Table of Contents
1
UI - 11764655
AU - Vordermark D; Sailer M; Flentje M; Thiede A; Kolbl O
TI -
Impaired sphincter function and good quality of life in anal carcinoma
patients after radiotherapy: a paradox?
SO - Front Radiat Ther Oncol 2002;37():132-9
AD - Department of Radiation Oncology, University of Wurzburg, Germany.
vordermark@strahlentherapie.uni-wuerzburg.de
2
UI - 11912514
AU - Hill DA; Dehner LP; Gow KW; Pappo AS; Crawford D; Pflaumer SM; Furman
TI -
WL; Hayes-Jordan AA; McDermott MB
Perianal rhabdomyosarcoma presenting as a perirectal abscess: A report
of 11 cases.
SO - J Pediatr Surg 2002 Apr;37(4):576-81
AD - Department of Pathology, St Jude Children's Research Hospital and
University of Tennessee, Memphis TN, USA.
BACKGROUND PURPOSE: The organs and soft tissues of the pelvis are some
of the most common primary sites for rhabdomyosarcoma (RMS) in children
and adolescents. In most cases a mass is detectable on clinical
examination, and the initial concern is focused on the possibility of a
neoplasm. The current report concerns 11 patients, each presented with a
painful perineal-perianal mass suggesting an abscess to the extent that
each one of these patients was treated initially with antibiotics or
incision and drainage for several weeks to months before the pathologic
diagnosis of RMS was established. METHODS: The authors reviewed the
clinical histories of all patients with perirectal/perianal RMS from
their respective institutions to identify cases in which the initial
clinical diagnosis or impression was that of a perirectal abscess.
Pathologic material was reviewed in all cases. RESULTS: Eleven patients,
7 of whom were girls, ranged in age from 1 to 16 years at diagnosis
(median age, 14 years). Fever accompanied the clinical presentation in 2
patients. None of the patients had a past medical history of illness
that may have predisposed them to a perirectal abscess, although one
patient had a family history of inflammatory bowel disease. Duration of
symptoms ranged from 1 month to 1 year (mean, 4.6 months). Each patient
presented with a tender perianal/perineal nodule or mass. Inguinal
adenopathy was present in 6 patients at diagnosis. White blood cell
counts ranged from 6,600/mm(3) to 24,500/mm(3). LDH levels ranged from
414 to 3,432 U/L. The average time from presentation to pathologic
diagnosis of RMS was 2.1 months. Nine of the 11 cases showed an alveolar
pattern. All were high-stage disease. Of 7 patients with follow-up
longer than 1 year, 2 (29%) are alive without disease. CONCLUSION: This
report presents the need to consider the possibility of a malignant
neoplasm, in this case RMS, in a child or adolescent with a putative
perirectal abscess that fails to respond in the expected manner to
incision and drainage and antibiotic therapy. Copyright 2002, Elsevier
Science (USA). All rights reserved.
3
UI - 12001039
AU - Da Costa MM; Hogeboom CJ; Holly EA; Palefsky JM
TI -
Increased risk of high-grade anal neoplasia associated with a human
papillomavirus type 16 E6 sequence variant.
SO - J Infect Dis 2002 May 1;185(9):1229-37
AD - Department of Laboratory Medicine, University of California, San
Francisco, San Francisco, CA 94143, USA.
Expression of the E6 and E7 genes of human papillomavirus (HPV) type 16
have been implicated in the etiology of anogenital premalignant and
malignant lesions. To evaluate whether variations in the HPV-16 E6
sequence were related to the incidence of high-grade anal neoplasia, 628
HPV-16-positive anal specimens from 193 human immunodeficiency virus
(HIV)-positive and 59 HIV-negative participants were typed for
variations in 15 E6 nucleotide positions. Although most participants
were infected with a prototype strain, 15 (6%) carried the G131 variant,
and 12 (5%) were infected with the Af1a variant. Two new variants not
previously reported were identified as well. An elevated risk for
high-grade anal squamous intraepithelial lesions was associated with
infection by G131 variants, compared with the prototype strain (odds
ratio, 3.4; 95% confidence interval, 1.1-10), after controlling for HIV
status. These data provide further evidence for HPV strain variation as
a factor in determining the natural history of anogenital neoplasia.
4
UI - 11893884
AU - Mai SK; Grieger J; Lachmann R; Bohrer M; Tiefenbacher U; Wenz F
TI -
Radiochemotherapy for anal carcinoma - effectivity and late toxicity.
SO - Onkologie 2002 Feb;25(1):55-9
AD - Sektion Strahlentherapie, Institut fur Klinische Radiologie,
Universitatsklinikum Mannheim, Germany.
sabine.mai@radonk.ma.uni-heidelberg.de
BACKGROUND: Radiochemotherapy of anal carcinoma is an organ-sparing
approach with a high curative potential. The purpose was to evaluate the
effectivity and late toxicity for patients treated with
radiochemotherapy in our department. PATIENTS AND METHODS: During
1990-2000, 27 patients with anal carcinoma were treated at the
Universitatsklinikum Mannheim. The median follow-up time was 23 months
(max. 68 months). Before treatment, 23 patients were colostomy-free.
Patients were treated according to 3 different protocols (Cummings n =
8, EORTC n = 5, RTOG n = 14). Acute toxicity was scored according to the
RTOG/EORTC scale, and late toxicity according to the LENT/SOMA scale.
RESULTS: 25 patients completed the therapy. One patient died due to
leukopenic sepsis, and 1 patient interrupted therapy. 4 patients had a
tumor relapse (2 patients immunosuppressed, 1 T4 tumor and 1 recurrence
at the field-margin), one underwent abdomino- perineal resection. This
resulted in a disease-free survival of about 80% and colostomy-free
survival of 90% at 5 years. Total doses < 50 Gy and immunosuppression
resulted in higher recurrence rates. Most patients suffered from acute
toxicity grades 2 (n = 7) and 3 (n = 19) and late toxicity grades 1 (n =
7) and 2 (n = 4). CONCLUSIONS: Radiochemotherapy for anal carcinoma is
an effective therapy with acceptable toxicity. Immunosuppressed patients
have a higher risk for tumor recurrences and should be monitored more
closely. Copyright 2002 S. Karger GmbH, Freiburg
5
UI - 12006924
AU - Chang GJ; Berry JM; Jay N; Palefsky JM; Welton ML
TI -
Surgical treatment of high-grade anal squamous intraepithelial lesions:
a prospective study.
SO - Dis Colon Rectum 2002 Apr;45(4):453-8
AD - Department of Surgery, University of California at San Francisco, San
Francisco, California, USA.
PURPOSE: The prevalence of anal squamous intraepithelial lesions is high
among human immunodeficiency virus-positive homosexual males and, to a
lesser extent, among human immunodeficiency virus-negative homosexual
males. Furthermore, the incidence of high-grade squamous intraepithelial
lesions, the putative precursor lesion to invasive cancer, is also high.
We report the first prospective study of high-resolution
anoscopy-directed surgical treatment of high-grade squamous
intraepithelial lesions. METHODS: A prospective study of patients
undergoing surgical treatment of high-grade squamous intraepithelial
lesions (excision/cauterization of lesions visualized with
high-resolution anoscopy) was performed. Follow-up anoscopy with biopsy
and Papanicolaou smear was performed every three to six months. RESULTS:
Patients diagnosed with high-grade squamous intraepithelial lesions
during the course of their participation in a prospective cohort study
of anal squamous intraepithelial lesions were identified. From this
group, 37 patients who were treated surgically between 1995 and 1999
were studied. Of these, 29 had tested positive for human
immunodeficiency virus and 8 were negative for the virus. Mean patient
age was 45 +/- 8 years. Mean duration of follow-up was 32.3 +/- 20.6
months in the human immunodeficiency virus-negative group and 28.6 +/-
12.9 months in the human immunodeficiency virus-positive group. No human
immunodeficiency virus-negative patient developed recurrent high-grade
squamous intraepithelial lesions. Twenty-three of 29 human
immunodeficiency virus-positive patients had persistent or recurrent
high-grade squamous intraepithelial lesions (P = 0.003; mean time to
recurrence, 12 months). Six patients underwent reoperation for
high-grade squamous intraepithelial lesions (4 recurred by 6 months). No
patients developed incontinence, stenosis, postoperative infection, or
significant bleeding after surgical treatment. CONCLUSIONS: Surgical
intervention directed by high-resolution anoscopy is safe and eliminates
high-grade squamous intraepithelial lesions in human immunodeficiency
virus-negative patients. The high persistence or recurrence rate in
human immunodeficiency virus-positive patients suggests that multiple
staged procedures and continued surveillance may be necessary.
6
UI - 12006932
AU - Goldstone SE; Palefsky JM; Winnett MT; Neefe JR
TI -
Activity of HspE7, a novel immunotherapy, in patients with anogenital
warts.
SO - Dis Colon Rectum 2002 Apr;45(4):502-7
AD - Mount Sinai School of Medicine, New York, New York, USA.
PURPOSE: Human papillomavirus causes anogenital squamous intraepithelial
lesions, warts, and cancer. Treatment of squamous intraepithelial
lesions to prevent cancer often requires extensive surgery. We tested a
human papillomavirus-specific immunotherapy, HspE7, as a potential
alternative. METHODS: HspE7 was constructed by fusing heat shock protein
Hsp65 from bacille Calmette-Guerin to E7 protein from human
papillomavirus-16. Improvement in pathologic diagnosis of patients with
persistent high-grade squamous intraepithelial lesions was studied in an
open-label trial (HspE7 500 microg monthly x3). Anogenital warts were
not a trial parameter, but a retrospective review of the medical records
of the first 22 patients enrolled at one site was undertaken to estimate
the quality and frequency of responses of anogenital warts. Patients
with warts by physical examination at baseline were scored at 24 weeks
as to the percent reduction in wart size. RESULTS: Fourteen of the 22
patients had warts at baseline. At Week 24, 3 of the 14 patients had
complete resolution of their warts, and 10 had warts reduced in size an
estimated 70 to 95 percent. The remaining patient's warts increased in
size. The reduction in size in most patients greatly diminished the
procedure necessary for complete ablation. No serious or severe adverse
events were related to HspE7. CONCLUSIONS: A retrospective review of
patients' medical records suggests that HspE7 may be broadly active in
anogenital warts. This activity crosses multiple human papillomavirus
types. The warts improved substantially but usually did not totally
disappear within six months. Patient follow-up continues. A new
randomized, placebo-controlled trial is underway to evaluate these
findings.
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