered in daily 2-gray (Gy) fractions 5 days a week until a total of 60 Gy was reached. 5-fluorouracil (5-FU) was infused continuously at a dose of 1000 mg/m 2 /day for 96 hours on Days 2-5 and 28-31. On Day 2, a 10 mg/m 2 bolus of mitomycin was injected intravenously. Esophagectomy was performed 4-8 weeks following completion of the radiotherapy. RESULTS. During the 18-month study period (August 1991 through January 1993), 46 eligible patients were accrued from 21 institutions. Eight patients were Stage I and 38 Stage II. Eighty-seven percent of patients (40 of 46) received 6000 centigray (cGy), and all received >5000 cGy. Seventy-eight percent of patients (36 of 46) received >90% of the planned 5-FU dose. Follow-up ranged from 11 to 36 months (median, 22 months). There were eight treatment-related deaths; two were preoperative (from adult respiratory distress syndrome) and six were postoperative. Complete or partial response prior to esophagectomy was observed in 63% of cases, stable disease in 15%, and progression in 20%. Thirty-three patients underwent esophagectomy (transhiatal, n = 14; Ivor Lewis, n = 16; other, n = 3). No tumor was found in the specimens resected from 8 of these 33 patients; this represented a pathologic complete response rate of 17% overall and 24% for those who undenvent esophagectomy. Overall median survival was 16.6 months, 1-year survival 57%, and 2-year survival 27%. Survival was significantly worse for patients with circumferential cancers (median, 18.1 months vs. 8.3 months; P < 0.05). CONCLUSIONS. High dose radiation therapy with concurrent 5-FU and mitomycin may be administered to patients with esophageal adenocarcinoma with acceptable morbidity. However, in a cooperative group setting, esophagogastrectomy following intensive chemoradiotherapy is associated with excessive morbidity and mortality. Circumferential tumor growth is a significant adverse prognostic factor.

Primary tumors from 39 patients with non-small cell lung carcinoma (NSCLC) were examined for cytogenetic abnormalities by conventional short-term harvest (1–39 days) of primary cultures of minced solid-tumor tissues and by harvest of monolayer cultures of tumor tissue (6 days to 5 months) on murine fibroblast feeder layers. A successful karyotype was obtained with both methods in nine of 39 cases. Among the remaining 30 cases, a successful karyotype was obtained in eight cases by the conventional method only and in three cases by the feeder cell method only. The success rates were 44% for the conventional method, and 31% for the feeder cell method, and the combined success rate was 51% for one or the other method. The feeder culture method, in which harvests were usually performed at later times than with the conventional method, generally produced metaphases with superior banding, which allowed clearer definition of cytogenetic abnormalities. In addition, cell lines were established in eight of these cases by the feeder cell method. Karyotypes from the longer-term harvests typically were very similar to those from short-term conventional cultures. Minor numerical differences and/or a few additional structural abnormalities were noted in seven of the nine cases analyzed by both methods. Overall, however, even in karyotypes from 5-month cultures, the prominent recurrent changes and modal chromosome numbers observed in short-term cultures were still present. The results indicate that long-term culture with fibroblast feeder cells is a valid means of obtaining cells from solid lung tumors for cytogenetic and molecular analysis. Cell lines established by this method will be useful in future molecular studies, for example, for mapping of chromosome breakpoints and sites of chromosome loss, for in situ hybridization, and for studies of the expression of critical candidate genes implicated by cytogenetic findings. In addition, by combination of conventional and feeder cell harvests, both the number of primary tumors successfully examined karyotypically and the quality of the analyses are improved.© 1993 Wiley-Liss, Inc.

Background. Thymic hyperplasia after successful treatment of malignant disease is a well-documented phenomenon, particularly in younger patients with testicular carcinoma. However, it has been reported only sporadically in association with Hodgkin disease. The authors report the first instance of an adult with nodular sclerosing Hodgkin disease who had thymic hyperplasia develop after clinical and radiographic complete remission (CR) with chemotherapy alone. Methods. In addition to the current case, 20 other instances of thymic hyperplasia have been culled from the literature and analyzed. Results. The median age of these 21 patients was 23 years of age (range, 8-40 years of age). Thymic hyperplasia was noted after treatment was initiated or completed in all but two patients; and all did well, with one exception: a 17 year-old boy who was inadvertently treated for relapsed Hodgkin disease and who died of fibrinous pneumonitis and nocardia, with pathologic CR noted at autopsy. Conclusions. Thymic hyperplasia in association with Hodgkin disease appears to be a favorable prognostic phenomenon, restricted to younger patients in the first modal peak of Hodgkin incidence. Prospective studies have yet to be performed.

Recent reports have suggested that perioperative blood transfusions may adversely affect prognosis after resection of non-small cell lung cancer (NSCLC). To determine the impact of perioperative transfusion on the recurrence-free interval, the status of 352 patients who underwent pulmonary resection for pathologic Stages I and II NSCLC was investigated. Transfused patients were significantly older than untransfused patients (P = 0.0009) but were not significantly different in sex distribution (P = 0.12) or tumor stage (P = 0.09). Recurrence was not significantly different in transfused patients when compared with patients who received no blood (P = 0.23) even when stratified for stage (Stage I, P = 0.58; Stage II, P = 0.14). Furthermore, the number of units transfused was not associated with time to tumor recurrence (P = 0.58). Contrary to other reports, these results do not support the contention that perioperative blood transfusion is significantly associated with decreased recurrence-free survival.

Bei Bestrahlung des Acetoxysilans (I) in Gegenwart von CCl4 in verschiedener Konzentration erfolgt durch Di-tert.-butylperoxid als Initiator eine Umlagerung zu (IIa) als Hauptprodukt neben (III) und tBuOH, fur deren Bildung ein Radikal-Kettenmechanismus vorgeschlagen wird.