Syrian golden hamsters of both sexes received 10 intratracheal instillations each of 3 mg benzo[a]pyrene (BP) and 3 mg hematite suspended in 0.2 ml saline. One group received no further treatment and developed 13 squamous tumors and 13 cases of squamous metaplasia in 53 animals at risk. The second group, one week after the end of the BP treatment, started to receive twice weekly stomach tube feedings of vitamin A palmitate (5 mg or 5000 IU in 0.1 ml corn oil) continued for life. In this group of 46 animals at risk only one developed a microscopic squamous tumor in a bronchus and one developed a patch of squamous metaplasia in the trachea. The incidence of forestomach papillomas was also reduced markedly by vitamin A treatment. The authors suggest that vitamin A has a systemic inhibitory effect on the induction of squamous changes (metaplasia as well as benign and malignant squamous tumors) in the columnar mucous epithelium of the respiratory tract.
Several authors have documented the phenomenon of spontaneous cavitation within both primary lung cancers and metastatic pulmonary nodules. Cavitation after treatment, particularly chemotherapy, has not been emphasized. We report on 3 patients who developed radiographic evidence of cavitation of pulmonary metastases as a direct response to systemic chemotherapy. Cancer 46:1329-1332. 1980. HE OCCURRENCE OF CAVITATION within lung T tumors has been documented in several reviews and case r e p o ~-t s. ~-~ , " ~ Dodd and Boyle, reviewing the chest roentgenograms of 6729 consecutive patients at M. D. Anderson Hospital, estimated the incidence of spontaneous cavitation to be 9% for primary tumors of the lung and 4% for metastatic pulmonary nodule^.^ Their series, however, did not report any cases of cavitation occurring after treatment with chemotherapy. Single cases of cavitation of pulmonary metastases secondary to treatment are mentioned in other We report on 3 patients with pulmonary metastases who demonstrate radiographic evidence of cavitation as a direct response to chemotherapy. Case Report Case 1 At age 15 the patient noted a swollen left testicle. H e had an orchiectomy one month later revealing a teratocarcinoma with embryonal elements. After a negative evaluation for metastatic disease, he was treated with left pelvic and para-aortic irradiation. One year later he presented with a cough and multiple nodules in the right hilar region on chest roent-genogram (Fig. 1A). Induction chemotherapy with bleomycin From the Departments of Medicine and Radiology, Rochester Gen-and vinblastine was followed by complete resolution of the pulmonary symptoms and synchronous cavitation of the pulmonary metastases (Figs. l B , C). H e completed two years of maintenance chemotherapy with vinblastine and now has been off all chemotherapy for two years. The patient feels well and the chest roentgenograms continue to demonstrate the residual thin-walled cavities. Case 2 A 40-year-old male complained of weight loss and fatigue. Chest roentgenogram showed multiple pulmonary densities (Fig. 2A). No primary lesion could be found despite extensive evaluation; he underwent thoracotomy and biopsy of a Ie-sion. Pathologic examination revealed metastatic malignant melanoma. H e was started on combination chemotherapy with Adriamycin, cyclophosphamide, and DTIC. Within two months he responded with improvement in his systemic symptoms and radiographic evidence of shrinkage of the pulmonary lesions. One such lesion developed cavitation (Fig. 2B). The response was brief, and progressive pulmonary involvement followed. H e died two months later with progressive pulmonary involvement after another brief response to CCNU and vincristine. Case 3 Ten years ago the patient, a 66-year-old male, had the first of many low-grade papillary transitional cell carcinomas of of bladder. Treatment with multiple fulgurations, thiotepa instillations, and pelvic irradiation was unsuccessful and he underwent a cystectomy and ileal loop diversion in 1970. In 197...
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