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Biomedical subjects

A Kuten

Publications and source records attributed to A Kuten.

At least 91 records · Page 5Linked to original sources
PubMed1993

Dermatofibrosarcoma protuberans appearing during pregnancy.

Dermatofibrosarcoma protuberans is an uncommon skin tumor with a high potential for local recurrence if not adequately excised. There are only two reports in the literature describing dermatofibrosarcoma protuberans that enlarged considerably during pregnancy. On the other hand, the new development or enlargement of dermatofibromas in pregnancy is well documented. We present 2 additional patients in whom a dermatofibrosarcoma protuberans appeared and grew rapidly during pregnancy. Immunohistochemical studies were negative for estrogen and progesterone receptors. The possible pathophysiology and surgical management are presented and discussed.

Adult↗
PubMed1992

[Multimodal management of bone sarcomas in children].

Osteogenic sarcoma and Ewing's sarcoma are the most common malignant bone tumors in childhood and adolescence. Marked improvement in prognosis and long-term survival have been achieved using combined modality protocols. We present a retrospective analysis of our experience with combined therapy of malignant bone tumors in children. Among 20 (ranging in age from 6-16, mean 11.4 years) with Ewing's sarcoma, 14 (70%) had complete remission by the end of treatment, 5 (25%) had partial response and 1 did not respond. The overall 10-year actuarial survival was 64%. Of the 10 with osteogenic sarcoma, 5 (50%) fully responded and are alive, 4 (40%) died after a partial or no response and 1 is receiving second-line therapy after partial response to primary treatment. The 10-year actuarial survival was 37.5% and the efficacy of combined modality therapy was demonstrated. However, further efforts are needed to arrive at optimal treatment for improved outcome.

Actuarial Analysis↗
PubMed1992

[Experience with endometrial carcinoma].

A series of 261 patients with endometrial carcinoma treated between 1980-1987 was retrospectively analyzed. There were 154 pathological Stage I cases, 37 Stage II, 30 Stage III, and 2 Stage IV. Most patients were treated by surgery combined with radiotherapy; 33 were treated by brachytherapy and/or external irradiation alone. While most received postoperative irradiation, a minority received preoperative irradiation. The actuarial 5-year disease-free survival was 79% for all patients, and 89%, 85% and 60% for Stages I, II, and III patients, respectively; 2 in Stage IV died shortly after diagnosis. The 5-year survival probability for 25 clinical Stage I-II patients treated by radiotherapy alone was 32%. Univariate analysis revealed that prognosticators of survival included histological subtype (papillary carcinoma vs other histological types, p less than 0.001), and degree of differentiation (Grade III vs Grades I-II, p less than 0.001). The prognosis of Stage I patients with deep myometrial invasion was markedly improved by adjuvant irradiation. The disease recurred in 50 patients (19.1%): 3 developed isolated vaginal recurrence, 7 had pelvic recurrence, and 40 developed distant metastases, with or without locoregional failure. The probability of 5-year survival was 50% for those with pelvic recurrence, and 9% for those with metastatic spread; 3 with isolated vaginal recurrence died within less than 40 weeks after diagnosis of recurrence. Risk factors for locoregional and/or distant failure were histologic subtype (papillary vs other histologic types, p = 0.001) degree of malignancy (Grade III vs Grades I-II, p = 0.001) and myometrial invasion (deep vs superficial, p = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Experience with brain tumors in children].

A series of 74 children with brain tumors treated between 1971-1988 was analyzed retrospectively. The mean age was 8.1 +/- 4.0 years; the m/f ratio was 1.4. In 37 (50%) the tumor originated in a cerebral hemisphere, in 27 (37%) in the cerebellum, in 6 (8%) in the brain stem, and in 4 (5%) in the thalamus. Histological material was obtained in 53 patients (72%). 62 (84%) were treated surgically, 63 (85%) received radiotherapy and 14 (19%) chemotherapy. The actuarial 5-year survival of the whole group was 69%. There were few side effects.

Adolescent↗
PubMed1992

[Primary breast cancer: conservation therapy].

A series of 200 patients with primary breast cancer, treated with breast conservation between 1981 and 1988, was analyzed retrospectively. The mean age was 54 +/- 14 years and mean follow-up 36 months. 58 patients (29%) were in pathological Stage I, 85 (42.5%) in II A, 34 (17%) in II B, and 7 (3.5%) in III. 16 (8%) were in clinical Stages I-II; 40 (20%) had multifocal tumors and 40 intraductal components. 45% of the lesions were excised with good margins, 13.5% with close margins (0.5 cm), 9% with microscopic residual, 4% with macroscopic residual and in 57 (28.5%) margins could not be determined. Level II axillary lymph node dissection was performed in 193 (96.5%). Adjuvant therapy (combined chemotherapy and/or hormones) was given to 105 (52.5%). Radiotherapy usually consisted of 50 GY tangential photon irradiation to the whole breast in 25 fractions. Electron or photon boost to the tumor bed was given to 112 (59%). Most patients received 20 GY, and most node-positive patients 50 GY to the lymphatic drainage. 69% tolerated combined radiotherapy-chemotherapy well and radiotherapy did not have to be interrupted. A year after completion of radiotherapy the cosmetic result was rated as good in 166/173 (96%) and fair in 7 (4%); there were no poor ratings. 11 (5.5%) developed breast recurrence and 5 (2.5%) supraclavicular or axillary lymph node metastases. 1 (0.5%) developed local recurrence and supraclavicular lymph node metastases simultaneously. 50 (10%) developed distant metastases, of whom 2 developed loco-regional recurrences simultaneously.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Anaplastic seminoma of the testis].

Between 1968-1988, 9 patients with Stage I anaplastic seminoma were registered at this oncology center, representing 11% of 83 with testicular seminoma referred for treatment and follow-up. They ranged in age from 33-50, with a mean of 41. In all orchiectomy was performed and 8 of them received postoperative radiotherapy. After a mean of 60 months, 7 were alive with no evidence of disease, 1 had no evidence of disease and was lost to follow-up 152 months following radiotherapy, and 1 had died of metastatic disease. One of the survivors developed widespread metastatic disease but was saved by chemotherapy and is now alive and well. It is suggested that decision as to treatment of anaplastic seminoma should be based mainly on the extent of the disease, rather than the degree of differentiation.

Adult↗
PubMed1992

Second cancer in patients treated for testicular seminoma.

The exact risk of developing a second primary cancer following radiotherapy for testicular seminoma is not known. At the Northern Israel Oncology Center, between the years 1968-1988, 75 patients with early stage (I,IIA) testicular seminoma were treated by orchiectomy followed by radiation therapy. The overall 10- and 20-year survival probability was 95% and 90%, respectively. Eight patients (11%) developed nine second cancers, with a cumulative rate of one case per 1,000 years of follow-up. The second primary cancers were: two bronchogenic carcinomas, one contralateral seminoma, one thymoma, one papillary carcinoma of the thyroid, one carcinoma of the stomach, one transitional cell carcinoma of the urinary bladder, one carcinoma of the colon, and one malignant melanoma. Three of these tumors developed within the irradiated field. Five of these eight patients are alive with no evidence of recurrent cancer. We conclude that patients treated for seminoma have an increased risk of developing a second cancer. There is a need for greater awareness of this possibility. The overall prognosis remains favorable.

Combined Modality Therapy↗
PubMed1992

Update of experience in the treatment of localized carcinoma of the prostate by definitive external irradiation.

In 1987 a retrospective analysis was performed of 116 patients with carcinoma of the prostate localized to the pelvis who were treated by radiotherapy at the Northern Israel Oncology Center during the period between 1977 and 1982. It was shown that definitive external beam irradiation is an effective, simple, and easy treatment modality for localized prostatic cancer.

Actuarial Analysis↗
PubMed1992

The value of postoperative irradiation in renal cell cancer.

This is a retrospective analysis of 147 evaluable patients, with histologically proven renal cell carcinoma, who were referred to our center between 1977 through 1988. All patients with disease limited to the kidney underwent nephrectomy. Post-operative megavoltage irradiation, with a median dose of 46 Gy, was given to 56 patients, using parallel opposing portals, or multiple field technique. Five and 10 year actuarial survivals in irradiated patients (Rt+) were 50 and 44%, respectively, and in non-irradiated patients (Rt-) 40 and 32%, respectively. The disease recurred locally in a total of 19 patients; 16 had tumor bed recurrence and three had scar recurrence. Local recurrence by stage was as follows: T2 N0M0: RT+ 0/17, RT- 2/28; T3 N0M0: RT+ 4/37 (10%), RT- 11/30 (37%) (p less than 0.05); T4 N0M0: RT+ 1/2, RT- 1/5. Two of the local recurrences in irradiated patients developed in a surgical scar which was not included in the treatment volume. Significant toxicity developed in three patients (5%). It is concluded that post-operative irradiation can reduce local recurrence rate in T3 N0M0 renal cell carcinoma. It is recommended that the surgical scar should always be included in the treatment volume and irradiated to a full dose.

Actuarial Analysis↗
PubMed1992

Clinical stage I endometrial cancer: prognostic factors for local control and distant metastasis and implications of the new FIGO surgical staging system.

A retrospective analysis is reported in 858 patients with clinical Stage I carcinoma of the endometrium treated definitively with combined irradiation and total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) from January 1960 through December 1986. Most patients received a preoperative intracavitary insertion (3500-4000 mgh to the uterus and a 6500 cGy surface dose to the upper vagina) followed by a TAH-BSO within 1-2 weeks. Some patients received postoperative external beam irradiation (2000 cGy whole pelvis and an additional 3000 cGy to the parametria, with a midline stepwedge) when factors such as deep myometrial invasion were present. Occasionally patients were treated with a preoperative intracavitary insertion and preoperative external beam irradiation (2000 cGy whole pelvis). The 5-year progression-free survivals by FIGO (1988) surgical stage were 93% for IA, 90% for IB, and 91% for Stage IC. An analysis of multiple variables was performed to ascertain their prognostic significance. Factors that significantly affected the 5-year progression-free survivals by univariate analysis were grade (grade 1 = 95%, grade 2 = 88%, grade 3 = 73%; p less than 0.0001), histology (adenoacanthoma = 96%, clear cell = 89%, adenocarcinoma = 89%, papillary = 81%, adenosquamous = 80%; p = 0.04), lower uterine segment involvement (uninvolved = 89%, involved = 73%; p = 0.006), depth of myometrial invasion (no residual tumor = 91%, limited to the endometrium = 96%, less than 1/3 myometrial penetration = 92%, 1/3 - 2/3 = 100%, greater than 2/3 = 50%; p = 0.02), peritoneal cytology (negative = 92%, positive = 56%, p less than 0.0001), uterine serosal involvement (uninvolved = 89%, involved = 55%; p less than 0.0001), vascular space invasion (absent = 89%, present = 75%; p = 0.001), and the presence of extrauterine disease (absent = 90%, present = 64%; p less than 0.0001). A multivariate analysis of these prognostic variables showed that histological grade (p = 0.001), peritoneal cytology (p = 0.004), and uterine serosal involvement were prognostic for local failure and that peritoneal cytology (p less than 0.001), grade (p = 0.001), age (p = 0.002), and extrauterine disease (p = 0.02) were prognostic for the development of distant metastasis.

Brachytherapy↗
PubMed1992

Local and systemic effects of radiation on bone metabolism measured by quantitative SPECT.

Quantitative bone scintigraphy (QBS), which measures 99mTc-MDP uptake expressed as percent of injected dose per cc, indicates bone metabolism. It is measured in the bones of patients before and after radiation treatment and then compared to normal controls. QBS was performed in a group of 22 normal individuals and was measured twice, 2-10 mo (mean 4.9) apart. There was no significant difference between the two measurements. QBS was performed also in 28 patients before, immediately after and at certain time intervals after radiation therapy for cancer. Both the irradiated and the nonirradiated bones showed significant decreases in bone metabolism at 2-18 mo (mean 8.8) after irradiation. In addition, increases and decreases of 99mTc-MDP uptake were similar in the irradiated and in the nonirradiated bones, and there were significant correlations of the QBS values in the different bones of each individual patient. The etiology of the changes in bone metabolism in the nonirradiated bones is not yet fully understood, but it appears to be the result of a systemic effect of radiation.

Bone and Bones↗
PubMed1992

Stage I-II low grade non-Hodgkin's lymphoma: prognostic factors and treatment results.

48 patients with stage I-II low-grade non-Hodgkin's lymphoma were treated by radiation and/or chemotherapy between 1970 and 1986. The histologic types were diffuse lymphocytic well differentiated, eleven patients; nodular lymphocytic poorly differentiated, 28 patients; nodular mixed, nine patients. Complete remission was obtained in 45 patients (94%). Overall survival was 83% and 68% at five and ten years, respectively. Five and ten-year relapse-free survival of complete responders was 71% and 57%, respectively. Univariate analysis of potential prognosticators showed the following to significantly increase the survival rate: one or two sites of disease (p less than 0.01), stage I (p less than 0.02), age less than 65 years (p less than 0.02), complete excision of tumor mass (p less than 0.03), and the use of radiotherapy (p less than 0.02). The extent of radiotherapy field did not affect survival. Multivariate analysis by the stepwise proportional hazards model of Cox showed that the use of radiotherapy was the factor which significantly produced better survival figures (p less than 0.03). It is concluded that two thirds of stage I-II low-grade lymphoma patients are potentially curable; radiotherapy plays a major role in the management.

Adult↗
PubMed1992

Hereditary ovarian cancer: a dilemma in prognosis.

Five women in three generations developed ovarian cancer. We closely monitored 36 descendent women in this family who were at high risk for developing this disease. Prophylactic oophorectomy is considered the optimal way to prevent the development of ovarian cancer. In the light of the young age of the women at risk and their strong objection to oophorectomy, we closely monitored the examinees for early signs of cancer for more than 5 years. None of them developed cancer. The dilemma in treatment of women at risk is discussed.

Adenocarcinoma↗
PubMed1991

Thyroid cancer and multiple primary malignancies in Israel.

The exact risk of multiple primary neoplasms in patients with thyroid cancer is difficult to ascertain from the data available in the literature. Three thousand seventy-two patients with thyroid cancer, listed in the Israel Cancer Registry during a 16-year time span, were studied to determine the true incidence of another primary cancer. Ninety-two cases were reported as having an additional primary cancer. The prevalence of multiple primary malignancies was 3%. The frequency was higher among patients of European rather than of Asian or African origin. The second primary cancers in order of decreasing frequency were of the breast, lung, colorectum, head and neck, and lymphoma/myeloma. Most of the deaths were due to the additional cancer. The 5-year survival rate was highest for head and neck and lowest for lung cancer patients. These results emphasize the need for greater awareness of the possibility of developing additional cancers, and indicate the need to incorporate strategies for the prevention, early detection, and treatment of multiple primary neoplasms.

Breast Neoplasms↗
PubMed1991

Results of multimodal therapy in Ewing's sarcoma: a retrospective analysis of 20 patients.

A retrospective analysis was performed of 20 patients with Ewing's sarcoma treated by combined modality therapy, consisting of surgery, radiotherapy, and chemotherapy. Fourteen patients (70%) achieved complete remission and 5 patients (25%) were in partial remission at the end of treatment. One patient (5%) failed to respond to combined modality therapy. The overall 5 year actuarial survival was 64% and the disease free survival, 55%. Persistent or recurrent disease occurred in 8 patients (40%); one of them was salvaged by surgery and chemotherapy. Site and extent of primary lesion were prognosticators of patients' outcome. One patient developed radiation-related-sequelae. The efficacy of aggressive management consisting of wide surgery, radiotherapy and intermittent high dose chemotherapy is discussed.

Actuarial Analysis↗