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Biomedical subjects

B Langholz

Publications and source records attributed to B Langholz.

66 records · Page 4Linked to original sources
PubMed1989

Surgical therapy and radiotherapy for carcinoma of the esophagus. Treatment results in 195 patients.

Between 1963 and 1986, 195 patients with carcinoma of the esophagus were seen in the Department of Radiation Oncology at the University of Southern California School of Medicine. Of these 195 patients, 137 had unresectable or inoperable tumors and received radiotherapy. A combination of radiotherapy and surgical therapy was used in 46 patients, 9 patients were treated with surgery alone, and three with chemotherapy alone. Among the nonsurgical patients, 13 scored less than 50 on the Karnofsky scale, 25 had distant metastases, and 69 lost more than 10% of their body weight. The majority (94%) had squamous cell carcinoma and a few (6%) had adenocarcinoma. Fifty percent had middle esophageal lesions, 30% had lower lesions, and 20% had upper esophageal lesions. Stage I was diagnosed in 13%, II in 27%, III in 29%, and IV in 27%; the disease was not staged in 5%. The 5-year actuarial survival rate for all patients was 4% (median 32 weeks). The 5-year survival rate of the 46 patients with combination therapy was 18%, and it was 2% for the remaining 149 patients (p less than 0.001). These figures are independent of stage of disease. The 2-year survival rate by stage was as follows: I, 25%; II, 21%; III, 5%; and IV, 0% (p less than 0.001). Complete response was obtained in 18% and partial response in 41%. Complete response was dependent on the tumor stage. It was 40% for stage I disease, 23% for stage II, 11% for stage III, and 6% for stage IV disease. Similarly, a larger percentage (39%) of the 46 patients with combination surgical/radiation therapy had a complete response than of patients treated by either radiotherapy alone (n = 137, 12%) or surgery alone (n = 9, 11%). Complete response and initial performance status were important factors influencing survival (p less than 0.001). Surgery with adjuvant irradiation offered a better survival rate than radiotherapy or surgery used as single modalities. Treatment results for patients with advanced carcinoma of the esophagus remain poor.

Adult↗
PubMed1988

Mortality of aircraft manufacturing workers in southern California.

A retrospective cohort mortality study was conducted among men and women employed for four or more years, between 1958 and 1982, at an aircraft manufacturing company in San Diego County. Specific causes of death under investigation included cancer of the brain and nervous system, malignant melanoma, and cancer of the testicle, which previous reports have suggested to be associated with work in aircraft manufacturing. Follow-up of the cohort of 14,067 subjects for a mean duration of 15.8 yr from the date of first employment resulted in successful tracing of 95% of the cohort and found 1,804 deaths through 1982. Standardized mortality ratios (SMRs) were calculated based on U. S. national mortality rates and separately based on San Diego County mortality rates. Mortality due to all causes was significantly low (SMR = 75), as was mortality due to all cancer (SMR = 84). There was no significant excess of cancer of the brain, malignant melanoma, cancer of the testicle, any other cancer site, or any other category of death. Additional analyses of cancer sites for which at least ten deaths were found and for which the SMR was at least 110 showed no increase in risk with increasing duration of work or in any specific calendar period. Although this study found no significant excesses in cause-specific mortality, excess risks cannot be ruled out for those diseases that have latency periods in excess of 20 to 30 yr, or for exposures that might be restricted to a small proportion of the cohort.

Aircraft↗
PubMed1988

Interstitial radiotherapy combined with interstitial hyperthermia in the management of recurrent tumors.

During a 2-year period 31 sites in 27 patients with recurrent, previously treated tumors received a combination of interstitial 192Ir radiation (RT) with microwave hyperthermia (HT). Head and neck sites were treated most frequently (48%), with breast and vagina each representing about 20% of sites. Complete response (CR) with no local recurrence was obtained in 61%, partial response (PR) in 11 (36%), and one (3%) had less than 50% tumor regression. Of these patients, nine had no evidence of tumor following HT-RT therapy, 8/18 in the CR group and 1/11 in the PR group. Significant factors influencing CR were: radiation dose, tumor volume and duration of tumor control following the initial therapy (p less than 0.02). Treated site, histology and thermal dose were not significant factors influencing tumor regression. Complications of significance developed in one patient who had local skin necrosis. Interstitial HT-RT combination provides an effective palliative therapy for recurrent and/or persistent tumors. Randomized trials are necessary to assess the effectiveness of this combination as a component part of primary management of selected tumors.

Brachytherapy↗
PubMed1988

Deep microwave hyperthermia for metastatic tumors of the liver.

Between 1981 and 1985, 44 patients with advanced metastatic carcinoma of the liver were treated with deep microwave hyperthermia (HT) in five medical centers in the US. This HT was given with a BSD-1000 Annular Phased Array (BSD Medical Corporation, Salt Lake City, Utah). Of the 44 patients treated, 18 (41%) were in poor general condition and scored less than 60 on the Karnofsky scale. In 50% upper abdominal pain was a major presenting symptom. Prior chemotherapy (CT) had been given in 12 (27%) patients, while 10 (23%) had received prior radiotherapy (RT). Colon (73%) was the most frequent site of the primary tumor, and adenocarcinoma (79%) was the most frequent histological diagnosis. A total of 150 HT treatments were given, with an average of 3.4. HT alone was administered to 12 (27%), HT-RT to 15 (34%), HT-CT to 13 (30%) and HT-RT-CT to four (9%). Therapeutic temperature was reached in 28 (64%) patients. The majority (66%) tolerated treatment well. Due to the poor general condition of over one-third of the patients, prior therapy in 50% and the presence of advanced tumor in all, it is not surprising to see a response rate of only 36%. The response rate was 53% among patients receiving RT in addition to HT and 46% in patients who had therapeutic temperature. Survival ranged from less than 1 to 63 months, with an average of 11 months. Relief of pain was observed in 8 of 22 patients who presented with this symptom. HT can be safely delivered to patients with metastatic tumor to the liver.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1988

Treatment of carcinoma of the skin with bone and/or cartilage involvement.

From 1956 to 1978, 23 patients with stage T4 carcinoma of the skin of the head and neck were treated with radiotherapy (RT). There were nine patients with cancer of the skin of the nose, eight with tumors of the pinna, and six with lesions of the eyelids. Basal cell carcinoma (BCC) was seen in 61%, squamous cell carcinoma (SCC) in 26%, and 13% of patients had tumors with BCC and SCC features. The majority of patients had large tumors. Less than one-third of patients had smaller lesions, whereas three patients had intermediate-size tumors (greater than 2 cm to less than or equal to 5 cm). Of the 23 patients treated, nine had prior surgical therapy and recurrent or persistent tumor. The remaining 14 patients had no prior therapy. RT was given up to an average total dose of 55 Gy. The 5-year actuarial tumor control rate was 80%. Of the 23 patients treated, four had recurrent tumors. There were no recurrences among the 14 BCC patients, whereas there were four recurrences among the nine SCC and mixed histology patients. Of the four patients who had tumor recurrence, one was salvaged by subsequent radical surgery and three died of their tumor. No serious complications were observed in this group of 23 patients. There was no cartilage, bone, or soft-tissue necrosis noted. RT is a good treatment option and it may be treatment of choice in patients with BCC and SCC of the skin with cartilage or bone involvement. It provides an excellent chance of tumor control, good cosmesis, preservation of function, and a low incidence of complications.

Adult↗
PubMed1988

External beam and intraluminal radiotherapy in the treatment of carcinoma of the esophagus.

During a 10-year period, 46 patients with unresectable or inoperable carcinoma of the esophagus were treated with teletherapy-brachytherapy combination at the University of Southern California School of Medicine. Stage distribution was as follows: stage I, 5 (11%) patients; stage II, 23 (50%) patients; stage III, six (13%) patients; and stage IV, 12 (26%) patients. Thirteen patients were treated for recurrent disease, including 11 patients initially treated with teletherapy and two who had had surgical resection. Radiotherapy was given by teletherapy in 33 and brachytherapy in all 46 patients. An average tumor dose was 50 Gy with teletherapy and 20 Gy per application with brachytherapy. There were 25 patients who had more than one brachytherapy application. The 5-year actuarial survival rate for 28 patients with stage I or II disease was 12%, with a median of 13 months. This compared with no 5-year survivals and a median survival of 10 months for the 18 patients with stage III or IV disease. Failure at the primary site was seen in 16 (35%) patients. Complete response was seen in 20%, partial response in 76%, and no response in 4%. Treatment was well tolerated. Complications included esophageal stenosis in two patients and tracheoesophageal fistula in one. Teletherapy-brachytherapy combination is an effective treatment in the management of unresectable or inoperable carcinoma of the esophagus.

Adenocarcinoma↗
PubMed1987

Treatment results and patterns of failure in 646 patients with carcinoma of the eyelids, pinna, and nose.

From 1956 to 1978, 646 patients were treated with radiotherapy for carcinoma of the nose (350 patients, 54 percent), eyelids (159 patients, 25 percent), pinna (93 patients, 14 percent), and skin adjacent to the lip (44 patients, 7 percent). The histologic distribution was 72 percent basal cell carcinoma, 18 percent squamous cell carcinoma, and 10 percent mixed basal and squamous cell features. Tumors less than 2 cm in diameter were found in 602 patients (93 percent), whereas 44 patients (7 percent) had larger tumors. Tumor involvement of cartilage and bone was seen in 23 patients at the time of diagnosis. The 5, 10, and 20 year control rates were 99 percent, 98 percent, and 98 percent, respectively, for 502 tumors less than 2 cm in diameter. This compared favorably with control rates of 92 percent at 5 years and 79 percent at 10 years for tumors from 2 to 5 cm in diameter and 60 percent at 5 years and 53 percent at 8 years for 12 patients with massive tumors (p less than 0.0001). The histologic characteristics of the lesion had a strong influence on tumor control (p less than 0.02). Of the patients with cartilage or bone invasion, tumor was controlled in 19 (83 percent). Of these 19 patients, 11 had no evidence of disease for 3 years or more. Of all 646 patients treated, failure was seen in 60 (9 percent). It correlated well with the size of the lesion, being 7 percent for tumors of less than 2 cm and 50 percent for tumors of greater than 5 cm. Of the 60 patients in whom treatment failed, 48 (80 percent) had prior definitive therapy. Radiotherapy was an efficient modality to control operative failures; however, it was not as efficient at control in patients in whom previous radiotherapy failed. Operation was the treatment of choice to salvage patients in whom radiotherapy failed. Of the patients in whom retreatment failed, 10 were known to have died from skin cancer, and an additional 6 patients were presumed to have died from the cancer. This study has demonstrated a good control rate and good cosmetic results for small tumors of the eyelids, pinna, and nose. In addition, a good control rate was obtained in patients with cartilage and bone involvement. Treatment of massive tumors should involve planned operative resection with adjuvant radiotherapy.

Adult↗
PubMed1987

Nonparametric estimation of relative mortality functions.

The standardized mortality ratio (SMR), which is the ratio of the number of deaths from a particular disease observed in a study cohort to the number expected from national vital statistics, has a long history of use in epidemiology. Separate SMRs computed according to discrete intervals of time since initial exposure, time on study, age or calendar year are used to examine effects of these variables on relative mortality. Applying some recent ideas of Andersen et al. (Biometrics 1985; 41: 921-932), we discuss refinements of this procedure that yield a nonparametric estimate of the SMR as a function of one time-varying factor while at the same time adjusting for the effects of other factors in a regression equation. The method is utilized to study relative lung cancer mortality as a function of years since initial employment in cohorts of 8014 Montana smelter workers and 679 Welsh nickel refinery workers. Suggestions are made for approximating the relative mortality function using only data for cases and matched controls sampled from the full cohort.

Epidemiologic Methods↗
PubMed1983

Childhood cancer incidence: geographical and temporal variations.

Data from the first four volumes of Cancer Incidence in Five Continents (CI-5) and from the first 5 years of the US Surveillance, Epidemiology and End Results (SEER) program were analyzed for evidence of geographical and temporal variations in the incidence of selected childhood tumors. Only lymphoid leukemia and glial neoplasms are common enough for the observed differences between US registries to be distinguished from sampling variation. Internationally, kidney and eye tumors and leukemia show less geographical variation than do lymphomas and brain tumors, but for none of the tumors examined is the incidence constant. Wilms' tumor rates among Japanese, Singapore Chinese and Indians (Bombay) are approximately 60% of the rates in North America and Britain, whereas in Scandinavia the rates are up to 30% higher. This lessens the status of Wilms' tumor as an "index tumor" of childhood. Areas or countries with especially high or low rates of other tumors are identified. Rates for glial neoplasms (SEER data) and Hodgkin's disease (CI-5) are increasing with time in the US, while brain tumors are being diagnosed more frequently worldwide. However, the results for brain tumors may largely reflect changes in pathology diagnosis or reporting practices, and those for Hodgkin's disease may reflect improvements in case ascertainment. Otherwise, there is a remarkable stability in the incidence of selected childhood cancers over time.

Adolescent↗
PubMedDate not supplied

Interstitial thermoradiotherapy for recurrent head and neck cancer.

From 1985 to 1987, 22 head and neck sites in 20 patients with recurrent tumors were treated with interstitial thermoradiotherapy (ITRT). The sites treated were 15 neck (68%), four tongue (18%), two parotid (9%), and one buccal mucosa (4%). Squamous cell carcinoma was diagnosed in 21 sites and adenocarcinoma in the other. All patients had prior radiotherapy (RT), including 15 who underwent a combination of RT and surgery. Interstitial RT with iridium 192 (mean dose, 40 Gy) was combined with interstitial microwave hyperthermia (mean thermal dose, 90 units). Complete response (CR) was obtained in 15 (68%) sites and partial response (PR) in seven (32%) sites. There were no local recurrences in the 15 CR patients during a period of observation of up to 30 months. Of the seven PR patients, one had radical neck dissection and is free of tumor after 28 months. Tumor volume was an important factor influencing CR (P less than .001), whereas RT and thermal dose were not (P = .3). Of the 20 patients treated, 19 experienced major subjective benefit. Serious complications occurred in two patients: one had localized soft tissue necrosis, the other had aspiration pneumonia. ITRT was well-tolerated by patients despite prior aggressive therapy. High objective response rate and low toxicity demonstrate the value of this treatment combination in the management of patients with postradiation recurrence of head and neck tumors.

Aged↗
PubMedDate not supplied

Interstitial thermoradiotherapy for recurrent or persistent tumours.

Between 1984 and 1986, 31 sites in 27 patients with biopsy proven tumours were treated with a combination of interstitial microwave hyperthermia (HT) and iridium 192 implants (RT). The 31 sites treated included fifteen (48 per cent) head and neck, six (20 per cent) breast, four (13 per cent) vagina and cervix, and six (20 per cent) others. All patients had prior surgery, RT, or chemotherapy. Of the 31 sites treated, 19 (61 per cent) had complete response (CR) with no recurrence in the volume treated. Additionally, eight patients remained free of tumour from 3 to 24 months. Partial response (PR) was seen in 11 (36 per cent) sites while one (3 per cent) had lesser degree tumour regression. Tumour control rate correlated well with the dose of radiation, p = 0.02, and tumour volume, p = 0.02, but not with thermal dose. Treatment complications of significance occurred in one (3 per cent) site, which developed soft tissue necrosis. This study again has demonstrated the effectiveness of RT-HT combination in treatment of recurrent tumours.

Adult↗