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Biomedical subjects

A Kuten

Publications and source records attributed to A Kuten.

At least 109 records · Page 6Linked to original sources
PubMed1991

Clinical stage I endometrial cancer: results of adjuvant irradiation and patterns of failure.

A retrospective analysis is reported in 858 patients with clinical Stage I carcinoma of the endometrium treated definitively from January 1960 through December 1986 with combined irradiation and total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO). Most patients received a preoperative intracavitary insertion (2500-4000 mgh to the uterus with Heyman capsules and tandem and 6500 cGy surface dose to the upper vagina) followed by a TAH-BSO within 6 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 deep myometrial invasion was present. Occasionally patients were treated with preoperative external beam irradiation (2000 cGy whole pelvis) and intracavitary insertion. The 5-year overall survival for all patients was 84.0% compared to an expected survival of 88.8%. The 5-year progression-free survivals were 92% for FIGO clinical Stage IA and 86% for stage IB (p = 0.12). The dose to the uterine fundus from the preoperative intracavitary insertion was found to have a significant correlation with progression-free survival in patients with grade 3 tumors. Those receiving less than 2500 mgh to the uterine cavity had a 48.9% 5-year progression-free survival compared to 62.7% for 2500-3500 mgh and 87.4% for those receiving greater than 3500 mgh. Analysis of sites of failure showed that less than 1% (7/858) failed in the pelvis alone, 3% (30/858) in the pelvis combined with distant sites, and 7% (60/858) developed distant metastasis only. The lateral pelvic sidewall was the most common site of failure within the pelvis (20/37) and intraperitoneal failures (28/90) and lung (21/90) were the most common sites of distant metastasis. The overall severe (grades 2, 3, and 4) complication rate was 2.7% (23/858).

Adenocarcinoma↗
PubMed1991

A simple method for determining breast and chest wall thickness.

When planning radiotherapy for primary breast cancer, it is essential to determine the thickness of the chest wall in mastectomized patients and of the intact breast in patients undergoing conservation therapy. A simple method, based on the use of the simulator, to determine breast and chest wall thickness is described.

Breast↗
PubMed1991

[Primary brain lymphoma].

Between 1973 and 1989, 739 patients with non-Hodgkin's lymphoma were referred here for treatment, of whom 10 (1.4%) had primary brain lymphoma (PBL) and 1 had acquired immunodeficiency syndrome (AIDS). There were 7 females and 3 males (mean age 58 years, range 35-77). Duration of symptoms ranged from several days to 3 weeks. The presenting symptoms were secondary to increased intracranial pressure. Computerized tomography (CT) performed in 8 revealed a solitary lesion in 7. Other CT scan features were various degrees of contrast enhancement, edema and midline shift. The most common site was the frontal lobe; infratentorially, the cerebellum was the most frequent site. The diagnosis was established in 8 patients by surgery and in 2 at autopsy. The most common subtype was the diffuse, large cell, immunoblastic lymphoma. 5 patients were irradiated following subtotal excision and 2 had combined radiation therapy and high-dose methotrexate-based chemotherapy; only 1 had no postoperative treatment. All patients treated by radiotherapy alone died within 3-5 months after diagnosis. The 2 who received combined therapy are alive, 15 and 48 months after diagnosis, respectively.

Adult↗
PubMed1991

The effect of in vitro irradiation on human NK cell activity. A preliminary report.

Natural killer activity of peripheral blood cells was evaluated after in vitro irradiation at doses ranging between 100 and 1600 cGy. Natural killer (NK) cells from normal donors exhibited a trend towards increased cytotoxicity peaking at about 600 cGy and then gradually decreasing. NK cells isolated from peripheral blood of cancer patients showed a lower baseline of activity, which was less affected by the same doses of in vitro irradiation. A distinction could be made between patients with early disease and those with advanced cancers; patients with early cancers showing NK activity close to that of normal donors.

Acute Disease↗
PubMed1991

Total-skin electron irradiation for cutaneous T-cell lymphoma: the Northern Israel Oncology Center experience.

Total-skin electron irradiation (TSEI) is effective and frequently used in the treatment of cutaneous T-cell lymphoma. A treatment technique has been developed at our center, using the Philips SL 75/10 linear accelerator. In our method, the patient is irradiated in a recumbent position by five pairs of uncollimated electron beams at a source to skin distance of 150 cm. This method provides a practical solution to clinical requirements with respect to uniformity of electron dose and low X-ray contamination. Its implementation does not require special equipment or modification of the linear accelerator, 19 of 23 patients (83%) with mycosis fungoides, treated by this method, achieved complete regression of their cutaneous lesions.

Adult↗
PubMed1990

Umbilical metastasis diagnosed by fine needle aspiration.

Fine needle aspiration (FNA) is emerging as a useful diagnostic tool in the evaluation of tumor masses, providing high diagnostic yield. Fine needle aspiration for cytologic evaluation was performed on 14 patients suspected of having umbilical metastasis. The site of the primary tumor was known in 12 patients. In nine patients with previously documented malignancy, FNA of the umbilical nodule demonstrated malignant cells compatible with the histologic diagnosis of the primary cancer. In five other patients metastatic umbilical nodule was the first or the only sign for the presence of primary cancer elsewhere and in four of them FNA revealed malignant cells prior to the diagnosis of internal carcinoma. In one case, FNA demonstrated only inflammatory cells while surgery revealed adenocarcinoma associated with inflammation. The sensitivity of FNA in diagnosing malignant umbilical nodule, and the accuracy of FNA findings were 98.2%, while the predictive value of a FNA cytologic finding of malignancy was 100%. It is recommended that an umbilical nodule should alert the clinician to the possibility of malignancy and FNA should be performed as the first diagnostic procedure. This safe, rapid, reliable, and inexpensive method may diagnose malignancy and preclude the need for umbilical biopsy or more complicated diagnostic intervention.

Abdominal Neoplasms↗
PubMed1990

Symptomatic pericardial effusion in lung cancer patients: the role of fluid cytology.

During the years 1975-1988, twenty lung cancer patients with symptomatic pericardial effusion were treated conservatively at our center. Echocardiography demonstrated small pericardial effusion in 2 patients, medium size effusion in 3 patients and large amount of fluid in 15 patients. Fifteen patients developed cardiac tamponade; in three of these patients, this was the presenting manifestation of lung cancer. Pericardiocentesis resulted in prompt, though temporary, symptomatic relief in all patients. Fluid cytology demonstrated suspected malignant cells in 2 patients and malignant cells in 13 patients. Based on cytology, the diagnosis of adenocarcinoma was established in six patients, small cell carcinoma in three patients, and epidermoid carcinoma in one patient. All patients were dead within 9 months from the time of diagnosis of pericardial effusion; 17 died within less than 3 months. It is concluded that pericardial effusion in lung cancer is indicative of rapid tumor progression and short survival. Fluid cytology provides an immediate and accurate means of diagnosis.

Aged↗
PubMed1990

Symptomatic pericardial effusion in breast cancer patients: the role of fluid cytology.

Clinical and cytologic findings in 21 breast cancer patients with symptomatic pericardial effusion are presented. The etiology of the pericardial effusion was definitely malignant, by cytology/histology in 13 patients (62%), and suspected malignant by cytology in 2 patients (9%). One patient (5%) with definitely nonmalignant pericardial effusion by cytology was found to be histologically positive at autopsy. In 5 patients (24%) there was no histological/cytological evidence of malignancy; radiation pericarditis could be the etiology in 4 of these 5 patients. The median time from the diagnosis of breast cancer to the development of symptomatic pericardial effusion was 60 months (range: 1-219 months). Ten patients developed cardiac tamponade; they were treated by either pericardiocentesis or pericardiectomy. The mean survival of patients with negative cytology/histology was 12 months; patients with suspicious cytology had a mean survival of 9 months; patients with malignant effusion, treated by pericardiectomy, had a mean survival of 22.3 months, while patients with malignant pericardial effusion, who were not subjected to surgery, had a mean survival of 4.7 months, only. It is concluded that the etiology of symptomatic pericardial effusion in breast cancer patients is not always malignant, which emphasizes the role of fluid cytology in establishing definite diagnosis. The survival probability is a function of the extent of extracardiac disease; among patients with malignant pericardial effusion those selected for pericardiectomy have a longer than average survival.

Adult↗
PubMed1989

Multiple primary thyroid and breast cancer in Israel, 1960-1976.

The occurrence of breast and thyroid multiple primary neoplasms has been evaluated using data from the Israel Cancer Registry. During the 16 years 1960-1976, 3,072 cases of thyroid cancer were registered in Israel. The occurrence of a second primary tumour was reported in 92 of these patients. In this latter group were 25 female patients (27%) with breast cancer, developing synchronously in 7 cases and metachronously in the remaining 18. The average age at the time of appearance of breast cancer was 50 years. Most of the patients (84%) were of European origin. The most common histological types were ductal and intraductal carcinoma and scirrhous adenocarcinoma. The possible aetiological factors common to breast and thyroid cancer are discussed. Efforts aimed at improving the survival of patients with thyroid cancer must incorporate strategies for the early detection and treatment of secondary breast cancer.

Adult↗
PubMed1989

Results of radiation therapy in early glottic carcinoma (T1, T2 N0).

Glottic carcinoma is curable by either surgery or radiotherapy. A total of 60 patients were treated by radiation alone at the Northern Israel Oncology Center, Rambam Medical Center, Haifa, between 1970 and 1980. Twenty-nine (48%) were classified as T1 N0 and 31 (52%) as T2 N0. All patients received radiotherapy primarily with curative intent, with surgery reserved for recurrences. The 5-year actuarial survival for all patients was 90% and actuarial disease-free survival was 95%. In ten patients (17%) there was local failure, and five of them were salvaged by surgery. There were no significant acute or long-term complications of radiation. Factors influencing treatment outcome (anterior commissures involvement, degree of differentiation, treatment volume, and technique of irradiation) and the occurrence of second primary malignancies are discussed.

Adult↗
PubMed1989

Non-Hodgkin's lymphoma in northern Israel: a study of 481 patients with emphasis on ethnic-related patterns.

During the period between 1970-1984, 481 patients with previously untreated non-Hodgkin's lymphoma were referred to the Northern Israel Oncology Center, Haifa. There were 264 (54.9%) Ashkenazi Jews, 123 (25.6%) non-Ashkenazi Jews, and 86 (17.9%) Arabs. The mean age at diagnosis was 60 +/- 15 years for Ashkenazi Jews, 45 +/- 22 years for non-Ashkenazi Jews, and 36 +/- 22 years for Arabs. Ashkenazi Jews had a higher rate of nodular lymphoma compared to non-Ashkenazi Jews and Arabs. Extranodal lymphoma occurred more frequently in non-Ashkenazi Jews and Arabs. Lymphoma of the small intestine was more common in Arabs than in Ashkenazi and non-Ashkenazi Jews. Despite these differences in the pattern of disease, 5 year actuarial survival figures for the various ethnic groups were similar.

Adult↗
PubMed1989

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

One hundred and sixteen patients with stages A2, B, and C histologically proven adenocarcinoma of the prostate were treated by definitive radiation. They received first whole pelvic irradiation, 46 Gy in 23 treatments, followed by a prostatic "boost" of 20 Gy in 10 fractions. Five-year survival rates varied between 39 and 84%. Prophylactic hormonal manipulation and transurethral resection of the prostate (TURP) did not influence survival figures. Complications of radiotherapy were in an acceptable range. It is concluded that external beam irradiation is an effective, simple, and usually well-tolerated treatment modality for localized carcinoma of the prostate. Stage and degree of differentiation and response of the primary tumour to radiation are predictors of patient outcome. There is no advantage in prophylactic hormonal manipulation, and TURP does not influence survival according to our experience.

Adenocarcinoma↗
PubMed1989

Results of radiotherapy in recurrent endometrial carcinoma: a retrospective analysis of 51 patients.

A retrospective analysis was performed of 51 patients with locoregional recurrence of endometrial carcinoma, treated by radiotherapy between 1959 and 1986. There were 17 patients (33%) with isolated vaginal recurrence, 12 patients (24%) with vaginal recurrence with pelvic extension, 7 patients (14%) with pelvic recurrence only, and 15 patients (29%) with simultaneous locoregional and distant failure. Eighty percent of the recurrences occurred within 3.5 years from primary treatment; time to relapse was shorter in patients with advanced-stage, high-grade malignancy at original diagnosis. Locoregional control was achieved in 18 patients (35%). Complete tumor regression in the vagina, irrespective of extravaginal pelvic disease status or distant metastasis, occurred in 28 of 34 patients with vaginal involvement (82%). The 5- and 10-year overall actuarial survivals for all patients were 18 and 12.5%, respectively. The 5- and 10-year progression-free survivals of patients with isolated vaginal recurrences were 40% and 29%, respectively; the 5-year progression-free survival of patients with vaginal recurrence with pelvic extension was 20%. There were no survivors beyond 1.5 years among patients with pelvic recurrence (p = 0.02). All patients with simultaneous locoregional and distant failure were dead by 3.5 years. Stage at original diagnosis, time to relapse from primary treatment, histologic pattern, and grade of malignancy were prognosticators of survival. Five patients (10%) developed a total of ten radiation-related sequelae.

Aged↗
PubMed1989

Results of radiotherapy in stage I to II extranodal non-Hodgkin's lymphoma of the head and neck.

29 patients with previously untreated clinical stage I and II extranodal non-Hodgkin's lymphoma of the head and neck received involved or extended field radiotherapy at the Northern Israel Oncology Center during the years 1968 to 1979. Complete initial locoregional control was achieved in all patients; however, 18 patients (62%) relapsed. Two of the relapsing patients (11%) had "in field" failure, and one (6%) had "marginal" failure, with no evidence of disease elsewhere. 13 of the relapsing patients (72%) failed at distant sites, and two of these (11%) both locally and systemically. 13 of 15 patients (87%) with lymphoma of Waldeyer's ring relapsed, most commonly in the abdominal cavity. Only one of seven patients (14%) with lymphoma of the paranasal sinuses recurred. The five- and ten-year actuarial survival of all patients was 50% and 46%, respectively. While patients with lymphoma of the paranasal sinuses had a survival probability of 86% at ten years, patients with disease originating in Waldeyer's ring had an actuarial ten-year survival of 18% only. The prognosis of younger patients was better than the prognosis of patients older than 65. Although this series is too small and heterogeneous to derive definite treatment recommendations, it is suggested that radiotherapy to doses of 4000 to 6000 cGy can control most local disease. The overall results of radiation therapy alone have been unsatisfactory in our patients with lymphoma of Waldeyer's ring and the parotid gland due to failure outside the locally treated area, frequently in the abdominal cavity. Precise staging procedures are needed to detect sites of occult disease which require the use of systemic chemotherapy. It is felt that adequately staged, localized, small size non-Hodgkin's lymphoma of the paranasal sinuses can be treated by radiotherapy alone without loss of curability.

Actuarial Analysis↗
PubMed1988

Subclavian artery occlusion after radiotherapy for carcinoma of the breast.

Disturbance of the arterial circulation in the ipsilateral upper limb following mastectomy is a rare sequel attributed to adjuvant radiotherapy. A review of the literature revealed 20 such cases, and two more are presented. Different mechanisms of injury leading to arterial occlusion have been proposed. This is a late complication with a considerable time lag between irradiation and onset of symptoms. The symptoms vary in type and severity, but are consistent with peripheral occlusive arterial disease. To alleviate symptoms and prevent limb loss, reconstructive vascular surgery is advocated, and was successfully performed in one of our patients.

Aged↗
PubMed1988

Carcinoma of the nasopharynx in Northern Israel: epidemiology and treatment results.

Between 1968 and 1984, 49 patients with carcinoma of the nasopharynx were treated at the Northern Israel Oncology Center. There were 6 stage I-II patients (12%) and 43 stage III-IV patients (88%). According to ethnic origin, there were 27 (55%) non-Ashkenazi Jews, 9 (18%) Ashkenazi Jews, and 13 (27%) Arabs. This distribution is different from the percentages of these ethnic groups in Northern Israel. All patients received combined cobalt 60 and 8-10 MeV electron beam radiotherapy to the primary tumor and the entire neck. Twelve stage III-IV patients received three courses of chemotherapy using bleomycin, methotrexate, and cisplatin (BMP) prior to definitive radiotherapy. The following 5-yr actuarial survival figures were achieved: all patients, 42%; stage I-II, 63%; stage III-IV, 37%; Arabs, 53%, non-Ashkenazi Jews, 47%; Ashkenazi Jews, 22%; BMP+radiotherapy, 54%; radiotherapy alone, 42%. It is concluded that there is an ethnic-related pattern of nasopharyngeal carcinoma in Northern Israel. Prognosis is better in non-Ashkenazi Jews and Arabs with early-stage lymphoepithelioma or anaplastic carcinoma, younger than 45 yr old, and receiving more than 5,500 cGy. Chemotherapy by BMP improves initial control rates with questionable benefit to long-term survival.

Adolescent↗