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Biomedical subjects

B McCormick

Publications and source records attributed to B McCormick.

At least 91 records · Page 5Linked to original sources
PubMed1992

Breast cancer in patients irradiated for Hodgkin's disease: a clinical and pathologic analysis of 45 events in 37 patients.

PURPOSE: To characterize the clinical and pathologic features of patients who developed breast cancer (BC) after treatment for Hodgkin's disease (HD). Recent epidemiologic studies have shown that women who are cured of HD have an increased risk of developing BC. PATIENTS AND METHODS: The clinical data, mammograms, and pathologic specimens of 37 women who developed 45 BCs (eight bilateral events), and had a prior history of treatment for HD were analyzed. RESULTS: The median age at diagnosis of HD was 27 years (range, 11 to 60). All patients received radiotherapy (RT) to the upper part of their body, and 10 also had chemotherapy for HD. The median interval from the treatment of HD to the diagnosis of BC was 15 years (range, 8 to 34). The median age at diagnosis of BC was 43 years (range, 27 to 75), 41% of patients were 39 years old or younger. Most mammograms (81%) showed abnormal findings of mass and/or microcalcifications. Of the eight patients (22%) with bilateral tumors, four were synchronous and four were metachronous. Involvement of the medial half of the breast occurred more frequently than in patients with primary BC (39% and 21%, respectively; P < .002). But, the histologic types, grades, presence of lymphocytic reaction, and lymphatic invasion were similar to those observed in 935 primary BC patients who were previously analyzed at our center. The 6-year actuarial relapse-free survival (RFS) for node-negative BC after HD was 85%. Node-positive patients had a significantly lower RFS of 33% (P = .002). CONCLUSIONS: In comparison to patients with primary BC, patients who develop BC after HD are more likely to be younger, have bilateral disease, and have their tumors more frequently involve the medial half of the breast. Pathologic characteristics, nodal involvement, and prognosis are similar to those of primary BC. BC in women who were treated for HD is becoming an increasing problem, as more patients cured of HD reach a follow-up time of 10 to 15 years. Breast examination and mammography at an early age should be part of the follow-up program for women who are cured of HD.

Adolescent↗
PubMed1992

Salvage mastectomy for local and regional recurrence after breast-conserving operation and radiation therapy.

Forty-six patients initially treated for carcinoma of the breast by tumor excision and radiation therapy who had local and regional recurrence with no evidence of distant disease and who underwent salvage mastectomy at Memorial Sloan-Kettering Cancer Center between 1970 and 1990 were reviewed retrospectively. These patients represent a recent series of patients treated with breast-conserving surgery, radiation therapy and subsequent salvage mastectomy with a median follow-up period of five years (range of one to 20 years). The mean age at initial diagnosis was 52 years (range of 31 to 75 years). All patients had excision of the primary tumor; 27 underwent local excision with axillary dissection. The median radiation therapy dose to the breast was 48 Gy. The distribution of stage of disease at the time of breast conserving treatment was stage 0 in seven patients, stage I in 13 patients, stage II in 14 and stage III in one patient. Twenty-seven patients received conservation treatment at other institutions and were referred to our institution for salvage operation. Local and regional relapse occurred at a median of 28 months (range of five months to seven years) after initial treatment. Relapses occurred only in the breast in 35 patients, in the axilla in one patient and in both sites in ten patients. Salvage operation consisted of total mastectomy in 50 per cent, modified radical mastectomy in 33 per cent and radical mastectomy in 17 per cent. Follow-up evaluation after salvage mastectomy (median 28 months, range of one month to 18 years) yielded an actuarial proportion free of disease at five years of 55 per cent (+/- 11 per cent) and an over-all five year survival rate of 76 per cent (+/- 10 per cent). The median time to relapse was 97 months (+/- eight months) and the median survival time was 103 months (+/- seven months). The local recurrence rate after salvage mastectomy was 15 per cent. These data suggest that salvage mastectomy provides local control of recurrent carcinoma of the breast and relapse-free survival time may be improved by postsalvage systemic therapy.

Adult↗
PubMed1991

Ten-year results of breast-conserving surgery and definitive irradiation for intraductal carcinoma (ductal carcinoma in situ) of the breast.

An analysis of 259 women with 261 treated breasts from nine institutions in Europe and the United States was performed to determine the 10-year results of the treatment of intraductal carcinoma of the breast with definitive irradiation. All patients had undergone complete gross excision of the primary intraductal carcinoma, and definitive breast irradiation was delivered in all cases. The median follow-up time was 78 months (range, 11 to 197 months). The 10-year actuarial overall survival rate was 94%, and the 10-year actuarial cause-specific survival rate (including deaths only from carcinoma of the breast) was 97%. The 10-year actuarial rate of freedom from distant metastases was 96%. There were 28 failures in the breast, and the 10-year actuarial rate of local failure was 16%. The pathologic type of local recurrences showed invasive ductal carcinoma in 14 of 28 recurrences (50%) and noninvasive ductal carcinoma in 14 of 28 recurrences (50%). The median time to local failure was 50 months (range, 17 to 129 months). Twenty-four of 28 patients with local failure were salvaged with additional treatment, generally mastectomy, and 4 of 28 patients with local failure subsequently had distant metastases. Median follow-up time after salvage treatment of breast recurrence was 29 months (range, 3 to 90 months). Two patients without local failure subsequently had distant metastases, one of which occurred after a node-positive, contralateral breast carcinoma. These results demonstrate high rates of overall survival, cause-specific survival, and freedom from distant metastases for the treatment of patients with intraductal carcinoma of the breast. The local recurrences within the treated breast were generally salvaged with additional treatment, although with limited follow-up. Because of the long natural history of intraductal carcinoma of the breast, prolonged and careful follow-up of patients after breast-conservation and definitive irradiation is required.

Actuarial Analysis↗
PubMed1991

Retinoblastoma. The long-term appearance of radiated intraocular tumors.

A retrospective analysis of 50 patients with retinoblastoma was undertaken to determine the appearance of intraocular retinoblastoma that had received external beam radiation a minimum of 10 years previously. Of the 91 tumors found in 59 eyes, 76 (84%) continued to be ophthalmoscopically visible after 10 years. The most common ophthalmoscopic appearance was a Type III regression pattern. The type of radiation regression pattern correlated with the pretreatment volume of the tumor. The largest tumors (mean, 10.0 disc diameter [dd]) became Type I regression patterns, whereas the smallest tumors (mean, 1.0 dd) completely disappeared. This represents the first long-term follow-up of the intraocular status of radiated retinoblastoma.

Child↗
PubMed1991

Retrospective study of the prevalence of bilateral sensorineural deafness in childhood.

This retrospective study was undertaken to estimate the causes of severe sensorineural deafness (greater than 40 dB HL) in children. The children were identified from case notes of all referrals made to the Children's Hearing Assessment Centre during a 5-year period (from 1st January 1981 to 31st December 1985). Results were tabulated and conclusions drawn following a literature search. It was deduced that following better antenatal screening, a more active immunisation program and improvements in resuscitation of small preterm infants, there was a shift of cases from prenatal to perinatal causes. The proportion of cases of severe sensorineural deafness was much the same as in previous studies.

Auditory Threshold↗
PubMed1991

Cobalt60 plaques in recurrent retinoblastoma.

Cobalt60 plaque irradiation is one treatment option for patients with recurrent retinoblastoma following conventional external beam irradiation (ERT). Tumorocidal doses can be delivered without excessive risk of normal tissue injury. In patients not considered candidates for xenon arc or cryotherapy, 60Co is an alternative to enucleation. Between 1968 and 1987, 85 patients were treated with 60Co plaques, 72 of whom had failed prior ERT. Age at diagnosis ranged from 1 week to 4 years. There are 37 males and 35 females. Seventy-one patients had bilateral disease and one had unilateral. Three patients had both eyes plaqued. Prior ERT ranged from 30 to 70 Gy (mean 4200 Gy). Time from initial therapy to failure ranged from 13 to 60 months. Cobalt plaques of 10 mm, 15 mm, or 10 x 15 mm were used depending on tumor size and location. Dose prescribed to the apex of the tumor ranged from 30 to 50 Gy (median 40 Gy) given over 3 to 8 days. Twelve patients had two plaque applications; three patients had three plaque applications. All patients were followed with routine ophthalmoscopic examinations. Follow-up ranged from 2 to 22 years (mean 8.7). Seven patients died of metastatic disease; 10 patients developed non-ocular second tumors. Thirty patients required enucleation. Twenty-two patients had clear tumor progression, two patients had radiation complications, and six patients had a combination of tumor growth and complications. Cobalt60 can salvage eyes in retinoblastoma patients failing ERT. Currently, we are using I125 in an attempt to spare normal ocular tissue and reduce subsequent complications.

Brachytherapy↗
PubMed1991

Duct carcinoma in situ of the breast: an analysis of local control after conservation surgery and radiotherapy.

Patients with duct carcinoma-in-situ are being treated with increasing frequency at our center. Between 1977 and 1988, 54 patients, including one with bilateral disease, opted for breast conserving surgery and radiation therapy. The median follow-up was 3 years (range 2-13 years). During this period, 10 patients (18%) had a recurrence in the breast; the local failure probability was 22% at 6 years (Kaplan-Meier). All patients had pre-biopsy mammograms, and in 67% this was the presenting abnormality. Thirty-three lesions (60%) required needle localization. Size, as determined by mammogram or pathology, was 2 cm or less in 60%, 2.1 to 4 cm. in 2%, and not measurable in the remainder. Close or involved margins were noted in 30% of patients who locally recurred, despite the fact that 50% had had a re-excision after their initial biopsy. Breasts which maintained local control had only 4% involved margins and re-excision was performed in only 20%. Radiation doses ranged from 4600 to 5200 cGy to the entire breast with tangential fields, followed by a boost dose in 73% of patients. No patient in the study has developed distant metastasis or died of breast carcinoma, but the local failure rate is of concern and has alerted our group to reexamine its treatment policy in patients with evidence of margin involvement. We continue to consider residual microcalcifications after surgery to be a contraindication to breast conservation.

Adult↗
PubMed1991

Primary breast irradiation in large-breasted or heavy women: analysis of cosmetic outcome.

Treatment of early stage breast cancer with lumpectomy, axillary dissection, and radiation therapy is considered by many to be relatively contraindicated in heavy women or women with large or pendulous breasts. To quantitatively analyze this, we reviewed the cosmetic outcome in 257 patients. These patients were divided into "large" (89) and "average" (168) groups by one or more of the following criteria: weight greater than or equal to 80 kg, bra size greater than or equal to 40 in., cup size greater than or equal to D, and tangent separation greater than or equal to 23 cm. All patients were given cosmetic scores on a 1-10 scale by an independent observer for each of 8 cosmetic indices. These scores were analyzed at 1, 3, and 5 years follow-up (median 3 years). The average group scored higher than the large group on overall cosmesis (8.01 vs 7.34, p = 0.0004) and on 5 of 7 subindices (p = 0.0001 to 0.05) at 1 year. At 3 and 5 year follow-up only symmetry and retraction remained significantly different, favoring the average group. The largest difference noted at any point between the groups was 1.27 (retraction at 5 years, 8.54 vs 7.27, p = 0.0148). Therefore, although an inferior cosmetic result has been documented in the large group, we do not feel the magnitude of the difference mandates a change in our policy of offering all of these women breast-conserving therapy.

Adult↗
PubMed1991

Radiotherapy in breast cancer.

This review focuses on four aspects of radiotherapy in the treatment of breast cancer. The most controversial area is the treatment of ductal carcinoma in situ. Recent studies exploring breast-conserving surgery with and without radiation are outlined. Although no consensus exists on the recent studies, the emergence of ductal carcinoma in situ as a cancer with both significant pathologic subtypes and significant differences in clinical presentation is clear. Concerning the role of radiation in invasive breast cancer, all reports indicate continuation of the earlier observed success. Predictors for recurrence, the diagnosis of recurrence, and the relationship of an apparent isolated local recurrence with the eventual development of distant metastatic disease are reviewed. The outcome of treatment with breast-conserving surgery in radiation in unusual situations is also presented, including patients with silicone prostheses, those presenting with an axillary mass and occult breast disease, and those with multiple primary tumors in the same breast. The clinical evidence continues to support radiation delivered after mastectomy in patients who are at high risk for locoregional recurrence. Systemic adjuvant chemotherapy alone does not appear to prevent many of these recurrences. With the improved local control following treatment with both adjuvant systemic therapy and comprehensive postoperative radiation, preliminary reports are also documenting advantages in terms of disease-free survival.

Breast Neoplasms↗
PubMed1991

Arm edema in conservatively managed breast cancer: obesity is a major predictive factor.

To identify risk factors in the development of arm edema (AE) after conservative management of breast cancer, the authors prospectively measured differences in upper and lower arm circumference in 282 patients with stage I or II breast cancer who received radiation. AE was defined as a difference of 2.5 cm or more in either measurement between treated and untreated arms. Median follow-up was 37 months (range, 7-109 months). The crude frequency of AE overall was 19.5% (55 patients). In 21 patients (7.4%) AE was transient; 34 patients (12.1%) had persistent AE, which is the focus of this article. The 5-year actuarial incidence of persistent AE was 16%. The crude risk of persistent severe AE was 3.9%. Various factors were examined for their ability to enable prediction of AE. Treatment-related factors did not significantly enable prediction of AE, whereas factors related to patient size, such as body mass index, were strongly associated with both the frequency and severity of AE.

Adult↗
PubMed1990

Can research change the way MDs practice medicine?

Health care clinicians are inundated with data from health services research, and many providers are pioneering local applications of the research findings. But are the fruits of this data revolution finding practical application at the patient's bedside? In many cases, yes. A significant number of health care executives and physicians are pioneering programs that bring the lofty goals and methods of national health services research down to "real world" applications appropriate for their hospitals. Lack of applicability is the main reason community hospitals have been slow to use health services research generated at teaching hospitals, say experts. Now, that is changing. Executives are finding that the exacting work required to design tailored clinical appropriateness studies for their institution results in improved physician relations and better patient care. "Almost consistently we find that physicians who practice at the high end respond [to this feedback] by altering their practice patterns and cutting the rate at which they perform a particular service or procedure," says Robert Keller, M.D., executive director of the Maine Medical Assessment Foundation.

Health Services Research↗
PubMed1990

Radiation therapy after breast augmentation or reconstruction in early or recurrent breast cancer.

Fourteen patients whose augmented or reconstructed breasts were treated with radiation therapy were analyzed. Silicone gel implants were used in 13 patients and free-injected silicone in one patient. The total radiation dose ranged from 4400 to 6200 cGy using tangential photon fields or an en face electron field by megavoltage equipment. In several cases, electron boost radiation was added to the tumor bed. The majority of the patients tolerated therapy well with minimal transient skin reactions; only three patients required a treatment break secondary to moist desquamation. Three patients developed documented implant encapsulation, although the majority retained good to excellent cosmesis. In summary, when breast carcinoma arises in the augmented or reconstructed breast, conservative management (i.e., limited surgery and definitive irradiation) is feasible without compromising the therapy or the cosmetic result. Thus, conservative management should be offered as an option to patients who are interested in breast prosthesis conservation.

Breast↗
PubMed1990

Changes in height of choroidal melanomas after plaque therapy.

Serial ultrasonic measurements of 82 uveal melanomas treated with brachytherapy plaques (cobalt-60 and iodine-125) and followed up for up to 141 months revealed that no two patients had identical patterns of change. The mean absolute change in tumour height after treatment was 1.8 mm at six months, 5.6 mm at 48 months for large tumours, and 0.9 and 1.9 mm for medium sized tumours. Eighty of the 82 patients fell into one of three patterns of response: 57 patients had a decrease in height after treatment (type D), 13 patients had the same height after treatment (type S), and 10 patients had a progressive increase in height (type I). Life table comparison showed no correlation between survival and location of tumour, sex of patient, size of tumour when treated, or laterality. There was a slight correlation between age and survival. Patients older than 60 died more frequently from metastatic melanoma than those under 60 (p = 0.06). Life table analysis showed a significant correlation between tumour regression type and survival. At 48 months the best cumulative probability of survival was in patients with type D (88% alive) compared with those of type I (34% alive, p = 0.0004).

Adult↗
PubMed1990

Ocular melanoma: total dose and dose rate effects with Co-60 plaque therapy.

From 1968 to 1987, 123 consecutive patients with nonmetastatic choroidal melanoma were treated with cobalt-60 plaques. One hundred sixteen patients were followed up for a mean of 3.8 years. Twenty patients had local failure, and 14 patients had distant failure. Complications included 32 cataracts, and seven enucleations were required. Local recurrence did not correlate with tumor height, tumor volume, dose, or dose rate. Increased volume (P = .004) and height (P = .01) correlated with increased rates of distant metastases. Dose adjusted for volume did not correlate with the rate of metastases.

Brachytherapy↗