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Biomedical subjects

B Hilaris

Publications and source records attributed to B Hilaris.

At least 37 records · Page 2Linked to original sources
PubMed1984

Comparison of conventional surgical resection, radioactive implantation, and bypass procedures for exocrine carcinoma of the pancreas 1975-1980.

To examine the efficacy of a variety of procedures for treatment of biopsy proven exocrine adenocarcinoma of the pancreas, a retrospective review of 231 patients surgically treated at a single institution from January 1975 through December 1980 was performed. Thirty-nine patients underwent resection for cure, of which 19 were conventional resection, 33 I125 implantation, 76 biliary or GI bypass, and 83 biopsy alone, a resectability rate of 16.9%. There was one pancreatic fistula in the implant group. Median survival following implant was 8 months (0%, 30-day mortality) and, for conventional resection (n = 19), 17 months with an inhospital mortality of 16%. Median survival excluding inhospital mortality was 17 months for the conventional resection group. For bypass, median survival was 4 months (p = 0.0001 vs. conventional resection) with an inhospital mortality of 14%. Of patients discharged from hospital, 5 of 16 (31%) survived 2 years in the conventional resection group, while 4 of 132 (3%) survived 2 years in the nonresected groups. Only one patient (5% of resected) has survived 4 years in the conventional resection group, although eight others are alive and at risk in this group. Resectability rate for patients referred with adenocarcinoma of the pancreas remains low. The only long-term survivors are in those patients undergoing resection. Local implantation with I125 requires prospective evaluation because of an apparent influence on palliation without significant morbidity.

Adenocarcinoma↗
PubMed1984

Anesthesia for the application of endotracheal and endobronchial radiation therapy.

High-activity remote afterloading was recently adapted at Memorial Sloan-Kettering Cancer Center for the treatment of carcinoma of the lung recurrent to the major airways. An anesthesia approach is presented which aids in the performance of this beneficial procedure. The remote afterloader is a device containing a high-intensity radioactive source which is applied intraluminally to control both endobronchial and endotracheal tumors. The patient is intubated with an endobronchial or endotracheal tube which facilitates passage and measurement of the Gamma Med catheter. The potential usage for airway maintenance is a secondary benefit. After bronchoscopic placement is verified radiographically, computerized treatment is initiated. The several advantages of this technique are presented.

Anesthesia, Endotracheal↗
PubMed1983

Cisplatin, vindesine, and bleomycin chemotherapy of local-regional and advanced esophageal carcinoma.

Seventy-one patients with epidermoid carcinoma of the esophagus were treated with a three-drug combination of cisplatin, vindesine, and bleomycin. Forty-five patients had local-regional tumor and received chemotherapy prior to surgery or radiation therapy. Twenty-six patients with extensive disease were treated primarily with chemotherapy alone. The overall major objective response rate to cisplatin-vindesine-bleomycin was 53 percent (36 of 68 evaluable patients). Patients with local-regional disease had a higher response rate than those with extensive disease (63 and 33 percent, respectively). Following preoperative chemotherapy, 34 patients with local-regional disease underwent exploration. Resectable disease was present in 82 percent. There was no increase in operative morbidity or mortality (5.6 percent), when compared with historical control groups. The median survival for the preoperative chemotherapy group was 16.2 months, which is superior to that of a historical control group (p = 0.023). For patients with extensive disease, treated primarily with chemotherapy alone, the median duration of response was seven months. Toxicities of cisplatin-vindesine-bleomycin were in general well-tolerated, and included nausea and vomiting (seen less frequently because of extensive use of metoclopramide), alopecia, nephrotoxicity, and peripheral neuropathy. The dose-limiting toxicity was myelosuppression. Although conventional chemotherapeutic agents have little activity, these results indicate that the investigational combination of cisplatin, vindesine, and bleomycin can induce major regressions in a substantial proportion of patients with esophageal cancer. When this drug combination is used preoperatively, high resection rates and possibly improved survival are seen.

Adult↗
PubMed1983

The role of radioactive colloids in malignant peritoneal mesotheliomas.

Malignant peritoneal mesothelioma remains a therapeutic problem. A review of the use of intraperitoneal 32P and a review of the status of therapy for this disease are presented. Six patients treated with 32P and combinations of external radiation therapy, surgery, and chemotherapy are reviewed with survival times from 5 months to 18 years. Overall survival in this disease is poor, about 44.2 months. This series suggests that with combined therapy with intraperitoneal 32P and chemotherapy, longer survivals can be achieved.

Adolescent↗
PubMed1983

Clinical and pathological evaluation of response to chemotherapy in patients with esophageal carcinoma.

Pretreatment clinical staging, radiographic response to chemotherapy, and posttreatment pathological staging were assessed in 39 patients with epidermoid carcinoma of the esophagus. Thirty patients received combined modality therapy with cisplatin, vindesine, and bleomycin followed by surgery; nine patients were treated with the same chemotherapy with or without radiation therapy. Using barium esophagrams as the measure of response, radiographic objective regressions were quantitated and considered as complete (CR), partial (PR), and minor or no radiographic response. Sixty percent of patients had CR or PR. However, surgical or endoscopic restaging showed residual microscopic or macroscopic disease in nine patients, with complete radiographic regression. Downstaging of the primary tumor following chemotherapy (pretreatment clinical staging as compared to posttreatment pathological staging) was common. Chemotherapy-induced objective regressions in esophageal carcinoma can be achieved frequently and can be quantitated, using serial barium esophagrams. Complete radiographic regressions should be confirmed by repeat endoscopy or surgery. Downstaging of the primary tumor is commonly noted in responding patients, but it is too soon to determine whether or not this will effect their long-term prognosis.

Antineoplastic Agents↗
PubMed1982

Combination chemotherapy of esophageal carcinoma using cisplatin, vindesine, and bleomycin.

Sixty-one patients with epidermoid carcinoma of the esophagus have been treated with a three drug combination of cisplatin, vindesine, and bleomycin. Of 53 patients currently evaluable for response, 29 (55%) have had partial remissions: 7/16 with metastatic, and 22/37 with local-regional disease. The median duration of response in metastatic patients is eight months. Of 28 patients treated preoperatively, 23 (82%) had resectable disease. The major toxicities seen were nephrotoxicity and myelosuppression. Cisplatin, vindesine and bleomycin is an effective combination in the treatment of esophageal carcinoma. Effects on long-term survival cannot yet be evaluated.

Acute Kidney Injury↗
PubMed1982

125I implantation for carcinoma of prostate. Further follow-up of first 100 cases.

Analysis of the first 100 patients at the Memorial Sloan-Kettering Cancer Center with Stage B or C prostatic cancer treated by pelvic lymph node dissection and Iodine-125 implantation and endocrine therapy when specifically indicated revealed five-year survival rates of 87 and 77 per cent, respectively. Tumor stage, tumor grade, and lymph node metastasis each correlated with survival, but the latter was the most significant factor. Although routine follow-up biopsies were not performed, local tumor control as judged by serial digital rectal examination defined a prognostically favored group of patients. In the absence of controls, however, whether the latter response indicates a salutary effect of the treatment which produces an improved survival or merely identifies a group of patients who were predetermined to have a more favorable survival is undetermined.

Brachytherapy↗
PubMed1976

Pleural mesothelioma.

Seventy-six patients with pleural mesothelioma were seen at Memorial Hospital from 1939 to 1972. There were 10 with benign and 66 with malignant mesotheliomas. The latter were histologically divided into 39 epithelial and 27 fibrosarcomatous types. Main symptoms were chest pain, dyspnea, and cough. Most of the patients with malignant disease had clinical and radiologic evidence of effusion with or without an intrathoracic mass. Thirty-seven patients had primary untreated mesothelioma and 29 patients had disease that had previously been treated elsewhere. Treatment at Memorial Hospital consisted of surgery, with or without radiation therapy, and supplemental chemotherapy. Survival was related to extent of disease and to treatment. In patients with epithelial mesothelioma confined to the hemithorax, resection was associated with a median survival of 21 months. When irradiation was the primary treatment, the median survival was 8 months. In fibrosarcomatous mesotherlioma, the median survival with resection was 11 months and with radiation, 9 months. Median survival in patients with advanced or recurrent disease was 3 to 6 months. It is concluded that epithelial mesotherlioma with diffused pleural involvement continues to carry a grave prognosis. Better survival is obtained where pleurectomy with resection of the bulk of the tumor is combined with external irradiation and systemic chemotherapy. In fibrosarcomatous mesothelioma, complete resection offers a significant chance of long-term survival. In patients with benign mesothelioma, none had recurrence nor died of disease after adequate resection.

Adolescent↗
PubMed1975

The influence of dose fractionation on acute and late reactions in patients with postoperative rasiotherapy for carcinoma of the breast.

The clinical courses of 418 patients with breast carcinoma who received postradical-mastectomy radiation therapy to the internal mammary and supraclavicular are were revied in order to determine the normal tissue tolerance with various time-dose fractionation radiation regimens. Four different dose fractionation schedules wereemplyed during the period 1958-1968 at Memorial Hospital: 4900 rads/10f/32d; 4410 rads/9f/30d; 5000 rads/13f/18d; and 4600 rads/20f/28d. There was no difference in the acute reaction or local recurrence rate of the tumor in the irradiated area among the four fractionation schemes, but the late effects were quite different. Patients who received 4900 rads in 10 fractions in 32 days had a 33% incidence of subcutaneous fibrosis.A similiar dose in 13 fractions in 21/2-3 weeks resulted in about 17% subcutaneous fibrosis. No significance of these clinical findings is discussed in relation to the various formulae currently being used to express time-dose equivalence.

Breast Neoplasms↗
PubMed1975

Iodine 125 source in interstitial tumor therapy. Clinical and biological considerations.

Our clinical experience with interstitial tumor therapy is presented in 2 groups of patients: 98 patients with metastatic carcinoma in neck lymph nodes implanted with iodine 125, iridium 192 or radon 222 encapsulated sources, and 105 patients with primary unresectable lung tumors, which were implanted either with radon 222 or iodine 125 seeds. The local tumor control rates with iodine 125, radon 222 and iridium 192 were 78 per cent (38/49), 65 per cent (15/23) and 58 per cent (7/12), while the local complication rates were 17 per cent, 35 per cent and 43 per cent, respectively. An analysis of the tumor control rate as a function of the implanted tumor dose shows that the iodine 125 implants with a delivery of the minimal effective tumor dose of 16,000 rads have a higher therapeutic effect than either radon 222 or iridium 192. The results of the patients with unresectable lung tumors similarly show that the implants with iodine 125 sources are superior to those with radon 222. The advantages could stem from the better spatial dose distribution, and from radiobiologic considerations associated with low dose rates, continous irradiation, and possibly gains in RBE. There present clinical data clearly demonstrate that iodine 125 seeds have a higher therapeutic ratio than radon 222 seeds. There are, in addition, distinct physical advantages making iodine 125 an attractive substitute for radon 222 for the interstitial implantation of malignant tumors.

Head and Neck Neoplasms↗