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Biomedical subjects

B J Cummings

Publications and source records attributed to B J Cummings.

At least 91 records · Page 5Linked to original sources
PubMed1989

Complications and functional results after limb-salvage surgery and radiotherapy for difficult mesenchymal neoplasms: a prospective analysis.

Wide resection with adjuvant radiotherapy is generally accepted as the optimal treatment for patients with extremity soft-tissue sarcomas. However, there is a subset of patients with "difficult" tumours who sustain such marked loss of function from limb-salvage procedures that amputation might offer a superior functional alternative. To evaluate this issue, the authors prospectively designated 19 of 52 patients registered in Toronto's Princess Margaret Hospital Prospective Sarcoma Database in 1986 as "difficult" cases, on the basis of tumour size and anatomical location. Complications and functional results of wide resection and adjuvant radiotherapy were documented. The most frequent complication was related to wound healing (8 of 19 patients). Functional analysis at 1 year follow-up demonstrated that all 19 patients had results superior to those that would be expected with amputation.

Adult↗
PubMed1988

The place of radiation therapy in the treatment of squamous cell carcinoma of the nasal vestibule. A review.

Radiation therapy and limited resection give equally good results in early squamous cell carcinomas of the nasal vestibule, each producing local control rates of 90% or more. For more extensive disease, primary radiation therapy with surgery reserved for residual or recurrent carcinoma is recommended in view of the significant cosmetic defects which generally follow major resection. Small and superficial lesions can be treated by external beam therapy or interstitial implants. Large or infiltrative lesions are best managed by external beam therapy. Serious late morbidity following irradiation is uncommon and has been reported in fewer than 5% of patients. Regional nodal metastases are diagnosed at the time of first presentation in about 5% of patients and signal a very poor prognosis. However, the data available do not support elective treatment of clinically uninvolved regional nodes. Fewer than 5% of patients manifest late nodal metastases when the primary tumor area remains free of recurrence, and most of these metastases can be controlled by neck dissection and/or irradiation.

Carcinoma, Squamous Cell↗
PubMed1988

The role of surgery in the treatment of squamous cell carcinoma of the nasal vestibule.

A retrospective analysis of 61 patients who were treated for squamous cell carcinoma of the nasal vestibule is presented. The general policy was to treat these carcinomas with radiation therapy, in view of the perception that this leads to a more acceptable cosmetic result. The primary nasal carcinoma was treated by surgery in five patients and by radiation in 56 patients. Surgical salvage of recurrent carcinoma in the nasal vestibule was performed without complications in 12 patients and resulted in local control in seven. Regional node metastases present at the time of diagnosis in two patients were not controlled by combined radiation and surgery. Late-developing regional node metastases were successfully managed by node dissection in three of four patients. The policy of initial treatment of the primary tumor by radiation, reserving surgery for the management of residual or metastatic cancer, resulted in good control rates and cosmesis.

Carcinoma, Squamous Cell↗
PubMed1987

Current management of epidermoid carcinoma of the anal canal.

Treatment with a combination of radiation therapy and chemotherapy currently allows about 80 per cent of patients with epidermoid carcinomas of the anal canal to retain anorectal function, with about a 70 per cent likelihood of cure at 5 years. In these programs, radical surgery is reserved for the management of residual cancer or of radiation- or chemotherapy-induced anorectal toxicity. Several different schedules of combined modality therapy are in use, but an important common element in most schedules appears to be the concurrent administration of radiation and 5-fluorouracil. The improvement in local control rates with combined radiation and chemotherapy, as compared to most series treated by either radical radiation or radical surgery, has not been matched by a marked improvement in survival rates, and the risk of distant metastases does not appear to have been altered by these combinations. The success of the combinations in improving local control has allowed the indications for local excision to be defined more narrowly, and should reduce the risks of local recurrence associated with conservative surgery.

Anus Neoplasms↗
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

External irradiation for squamous cell carcinoma of the nasal vestibule.

A retrospective analysis of 56 patients who underwent primary external irradiation for squamous cell carcinoma of the nasal vestibule between 1958 and 1983 is presented. The overall 5 year actuarial survival and cause specific survival rates were 64 and 87%, respectively. The 5-year local relapse-free rate after primary irradiation was 80%. Prognostic factors which lowered the local control rate after irradiation included a primary tumor size of 2 cm or more, or involvement of the skin of the ala nasi, columella, lip, cartilage, or bone. Local control was improved in patients who received a tumor dose equivalent to, or greater than, 5500 cGy/25 fractions/5 weeks. Only two patients in whom the primary tumor was controlled developed regional nodal metastases, and elective regional nodal irradiation is not recommended. Four patients (9%) developed significant late morbidity after irradiation. External irradiation is effective treatment for squamous cell carcinoma of the nasal vestibule, and produces high local control and cure rates and good cosmetic results.

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↗
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↗
PubMed1984

The treatment of glomus tumors in the temporal bone by megavoltage radiation.

Forty-five patients with glomus tumors in the temporal bone region were treated by radiation therapy. Only three patients had recurrence or progression of tumor during the follow-up period of 3 to 23 years (median, 10 years). No patient died from uncontrolled glomus tumor. The majority of patients noted symptomatic relief after radiation, but objective neurologic deficits usually remained unchanged or showed only partial improvement. The most commonly used radiation dose was 3500 cGy tumor dose delivered in 15 fractions in 3 weeks by a homolateral wedge technique from megavoltage radiation apparatus. This dose is less than that usually recommended for glomus tumors. From these results and from review of the literature, it is suggested that a moderate radiation dose of 3500 cGy in 3 weeks is effective treatment for glomus tumors, even if complete tumor involution does not occur.

Adolescent↗
PubMed1984

Ameloblastoma of the jaw. A reappraisal of the role of megavoltage irradiation.

Ten patients with ameloblastoma of the jaw were treated with megavoltage irradiation between 1958 and 1982. Seven cases were treated with radiation alone and six responded initially. One patient subsequently recurred and was successfully salvaged surgically. Three patients were treated with combined radiation therapy and surgery. Carefully applied megavoltage irradiation has a useful role in the management of ameloblastoma, particularly in large maxillary tumors with associated destruction of the infrastructure of the maxillary antrum. It is apparent from this series, and from the literature, that the ameloblastoma is not an inherently radioresistant tumor.

Aged↗
PubMed1984

Adjuvant radiation therapy for rectal adenocarcinoma.

Adjuvant pelvic radiation is intended to reduce the incidence of pelvic tumor recurrence and improve the survival rates of patients who have "curative" resections for adenocarcinoma of the rectum. The results of trials of preoperative radiation of up to 2500 cGy in two weeks have been disappointing. However, studies with preoperative or postoperative radiation doses of 4500 cGy in five weeks or more suggest that the risk of pelvic recurrence can be reduced to 15 per cent or less, although follow-up in most studies is too brief to allow any comment on changes in survival rates. These promising results need to be confirmed, since most were not obtained in appropriately controlled studies. Although these higher radiation doses do appear to be safe when attention is paid to surgical and radiotherapy techniques, this also needs to be confirmed with larger numbers of patients and longer follow-up. While the studies suggest that higher radiation doses are more effective than lower doses, there is no agreement on whether radiation should be directed to the region of the primary tumor only, or also to the pelvic lymph nodes, nor whether radiation should be given before or after surgery. Although the use of adjuvant pelvic radiation is becoming more widespread, these and other questions need to be answered before adjuvant radiation can be considered standard therapy.

Adenocarcinoma↗