Cisplatin-based combination chemotherapy in the treatment of poorly differentiated carcinoma and poorly differentiated adenocarcinoma of unknown primary site: results of a 12-year experience.

1992 ◽  
Vol 10 (6) ◽  
pp. 912-922 ◽  
Author(s):  
J D Hainsworth ◽  
D H Johnson ◽  
F A Greco
Keyword(s):  
Prognostic Factors ◽  
Lymph Nodes ◽  
Tumor Location ◽  
Primary Site ◽  
Unknown Primary ◽  
Unknown Primary Site ◽  
Poorly Differentiated Adenocarcinoma ◽  
Poorly Differentiated Carcinoma ◽  
Peripheral Lymph ◽  
Poorly Differentiated

PURPOSE We previously reported excellent responses to cisplatin-based chemotherapy in a minority of patients with poorly differentiated carcinoma (PDC) or poorly differentiated adenocarcinoma (PDA) of unknown primary site. We have continued to study and to treat these patients, and now report clinical characteristics, treatment results, and prognostic factors in a large group of patients identified prospectively. PATIENTS AND METHODS Between February 1978 and December 1989, we treated 220 patients with PDC or PDA of unknown primary site. The median age was 39 years; 48% of patients had predominant tumor location in the mediastinum, retroperitoneum, or peripheral lymph nodes. Specialized pathologic studies resulted in the identification of specific tumor types in only a few cases. All patients received cisplatin-based chemotherapy; between 1978 and 1984, 116 patients received cisplatin, vinblastine, and bleomycin (PVeB) +/- doxorubicin, and 104 patients treated since January 1985 received cisplatin and etoposide +/- bleomycin. RESULTS One hundred thirty-eight patients (63%) had objective responses to therapy, and 58 (26%) had complete response. Thirty-six patients (16%) are currently disease-free at a median of 61 months following therapy (range, 11 to 142 months). Actuarial 10-year survival is 16%. Favorable prognostic factors identified by Cox regression analysis include: (1) predominant tumor location in the retroperitoneum or peripheral lymph nodes, (2) tumor limited to one or two metastatic sites, (3) no history of cigarette use, and (4) younger age. CONCLUSION Patients with PDC or PDA of unknown primary site represent another group of patients for whom potentially curative therapy is available. Patients with this syndrome should be distinguished from patients with well-differentiated adenocarcinoma of unknown primary site, and should receive a trial of cisplatin-based chemotherapy.

Overexpression of Her-2 in Patients With Poorly Differentiated Carcinoma or Poorly Differentiated Adenocarcinoma of Unknown Primary Site

2000 ◽  
Vol 18 (3) ◽  
pp. 632-632 ◽  
Author(s):  
John D. Hainsworth ◽  
Wayne J. Lennington ◽  
F. Anthony Greco
Keyword(s):  
Tumor Location ◽  
Primary Site ◽  
Immunohistochemical Method ◽  
Unknown Primary ◽  
Unknown Primary Site ◽  
Poorly Differentiated Adenocarcinoma ◽  
Carcinoma Of Unknown Primary ◽  
Poorly Differentiated Carcinoma ◽  
Poorly Differentiated ◽  
Her 2

PURPOSE: To determine the frequency of Her-2 overexpression in patients with poorly differentiated carcinoma or poorly differentiated adenocarcinoma of unknown primary site. PATIENTS AND METHODS: Tumor specimens from 100 patients with poorly differentiated carcinoma or poorly differentiated adenocarcinoma were stained for the Her-2 protein using the Dako immunohistochemical method. Clinical and pathologic characteristics of patients with and without Her-2 overexpression were compared. RESULTS: Staining for Her-2 overexpression was successful in 94 of 100 patients. Ten (11%) of 94 tumor specimens overexpressed Her-2. Eight of 10 overexpressors had poorly differentiated adenocarcinoma, and all overexpressors had predominant tumor location above the diaphragm, usually in the mediastinum or lungs. CONCLUSION: Her-2 overexpression occurs in a minority of patients with poorly differentiated carcinoma/adenocarcinoma of unknown primary site. Because most overexpressors had poorly differentiated adenocarcinoma, further evaluation of patients with adenocarcinoma of unknown primary site is necessary to determine the frequency of Her-2 overexpression in this common subgroup. Evaluation of the efficacy of trastuzumab in Her-2 overexpressors with carcinoma of unknown primary site is indicated.

Poorly differentiated carcinoma of unknown primary site: clinical usefulness of immunoperoxidase staining.

1991 ◽  
Vol 9 (11) ◽  
pp. 1931-1938 ◽  
Author(s):  
J D Hainsworth ◽  
E P Wright ◽  
D H Johnson ◽  
B W Davis ◽  
F A Greco
Keyword(s):  
Yolk Sac ◽  
Primary Site ◽  
Unknown Primary ◽  
Immunoperoxidase Staining ◽  
Unknown Primary Site ◽  
Carcinoma Of Unknown Primary ◽  
Poorly Differentiated Carcinoma ◽  
Poorly Differentiated ◽  
Long Term Survivors

To assess the clinical utility of immunoperoxidase tumor-cell staining in patients with poorly differentiated carcinoma of unknown primary site, we performed a battery of stains on tumors from 87 patients treated between August 1978 and April 1983. Poorly differentiated carcinoma or poorly differentiated adenocarcinoma was diagnosed on the basis of light microscopic examination, and all patients were treated before the technology of immunoperoxidase staining was routinely used. Therefore, results of immunoperoxidase staining can be correlated with clinical outcome in this group of similarly treated patients with a long median follow-up. Immunoperoxidase staining confirmed the diagnosis of poorly differentiated carcinoma in 49 patients (56%) and yielded other diagnoses in 14 patients (16%): melanoma, eight; lymphoma, four; prostatic carcinoma, one; and yolk sac carcinoma, one. In 24 patients (28%) the immunoperoxidase staining pattern was inconclusive; electron microscopy was usually helpful in clarifying the diagnosis in these patients. Seventy-five patients (86%) received combination chemotherapy with a cisplatin-based regimen, and 24 patients (28%) had a complete response. Nine of these patients were later given specific diagnoses by immunoperoxidase staining (lymphoma, four; melanoma, four; yolk sac tumor, one). All patients with an immunoperoxidase diagnosis of lymphoma also had clinical features compatible with lymphoma and are long-term survivors. Patients with immunoperoxidase features suggesting melanoma were surprisingly responsive to chemotherapy, with three of seven complete responses and two long-term survivors. Patients with melanoma diagnosed by immunoperoxidase staining should not be excluded from a trial of cisplatin-based therapy. Immunoperoxidase staining is useful in the routine evaluation of metastatic poorly differentiated carcinoma of unknown primary site, as it can occasionally suggest the lineage of the tumor and have specific therapeutic implications.

Poorly differentiated carcinoma of unknown primary site: correlation of light microscopic findings with response to cisplatin-based combination chemotherapy.

1987 ◽  
Vol 5 (8) ◽  
pp. 1275-1280 ◽  
Author(s):  
J D Hainsworth ◽  
E P Wright ◽  
G F Gray ◽  
F A Greco
Keyword(s):  
Light Microscopy ◽  
Germ Cell ◽  
Combination Chemotherapy ◽  
Primary Site ◽  
Unknown Primary ◽  
Unknown Primary Site ◽  
Term Survival ◽  
Poorly Differentiated Carcinoma ◽  
Poorly Differentiated ◽  
Histopathologic Features

We have previously reported complete responses and long-term survival in patients with metastatic poorly differentiated carcinoma (PDC) of unknown primary site who received intensive cisplatin-containing chemotherapy regimens. We reviewed the light microscopic specimens from 113 patients with PDC in an attempt to identify common histopathologic features in the chemotherapy-responsive subgroup, and to rule out the presence of previously unrecognized germ cell tumors. Relatively few diagnoses more specific than PDC could be made. We could identify no histopathologic features by light microscopy that distinguished responsive from unresponsive neoplasms. Only one patient was found to have a previously unrecognized yolk sac carcinoma, and in five other patients the possibility of a germ cell neoplasm was considered in the differential diagnosis by at least one reviewer. The remaining tumors had no histologic features suggestive of germ cell neoplasms. Ninety-six patients had received combination chemotherapy (89 with cisplatin-containing regimens); 27 patients (28%) achieved complete remission, and 16 remain free of disease at a median of 65 months after completion of therapy. Patients with PDC of unknown primary site who are responsive to cisplatin-containing chemotherapy regimens cannot be reliably identified by light microscopy. At present, all such patients should be considered for an empiric trial of chemotherapy with cisplatin-based regimens, since cure is achievable in a minority.

scholarly journals The Usefulness of PET/CT In Detecting and Managing Cancers With Unknown Primary Site Depends on Histological Subtype

2021 ◽  
Author(s):  
Ella Nissan ◽  
Uri Amit ◽  
Leo Baron ◽  
Amit Zabatani ◽  
Damian Urban ◽  
...  
Keyword(s):  
Primary Site ◽  
Unknown Primary ◽  
Histological Subtype ◽  
Unknown Primary Site ◽  
Primary Tumors ◽  
Poorly Differentiated Carcinoma ◽  
Pet Ct ◽  
Poorly Differentiated ◽  
The Mean

Abstract Introduction: We assessed the role of PET/CT in identifying and managing cancer of unknown primary site (CUP). Methods: We reviewed 64 patients' PET/CT scans with CUP performed during 2012–2019. Results: The median age was 65 years. Of 138-FDG-avid lesions, the mean SUVmax was10.6±6.0. Primary tumors (PT) were detected in 28(44%) patients. Detection was positive in only one(10%) patient with squamous cell carcinoma (SCC) histology, compared to 4/14(29%) with poorly differentiated carcinoma, 4/9(44%) with adenocarcinoma, 18/30(60%) of those for whom the origin could be presumed (p= 0.034 for SCC compared to other histologies). The mean age, mean SUVmax, and the distribution of organ involvement were similar between patients with and without discovered PTs, and also between patients with SCC and with the other histologies combined. However, those with SCC were less likely than the others to present with multi-lesion involvement, p<0.001. PET/CT interpretations apparently affected treatment of 8/28(29%) patients with PT detected and in none of the 35 whose PT was not discovered, p<0.001. Conclusion: PET/CT detected PT in almost half of CUP. However, it did not appear beneficial in those with SCC histology. PET/CT showed limited overall value in guiding clinical management but benefited a subgroup with discovered PT.

Poorly differentiated carcinoma and poorly differentiated adenocarcinoma of unknown origin: favorable subsets of patients with unknown-primary carcinoma?

1997 ◽  
Vol 15 (5) ◽  
pp. 2056-2066 ◽  
Author(s):  
R Lenzi ◽  
K R Hess ◽  
M C Abbruzzese ◽  
M N Raber ◽  
N G Ordoñez ◽  
...  
Keyword(s):  
Median Survival ◽  
Proportional Hazards ◽  
Primary Carcinoma ◽  
Unknown Primary ◽  
Entire Group ◽  
Poorly Differentiated Adenocarcinoma ◽  
Prognostic Features ◽  
Poorly Differentiated Carcinoma ◽  
Poorly Differentiated ◽  
Unknown Primary Carcinoma

PURPOSE The objectives of this study were to assess clinical outcomes and prognostic factors in unselected, consecutive patients with poorly differentiated carcinoma (PDC) or poorly differentiated adenocarcinoma (PDA). PATIENTS AND METHODS The 1,400 patients analyzed were referred to our unknown-primary tumor (UPT) clinic from January 1, 1987 through July 31, 1994. Clinical data from these patients were entered into a computerized data base for storage, retrieval, and analysis. Survival was measured from the time of diagnosis; survival distribution was estimated using the product-limit method. Multivariate survival analyses were performed using proportional hazards regression and by recursive partitioning. RESULTS Nine hundred seventy-seven patients were diagnosed with unknown-primary carcinoma (UPC) and 337 of these patients had PDC or PDA. No clinical differences were identified among patients with PDC, PDA, or UPC patients with other carcinoma or adenocarcinoma subtypes. PDC patients enjoyed better survival than PDA patients. Poor cellular differentiation was not an important prognostic variable. Variables predictive of survival included lymph node metastases, sex, number of metastatic sites, histology (PDC v PDA), and age. Although chemotherapy did not appear to influence survival for the entire group of PDC or PDA patients, a subset of patients with good prognostic features experienced median survival durations of up to 40 months. CONCLUSION The long median survival and chemotherapy responsiveness of UPC patients with PDC and PDA could not be confirmed. However, subpopulations with prolonged median survival durations could be defined, and the value of chemotherapy in this group remains to be determined. Identification and exclusion of treatable or slow-growing malignancies may account for the poor survival of the PDC and PDA patients reported in this study.

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