This is a retrospective analysis of 50 patients with carcinoma of the superior pulmonary sulcus, treated with curative intent at the University of Florida between October 1964 and October 1981. Treatment groups included preoperative radiation therapy and surgery (40 patients), radiation therapy alone (7 patients), and surgery with postoperative radiation therapy (3 patients). There was a minimum 2-year follow-up. Local control was obtained in 8 of 26 evaluable patients (31%) treated with preoperative radiation therapy and surgery, 2 of 6 patients treated with radiation therapy alone, and 0 of 2 patients treated with surgery and postoperative radiation therapy. Twelve (30%) of 40 patients receiving planned preoperative radiation therapy did not undergo definitive surgery. Absolute survival free of disease at 5 years by treatment group for patients at risk was 3 of 30 (10%) with preoperative radiation therapy and surgery, 0 of 3 with surgery and postoperative radiation therapy, and 2 of 7 with radiation therapy alone. Since one third of the patients who received low- to moderate-dose preoperative radiation therapy did not undergo definitive surgery, and since there is a small but significant survival with radiation therapy alone, it seems unwise to give moderate-dose preoperative radiation therapy, which implies an unfavorable radiation technique for the unresectable cases. The recommendation is to treat patients with lesions believed to be resectable by initial surgical resection followed by high-dose radiation therapy in selected patients with questionable margins or positive lymph nodes. Those patients with borderline or apparently unresectable lesions are recommended to be treated with radiation therapy alone.
As a basis for assessing protein metabolism in cancer patients, whole body protein turnover, synthesis and breakdown were measured preoperatively using a constant rate infusion of L-(1-14C) leucine in patients with differing stages of colorectal carcinoma. The levels of protein synthesis and breakdown were correlated with the extent of disease as measured by the percentage incorporation of the labelled amino acid into plasma protein (1) and the subsequent modified Dukes' classification (2). Eleven apyrexial patients were divided into two groups; 6 of whom had normal appetites while 5 were anorectic. Protein synthesis increased with advancement of disease in both groups, as did protein breakdown. Protein synthesis and breakdown were lower in the anorectic group, suggesting some degree of starvation adaptation. All patients were in positive balance, despite anthropometric data to support loss of host body protein. This suggests translocation of protein stores from muscle to areas of more rapid protein synthesis such as tumour. Remodelling of body protein is an important facet of metabolism in cancer patients.
Following initial diagnostic cardiac catheterization in 20 patients with unstable angina, percutaneous transluminal angioplasty (PTCA) was successfully performed either immediately (15 patients) or later in the day (five patients). This approach offers certain clinical and financial advantages. PTCA immediately following diagnostic catheterization should probably only be performed by experienced operators and only when excellent cooperation with cardiovascular surgeons is possible.
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