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Biomedical subjects

B O'Sullivan

Publications and source records attributed to B O'Sullivan.

At least 91 records · Page 5Linked to original sources
PubMed1994

Outcome and prognosis in retroperitoneal soft tissue sarcoma.

PURPOSE: To retrospectively evaluate the outcome of treatment and identify factors prognostic for survival and locoregional and distant disease control for patients with retroperitoneal soft tissue sarcoma. METHODS AND MATERIALS: The records of 104 patients with retroperitoneal soft tissue sarcoma (RSTS) managed with surgery and irradiation at Princess Margaret Hospital between 1975 and 1988 were retrospectively reviewed. Univariate log-rank analysis was used to evaluate potential prognostic factors. RESULTS: Presentation was new primary disease, 74; primary recurrence, 20; metastases, 10. Pathology was liposarcoma for 42, leiomyosarcoma for 22, malignant fibrous histiocytoma for 19, and 21 with other histologies. Grade was low for 36, high for 35, and 33 were not graded. Median tumor size was 17 cm. Grossly complete surgical excision was achieved for 45 (43%), of whom 6 (6%) also had clear surgical margins. Adjuvant postoperative irradiation was administered to 36 patients to a median dose of 40 Gy/20 fractions/4 weeks and 16 received adjuvant chemotherapy. Nine patients received no adjuvant postoperative radiotherapy. Gross residual tumor was present postoperatively in 57 patients. The overall 5- and 10-year survival rates were 36% and 14%, respectively. The locoregional relapse free rate (RFR) was 28% at 5 years and 9% at 10 years, and the distant RFR was 76% at 5 years and 60% at 10 years. For the 45 patients treated with complete excision, survival was 55% and 22% at 5 and 10 years, and locoregional RFR was 50% and 18% at 5 and 10 years. Univariate analysis demonstrated that complete surgical removal was the only factor significant for improved survival, locoregional RFR, and distant RFR. Liposarcoma histology predicted for improved survival (p = 0.02), and leiomyosarcoma histology for a lower distant RFR, compared to other histologies (p = 0.003). Patients under 62 years had an improved survival (p = 0.002) and local RFR (p = 0.02), and patients presenting with recurrent disease had improved survival (p = 0.03). Sex, tumor size, or grade, or the use of adjuvant chemotherapy were not predictive for any of the endpoints tested. Those who received adjuvant irradiation following gross surgical clearance experienced a prolonged median locoregional RFR over those who did not, and this approached statistical significance for those receiving radiation doses > 35 Gy. (103 months vs. 30 months, p = 0.06). Statistical significance was reached (p = 0.02) if only the infield RFR was considered. CONCLUSIONS: This study demonstrates that failure to achieve local control is the primary cause of treatment failure for patients with RSTS, and that postoperative irradiation in doses > 35 Gy after complete surgery delayed, but did not prevent local recurrence. Improvements in outcome for patients with RSTS will require alternate treatment strategies, and preoperative irradiation with an aggressive surgical attempt at complete excision is currently under investigation.

Combined Modality Therapy↗
PubMed1994

An assessment of prognostic factors in soft-tissue sarcoma of the head and neck.

OBJECTIVE: This study evaluates the outcome, patterns of failure, and prognostic factors in head and neck soft-tissue sarcoma in the adult. DESIGN: A retrospective evaluation of 73 patients treated recently for this rare disease. The minimum follow-up for all patients was 3 years with the living patients having a mean follow-up of 4.6 years. SETTING: All patients were treated between January 1980 and December 1988, at the Princess Margaret Hospital-Ontario Cancer Institute, Toronto, the major sarcoma referral center for a population in excess of 3 million. PATIENTS OR PARTICIPANTS AND INTERVENTIONS: Fifty-two patients were treated with curative intent: 10 by surgery without radiotherapy and 42 with surgery and radiotherapy. Twelve patients received adjuvant chemotherapy. OUTCOME MEASURES: Five-year cause-specific survival, local relapse, and distant failure rates were calculated by the product limit method. Comparisons between survival curves were carried out by the log-rank statistic and Cox regression analysis was performed to assess the influence of prognostic factors. RESULTS: The 5-year cause-specific survival was 62%, with a local relapse rate of 41% and distant relapse rate of 31%. Extension to adjacent structures, high grade, and large lesion size were associated with poorer survival. Gross residual tumor also was associated with high local failure (75% failure) despite the addition of radiation therapy. Those with clear surgical margins or only microscopic involvement fared much more favorably and had similar local control rates (26% and 30% failure, respectively) provided adjuvant radiotherapy was given. However, 68% of patients dying as a result of their sarcoma had uncontrolled local disease because of the high incidence (27%) of gross residuum following surgery in this series. CONCLUSIONS: This series highlights the absolute necessity for resection of all overt disease with planned adjunctive radiotherapy and appropriate reconstruction in most cases. This is achieved more easily in the setting of a specialized sarcoma treatment unit.

Adolescent↗
PubMed1994

Anorexia nervosa in an adolescent with early profound deafness.

This paper reports a case of anorexia nervosa in a 15-year-old schoolgirl who had been profoundly deaf since birth. She was admitted to a specialized eating disorders unit following a dramatic reduction in her weight. Her deafness and limited communication skills posed significant problems with regard to her overall management on the unit. Her clinical presentation and difficulties in management are presented.

Adolescent↗
PubMed1994

Histological necrosis in soft tissue sarcoma following preoperative irradiation.

Forty-eight patients with soft tissue sarcomas that presented adverse features for treatment by limb salvage surgery and postoperative irradiation were treated by preoperative irradiation and surgery using a consistent protocol. Following resection, the extent of histological necrosis in the specimen was scored according to the criteria of Willet et al. Of the 48 cases, 16 (34%) demonstrated Grade 1 response (< 50% necrosis), 15 (31%) Grade 2 (50-80% necrosis), and 17 (35%) Grade 3 (> 80% necrosis). There was a trend toward more extensive necrosis in liposarcoma tumors (53% showing Grade 3 response compared to 26% of other sarcomas). Logistic regression analysis demonstrated a significant relationship between necrosis and tumor size (P < 0.001) with larger tumors having higher grades of necrosis. Tumor grade did not seem to affect the extent of necrosis. In comparison to the previous report of necrosis in soft tissue sarcoma following irradiation, the current analysis revealed a smaller proportion of tumors with Grade 3 necrosis.

Adult↗
PubMed1994

Controversies in the management of laryngeal cancer: results of an international survey of patterns of care.

Cancer of the larynx is the most prevalent non-cutaneous malignancy of the head neck region and its treatment presents a threat to both natural speech and survival. This study examines the manner in which two separate specialties in the same and different geographic regions vary in their opinions about the treatment of glottic laryngeal cancer. The goal was to define options available to patients and to classify controversies about optimal treatment which might be resolved in clinical trials. Questionnaires depicting different presentations of glottic larynx cancer were mailed to 1649 otolaryngologists and radiation oncologists in North America, Europe and Australasia. Half the doctors were asked to describe their preferred treatment for a patient while the others were asked to imagine that they themselves were the patient. In all the disease situations opinions varied significantly with respect to the treatment modality advised (whether to employ surgical or radiotherapy approaches) and in more extensive disease situations the intention of treatment also varied depending on whether a curative approach should involve conservation or loss of the larynx. Doctors also recommended similar treatment for their patients as they would for themselves. Apart from disease extent the most significant variables influencing recommendations were the physicians' specialty (P = 0.0001) and where they practice (P = 0.0001). These findings demonstrate diversity of opinion which is influenced more profoundly by the traditions of the specialties and geographic location of practice than by the reported results of treatments for laryngeal cancer. Convictions about optimal management have become barriers to the assessment of the relative value of different treatments and to ensuring that patients are fully informed about management options. The profession should regard as a high priority efforts to resolve these therapeutic conflicts which are associated with major differences in quality of life.

Attitude of Health Personnel↗
PubMed1994

Aggressive fibrous tissue lesions in the upper extremity: treatment and results.

The oncologic and functional results of treatment of aggressive fibromatosis were reviewed in 16 patients. Five had undergone previous resections. Complete surgical excision, the recommended primary treatment modality for aggressive fibromatosis tissue lesions, could only be performed in five patients. Radiation was administered in 13 patients and mainly used when the resection margins were positive. One patient required reoperation for recurrence. Complete detailed follow-up data were available in 15 patients. Functional analysis revealed 11 good-excellent, 2 fair, and 2 poor results using the Enneking classification. Local control was achieved with a combination of surgery and radiation, maintaining good-excellent function in most patients. The local nature of this tumor can be controlled with surgery and radiation while preserving function in the upper extremity.

Adult↗
PubMed1994

Local control of soft tissue sarcoma of the extremity: the experience of a multidisciplinary sarcoma group with definitive surgery and radiotherapy.

Data gathered on 62 patients with soft tissue sarcoma of an extremity, treated in entirety by an experienced multidisciplinary sarcoma group, were analysed. With a philosophy of emphasising attainment of histologically negative margins at carefully planned limb sparing surgery, combined with either pre-operative or postoperative radiation therapy, a crude local control rate of 95% (59 of 62 patients) at a minimum of 24 months follow-up was obtained. Of 9 patients with microscopically positive margins after definitive surgery, 8 had undergone maximal resection compatible with preservation of function. One of these 9 failed locally, indicating that radiation therapy is effective in eradicating microscopic disease in this tumour. The excellent local control obtained with limb-sparing surgery in this series justifies early referral of patients with these uncommon cancers to an experienced multidisciplinary unit. 26 patients (42%) failed systemically at a minimum of 24 months follow-up, and 19 (30.6%) died of their disease, confirming the need for effective systemic therapy in soft tissue sarcoma. Tumours greater than 10 cm in diameter had a greater risk of systemic relapse.

Adolescent↗
PubMed1994

Wound-healing complications after soft-tissue sarcoma surgery.

One-hundred and eighty patients undergoing limb-salvage surgery for soft-tissue sarcoma from 1986 to 1991 were assessed retrospectively for risk factors associated with major wound-healing complications. Twenty-three of 137 patients (16 percent) treated with primary direct wound closure sustained complications. In univariate analysis, the cross-sectional area of tumor resection, the use of preoperative irradiation, the width of the skin excision, a history of smoking, and a history of diabetes and/or vascular disease were associated with wound failure. Multivariate analysis revealed that preoperative irradiation (p = 0.04) and resection diameter (p = 0.017) accounted for the risk of complications. Eighteen additional patients were treated empirically with distant vascularized tissue transfer following preoperative irradiation because of concerns regarding potential wound complications. The lower complication rate in this group suggested that vascularized tissue transfer may be beneficial in lowering wound complication rates.

Adolescent↗
PubMed1994

Biostereometric measurement of oral tumour growth. Description of the technique and case report.

Following radiotherapy, it may be difficult to determine clinically whether tumour regression, stabilization or growth has occurred. Traditional diagnostic imaging may not be possible due to the small size of the tumour and the proximity of metallic restorations. A case of squamous cell carcinoma of the mandibular alveolar process in which these problems arose is presented. A computer-assisted biostereometric technique was used to identify volumetric change of the tumour. Polyvinylsiloxane impressions were obtained to record the anatomy of the tumour site. From these, stone models were made at four and eight weeks following radiotherapy. Using optical mapping techniques, tumour growth was demonstrated which was not evident on follow-up examinations. The methodolgy of biostereometry is presented and its advantages and potential applications are discussed.

Carcinoma, Squamous Cell↗
PubMed1993

Outcome and prognostic factors in soft tissue sarcoma in the adult.

PURPOSE: To evaluate the outcome, patterns of failure and prognostic factors in this rare disease in adult patients treated at a single institution in the modern era. METHODS AND MATERIALS: The records of all patients (389 cases) with soft tissue sarcoma in the extremities, torso (excluding retroperitoneum), and head and neck managed between 1980 and 1988 were reviewed. A curative (radical) approach was used in 321 patients of whom 10% were recurrent lesions. The local management consisted of surgery alone in 54 cases, surgery and radiotherapy in 250 and radiotherapy alone in 17. Adjuvant chemotherapy was used as a policy for high grade lesions in the initial five years of the study (98 cases), but was omitted subsequently. RESULTS: Extremity lesions fared more favourably compared to head and neck and torso lesions (p = 0.02) with respect to survival. Extremity and torso lesions had significantly better local control (p < 0.0001) than in the head and neck where local failure was a common cause of death. A multiple Cox regression analysis revealed that resection margins, local extension of tumor, age at diagnosis, and grade correlated with local relapse and distant relapse was also associated with local extension, high grade and in addition, large lesions. Size appeared especially predictive for distant failure, the most common cause of death. Distant failure was not influenced by the use of adjuvant chemotherapy. Patients treated for recurrence in this series had significantly worse survival due to increased distant failure despite similar local control to primary cases. CONCLUSION: This series highlights the overall problem of distant failure in this disease. It also reaffirms the importance of obtaining local control both in the head and neck, where uncontrolled local disease is the major cause of death, and in general since local relapse appears to increase the risk of distant failure. It appears that the current staging systems should be reviewed in the light of the apparent effect of different prognostic factors.

Actuarial Analysis↗
PubMed1993

A randomized trial of radiation therapy compared to split course radiation therapy combined with mitomycin C and 5 fluorouracil as initial treatment for advanced laryngeal and hypopharyngeal squamous carcinoma.

Two hundred and twelve patients with previously untreated advanced squamous carcinoma of the larynx or hypopharynx were randomized to receive initial treatment with radiotherapy, 50 Gy in 20 fractions in 28 days or split course radiotherapy and concurrent chemotherapy, 25 Gy in 10 fractions in 14 days followed by a 4 week rest and a further 25 Gy in 10 fractions in 14 days starting on day 43; Mitomycin C was given on day 1 and day 43 and 5FU continuous infusions on days 1--4 and days 43--46. Surgery was reserved for persistent or recurrent disease. Two hundred and nine of the 212 patients randomized were included in the analyses. Outcome analyses were performed at a median follow-up interval of 4.4 years. No patients were lost to follow-up. No significant difference was found between the two arms for the end points of local relapse-free rate (p = 0.91), regional relapse-free rate (p = 0.17, adjusted) or overall survival (p = 0.86). Eight-eight patients had attempted surgical resection following radiotherapy failure. The contribution of salvage surgery to overall survival was similar for both arms of the study as was the surgical complication rate. Serious late radiation toxicity was minimal (3% in the RT group, 0% in the radiation therapy plus chemotherapy group). The result of the trial shows no advantage in terms of local control or survival for the experimental treatment arm of split course radiotherapy and concurrent chemotherapy with Mitomycin C and 5 Fluorouracil compared to radiotherapy alone.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Paraspinal soft-tissue sarcoma. Classification of 14 cases.

Fourteen patients were treated surgically for soft-tissue sarcoma arising in the paraspinal muscles. Eleven patients received adjuvant irradiation administered before or after resection. In describing the treatment and outcomes of these patients, a new classification of paraspinal soft-tissue sarcoma is introduced that is based on the anatomic relationship of the tumor to the spinal lamina and the epidural space. This classification can be used in planning combined modality treatment for paravertebral sarcomas. Lesions that extend through the lamina into the epidural space present an unanswered problem for local control.

Adult↗
PubMed1993

Mitomycin in anal canal carcinoma.

One hundred and ten patients with primary epidermoid cancers of the anal canal were treated in a series of prospectively designed, nonrandomized protocols of split-course radiation therapy with concurrent administration of 5-fluorouracil (5-FU) with or without mitomycin. The addition of mitomycin was associated with improved primary tumor control rates (87 vs. 58% at 4 years, p = 0.005) and improved 4-year actuarial cause-specific survival (80 vs. 64%, p = 0.02). Hematologic toxicity was the most frequent acute side effect of mitomycin use. No long-term toxicity was attributed to mitomycin only. Mitomycin appeared to benefit patients principally through improved control of cancer in the irradiated volume; there was no evidence of reduced risk of extrapelvic metastases. Several investigators have reported high rates of control of epidermoid anal cancers with preservation of anorectal function following concurrent treatment with mitomycin, 5-FU, and radiation. Mitomycin's role in anal cancer is being evaluated in a randomized clinical trial by the Radiation Therapy Oncology Group. The mechanisms of any interactions between mitomycin and radiation or other cytotoxic drugs in clinical practice remain to be determined.

Actuarial Analysis↗
PubMed1992

Management of long-term postirradiation periclavicular complications.

Four cases of periclavicular postirradiation sarcoma and two cases of clavicular osteoradionecrosis with pathologic fractures are reported. All six cases presented more than 10 years after irradiation for breast cancer (five) or nasopharyngeal carcinoma (one). A review of radiotherapy received showed that they were subjected to unconventional radiation schedules (hypofractionation or high dose per fraction treatment). An approach to diagnosis and management of periclavicular lesions arising long after therapeutic irradiation is presented and the unique problems encountered with periclavicular surgery are discussed.

Aged↗
PubMed1992

Some effects of feeding Tribulus terrestris, Ipomoea lonchophylla and the seed of Abelmoschus ficulneus on fetal development and the outcome of pregnancy in sheep.

Pregnant ewes and their fetuses were chronically catheterized using aseptic procedures under general anaesthesia, and the ewes were then fed either lucerne chaff alone, or lucerne mixed with dried plant material obtained from one of three forb species, Tribulus terrestris (caltrop), Abelmoschus ficulneus (native rosella) or Ipomoea lonchophylla (cowvine), from 103-112 days gestation until term. Ingestion of the forb material was not associated with changes in maternal blood gases, plasma glucose concentrations, or the length of gestation. However, ingestion of rosella seed was associated with a significantly greater fall of fetal arterial pO2 with advancing gestation, and ingestion of either rosella or cowvine was associated with significantly lower fetal mean arterial pressure at 127-131 days, compared with the Tribulus and lucerne groups. Also, the incidence of fetal breathing movements was significantly lower, and did not show a normal day-night variation, in each of the forb-fed groups compared with the lucerne-fed group. The results indicate that these forb plants may contain substances that affect the functional development of the fetal brain. Although ingestion of these plants did not appear to affect the outcome of pregnancy in this study, the possibility that these forbs have a greater impact in sheep populations with poor nutrition and in more extreme environmental conditions is discussed.

Animal Feed↗
PubMed1992

An Australian multicentre study of moclobemide versus amitriptyline in the treatment of depression.

This paper reports the results of a multicentre study of the new monoamine oxidase inhibitor, moclobemide, in the treatment of major depression. Moclobemide is a specific monoamine oxidase-A inhibitor which does not bind irreversibly to the enzyme, unlike the currently available MAOIs. Recent studies would suggest that in subjects taking moclobemide blood pressure elevation caused by tyramine is significantly less than that induced by the irreversible MAOIs, particularly when tyramine is administered in an oral form. Forty-eight patients with major depression were randomly allocated to treatment with either moclobemide or amitriptyline for 4 weeks in a double-blind comparison. There were no statistically significant differences between the two groups on measures of efficacy. Patients taking amitriptyline reported a greater number of side-effects and more patients in the amitriptyline group dropped out because of these. There were no reports of interactions with tyramine-containing foods.

Adult↗
PubMed1991

Wound healing complications in soft tissue sarcoma management: comparison of three treatment protocols.

A prospective, nonrandomized comparison of three treatment protocols was undertaken in 45 patients with soft tissue sarcoma designated preoperatively as being at high risk of wound healing complications. All patients underwent complete resection of the gross tumour mass (5 with positive and 40 with negative microscopic margins). Fourteen patients received postoperative adjuvant irradiation (group I), 16 preoperative irradiation (group II), and 15 preoperative irradiation and vascularized tissue transfer to the surgical bed after resection (group III). Major wound healing complications (defined as complications requiring at least 1 further surgical procedure) were lower in group III patients (chi-square = 5.57, P less than 0.03), as was the mean postoperative hospital stay (P less than 0.02, analysis of variance), and the mean number of secondary surgical procedures. Multivariate analysis showed that the only variable influencing length of stay was the use of tissue transfer. Careful intraoperative assessment of the adequacy of resection is essential prior to performing vascularized tissue transfer to ensure that tumour contamination of the donor site is avoided. Since this study is a nonrandomized clinical trial using sequential distribution of patients to the treatment groups, the data should be considered as preliminary, rather than definitive, evidence of the efficacy of vascularized tissue transfer.

Combined Modality Therapy↗