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Biomedical subjects

A Kuten

Publications and source records attributed to A Kuten.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Primary brain tumors].

In our retrospective analysis of 305 patients with primary brain tumors, treated and followed at Rambam Medical Center between 1983-1990, 56% were males; mean age was 43; 47% were Ashkenazi Jews, 22% Sephardi Jews, 22% Arabs and 9% were Jews of unspecified origin. 3-year actuarial survival for all patients was 33.5%, Arabs 51%, Sephardi Jews 40%, Ashkenazi Jews 20%; for those younger than 20, it was 57%, and older than 20, 26%. Diagnoses were: astrocytoma grades I-II, 68%; astrocytoma grade III, 24%; glioblastoma multiforme, 5.5%; medulloblastoma 73%; ependymoma, 75%; oligodendroglioma, 85%; meningioma, 100%; pituitary adenoma, 100%. Survival probability of those with glioblastoma multiforme treated by combined surgery and radiotherapy was superior to that of those treated by surgery alone. In low-grade astrocytoma there was no difference in survival probability between those with combined therapy and those treated by surgery alone. Survival when the diagnosis was based on imaging studies alone without histological confirmation of malignancy, was similar to that of those with glioblastoma: only 3.0% at 3 years. Prognostic factors identified by univariate analysis were histology, age of patient and ethnic origin, and type of treatment.

Astrocytoma↗
PubMed1996

Intensive short cause chemotherapy followed by radiotherapy of locally advanced nasopharyngeal carcinoma.

BACKGROUND: We designed a protocol with the goal of improving the disease free and overall survival of patients with previously untreated Stage IV nasopharyngeal carcinoma (NP(C)). The regimen consisted of intensive induction chemotherapy followed shortly thereafter by radiation therapy. METHODS: Between March 1986 and March 1992, 27 patients with T3-4, N2-3, M0 squamous cell carcinoma of the nasopharynx were treated with 2 cycles of chemotherapy, using cisplatin, 100 mg/m2 intravenously, on Day 1, and 5-fluorouracil (5-FU), 1000 mg/m2 per day continuous infusion, on Days 2-5. The second cycle was given on Day 16 and was followed by radiotherapy (RT), 70 Gray, given on Day 31. RESULTS: The objective response rate to chemotherapy was 93%, with a 37% complete response (CR) rate and a 56% partial response (PR) rate. The overall CR rate after RT was 85%. With a median follow-up of 60 months, the overall actuarial survival rate was 66%. Patients who had a CR after chemotherapy had a superior survival probability (100%). Toxicity was tolerable, without lethal complications. CONCLUSIONS: This study demonstrates that cisplatin/5-FU chemotherapy given in an intensive schedule and followed shortly thereafter by radical RT can improve the CR rate and survival of patients with locally advanced NPC, with tolerable toxicity.

Adolescent↗
PubMed1996

[Experience with conservative therapy in primary breast cancer: experiences Northern Israel Oncology Center, 1981-1990].

Between 1981 and 1990, 346 patients with primary breast cancer were treated using breast conservation. Mean age was 55 +/- 13 years and median follow-up 53 months. 36.5% were in pathological Stage I, 55% in Stage II, and 4% in Stage III, while 4.5% were in clinical Stages I-II. 60% of the lesions were excised with good margins, 12% with close margins (0.5 cm), 2.5% with macroscopic residuals, 7.5% with microscopic residuals and 18% with margins that could not be determined. Level II lymph node dissection was performed in 334 patients (97%). Adjuvant therapy (combination of chemotherapy and/ or hormones) was given to 223 (64%). Radiotherapy, usually 50-55 Gy tangential photon irradiation to the whole breast, was given to 335 (97%); electron or photon "boost" to the tumor bed was given to 234 (70%); most patients received 20 Gy. Most node-positive patients received 50 Gy to the lymphatic drainage system. A year after completion of radiotherapy cosmetic results were rated as good in 195/212 (92%), moderate in 17/212 (8%), but in none as poor. 5-year actuarial survival was 90% for Stage I and 81% for Stage II disease. 24 (7%) developed breast recurrence, 8 of whom (2%) also had distant metastases; 5 (1.5%) developed supraclavicular lymph node metastases and 59 (17%) distant metastases. Predictors of poor survival or local recurrence were: age under 40 years, premenopausal status, multifocality, and blood/lymph vessel infiltration by tumor cells. The satisfactory level of local control achieved is attributed to the high doses of radiation administered in high-risk lesions (up to 70 Gy total tumor dose).

Actuarial Analysis↗
PubMed1996

[Ifosfamide in pediatric malignancy--experiences in the Northern Israel Oncology Center].

The records of 46 children treated with ifosfamide between 1987-1994 were analyzed. 24 received the drug as first-line chemotherapy in combination with vincristine and etoposide or with adriamycin, vincristine and cyclophosphamide. Complete remission was achieved in 8/10 children with soft tissue sarcoma, 7/8 with Ewing's sarcoma, 2/2 with ovarian carcinoma and 2/2 with clear cell sarcoma of the kidney. 22 children in whom first-line chemotherapy failed were then treated with ifosfamide and etoposide. Complete remission was achieved in 7/10 children with osteosarcoma, 1/2 with Wilms' tumor and 1/3 with neuroblastoma.

Antineoplastic Agents, Alkylating↗
PubMed1996

Preoperative concurrent chemoradiotherapy for unresectable Stage III nonsmall cell lung cancer.

PURPOSE: We carried out a Phase II trial in an attempt to improve resectability and survivability of inoperable Stage III A and III B nonsmall cell lung cancer (NSCLC) patients by implementing a neoadjuvant chemoradiotherapy treatment program. METHODS AND MATERIALS: Thirty-six patients with locally advanced Stage III NSCLC received neoadjuvant therapy consisting of 50.4 Gy in 5.5 weeks concurrent with two cycles of chemotherapy, using cisplatin and etoposide. No postsurgical consolidation therapy was given. RESULTS: Assessment at 3 to 6 weeks after treatment suggested that 26 (72%) patients had been rendered resectable. Toxicities were common but usually tolerable; however, one toxic death occurred. Of 24 patients who proceeded to thoracotomy, complete resection was achieved in 20 (56%). There were two surgically related deaths. Surgical-pathological staging showed downstaging in 18 patients, including complete sterilization of the tumor in 3 (8%). The median survival for all 36 patients is 15 months, but at the time of analysis, median survival of resectable patients had not been reached. The actuarial 2-year survival is 39% for all study groups, 57% for resectable patients, and 16% for the remaining (p < 0.005). CONCLUSIONS: While this preoperative neoadjuvant appears to improve survival of patients with Stage III NSCLC, comparison with previous reports of other similar trials indicate a superior survival advantage in association with higher doses of radiotherapy.

Adult↗
PubMed1996

Postradiotherapy hypothyroidism: radiation dose response and chemotherapeutic radiosensitization at less than 40 Gy.

To analyze our experience with iatrogenic hypothyroidism, we prospectively followed 84 patients, seen from 1984 to 1990, who had been diagnosed with either Hodgkin's disease (HD) or head and neck (H&N) carcinoma and subsequently treated with radiotherapy. Within these two diagnostic groups were subgroups whose treatment differed as to dose of therapeutic irradiation received or adjunctive use of chemotherapy. Approximately 50% of all patients and of each subgroup developed either clinical or subclinical hypothyroidism during follow-up. However, among the HD patients who received irradiation plus chemotherapy, a dose-response relationship below a threshold limit of dose received, probably 40 Gy, was observed.

Adolescent↗
PubMed1996

Reduction of the rectal dose in gynecological brachytherapy: modification to the Fletcher-Suit applicator.

The dose to the anterior rectal wall is a known limiting factor for the delivery of radical doses of radiation to the uterine cervix with brachytherapy. We developed a modification to the Fletcher-Suit afterloading applicator, consisting of two small inflatable balloons attached to the posterior end of each colpostat. The balloons are connected to catheters that emerge from the vagina attached to the colpostat's handles. The balloons were affixed to the colpostats with a plastic adaptor and are inserted empty. After an anterior radiograph is taken, the balloons are filled with radiological contrast material and a lateral orthogonal film is made. This lateral film taken with the balloons filled with contrast typically shows a significant posterior displacement of the anterior rectal wall away from the vaginal sources. The International Commission on Radiation Units (ICRU) rectal point is then determined 5 mm beyond the posterior boundary of the opacified balloons. We have performed 90 applications using this device, including brachytherapy applications for cervical cancer, as well as vaginal applications for endometrial carcinoma following TAH-BSO. On average, the ICRU rectal point was displaced 14 mm away from the colpostats, thus reducing the dose rate by 60% and resulting in an average dose sparing of about 1000 cGy to the anterior rectal wall.

Brachytherapy↗
PubMed1995

[Malignant salivary gland tumors].

Records of 60 patients with primary salivary gland tumors were retrospectively analyzed. Most were European Jews, 60% were males, and the average age was 57 years. The parotid gland was the most frequent site of origin (76%). The main presenting symptom was painless swelling. Pain or facial palsy were rare and associated with poor prognoses. The most common types were mucoepidermoid, adenocystic, adenocarcinoma and malignant, mixed carcinomas (in descending order of frequency). Squamous cell carcinoma was the most prevalent histologic type. Most patients presented at an advanced stage. Treatment was mainly surgical and postoperative radiotherapy was given to those with advanced disease. Most recurrences occurred within 3 years of initial treatment. Actuarial 10-year survival for all patients was 40%. Superior survival rates were achieved in women, probably due to less aggressive malignancies. Low grade mucoepidermoid carcinoma had a favorable prognosis, whereas anaplastic carcinoma had the worst. Other significant prognostic factors included stage and grade of disease.

Adenocarcinoma, Mucinous↗
PubMed1995

Spontaneous pneumothorax complicating chemotherapy for metastatic seminoma. A case report and a review of the literature.

BACKGROUND: Spontaneous pneumothorax complicating chemotherapy has been reported mainly in metastatic sarcoma, particularly of the osteogenic type. The main factor in the etiology of spontaneous pneumothorax could be related to tumor lysis and/or rapid rupture of chemosensitive peripheral or subpleural metastasis into the pleural cavity, thus leading to a bronchopleural fistula. METHODS AND RESULTS: A 49-year-old patient in whom spontaneous pneumothorax developed after successful chemotherapy for metastatic seminoma is described. On chest tube drainage, the lung reexpanded rapidly and the patient became clinically and radiographically symptom free. CONCLUSION: To the authors' knowledge, this is only the second case of spontaneous pneumothorax complicating chemotherapy-induced rapid regression of lung and mediastinal metastases in patients with seminoma. Spontaneous pneumothorax should be included in the spectrum of chemotherapy-related side effects in chemosensitive solid tumors with lung metastases.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

[Treatment of urinary bladder cancer--a retrospective analysis].

Data on 482 stage A-0--D2 bladder cancer patients referred between 1975-86 were analyzed. Prognosticators of survival were stage, histologic subtype and differentiation. 143 patients with disease localized to the pelvis (stage A-0--D1) received definitive radiotherapy with 60 Gy or more, and 25 underwent preoperative irradiation and cystectomy. Later, a group of 56 selected patients with stage B--D1, referred between 1988-1991, received neo-adjuvant MCV chemotherapy (methotrexate, cisplatin and vinblastine) preceding either definitive radiotherapy or surgery. The 2-year overall actuarial survival rates were similar: 63% for radiotherapy only, 72% for cystectomy and 68% for neo-adjuvant chemotherapy; they were also similar when broken down by stage and grade.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Wilms' tumor: the Northern Israel Oncology Institute experience.

Between 1971 and 1992, 42 children (median age = 2 years) with histologically proven Wilms' tumor were evaluated at the Northern Israel Oncology Institute. Most patients were staged according to National Wilms' Tumor Study (NWTS) criteria by which 18 were clinical stage I-II and 24 were III-IV. Combined therapy (surgery, chemotherapy, and radiotherapy) was given with a change to lower dose radiotherapy (< 2,000 cG) after 1981. The pre-1981 group (13 patients) suffered six relapses, most of which were pulmonary, whereas the 1981-1992 group (29 patients) had three relapses. The actuarial 5-year survival rate using Kaplan-Meier tables was 79% for the entire group but 100% for the 1981-1992 group and 38% for the 1971-1980 group. One case of immediate hepatic toxicity and one sudden death, unknown cause, of a patient in remission occurred in the group. Late deleterious effects were seen in five other patients; four had scoliosis and one developed osteoid osteoma of a rib. Despite these encouraging results, the necessity of ongoing monitoring for further long-term toxicities is apparent.

Child, Preschool↗
PubMed1995

Case report: late aggressive meningioma following prophylactic cranial irradiation for acute lymphoblastic leukaemia.

The clinical, radiological and pathological findings in a 28-year-old female patient who developed aggressive meningioma 20 years after prophylatic cranial irradiation (PCI) for acute lymphoblastic leukaemia (ALL) are described here. Only four cases of late atypical/aggressive meningioma following PCI were detected in a thorough search of the literature. The high cure rate in childhood ALL, attributable to aggressive chemotherapy and PCI, is capable of inducing secondary brain tumour, including aggressive meningioma.

Child↗
PubMed1995

Clinical characteristics of patients with a second primary tumor in the endometrium or ovary.

The clinical characteristics of patients with second primary tumors in the ovary and endometrium were compared to those with single primary tumors treated at our Center during the same period of time. Despite the fact that the patients were under medical surveillance for the first primary tumor, most second tumors were diagnosed following patient symptoms and complaints, and not at a routine follow-up appointment. Patients with a second primary endometrial cancer had a more advanced stage of disease at diagnosis as compared to those with single endometrial cancer. This was not found to be true for patients with second ovarian cancer. Patients with primary breast cancer and colon cancer, lymphoma or melanoma were found to be at higher risk for developing a second primary tumor in the endometrium or ovary as compared to those with a primary tumor at other sites. Although there are no proven means for the early detection of these gynecologic malignancies, it seems prudent to draw the attention of medical practitioners to the need for a better gynecologic evaluation for women with cancer at other sites during their follow-up visits. Studies on the efficacy of currently available diagnostic techniques should be carried out to evaluate their yield in this high risk group.

Breast Neoplasms↗
PubMed1995

[Osteoradionecrosis of the jaws].

9 patients with osteoradionecrosis of the mandible were treated during 1975-1994. All primary tumor had received high dose external radiation or brachytherapy, using iridium-192 sources. In 6 patients the complication was triggered, shortly before or after irradiation, by surgical interventions such as tooth extraction, or by the presence of an infected focus in the mandible. The complications were treated conservatively, including 2 cases by hyperbaric oxygen. The value of prevention is emphasized.

Adult↗
PubMed1994

Radiation therapy for non-AIDS associated (classic and endemic African) and epidemic Kaposi's sarcoma.

PURPOSE: A retrospective analysis of patients with non-AIDS and AIDS-related Kaposi's sarcoma, who were treated with radiation therapy. METHODS AND MATERIALS: Between 1978 and 1992, 56 patients with one of the three major types (classical, endemic, epidemic) of Kaposi's sarcoma received radiation therapy as their sole treatment modality. Extent of fields, daily fractionation, and total dose were applied on a clinical basis. These lesions received superficial x-ray therapy, Co-60 teletherapy, or 6-8 MeV electron beams. Field sizes depended on extent of the lesion. Total dose administration ranged from 8-12 Gy in one exposure, or a total of 24-30 Gy fractionated over 2-3 weeks. RESULTS: The majority of patients responded to radiation therapy. Symptomatic relief was achieved in 80-100% of patients irrespective of the type of Kaposi's sarcoma, treatment modality, or schedule. Side effects were tolerable in all but three patients with epidemic type Kaposi's sarcoma, who developed severe mucositis. CONCLUSION: Radiotherapy is the most useful mode of palliative treatment for all forms of Kaposi's sarcoma in southern African patients.

Acquired Immunodeficiency Syndrome↗