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Cancer is a growing global health issue, and many countries are ill-prepared to deal with their current cancer burden let alone the increased burden looming on the horizon. Growing and aging populations are projected to result in dramatic increases in cancer cases and cancer deaths particularly in low- and middle-income countries. It is imperative that planning begin now to deal not only with those cancers already occurring but also with the larger numbers expected in the future. Unfortunately, such planning is hampered, because the magnitude of the burden of cancer in many countries is poorly understood owing to lack of surveillance and monitoring systems for cancer risk factors and for the documentation of cancer incidence, survival and mortality. Moreover, the human resources needed to fight cancer effectively are often limited or lacking. Cancer diagnosis and cancer care services are also inadequate in low-and middle-income countries. Late-stage presentation of cancers is very common in these settings resulting in less potential for cure and more need for symptom management. Palliative care services are grossly inadequate in low- and middle-income countries, and many cancer patients die unnecessarily painful deaths. Many of the challenges faced by low- and middle-income countries have been at least partially addressed by higher income countries. Experiences from around the world are reviewed to highlight the issues and showcase some possible solutions.

Increasing evidence suggests the existence of polarized human T cell responses described as Th1-type (promoting cell-mediated immunity) and Th2-type (promoting humoral immunity), characterized by a dominant production of either interferon-gamma (IFN-γ) or IL-4, respectively. Little is known about the intratumoural activation of infiltrating lymphocytes (TIL) in human gliomas. Therefore, we assessed fresh TIL at cellular and molecular levels to find out if they were activated and polarized into a type 1 or 2 immune response. Flow cytometry analysis of TIL revealed that the major subset was made of T lymphocytes. Double labelling with α-CD3 and adhesion/activation markers revealed T cell subsets expressing CD49a, CD49b, CD54, and CD15, some of which were almost absent in autologous T peripheral blood lymphocytes (T-PBL). Furthermore, the proportions of T-TIL expressing CD56, CD65, or CD25 were several-fold higher than in T-PBL. Intratumoural functional activation of TIL was tested by semiquantitative assessment in relative units (RU) of lymphokine gene activation with mRNA reverse transcriptase-polymerase chain reaction (RT-PCR). All TIL populations except one significantly expressed IL-4 1 to 2 logs of RU above healthy PBL baseline. Similarly, all patients expressed granulocyte-macrophage colony-stimulating factor (GM-CSF) in a range comparable to IL-4. However, most TIL populations did not express IFN-γ, IL-2, and tumour necrosis factor-beta (TNF-β) at higher levels than healthy normal PBL. The increased proportion of T cells expressing activation markers and the consistent detection of significant IL-4 and GM-CSF lymphokine gene activation in TIL populations suggested a predominant type 2 intratumoural immune response that does not promote cell-mediated tumouricidal activity and may contribute to the inefficiency of the antiglioma immune response.

Oligoclonality was investigated in interleukin-2 (IL-2)-activated T cells (tumor-infiltrating lymphocytes, TILs) residing in metastatic melanomas using seven different monoclonal antibodies (mAbs) specific for T-cell receptor (TCR) V alpha or V beta regions and flow cytometry. IL-2-activated TILs from 25 of 42 metastatic melanomas (60%) displayed oligoclonal expansion, whereas IL-2-activated peripheral bllod mononuclear cells (PBMCs) from only 2 of 20 patients (10%) did so during 2-5 weeks in culture. Skin-derived lymphocytes from 20 patients were cultured; only four samples proliferated and none showed oligoclonal expansion. Preferential oligoclonal expansion of TILs was observed in V beta 8+ cells (10/42, P less than 0.05), V beta 6.7+ cells (7/42, P less than 0.05), and V alpha 2+ cells (7/42, not significant). Oligoclonal expansion of V beta 8+ cells was primarily found in T cells from subcutaneous metastases (8/20 cases, P less than 0.05), whereas that of V beta 6.7+ cells and V alpha 2+ cells was also found in T cells from lymph node or organ metastases. These mAbs to TCR V regions stimulated effector TILs to produce interferon-gamma, but not IL-2 or IL-4. Subcutaneous tumor-specific (V beta 8+ cells) and non-specific (V beta 6.7+ cells and V alpha 2+ cells) oligoclonalities were observed in IL-2-activated melanoma TILs, suggesting different immune responses among different sites of metastases.

Objective: Past studies have produced ambiguous or inconsistent results when testing whether smokers actually underestimate their own risks of experiencing tobacco related illness. Whereas smokers claim that they are less at risk than the average smoker on self administered questionnaires, this unrealistic optimism has not been found in telephone or face-to-face interviews. We avoided the measurement problems of past studies and examined responses to a number of new questions to assess different aspects of smokers’ perceptions. Methodology: A US national telephone survey (n = 6369; 1245 current smokers) posed a variety of questions designed to examine beliefs about the risks of smoking. For key questions, separate samples of smokers were asked either about their own risk or about the risk of the average smoker. Results: Smokers underestimated their relative risk compared to non-smokers and, contrary to previous interview surveys, believed they have a lower risk of developing lung cancer than the average smoker. Furthermore, their perceived risk of lung cancer and of cancer in general barely increases with the number of cigarettes smoked per day, and their estimates of their risk of cancer are actually slightly lower than their estimates of their risk of lung cancer. Substantial proportions of smokers and former smokers agree with several myths, more than half agreeing that exercise undoes most smoking effects. Conclusion: Smokers underestimate their risk of lung cancer both relative to other smokers and to non-smokers and demonstrate other misunderstandings of smoking risks. Smoking cannot be interpreted as a choice made in the presence of full information about the potential harm.

The exquisite soft-tissue contrast and multi-planar imaging capabilities of MR imaging uniquely qualify this modality for the evaluation of periarticular pathology. MR evaluation can be diagnostic by signal characterization, as in a lipoma, or by anatomic location, as seen in meniscal and synovial cysts. In other less diagnostic pathology, MR imaging can focus a differential diagnosis, guide percutaneous or surgical biopsy, provide local staging, and serve as a surgical map.

Therapeutic use of lymphokine-activated killer (LAK) cells frequently requires higher numbers of effector cells than can be produced in short-term cultures. Extended stimulation of these cells by interleukin-2 (IL-2) past 2 weeks leads to a decrease in cytolytic activity and cell proliferation. To determine how known regulatory cytokines are involved in the mechanism responsible for loss lf IL-2 responsiveness, adherent LAK (A-LAK), nonadherent LAK (NA-LAK), monocyte-depleted (MD-LAK), and unmanipulated LAK (UN-LAK) cells derived from human peripheral blood were stimulated with high-dose IL-2 for 4 weeks, and cytokine production was measured serially. Despite continued supplementation with IL-2, cell number plaeaued at 2 weeks with a 2.5-3.0 log increase in A-LAK cultures and a 1.0 log increase in NA-LAK, MD-LAK, and UN-LAK cultures. Cytolytic activity had decreased significantly in all four culture systems after only 14 days of stimulation with IL-2 as assessed by the chromium release assay using K562, Daudi, and RP-mel tumor cell lines as targets, and LAK activity was barely detectable after 28 days of stimulation. Bioactive tumor necrosis factor (TNF) was present in concentrations of 15-55 U/ml during the first week of culture and at less than 10 U/ml thereafter. Bioactive transforming growth factor-beta (TGF-beta) was detected at 1-36 U/ml from 5 to 14 days of culture and decreased thereafter. Immunoreactive TGF-beta 2 was still present at concentrations of 20-90 pg/ml after 21 days of culture.(ABSTRACT TRUNCATED AT 250 WORDS)

In summary, MR imaging is the preferred modality for the evaluation of a soft tissue mass after plain films have been taken. The radiologic appearance of certain soft tissue tumors or tumorlike processes such as myositis ossificans, benign fatty tumors, intramuscular hemangiomas, pigmented villonodular synovitis, and certain hematomas may be sufficiently unique to allow a strong presumptive radiologic diagnosis. It must be emphasized that MR cannot reliably distinguish between benign and malignant lesions, and when radiologic evaluation is nonspecific, one is ill advised to suggest a lesion is benign or malignant solely on the basis of its MR appearance. CT may be useful in specific instances for the identification of subtle soft tissue mineralization in those patients in whom lesions are not adequately evaluated by radiographs. Ultrasonography may be useful in the assessing of recurrent disease as well as in establishing tumor vascularity.

Cartilaginous tumors can be subdivided into several categories according to the following three criteria: (1) Is the lesion benign or malignant? (2) Is the lesion a pure or impure cartilaginous tumor? (3) Is the epicenter of the lesion intraosseous, juxtacortical, or in the soft tissues? This article focuses on the four most common benign cartilaginous tumors, enchondroma, osteochondroma, chondroblastoma, and chondromyxoid fibroma, and on chondrosarcoma. It reviews the biologic and developmental considerations of each and discusses in depth the basic concepts in the radiologic diagnosis of cartilaginous tumors.

Ewing's sarcoma is a highly malignant tumor of uncertain origin. A strong relationship is suggested between Ewing's sarcoma and tumors of neural origin. The radiologic manifestation of Ewing's sarcoma are protean and lesions may be lytic, mixed lytic-sclerotic, or rarely, predominantly sclerotic. The lower extremity long bones are predominantly affected and most lesions are diaphyseal or metadiaphyseal. CT and particularly MR imaging are invaluable in further delineating the extent of disease not readily manifested on plain radiographs. Gallium scintigraphy and gadolinium-enhanced MR images are best for following the response to therapy. Ewing's sarcoma must be distinguished from other round cell tumors including lymphoma, neuroblastoma, and primitive neuroectodermal tumor of bone as well as from osteosarcoma.

Isolated venous aneurysm is a rarely reported cause of a mediastinal mass. The authors describe a patient who demonstrated aneurysmal dilatation of the superior vena cava, the left innominate vein, the azygos and the hemiazygos veins and the left inferior pulmonary vein after blunt chest trauma. This case emphasizes the value of computed tomography in the diagnosis of this complex, presumably congenital entity.

Positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (FDG) was used to differentiate recurrent or residual malignant disease from the effects of cancer treatment. Transaxial images were obtained after injection of 5-10 mCi (185-370 MBq) of F-18 FDG in 68 patients (including 33 with brain tumors) whose posttreatment computed tomographic (CT) or magnetic resonance (MR) imaging findings had been suggestive of malignant disease. PET findings were correlated with surgical results in 18 patients and with the outcomes of CT, MR imaging, clinical, and laboratory 9-month follow-up studies in 50 patients. There was good agreement between F-18 FDG uptake and presence or absence of malignant disease except in four cases of brain tumors in which histologic findings could not be correlated with biologic behavior. The putative sensitivity and specificity in the 33 cases of brain tumors were 80% and 94%, respectively. The authors conclude that PET with F-18 FDG is useful in detection of previously treated metabolically active tumors but is limited in diagnosis of recurrent microscopic or metabolically inactive tumors.

We describe the case of a 21-year-old woman with a synovial sarcoma of the thigh, who exhibited a soft-tissue metastasis to the shoulder approximately 3 months after her initial presentation. Due to its increasing availability and the recognized importance of MRI in the preoperative evaluation of patients with soft-tissue masses, it is important to be aware of even the uncommon manifestations of frequently encountered soft-tissue sarcomas.

We present a case of primary lymphoma of bone arising in the proximal tibial epiphysis of a 16-year-old boy. To the best of our knowledge, primary lymphoma of bone has not been described previously as a mimicker of chondroblastoma. This case report is intended to increase awareness among clinicians and radiologists that primary lymphoma of bone can present with a long clinical prodrome and initially benign radiographic appearance. Early recognition of this unusual presentation will (hopefully) increase the likelihood of cure. However, it is recognized that in children, primary lymphoma of bone is a rare diagnosis and associated with a poor prognosis unless aggressive treatment is utilized [8].

We report a case of a clinically and radiographically dominant osteosarcoma of the proximal end of the tibia, in which the second skeletal focus of osteosarcoma was apparent on MRI, after having escaped detection on routine radiographs and scintigraphy. Detection of the second lesion significantly altered the subsequent treatment and prognosis. The improved sensitivity of MRI may increase the accuracy of the diagnosis of osteosarcomatosis. Although further study is needed, MRI study of long bones, especially T1-weighted images in the coronal plane, may be considered as a screening procedure to exclude occult skeletal involvement in patients with osteosarcoma and negative standard metastatic evaluation.

Type β-transforming growth factors (TGF-β) are multifunctional polypeptides that regulate cell growth and differentiation. TGF-s1 and TGF-β2 are closely related and resemble the immunosuppressive effects of malignant gliomas. As TGF-s2 is produced by gliomas, it may contribute to glioma-mediated immunosuppression. To inhibit TGF-β production, a set of 16mer antisense oligodeoxynucleotides (ODNs) was constructed. The glioma cell line U-251 was incubated with 10 μM antisense oligodeoxynucleotides for 24 h. A specific antiproliferative effect was observed for an oligodeoxynucleotide complementary to a region of complete mRNA homology between TGF-s1 and TGF-s2. Inhibition of TGF-s expression could not be verified in a standard Mv-1-Lu bioassay. In this assay TGF-s inhibits proliferation of Mv-1-Lu cells. Direct treatment of Mv-1-Lu with TGF-s1 and TGF-s2 specific antisense as well as unspecific oligodeoxynucleotides resulted in a dose-dependent inhibition of proliferation, indicating direct and unspecific effects of these oligodeoxynucleotides on Mv-1-Lu.

Osteoid osteoma is a benign skeletal neoplasm composed of osteoid and woven bone that rarely exceeds 1.5 cm in greatest dimension. The lesion is most commonly located in the cortex of long bones where it is associated with dense, fusiform, reactive sclerosis. Less often, it may be cancellous, where reactive osteosclerosis is usually less intense and may be distant from the lesion. Cancellous lesions are frequently intraarticular (most often in the hip) and may be associated with synovitis and joint effusion. Rarely, osteoid osteomas occur in a subperiosteal location. Patients are usually young, and there is a strong male predominance. Pain is the most common symptom. Radiographs of patients with cortical osteoid osteoma are often diagnostic. Intraarticular lesions, however, may be subtle, and scintigraphy may be required to locate the lesion for subsequent computed tomography (CT). CT is useful to identify and precisely locate the lesion and to provide guidance for percutaneous localization or treatment.

Nine patients with leptomeningeal disease are reported who were treated with intraventricular alpha-interferon (alpha-IFN). In seven of these patients, a progressive vegetative state developed during treatment. The patients became unresponsive to verbal commands but opened their eyes with auditory or tactile stimulation. It took an average of 3 weeks for these patients to become verbally responsive after treatment was discontinued. Electroencephalographic findings showed evidence of irritative involvement of the deep midline nuclei in 80% of patients. Periventricular white matter changes developed during treatment in three of six patients who underwent computed tomographic scans. All patients with this severe neurotoxicity received whole-brain irradiation before treatment. Possible mechanisms for the development of this neurotoxic syndrome are discussed. The neurotoxicity of alpha-IFN and brain irradiation may be additive, suggesting a cautious approach when using this combination for treatment.

The classic prototypes of the gastrointestinal polyposis syndromes are familial polyposis coli and Gardner syndrome. Extracolonic manifestations have been described in both diseases, and the distinction between them has become less clear. In fact, some authorities have suggested that familial polyposis coli and Gardner syndrome may represent a spectrum of the same disease. In both conditions, extracolonic expressions are the rule rather than the exception, and familiarity with them is essential for accurate diagnosis and correct patient management. In this pictorial essay, we discuss familial polyposis coli and Gardner syndrome together under the heading familial adenomatous polyposis syndromes. The colonic characteristics of these syndromes will be reviewed briefly, followed by examples of the most common extracolonic manifestations.

We present a case of arthritis of the wrist in an elderly man due to Mycobacterium avium-intracellulare. Prior steroid injections and a surgical procedure on the affected wrist were predisposing risk factors for subsequent mycobacterial involvement of the skeleton. Radiographs demonstrated findings characteristic of tuberculous arthritis: particularly, osteopenia with marginal erosions and diffuse lytic lesions involving the carpals, proximal metacarpals, and distal ends of the radius and ulna. MR scans showed soft-tissue involvement and extensive marrow replacement consistent with infection. It is to be reemphasized that the clinical and radiological findings in this case are very often indistinguishable from TB. The diagnosis depends on the results of tissue culture. Since radiologists are likely to be involved increasingly in interpreting images of immunocompromised patients afflicted with a variety of both typical and atypical infections, it is important occasionally to report rare infections such as that described herein.

A case of extraskeletal osteosarcoma occurring in its most common location, the thigh, is reported. Particular emphasis is given to demonstrating the spectrum of radiological findings, including CT, MRI, and scintigraphy and to illustrate that this entity can metastasize to bone.

The case discussed is that of a 31-year-old woman with long-standing hypertrophy and vascular symptoms of the right lower extremity. The etiology of these abnormalities remained undiagnosed, although the patient was treated symptomatically. Following presentation, both MR images and contrast-enhanced CT scans were adequate for diagnosis of the underlying arteriovenous malformation. This was confirmed by arteriography, and the patient received palliative treatment by sequential intra-arterial embolization.

Parosteal osteogenic sarcoma is a distinct surface bone tumor with a better prognosis than conventional osteogenic sarcoma. We studied eight histologically proved cases of cranial parosteal osteogenic sarcoma. The tumors were identical in histologic appearance to parosteal osteosarcoma arising in long bones. Clinically, the tumor presented as a hard, painless, nodular scalp mass. The prevalence in women outnumbered that in men by 3:1, with most cases occurring between the second and third decades of life. Plain radiographs showed a rounded, sessile bone growth of variable size arising from the outer table of the skull. The tumor was heavily ossified centrally with variable margins and, at times, with radiating bony spicules at the periphery. No satellite bone nodules were noted in adjacent soft tissues. In three cases a fine radiolucent cleft was demonstrated between the tumor and the underlying outer table on the tangential radiographs or CT. After en bloc resection of the tumor, follow-ups for 20 years in one patient and 1 year in two patients showed no recurrence. Parosteal osteosarcoma of the skull is a rare low-grade tumor that usually arises from the outer table of the skull and has distinctive radiologic features that should distinguish it from other exophytic cranial bone neoplasms.

Skeletal fibrous dysplasia is a developmental anomaly in which normal bone marrow is replaced by fibroosseous tissue. This process may be localized to a single bone, or even a small segment thereof, or affect the skeleton diffusely. The radiologic archives of the Armed Forces Institute of Pathology (AFIP) contain 501 cases of histologically proved and radiographically correlated fibrous dysplasia (of which 427 cases are monostotic and 74 cases are polyostotic). We present the spectrum of radiologic findings, including those from bone scintigraphy, computed tomography, and magnetic resonance imaging, augmented where appropriate by accompanying pathologic material.

A review of the 690 cases of osteosarcoma in the radiographic file of the Armed Forces Institute of Pathology revealed 29 cases of "osteosarcomatosis" (multiple skeletal sites of osteosarcoma). Fifteen of these patients were 18 years old and under and manifested rapidly appearing, usually symmetric, sclerotic metaphyseal lesions. The remaining 14 patients were more than 18 years old and had fewer, asymmetric sclerotic lesions. In most patients (28 of 29), a radiographically dominant skeletal tumor was seen. Pulmonary metastases occurred in the majority of patients and were detected at the same time as the bone lesions. These 29 patients were studied with regard to demographic data and skeletal distribution and radiographic appearance of their lesions. As a result of the findings, a metastatic origin from a primary dominant osteosarcoma is favored over a multifocal origin as the basis for osteosarcomatosis. Osteosarcomatosis is more commonly encountered in the mature skeleton than has been previously recognized.

This article is designed to provide the busy, practicing physician with the essential information needed to approach the patient with a primary bone tumor. An algorithm provides a suitable method of assessing most patients with bone tumors, recognizing slight modification is necessary in each case. Following this approach should allow successful accomplishment of the therapeutic triad: (1) do not "over-treat" a benign bone tumor, (2) do not "under-treat" a malignant bone tumor, and (3) do not misdirect the biopsy approach to the lesion so as to convert a more conservative operation into a more radical operation.

A difference in the expression and metabolism of sulfated glycosaminoglycans between rat mammary tumor cells derived from a primary tumor and those from its metastatic lesions has been observed. Cells from the primary tumor possessed about equal quantities of chondroitin sulfate and heparan sulfate on their cell surfaces but released fourfold more chondroitin sulfate than heparan sulfate into their medium. In contrast, cells from distal metastatic lesions expressed approximately 5 times more heparan sulfate than chondroitin sulfate in both medium and cell surface fractions. This was observed to be the result of differential synthesis of the glycosaminoglycans and not of major structural alterations of the individual glycosaminoglycans. The degree of sulfation and size of heparan sulfate were similar for all cells examined. However, chondroitin sulfate, observed to be only chondroitin 4-sulfate, from the metastases-derived cells had a smaller average molecular weight on gel filtration chromatography and showed a decreased quantity of sulfated disaccharides upon degradation with chondroitin ABC lyase compared to the primary tumor derived cells. Major qualitative or quantitative alterations were not observed for hyaluronic acid among the various 13762NF cells. The metabolism of newly synthesized sulfated glycosaminoglycans was also different between cells from primary tumor and metastases. Cells from the primary tumor continued to accumulate glycosaminoglycans in their medium over a 72-h period, while the accumulation of sulfated glycosaminoglycans in the medium of metastases-derived cells showed a plateau after 18-24 h. A pulse-chase kinetics study demonstrated that both heparan sulfate and chondroitin sulfate were degraded by the metastases-derived cells, whereas the primary tumor derived cells degraded only heparan sulfate and degraded it at a slower rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors that contribute to an increased prevalence of squamous cell carcinoma of the upper aerodigestive tract among young adults in the United States remain unknown. A potential etiologic factor may relate to a genetically controlled sensitivity to environmental carcinogens. This study, therefore, examined 20 young adult patients who had squamous cell carcinoma for mutagen-induced chromosome sensitivity. Lymphocytes from respective patients were cultured, exposed to the clastogen bleomycin, arrested during metaphase, and examined quantitatively for chromosome breakage. As compared with an age- and sex-matched control population, as well as a population of patients who had non-squamous cell carcinoma head and neck tumors, the young adult population with squamous cell carcinoma expressed a significantly increased number of bleomycin-induced chromosome breaks per cell. Furthermore, among the study patients, chromosome sensitivity was most apparent in the non-tobacco users and in patients less than 30 years of age. The expression of such chromosome fragility following mutagen exposure should be considered in epidemiologic studies that intend to define risk factors for development of head and neck cancer.

Five cases of rare gliosarcoma are described with pathologic correlation. Because of its sarcomatous component, gliosarcoma tends to present as a sharply defined, round or lobulated, hyperdense solid mass with relatively homogeneous contrast enhancement and peritumoral edema. Sharp demarcation of the tumor from surrounding tissue may lead to complete removal and prolonged survival despite high malignancy. However, aggressive tumor regrowth occurs often after incomplete resection. The genesis of gliosarcoma is also discussed.

The expression of heparan sulfate proteoglycans (HSPGs) by human glioma cells was examined by biochemical and immunological methods in vitro and in vivo. Chondroitin sulfate was shown to represent the major [3H]glucosamine-labeled glycosaminoglycan synthesized by cultured normal brain cells. However, high-grade glioma-derived cells were shown to express significantly increased quantities of hyaluronic acid and heparan sulfate and approximately equal amounts of chondroitin sulfate compared with normal glial cells. To investigate further the differential expression of HSPGs, proteoglycans were isolated from glioma cells and were used as an immunogen to generate monoclonal antibodies (MAbs). One of these MAbs, 39H (an IgM), was shown to bind more to high-grade glioma-derived cells then to low-grade glioma or normal brain cells in vitro. MAb 39H was also observed to bind to isolated HSPGs but not to heparan sulfate glycosaminoglycan chains or trypsin-treated cells. Immunofluorescence staining of the cultured high-grade glioma cells revealed an intense diffuse cell surface staining pattern over the entire cell and also isolated footpads. In contrast, the low-grade tumor or normal glial cells showed a distinctive punctated staining. A similar differential staining of MAb 39H was most prominent between tissue sections of glioblastoma multiforme and anaplastic astrocytomas versus low-grade astrocytomas and normal brain. The low grade gliomas exhibited a weak punctated staining, whereas the high-grade gliomas showed significantly more intense staining, particularly along the apical regions of the cells. These results suggest that altered expression of HSPGs may be related to the malignant transformation or growth potential of glial-derived cells.

The English word “salvage” comes from the Middle French “salver” (to save). In cancer therapy, it refers to the treatment of patients who have failed to respond to or relapsed following front-line therapy. Patients with glial tumors present in all age groups and are generally seen by a neurosurgeon, whose role is both diagnostic and therapeutic (resection or in-situ ablation of the tumor mass). The location of the tumor, its invasive character, and the ability of the surgeon impact on the safety and thoroughness of the operation. The prognosis depends on several factors including the age of the patient, the histology of the tumor, and the patient’s performance.

Treatment of cancer metastatic to the brain is dictated by both the need to achieve immediate short-term palliation and the desire for durable symptom-free remission. Surgical resection of brain metastases makes available tissue for diagnosis and experimental study, permits prompt relief of neurological signs and symptoms secondary to tumor mass effect, enhances the potential for sustained local tumor control in those patients with solitary disease, and allows greater therapeutic flexibility by obviating the need for cranial radiation in some situations and by expanding patient access to alternative experimental protocols or systemic chemotherapy.

Three patients with the unusual manifestation of atlantoaxial subluxation in Reiter's syndrome are studied. Each patient had mild symptoms referable to the cervical spine and radiologic evidence of erosive disease elsewhere in the skeleton. One patient had an 11-year history of Reiter's syndrome when the atlantoaxial subluxation was detected. The other two had atlantoaxial subluxation detected within 1 year of initial presentation, at variance with three other such patients that were reported previously, in whom there was a 6- to 10-year interval from initial presentation until radiographic documentation of atlantoaxial subluxation. Cervical spine radiographs, including flexion and extension views, are recommended for all patients with Reiter's syndrome and cervical spine symptoms.

Growth inhibitory activity of recombinant alpha and beta interferon on two human glioma cell lines, EFC-2 and KE cells, was determined by two different growth assays. Recombinant beta interferon showed a slight growth inhibitory effect on EFC-2 cells at day 3, and maximum inhibition was seen on day 6 with an ID50 of 50 U/ml. Recombinant alpha interferon showed no significant growth inhibition at any concentration. KE cells were resistant to both recombinant alpha and beta interferon. The growth inhibitory activity of recombinant beta interferon on EFC-2 cells was not blocked by recombinant alpha interferon, although recombinant alpha and beta interferons shared same receptors on EFC-2 cells. Addition of DFMO (alpha-difluoromethylornithine) to interferon in the media showed additive effect rather than synergistic effect in growth inhibition of glioma cells. Out of 7 glioma cell lines tested, 4 showed heterogeneous sensitivity to recombinant beta interferon, and all were resistant to recombinant alpha interferon. These results suggest a differential sensitivity of EFC-2 cells to recombinant beta interferon, as well as a heterogeneous sensitivity to recombinant beta interferon among different glioma cell lines.

The role of cytoreductive surgery alone as effective salvage therapy for immediate palliation and durable symptom-free remission was examined in 17 patients (six with astrocytoma, seven with anaplastic astrocytoma, and four with glioblastoma) who developed symptomatic tumor relapse after initial surgery and irradiation. Individuals with widely disseminated subependymal, bihemispheral, or brainstem involvement were excluded. After reoperation, patients with astrocytoma and anaplastic tumors have been observed for an average of 31 and 29 months, respectively. As of this writing, all 13 patients are alive without evidence of tumor progression. Three of the four patients with glioblastomas have died 5, 12, and 17 months after reoperation, respectively. The 14 surviving patients overall have a current average Karnofsky performance level of 95. The durability of surgically induced palliation alone, the safe limits of resectability, and the clinical features associated with a favorable surgical response have been examined. The results indicate that, in selected individuals, durable remissions can be achieved by adequate resection of symptomatic tumor mass.