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Biomedical subjects

A Kuten

Publications and source records attributed to A Kuten.

At least 73 records · Page 4Linked to original sources
PubMed1994

Testicular seminoma: 20-year experience at the Northern Israel Oncology Center (1968-1988).

Eighty-four patients with testicular seminoma were treated at the Northern Israel Oncology Center during the years 1968-1988. Using the staging classification of Hussey, 69 patients (82%) had Stage I, eight (10%) had Stage IIA, four (5%) had Stage IIB, one (1%) had Stage IIIA, and two (2%) had Stage IIIB disease. Sixty-nine patients (82%) had classic pure seminoma, nine (11%) had anaplastic seminoma and six (7%) had spermatocytic seminoma. Seventy-four patients (88%) underwent high inguinal orchiectomy and ten (12%) had a scrotal approach. Seventy-five patients (85%) were treated with postoperative irradiation. Stage I patients received 26-30 Gy to the paraaortic and ipsilateral pelvic lymph nodes. Stage IIA patients were treated in the same manner with a boost to the involved lymph nodes. With a mean follow-up of 97 months, 65 patients (77%) are alive and well with no evidence of disease, 7 patients (8%) are dead due to disease progression. The 5-, 10-, 15-, and 20-year actuarial survival for all patients was 90%, and for early stage patients 94%. Eight patients (14%) relapsed; 3 of them were salvaged by chemotherapy. Serious side effects of irradiation included lethal respiratory failure due to bleomycin-induced pulmonary fibrosis in one patient, peptic ulcer in three patients, hydronephrosis due to paraureteral fibrosis in one patient and recurrent paralytic ileus in one patient. Eight patients (10%) developed nine second cancers, three of them within the previous radiation field.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Treatment of muscle invasive bladder cancer. Is there a role for neoadjuvant chemotherapy?

PURPOSE: Because 5-year survival with advanced bladder cancer is still poor, the search for optimal treatment continues as dose the necessity of clarifying goals of treatment. PATIENTS AND METHODS: We compared the outcome of 3 different but widely accepted treatment protocols for bladder cancer in order to find which, if any, was superior, with particular emphasis upon the performance of the newest treatment, neoadjuvant chemotherapy. Data on 224 bladder patients treated at our institution (1975 to 1991) with 1 of the 3 protocols was analyzed. Those protocols were: 1. radiotherapy > 60 Gy (143 patients); 2. low dose radiotherapy followed by cystectomy (25 patients); 3. chemotherapy followed by either definitive radiotherapy or surgery (56 patients). Because the latter group was also a chronologically newer group with a shorter possible follow-up, we compared all treatments on the basis of 2-year survival, using Kaplan-Meier life tables. We briefly reviewed those modalities which are bladder-sparing because of the significance to quality of life of this factor. RESULTS: Two-year survival figures for the patients were: 63% for those who received only radiotherapy; 72% for those undergoing cystectomy: 68% for the group to whom neoadjuvant chemotherapy was administered. The differences were not statistically significant. However, 23% of those patients treated neoadjuvantly were alive with intact bladders at 2 years. CONCLUSION: These results do not suggest that a superior survival advantage is associated with any of these 3 protocols and neoadjuvant chemotherapy, in particular, cannot be seen as conferring a new and important survival advantage. However, neoadjuvant chemotherapy followed by radiotherapy does permit bladder conservation and, given that life span will often be reduced, the importance of helping to keep the remainder of the patient's life as comfortable as possible, can hardly be overestimated.

Aged↗
PubMed1994

Update on nasopharyngeal carcinoma in northern Israel.

PURPOSE: Because Israel is one of the world's intermediate risk areas for nasopharyngeal carcinoma (NPC), we continue to analyze retrospectively all referred cases. PATIENTS AND METHODS: We previously reported our work with 49 NPC patients, and we now extend our analysis to include an additional 26 patients. All our 75 patients were treated between 1968 and 1991 at the Northern Israel Oncology Center in Haifa. They were typical in the preponderance of male sex (74%), Mediterranean origin (80%) and late stage presentation (91%). All patients received a combination of photon and electron radiotherapy to the tumor site, base of skull and neck, with an average dose to the nasopharynx of 6095 cGy. Nearly 40% of the patients received combined modality treatment (CMT), i.e., cisplatin-based chemotherapy prior to radiotherapy. RESULTS: There was an overall complete response (CR) of 88%, with 44% of the patients experiencing recurrence. Serious complications occurred in 5%. We found a 5-year survival rate of 48% and a 10-year survival rate of 44%, with some indication that CMT was advantageous to later-stage patients with non-keratinizing histologies, but not to earlier stages nor to those with keratinizing squamous cell carcinoma (SCC). Pediatric patients had better survival rates. CONCLUSIONS: 1. The somewhat better survival performance of Arabs and Sephardic Jews may reflect their greater tendency to have the non-keratinizing histological variants (lymphoepithelioma and undifferentiated carcinoma). 2. Ethnicity was consistently prognostic, both as risk and survival factors. 3. The role of CMT in advanced non-keratinizing NPC should be explored in future randomized trials.

Adolescent↗
PubMed1994

Fibromatosis (desmoid tumor) following radiation therapy for Hodgkin's disease.

Fibromatosis (desmoid tumor) can sometimes develop at sites of previous surgery or previous trauma, but it is very rarely detected at sites of prior irradiation. We report two cases of fibromatosis following radiotherapy for Hodgkin's disease. The fibromatoses, developing in the radiation fields, were detected at the posterior area of the neck 11 years after irradiation in one case and in the peritoneal cavity 3 years after laparotomy and irradiation in the second case. The tumors did not differ clinically or histologically from those seen in patients who did not undergo irradiation. Although rare, fibromatosis should enter the differential diagnosis of masses developing in irradiated fields in patients with treated Hodgkin's disease.

Adult↗
PubMed1994

Hodgkin's disease in childhood: treatment modalities, outcome and epidemiological aspects. The Northern Israel Cancer Center experience.

PURPOSE: A retrospective analysis of Hodgkin's disease (HD) in children treated at the Northern Israel Cancer Center between 1971 and 1990 was conducted. PATIENTS AND METHODS: Records of 102 patients < 18 years of age at diagnosis were reviewed. Patient characteristics were similar to those previously reported. There were 54 boys and 48 girls (1.1:1 boy:girl ratio), with more boys < 10 years of age. Forty-four patients were of Arab ancestry and 58 were Jewish; incidence rates were similar in both groups. The most common histological types were nodular sclerosing and mixed cellularity, the latter being more commonly diagnosed in the younger age group. RESULTS: The outcome of various treatment modalities in childhood HD were evaluated. Sixty-five patients (64%) had stage I or II and 37 (34%) had stage III or IV at diagnosis. Patients with stage I-II received radiotherapy alone (20 patients), chemotherapy alone (10 patients), or a combined approach of chemotherapy plus radiotherapy (35 patients). Survival rates and median disease-free intervals were statistically similar in all three modalities. However, relapse rates were higher among patients receiving radiotherapy alone or chemotherapy alone (35% and 38%, respectively) compared with patients receiving chemotherapy plus radiotherapy (14%). CONCLUSIONS: We conclude that a combined approach of chemotherapy plus radiotherapy is advantageous over radiotherapy alone or chemotherapy alone.

Adolescent↗
PubMed1994

AIDS-related Kaposi's sarcoma: a review.

Infection with the human immunodeficiency virus (HIV) is the primary cause of AIDS and related disorders. Infection with HIV results in diminished cellular immunity, propensity to opportunistic infections, and an increased incidence of certain neoplasms. Kaposi's sarcoma (KS) is the most common neoplasm in persons infected with HIV. This epidemic, or HIV-related KS, usually follows an aggressive course with involvement of skin, lymph nodes, and internal organs. Normally, the disease has a progressive clinical course despite being responsive to radio- or chemotherapy.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Pathological stage I endometrial carcinoma: the role for adjuvant radiotherapy.

BACKGROUND: In order to assess the efficacy of adjuvant radiotherapy in the treatment of pathological stage I endometrial carcinoma, we performed a retrospective analysis of 158 patients with this diagnosis who after surgery were either treated with radiation therapy or only followed from January 1980 through December 1987. METHODS: Patients were divided into two prognostic categories, high and low risk, on the basis of three known predictors of survival: histology, differentiation, and depth of myometrial invasion. All patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy but only the high risk group received radiotherapy as well. RESULTS: After a median follow up time of 59 months the survival rates of the two groups were similar. The 5-year disease-free survival of the surgery alone group was 92% compared to 89% for the postoperative radiotherapy group. Side effects of treatment were minimal. CONCLUSIONS: Postoperative radiation therapy for high risk pathological stage I endometrial carcinoma is an effective adjuvant therapy and confers an excellent prognosis.

Carcinoma↗
PubMed1993

Radiation therapy in endemic (African) Kaposi's sarcoma.

PURPOSE: Evaluating the role of radiation therapy in the treatment of the endemic, African variant of Kaposi's sarcoma. A retrospective analysis. METHODS AND MATERIALS: Between 1978 and 1990, 28 symptomatic African patients with the African Human Immunodeficiency Virus negative type of Kaposi's sarcoma were referred to the Johannesburg General Hospital. Following staging, all patients were treated with radiation therapy. Doses ranged between 8-10 Gy (single fraction) or 14-24 Gy fractionated over 1-3 weeks. RESULTS: Complete and partial regression of cutaneous lesions was achieved in 9 (32%) and 15 (54%) patients, retrospectively. A complete/near-complete alleviation of symptoms was achieved in all patients. Response rate and duration of response was not influenced by age, radiation modality or schedule. Side effects were minimal. CONCLUSION: Our study emphasizes the high radiosensitivity of the endemic, African type of Kaposi's sarcoma, indicating its usefulness as the treatment of choice for this disease.

HIV Seronegativity↗
PubMed1993

[Hodgkin's disease in childhood--northern Israel cancer center experience, 1971-1990].

Records of children treated for Hodgkin's disease between 1971-1990 were analyzed retrospectively, and 102 cases of children younger than 18 years when diagnosed were reviewed. There were 54 boys and 48 girls, with male predominance in those younger than 10 years. 44 patients were of Arab ancestry and 58 were Jewish; the incidence was similar in both groups. Most common were the nodular sclerosing and mixed cellularity types, the latter more common in the younger age group. The outcome of various treatments was evaluated. At diagnosis, 64% were in stages I or II and 34% in stages III or IV. 20 of those in stages I-II received radiotherapy (RT) alone, 10 chemotherapy (CT) alone, and 35 combined CT and RT. Survival rates and median disease-free intervals were statistically similar with all 3 modalities. However, relapse rates were higher with either RT or CT alone (35% and 38%, respectively) than with combined therapy (14%). We conclude that combined CT and RT is superior to RT or CT alone.

Adolescent↗
PubMed1993

The management of metastatic spinal cord compression: a radiotherapeutic success ceiling.

PURPOSE: In assessing the effectiveness of the management of metastatic spinal cord or cauda equina compression, we performed a retrospective analysis of 70 patients with this complication whom we treated from 1985 to 1989. METHODS AND MATERIALS: The most frequent primary diagnoses in our series were carcinomas of unknown origin and of the breast, lymphoproliferative disease, lung cancer, and prostatic carcinoma. We used the Findlay classification to group all patients according to their pre-therapeutic functional motor status as Grade I (24 patients or 34%), Grade II (27, or 39%) or Grade III (19 or 27%). Treatment consisted of 30-45 Gy of irradiation (using two different schedules) together with high-dose dexamethasone; in only five cases was there surgical intervention. RESULTS: We found that a powerful predictor of response to radiotherapy was the patient's neurologic status (Findlay grade) at the time of diagnosis: 66% of previously ambulatory patients remained so, whereas 30% of non-ambulatory patients and only 16% of paraplegic patients regained the ability to walk. Another important predictor of response was primary tumor histology, with the most favorable responses to radiation therapy having been observed in lymphoproliferative diseases and in breast cancer, but with some response in other radiosensitive malignancies as well. CONCLUSION: The similarity of our results to those of other centers leads us to conclude that a radiotherapeutic success ceiling of 80% may have been reached for Findlay Grade I patients with metastatic spinal cord compression. In view of this, we suggest that future therapeutic endeavour would be best directed toward early diagnosis of the condition.

Adolescent↗
PubMed1993

[Update of experience with prostatic cancer].

A retrospective analysis of 302 patients with prostatic cancer, referred between 1977-1982, was updated. 15 patients (5%) with Stage A1 disease did not receive any specific treatment, and their 10-year actuarial survival was 77%. 22 (7%) had Stage A2 disease at diagnosis, 82 (27%) Stage B, 88 (29%) Stage C, and 95 (32%) Stage D. Their 10-year actuarial survival rates were 75%, 56%, 38%, and 2%, respectively. The 10-year actuarial survival of patients with well- and moderately well-differentiated adenocarcinoma was 61%, but only 13% in those with poorly differentiated adenocarcinoma (p < 0.001). A total of 116 patients with Stages A2, B and C were treated by irradiation and 71 of them also received prophylactic hormone therapy. The 10-year actuarial survival of those treated by combined irradiation and hormone therapy was 59%, compared to 19% for those treated by irradiation alone (p < 0.02). Our results emphasize the need for early diagnosis of prostatic cancer, using modern diagnostic tools such as transrectal ultrasonography and determination of prostatic specific antigen. They also prove that radiotherapy is effective and curative in a high percentage of patients with disease confined to the pelvis.

Adenocarcinoma↗
PubMed1993

Testicular seminoma stage I: treatment results and long-term follow-up (1968-1988).

Sixty-nine patients with stage I testicular seminoma were referred to the Northern Israel Oncology Center between 1968 and 1987. Sixty-four patients were irradiated postoperatively and five patients had surveillance alone. Complete follow-up was available for all patients, with a median follow-up of 86 months (range 9-239 months). The last follow-up was in December 1988. Actuarial survival was 94% to 5, 10, 15, and 20 years. Six patients relapsed following completion of irradiation. All the recurrences occurred outside the radiation field. Three of the relapsed patients could be salvaged with cisplatinum-based chemotherapy and are alive at 4, 7, and 10 years following second-line treatment. Acute or chronic side effects were mild and manageable. Seven patients developed second primary cancers, two within and six outside the radiation field. While surveillance policy alone in stage I testicular seminoma may be successful in terms of patient outcome, it requires prolonged observation, good compliance of patients, and intensive use of resources. Thus, until proved otherwise, infradiaphragmatic radiotherapy should further remain the optimal routine treatment in seminoma patients with stage I disease.

Actuarial Analysis↗
PubMed1993

Classical disseminated Kaposi's sarcoma in HIV-negative patients; an unusually indolent subtype.

Kaposi's sarcoma is a rare neoplasm of characteristic chronicity. The classical form which occurs most often in elderly men of Eastern European origin, comprises both an indolent, cutaneous type marked by spontaneous regression with prolonged survival, and a rarer, disseminated variant is more fulminant. Seven elderly Jewish patients with classical, disseminated, visceral Kaposi's sarcoma were studied; they were neither homosexual nor drug-abusers. All immunologic parameters were normal and serum tests for HIV antibodies, CMV, and EBV were negative. Five of these patients were treated and four responded well, including two complete remissions. The prolonged survival of these patients (82% at 5 years) suggests the existence of an indolent subtype or forme fruste of the usually aggressive form of classical Kaposi's sarcoma.

Adult↗
PubMed1993

Total skin electron irradiation: efficacy in early mycosis fungoides.

The rare, indolent, but lethal malignancy, mycosis fungoides (MF), is amenable to durable remissions if treated topically at an early stage with nitrogen mustard, PUVA, or radiotherapy. A modification of conventional therapeutic irradiation which utilizes electron beams rather than photons, has been in use since 1951. This method, termed total skin electron irradiation (TSEI), has achieved consistently good CR rates (95-100%) at a variety of centres in the U.S.A., England, France, and Italy, despite troublesome differences in staging systems. In northern Israel we have treated 37 MF patients with TSEI during the past 13 years. All 21 of our early stage patients achieved CR, which is no longer regarded as an unusual result. However, most workers in the field acknowledge that issues of optimal dosing and curative potency remain unresolved.

Adult↗
PubMed1993

Anaplastic seminoma and spermatocytic seminoma--a retrospective analysis.

Through the years 1968-1990, 10 patients with anaplastic seminoma and 7 patients with spermatocytic seminoma were referred to the Northern Israel Oncology Center, Haifa, Israel. These patients represent 20% of a total of 85 seminoma patients referred for treatment and follow-up. All patients underwent orchiectomy. Metastatic work-up revealed stage I disease in all patients. Sixteen patients received postoperative prophylactic radiation therapy to the para-aortic lymph nodes and the ipsilateral iliac region, dose range 25-30 Gy (daily fractionation 200 cGy). With a mean follow-up of 98 months, 15 patients are alive with no evidence of disease or long-term side-effects of treatment. One patient died of ischaemic heart disease without evidence of recurrent tumour. One patient with anaplastic seminoma died from progressive disease. In the light of our experience and a review of the literature, it is suggested that treatment of stage I non-pure seminoma should be based on the extent of disease alone and not on the degree of histological differentiation. Stage I non-pure seminoma has the same good long-term survival and low complication rate as typical seminoma when treated with adjuvant radiotherapy. Prospective, randomised trials are required to evaluate the role of a surveillance policy alone in stage I non-pure seminoma.

Adult↗
PubMed1993

Melanocytic schwannoma of the spinal cord: a case report.

Melanocytic schwannoma of the spinal cord is a tumour composed of Schwann cells capable of producing intracellular melanin. We present a case report of a 25-year-old male with melanocytic schwannoma of the 5th lumbar spinal cord root; the patient is alive and well 48 months after neurosurgical removal of the tumour. A review of the literature revealed 14 similar cases. These tumours have a local recurrence rate of up to 14%, and have a metastatic potential.

Adult↗
PubMed1993

Second primary cancer in irradiated stage I testicular seminoma.

The incidence of second primary cancer (SPC) was determined in 64 irradiated stage I testicular seminoma patients, treated and followed at the Northern Israel Oncology Center from 1968 to 1988. Seven (11%) patients developed a total of eight second cancers. The cumulative risk for developing second primary cancer at ten, 15 and 20 years following the diagnosis of seminoma was 2.5%, 5.1% and 8.9%, respectively. Two patients developed SPC within the radiation field (urinary bladder, sigmoid colon) and four patients outside the radiation field (bronchogenic cancer, thymoma, malignant melanoma, thyroid cancer). In two patients, who developed lung cancer and testicular seminoma, respectively, scatter dose from the main radiation field could not be excluded as one of the factors contributing to the SPC. Three patients died as a direct result of their SPC. It is concluded that there is a low, but significant risk of solid SPC among patients apparently cured of early stage seminoma. It will be important in future surveillance studies of stage I seminoma to assess the risk of SPC in the non-irradiated patients.

Actuarial Analysis↗