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Biomedical subjects

A R Harwood

Publications and source records attributed to A R Harwood.

At least 19 recordsLinked to original sources
PubMed1999

Radiotherapy of acral lentiginous melanoma of the foot.

Four previously unreported cases of acral lentiginous melanoma of the foot treated by radiation are reported. All patients, for a variety of reasons, were not suitable for complete surgical excision. Three large doses of radiation were employed using the 0, 7, 21 technique. Local response of the melanoma to radiotherapy was excellent and all patients were well palliated by the treatment. This treatment of acral lentiginous melanoma is recommended in patients with this diagnosis who, due to age, medical condition, or the presence of metastasis, are not suitable for standard treatment (surgery).

Aged↗
PubMed1994

Cancer of the esophagus in Acadiana.

Cancer of the esophagus is a frequently fatal cancer whose incidence appears to be increasing. In Acadiana, esophageal cancer occurs predominantly in males, with a higher incidence in black males. Results of surgical treatment, with or without other therapy, are dismal. Combined treatment with chemotherapy and radiotherapy improved survival when compared to surgery. Survival benefits with chemotherapy and radiotherapy are, unfortunately, modest at present.

Adenocarcinoma↗
PubMed1988

T3N0M0 glottic carcinoma--a failure analysis.

There is at present considerable controversy regarding the appropriate management of a patient who presents with a T3N0M0 glottic carcinoma. This paper presents the results for 141 patients presenting clinically with T3N0M0 glottic carcinoma between 1964 and 1981 and treated with primary radiotherapy reserving surgery for residual or recurrent disease. The actuarial survival for the entire group of patients was 50.5% at 5 yr; 28% of the patients died of glottic cancer. The local relapse-free rate achieved with radiotherapy was higher in female patients (68%) than male patients (41%) (P = 0.04); the local relapse-free rate was higher in males 60 yr of age or older (46%) than in males 59 yr of age or younger (31%) (P = 0.02). Involvement of all three laryngeal regions and initial tracheotomy were associated with a high primary failure rate. Fifty-nine per cent of patients alive at 5 yr retained and intact and functioning larynx. The time up until diagnosis of recurrence and the number of endoscopies required to establish recurrent or residual disease were all assessed with respect to their effects on survival and were shown to have no significant impact. Methods of improving the results of treatment for those patients with a high primary failure rate following radiotherapy are discussed.

Adult↗
PubMed1986

Prognostic significance of thyroid gland involvement in laryngeal carcinoma.

We reviewed 173 laryngeal specimens that included thyroid tissue received from patients undergoing laryngectomy between 1966 and 1980 for evidence of thyroid gland invasion. Twenty-three (14%) of the larynges demonstrated thyroid involvement. In 15 specimens, involvement of the thyroid gland was by direct extension, and in eight the thyroid was involved metastatically. The survival in this group of patients was poor, with 18 patients dying of their disease within three years. Subglottic extension of 10 mm or greater was noted in 21 of 23 patients, and local recurrence was noted in 15 of 18 patients dying of their disease. The importance of removing one or both lobes of the thyroid gland in advanced laryngeal cancer is restated, and a surgically aggressive approach to the paratracheal nodes is recommended in patients with extensive subglottic involvement.

Adult↗
PubMed1986

Radiotherapy of Kaposi's sarcoma.

Between 1958 and 1983, 91 patients with Kaposi's sarcoma were referred to the Princess Margaret Hospital. Eight patients received no specific therapy immediately following their first assessment. Twenty-seven patients were treated by local field radiotherapy, of whom 17 entered complete remission and 6 have remained relapse-free. Fifty-six patients received extended field radiotherapy, usually a single fraction of 8 Gy megavoltage gamma-ray or photon therapy; 38 achieved completed remission, and 24 have remained relapse-free for a median duration of 3 years. The actuarial relapse-free survival for patients treated by local versus extended field radiotherapy significantly favors the extended field technique although the rates of relapse after complete remission has been achieved appear similar. Immunosuppression was present in 12 patients prior to the diagnosis of Kaposi's sarcoma; these patients had a similar response rate to radiation therapy to those who were not known to be immunosuppressed. A rationale for management, and radiation technique and dose are discussed. It is concluded that radiotherapy is an effective treatment for most forms of Kaposi's sarcoma.

Adult↗
PubMed1986

Ewing's sarcoma: a trial of adjuvant chemotherapy and sequential half-body irradiation.

The results of a pilot study using adjuvant chemotherapy and sequential half-body irradiation (HBI) for nonmetastatic Ewing's sarcoma are presented. Seventeen patients received Cyclophosphamide, Vincristine, and Adriamycin (8 cycles), followed by sequential radiation treatment of the upper (500 cGy) and lower (600 cGy) half body. Survival at 3 years was 49%. These results are contrasted with those for 18 concurrently treated patients who received standard adjuvant therapy. Overall 5-year survival and relapse-free survival for these 35 consecutive patients was 61 and 53%. The pilot protocol was given on an out-patient basis with limited and acceptable acute toxicology. Further study is necessary to determine the value of the pilot protocol.

Adolescent↗
PubMed1986

A pilot study of mitomycin-C/5-fluorouracil infusion combined with split course radiation therapy for carcinomas of the larynx and hypopharynx.

Fifty-seven patients with advanced squamous carcinoma of the larynx and hypopharynx were entered on a pilot study of initial therapy using split course radiation therapy combined with simultaneous chemotherapy using mitomycin-C and 5-fluorouracil. The treatment was well tolerated with 90% of patients completing their planned radiation treatment. Seventy percent of this group completed their planned chemotherapy. Significant hematological toxicity was not observed. Survival and loco regional control at one and two years of follow-up were considered at least comparable to that achieved with conventional single-course radical radiation therapy as primary treatment. Based on these results a randomized trial of this radiation-chemotherapy regimen compared to radiation therapy alone as initial therapy is in progress.

Adult↗
PubMed1986

New perspectives.

Explore the source record for details and available documents.

Brachytherapy↗
PubMed1985

Postoperative local abdominal irradiation for cancer of the colon above the peritoneal reflection.

A retrospective analysis of 82 patients with cancer of the colon above the peritoneal reflection who received postoperative local abdominal irradiation was undertaken to assess the survival, patterns of failure, and toxicity of treatment. Forty-eight patients (adjuvant group) had a complete resection, but were felt to be at high risk for local relapse and received postoperative local abdominal irradiation. Thirty-four patients had gross residual disease following surgery. The 5-year actuarial survival and local relapse free survival were 67 and 67%, respectively, in the adjuvant group. In this group, local relapse was observed in 9 of 28 patients with Stage C disease in contrast to 3 of 20 patients with Stage B2 disease; 1 of 14 patients with lesions in the right colon failed locally compared to 11 of 35 patients with lesions in the left. Only 2 of the 34 patients with gross residual disease remained relapse free from 93% of patients having a component of local failure. The majority of the treatment morbidity was seen in patients with gross residual disease. Prospective randomized studies should be done to determine the efficacy of postoperative irradiation in patients with colon carcinoma who are at high risk for local recurrence following surgical resection.

Abdomen↗
PubMed1985

Carcinoma of the tonsil: the effect of dose-time-volume factors on local control.

Between 1970 and 1979, 372 patients with squamous cell carcinoma of the tonsil were treated with primary irradiation therapy, with salvage surgery for failures. The median age was 60 years and the male to female ratio was 2:1. The staging system used was the 1974 UICC TNM system. There were 47 T1 lesions (13%), 161 T2 lesions (43%), and 164 T3 lesions (44%). Regional nodes were not palpable in 173 (46%); 122 had N1 nodes (33%), 6 had N2 nodes (2%) and 71 had N3 nodes (19%). All patients received external beam radiation which was supplemented in 68 patients with a radioactive implant for disease into adjacent tongue. The overall survival for all patients was 38% at 5 years and 54% when corrected for intercurrent disease. Local control was 87% for T1 lesions, 68% for T2 lesions and 50% for T3 lesions. Regional control was 96% for N0, 67% for N1 and 37% for N2-3. A detailed dose-time-volume analysis revealed that increasing volume improved local control in T1 and T2 lesions (77% had local control if the volume was greater than 80 cm2 versus 53% if the volume was less than 80 cm2, p = 0.014), except for T3 lesions. Increasing the dose in the range of 5000 to 6500 rad had no significant effect on primary control in any stage of disease. The addition of a radioactive implant did not increase local control if disease extended into the tongue (57% local control if implant, 52% if no implant). This study demonstrates the significance of adequate treatment volume in local control for carcinoma of the tonsil. No significant dose response was found and subsequent surgery was not compromised when a moderate dose of radiation was used.

Adult↗
PubMed1985

Radical radiation therapy with 5-fluorouracil infusion and mitomycin C for oesophageal squamous carcinoma.

Thirty-five patients with clinically staged non-metastatic squamous carcinoma of the oesophagus were treated with radiation combined with mitomycin C, and 5-fluorouracil (5-FUra) infusion. Twenty patients were planned for a split course regimen 2250-2500 cGy in 10 fractions and chemotherapy. This dose of radiation to be repeated with another course of chemotherapy after 4 weeks rest. Fifteen patients were planned for a single course 4500-5000 cGy in 20 fractions and a single course of chemotherapy. Thirty-one patients are available for a minimum follow-up of one year, 26 patients for a minimum follow-up of 2 years. All 35 patients are included in the survival and local relapse-free analysis. Survival at one year is 47% and at 2 years 28%. The local relapse-free rate at both one and 2 years is 48%. There was an improvement in survival and local relapse-free rate for the single course regimen compared to the split course; 2 years survival 48% versus 12% (p = 0.24) local relapse-free rate 79% versus 27% (p = 0.07). All patients receiving radiation and chemotherapy were compared with historical controls treated by radiation alone. This matching procedure was done independent of knowledge of outcome (two controls were matched/case). Patients were matched for age, sex. TNM stage, and total radiation dose. There was a significant difference in survival p = 0.004 and local relapse-free rate p = 0.05 for patients receiving radiation and chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Primary subglottic carcinoma masquerading clinically as T1 glottic carcinoma--a report of nine cases.

In a clinical and pathological study of patients who had failed radiotherapy for T1 glottic carcinoma, nine patients were encountered who presented with hoarseness, and were considered clinically to have glottic carcinoma at an early stage. Whole organ sections of the laryngectomy specimens showed them to be tumors arising in the subglottic region with involvement of the vocal cord as a late manifestation of their disease. The clinical and pathological features of these nine patients and their tumors are discussed with emphasis on how the diagnosis may be made prior to embarking upon therapy.

Adult↗