Anesthesia and remote monitoring for intraoperative radiation therapy.
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Anesthesia↗
Biomedical subjects
A H Russell
Publications and source records attributed to A H Russell.
Intraoperative US as an aid to intraoperative electron beam radiation therapy.
Intraoperative electron-beam radiation therapy (IRT) is being used to treat certain abdominal malignancies. Accurate determination of tumor size, depth, and extent is necessary to select a treatment cone of appropriate size and appropriate electron beam energy for the treatment portal. Fourteen patients undergoing evaluation for this treatment were examined with intraoperative ultrasonography (IUS) to aid therapy planning. IUS study required little additional time and readily delineated tumor size, depth, and relationship to adjacent structures. In two patients, the US and operative findings provided information that precluded use of IRT. The traditional method of tumor evaluation by intraoperative palpation and inspection was consistently enhanced by the use of IUS findings. IUS is a valuable adjunct that improves the accuracy of therapy planning for IRT.
Abdominal Neoplasms↗
Adenocarcinoma of the colon: an autopsy study with implications for new therapeutic strategies.
Clinical, pathologic, and autopsy records of 53 patients who had localized adenocarcinoma of the proximal colon and had undergone potentially curative surgery were analyzed to define ultimate patterns of recurrence and final patterns of dissemination. Ten patients (19%) died with locoregional recurrence alone (operative bed and retroperitoneal nodes). Liver metastases were present in 31 patients, accompanied by other sites of infradiaphragmatic failure in 29 patients (94%). Twenty-three patients (43%) died with cancer confined to the abdomen, retroperitoneum, and liver. The distribution of involved sites points to potential refinements in the surgical staging of this cancer and suggests a rational strategy for planning adjuvant therapy designed to address all the principal early mechanisms of disease dissemination.
Adenocarcinoma↗
Treatment planning for colorectal cancer: radiation and surgical techniques and value of small-bowel films.
For colorectal cancer, the adjuvant radiation dose levels required to achieve a high incidence of local control closely parallel the radiation tolerance of small bowel (4500-5000 rad), and for patients with partially resected or unresected disease, the dose levels exceed tolerance (6000-7000 rad). Therefore, both the surgeon and the radiation oncologist should use techniques that localize tumor volumes and decrease the amount of small intestine within the irradiation field. Surgical options include pelvic reconstruction (reperitonealization, omental flaps, retroversion of uterus, etc.) and clip placement. Radiation options include the use of radiographs to define small bowel location and mobility combined with treatment techniques using multiple fields, bladder distention, shrinking or boost fields, and/or patient position changes (prone, decubitus, etc.). When both specialties interact in optimum fashion, local control can be increased with minimal risks to achieve a suitable therapeutic ratio.
Colonic Neoplasms↗
Adenocarcinoma of the proximal colon. Sites of initial dissemination and patterns of recurrence following surgery alone.
Seven hundred ninety-five patients were adenocarcinomas of the proximal colon were reviewed. Two hundred forty-five patients presented with disseminated disease at the time of diagnosis, and were analyzed to identify mechanisms and sites of disease spread. Five hundred fifty patients underwent radical resection, and were followed for a minimum of 48 months or until time of documented relapse. One hundred eighty-six patients (34%) manifested recurrent carcinoma, 64 (34.5%) of whom underwent second laparotomy at the time of initial recurrence. In 139 patients (74.5%), the distribution of clinical recurrence was confined to the abdomen, retroperitoneum, and liver. Prognostic influence of initial stage and tumor grade are analyzed, and possible implications for surgical staging and adjuvant therapy are discussed.
Adenocarcinoma↗
Adjuvant postoperative pelvic radiation for carcinoma of the uterine cervix: pattern of cancer recurrence in patients undergoing elective radiation following radical hysterectomy and pelvic lymphadenectomy.
Thirty-seven patients with invasive cervical cancer have been referred to the Department of Radiation Oncology at the University of Washington following radical hysterectomy and pelvic lymphadenectomy. Patients at high-risk for tumor recurrence were selected for adjuvant pelvic irradiation because of adverse risk factors identified on pathological study of the hysterectomy specimen. All patients were treated because of possible residual, microscopic carcinoma. Fourteen patients (38%) developed recurrent cancer, of whom 10 (27%) manifested initial failure within the irradiated volume. Possible explanations for this observation are discussed.
Brachytherapy↗
Intracavitary irradiation for carcinoma of the urinary bladder: rationale, technique, and preliminary results.
Twelve patients with transitional cell carcinoma of the bladder have been treated employing a combination of external beam radiation (4000 to 5040 cGy/4 to 5.5 weeks) supplemented by intracavitary irradiation (1500 to 3000 cGy mucosal dose) using a triple lumen balloon catheter containing a central 137Cs source. The rationale, patient selection, and preliminary results are reported, and the technique of the intracavitary brachytherapy is described.
Brachytherapy↗
Adenocarcinoma of the sigmoid colon: sites of initial dissemination and clinical patterns of recurrence following surgery alone.
Three hundred and fifty-five patients with primary adenocarcinoma of the sigmoid colon were retrospectively reviewed. One hundred and eighteen patients who had disseminated disease at diagnosis were analyzed to identify sites and mechanisms of disease spread. Two hundred and thirty-seven patients treated by surgery alone with curative intent were analyzed to determine clinical patterns of recurrence and identify prognostic factors. Operative findings in 27 patients undergoing second laparotomy at the time of initial disease recurrence are described, and implications for adjuvant therapy discussed.
Adenocarcinoma↗
Second laparotomy for proximal colon cancer. Sites of recurrence and implications for adjuvant therapy.
Sixty-four patients with primary adenocarcinomas of the colon proximal to the peritoneal reflection underwent exploratory laparotomy at the time of first recurrence of their cancers. Local recurrence, retroperitoneal lymph node metastases, parenchymal liver metastases, and diffuse peritoneal seeding were identified as frequent components of the overall pattern of recurrence. The significance of these findings has been discussed herein, relative to refinements of operative technique and selection of appropriate adjuvant therapy.
Adenocarcinoma↗
Adenocarcinoma of the cecum: natural history and clinical patterns of recurrence following radical surgery.
One hundred and forty-three patients with previously untreated primary adenocarcinomas of the cecum were analyzed. Fifty-three patients manifesting disseminated disease at diagnosis were analyzed to define mechanisms of disease spread. Ninety patients were analyzed following attempted curative resection to determine anatomical distribution of initial clinical recurrences. Twenty-eight patients recurred (31%), of whom 9 underwent a second laparotomy. Nineteen of the 28 patients who recurred (68%) demonstrated an initial pattern of relapse clinically confined to the abdomen, liver, and retroperitoneum. Analysis was performed to determine the influence of stage and grade of the primary tumor on prognosis. Implications for adjuvant therapy are discussed.
Adenocarcinoma↗
Adenocarcinoma of the retroperitoneal ascending and descending colon: sites of initial dissemination and clinical patterns of recurrence following surgery alone.
One hundred twenty-seven patients with previously untreated primary carcinomas of proximal, retroperitoneal large bowel were retrospectively analyzed. Sites of involvement in 33 patients with surgically incurable (disseminated) disease were analyzed to define patterns of initial spread. Ninety-four patients were analyzed following attempted curative resection to determine anatomical distribution of initial clinical recurrences. Thirty-one patients recurred (33%). Twenty-four of these patients (77.5%) demonstrated an initial pattern of relapse clinically confined to the abdomen and retroperitoneum. Analysis was performed to identify factors of prognostic significance. Implications for adjuvant therapy are discussed.
Adenocarcinoma↗
Carcinoma of the tonsillar region: results of external irradiation.
A retrospective analysis is made of 104 patients treated with photon megavoltage radiotherapy for squamous cell carcinoma of the tonsillar region during the period 1965--1975. Moderately differentiated squamous cell carcinoma was the most common histological grade. Fifty-three per cent of the cases presented with cervical lymphadenopathy with three cases of bilateral involvement. The three year local control rate was 100% for Stage I, 74% Stage II, 49% Stage III, and 33% Stage IV. Two Stage III cases and one Stage IV case developed subsequent contralateral neck disease. No patient with either T1N0 or T2N0 tumor failed in the ipsilateral or contralateral neck despite the fact that 42% of the T1N0 cases and 37% of the T2N0 cases were treated with unilateral portals. The prognostic significance of the T and N stages, treatment techniques, as well as dose response relationships are analyzed and the literature is reviewed.
Adult↗
Pineal region tumors: results of radiation therapy and indications for elective spinal irradiation.
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Adolescent↗
Fast neutron teletherapy for advanced carcinomas of the oral cavity and soft palate.
A retrospective study was performed to determine the efficacy of using fast neutron radiation for treating advanced squamous cell carcinomas of the oral cavity and soft palate. The majority of patients were judged to have less than a 10% 5-year survival with conventional medical treatment. Fifteen patients with oral cavity tumors were treated for cure with neutrons alone and six were treated with a combination of neutrons and photons as part of a mixed beam fractionation scheme. In the neutron-only group, the complete regression rate was 33% in the mixed beam group, the rate was 50%. Five patients who had squamous cell carcinomas of the soft palate were treated for cure, one with neutrons alone and four with a mixed beam regimen. The complete regression rate was 100%. The two-year NED results are comparable with literature results for more selected groups of patients with oral cavity and soft palate tumors treated by conventional photon therapy. The acute treatment morbidity was perhaps somewhat greater in the subgroup of patients treated with neutrons alone, and this subgroup later developed a more pronounced subcutaneous fibrosis. Morbidity associated with the mixed beam treatment regimen was comparable to that associated with conventional radiotherapy.
Carcinoma, Squamous Cell↗
Management of solitary metastasis to the brain: the role of elective brain irradiation following complete surgical resection.
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Brain Neoplasms↗
Solitary plasmacytoma of bone and soft tissues.
Between 1956 and 1978, nine patients with solitary plasmacytoma of bone (SPB) and seven with extramedullary plasmacytoma (EMP) were treated at the University of Washington Hospital and Swedish Tumor Institute. All but one patient had local radiotherapy. In the SPB group, six of nine patients progressed to multiple myeloma (MM) and five died of disease within three years after dissemination. Three of the nine patients are alive at 5, 8, and 16 years, respectively. In the EMP group, none of the seven patients progressed to MM. Five are alive 16 months to 23 years after radiotherapy. Since there are no reliable criteria for prospectively distinguishing true solitary plasmacytoma from occult MM, all patients with apparently isolated plasmacytoma should receive local radiotherapy with curative intent.
Adult↗
Fast neutron teletherapy for advanced carcinoma of hypopharynx and supraglottic larynx.
The results of a Phase I clinical trial using fast neutron teletherapy for advanced squamous cell carcinoma of the hypopharynx and supraglottic larynx are reported. Ten patients with hypopharyngeal tumors were treated for cure using neutrons alone and 6 patients with hypopharyngeal tumors were treated for cure using a combination of neutrons and photons as part of a mixed beam fraction scheme. In the neutron-only group, the initial complete remission rate was 4/10 (40%). The mean survival of this group of patients with initial complete remission was only 5.75 months (range 2--10) but all patients died without evidence of recurrent tumor at the primary site. In the mixed beam group, the initial complete remission rate was 5/6 (83%) but the local control rate dropped rapidly to 41 per cent when displayed on an actuarial plot. Six patients with advanced tumors of the supraglottic larynx were treated for cure, 5 with neutrons alone and one with a mixed beam regime. The initial complete remission rate was 3/6 (50%) but 2 of these patients rapidly recurred, which reduced the local control rate on an actuarial plot to 16 per cent. The relative adverse effects of the neutron-only treatment regime appear to be substantially greater than those of the mixed beam treatment regime.
Clinical Trials as Topic↗
Endometriosis-related malignancies.
The purpose of this study is to describe the clinical findings, treatment, and outcome of patients with endometriosis-related cancers. Patients meeting Sampson and Scott's criteria for cancer associated with endometriosis in the Sacramento region were identified by chart review and pathology reports. Twenty-seven patients were identified with endometriosis-related malignancies (mean age 51.4 years). The site of origin was ovary in 17 (63.0%) and extra-ovarian in 10 (37%) including vagina, fallopian tube or mesosalpinx, pelvic sidewall, colon, and parametrium. The pattern of spread was local in five (18.5%), regional in 20 (74.1%) and distant in two (7.4%). Six patients had taken unopposed estrogen replacement (mean duration 23.4 years) and all six had extragonadal disease. Surgical procedures included hysterectomy, salpingo-oophorectomy, radical local excision, partial colectomy, and surgical staging. Eighteen patients received postoperative chemotherapy since the majority of patients had ovarian involvement. Fifteen patients received regional radiation therapy. Nineteen patients are without evidence of recurrence (70.4%, mean follow-up of 31 months). Endometriosis-related malignancies have a favorable prognosis. Extragonadal disease was commonly associated with unopposed estrogen replacement therapy. The predominance of local and regional disease strongly influence the application of treatment modalities.
Adult↗