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Biomedical subjects

C B Pratt

Publications and source records attributed to C B Pratt.

At least 181 records · Page 10Linked to original sources
PubMed1985

Treatment of unresectable or metastatic osteosarcoma with cisplatin or cisplatin-doxorubicin.

Responses and toxicity after treatment with cisplatin and cisplatin-doxorubicin were compared in two groups of patients with unresectable or metastatic osteosarcoma. Complete or partial responses developed in 3 of 18 individuals treated with cisplatin, and in 5 of 19 after the two-drug combination. Hematologic and gastrointestinal complications were more frequent and severe in patients who received both agents. The combined use of cisplatin and doxorubicin is justified for patients with unresectable or metastatic osteosarcoma at diagnosis because of the potential therapeutic benefits for these individuals.

Adolescent↗
PubMed1985

Childhood multifocal osteosarcoma. Clinicopathologic and radiologic correlates.

The authors reviewed the clinical charts and pathologic and radiographic materials of nine pediatric patients (mean age, 11.0 years) presenting with multiple skeletal foci of osteosarcoma. Four patients presented with pulmonary metastases, and five had osseous disease only. All had densely sclerotic, predominantly osteoblastic tumors, usually in metaphyseal locations. Evidence of aggressive tumor cell behavior--such as vascular, articular, epiphyseal, or soft-tissue invasion--was usually present in surgical specimens. Despite intensive chemotherapy, all patients died from 6 to 37 months after diagnosis (median survival, 12 months). Comparison of clinical and pathologic features for patients presenting with or without pulmonary metastases failed to disclose any notable differences between the two groups, indicating a common pathogenesis and evolution for their multifocal disease. The authors conclude that this variant of osteosarcoma is a highly aggressive form of the disease that may be accompanied by pulmonary metastases.

Adolescent↗
PubMed1985

Colon carcinoma in children and adolescents. A review of 30 cases.

Carcinoma of the large bowel is rare in persons under the age of 30, and generally presents with advanced stages of disease. From 1964 to 1984, 30 patients presented with nonfamilial large bowel malignancies. Seventeen patients were male, and 13 female (age range, 8-25 years). In 15 patients the primary was in the right transverse colon. In 26 patients the lesion was above the peritoneal reflection. Classification by Dukes' staging demonstrated Stage B in 3 patients, Stage C in 7 patients, and Stage D in 20 patients. Twenty-five patients had a mucinous variety of adenocarcinoma. Surgery at initial laparotomy consisted of biopsy (10 patients), palliative segmental resection (7 patients) and complete resection (13 patients; survival in each of these groups ranged from 1 to 15 months (median, 6 months), 6 to 36 months (median, 8 months) and 7 months to 14 years (median, 6 months), respectively. The only long-term survivors are three patients who had complete resection, two of whom are surviving free of disease after 5 and 15 years, respectively. Common sites of abdominal recurrence were the omentum (6 patients) and ovaries (7 patients). All patients received chemotherapy. In 16 of 24 evaluable patients, responses lasting 3 to 18 months were observed. Five patients also received radiation therapy. Follow-up of these patients included computed tomographic scans, ultrasound, and determination of carcinoembryonic antigen (CEA) levels. The CEA level in 9 of 23 patients did not correspond with the presence of either residual disease or progression of disease. Chemotherapy combined with a second-look surgical procedure in selected cases may improve the proportion of patients surviving and the duration of survival.

Adenocarcinoma↗
PubMed1985

Effective cisplatin (DDP) based chemotherapy in the treatment of hepatoblastoma.

Nine of 11 patients with hepatoblastoma treated with cisplatin (DDP) based chemotherapy had a complete (CR) or partial (PR) remission. Five of these patients had measurable pulmonary disease and four achieved a CR of pulmonary lesions. The average interval of disease control following DDP was three times that of Adriamycin (ADR). DDP is an effective agent in the treatment of hepatoblastoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

The use of chemotherapy for extraocular retinoblastoma.

Among the 114 children with retinoblastoma seen at St. Jude Children's Research Hospital 1962-1984, 11 have received treatment with chemotherapy for measurable extraocular disease which was present at diagnosis (seven patients) or developed later during the subsequent course of their disease (four patients). Metastatic disease involved the brain and spinal fluid of four persons, the orbit of five, the bone marrow of five, lymph nodes of four, and soft tissues of three individuals at the time of their treatments. Single agents or combinations were used. Two patients with orbital extension of primary retinoblastoma developed complete responses following chemotherapy and subsequently received orbital irradiation, and have had long-term disease-free survival. Additional responses developed in patients who received vincristine, cyclophosphamide, adriamycin, cisplatin, VM-26, and ifosfamide, singly or in combination. With future identification of effective chemotherapy, new studies may be focused upon patients with localized disease to reduce radiation dosage or the need for immediate surgical resection of all involved eyes.

Bone Marrow Diseases↗
PubMed1985

Some aspects of childhood cancer epidemiology.

Various aspects of childhood cancer, including frequency-incidence; variations by age, race, sex, and geography; and individuals at high risk are discussed in this article. Types of family cancer syndromes, clusters, and environmental factors impacting on childhood cancer are also covered.

Adolescent↗
PubMed1985

The significance of calcified regional lymph nodes at the time of diagnosis of osteosarcoma.

The presence of lymph node metastases from osteosarcoma was rare at diagnosis, occurring in only four of 176 patients (2.3%) at St. Jude Children's Research Hospital. An additional patient presented with calcified lymph nodes, which were demonstrated to contain no evidence of metastatic osteosarcoma. These patients did not differ in race, sex or age at diagnosis from other osteosarcoma patients. Each of the four patients with lymph node metastases of osteosarcoma had tumors composed predominantly of the osteoblastic type. Regional nodal metastases, whether alone or in conjunction with other metastatic disease were a poor prognostic factor. Despite aggressive therapy, median survival was 8 1/2 months from diagnosis, which did not differ significantly from the survival achieved by other osteosarcoma patients who had other hematogenous metastases.

Adolescent↗
PubMed1985

Phase I trial of mitoxantrone in children.

Mitoxantrone was administered as a single iv injection once every 3 weeks to 84 children with advanced acute leukemia and solid tumors in a phase I trial. Dose-limiting granulocytopenia occurred at dosages greater than 18 mg/m2 in children with solid tumors, while hospitalization for febrile episodes occurred in nine of 12 patients with acute leukemia receiving dosages greater than 24 mg/m2. Six children developed evidence of cardiac dysfunction, including three instances of congestive heart failure. No other significant toxicity was noted. Complete responses were seen in one child with neuroblastoma metastatic to bone, one with acute lymphoblastic leukemia, and four with acute nonlymphoblastic leukemia.

Acute Disease↗
PubMed1984

The effect of prior cisplatin therapy on the pharmacokinetics of high-dose methotrexate.

The pharmacokinetics of high-dose methotrexate (MTX, 5-15 g/m2) were evaluated in 11 children and adolescents who had previously received two to eight doses of cisplatin (90 mg/m2) in the treatment of malignant solid tumors. The half-life for disappearance of MTX from serum during the first 24 hours after infusion was determined from serum samples obtained at the end of a six-hour infusion and six, 12, and 24 hours after infusion. These values were compared to a mean half-life of 2.83 (+/- 0.34) hours following 489 courses administered to 71 patients who had not received cisplatin. Stepwise multiple linear regression analysis of patient variables revealed cumulative cisplatin dosage and time from last cisplatin dose as the best predictors of MTX half-life (r2 = 65.4%, p less than 0.001). The best predictors of 24-hour serum concentration were cumulative cisplatin dosage and MTX dosage (r2 = 54.2%, p less than 0.001) in the multiple linear regression model. Patients with delayed MTX clearance received additional leucovorin and experienced no severe toxicity. Patients receiving up to 270 mg/m2 of cisplatin appear to have minimal increases in MTX half-life, while the likelihood of delayed clearance increases in patients who have received 360 mg/m2 or more of cisplatin. All patients who have previously received cisplatin should be treated cautiously with high-dose MTX and prospective pharmacokinetic monitoring should be routinely performed.

Adolescent↗
PubMed1984

Cisplatin and doxorubicin for locally recurrent and metastatic childhood rhabdomyosarcoma.

Five pediatric subjects, each of whom had been treated with multiple agents including doxorubicin, received cisplatin and doxorubicin following the development of locally recurrent or metastatic rhabdomyosarcoma. Although there was no definite evidence that the tumor of these individuals was resistant to doxorubicin, tumor responses developed in 3 of 5 patients. Additional trials of this combination in similar patients with primary or recurrent metastatic rhabdomyosarcoma are indicated.

Adolescent↗
PubMed1983

Limb salvage procedures for children with osteosarcoma: an alternative to amputation.

Amputation remains the standard surgical management for patients with osteosarcoma. However, in carefully selected patients, eradication of the primary tumor can be achieved by En-Bloc resection of the affected bone preserving both anatomical and functional status. Our criteria for limb salvage procedures are that patients must: (1) be age 12 years or older, (2) have no angiographic or clinical evidence of neurovascular involvement, (3) have low-grade osteosarcoma and/or good response to preoperative chemotherapy, and (4) be compliant. Between November 1980 and October 1982, 32 patients with osteosarcoma of an extremity were seen. Eight patients ranging in age from 13 to 21 years underwent limb salvage procedures. Five of these had Tikhoff-Linberg procedures for upper extremity lesions, two had En-Bloc resections for distal femur lesions, and one patient had a segmental arthrodesis for a distal tibial lesion. Of these eight patients, two had low-grade parosteal osteosarcoma. Follow-up ranged from 10 to 28 months (median 16 months). The two patients with parosteal osteosarcoma received no further therapy, while the other six patients received multiple agent chemotherapy. One patient died at 18 months with bilateral pulmonary disease. None have had local recurrences. Two of the eight patients had minor skin necrosis, requiring revision subsequently. Three patients have had transient nerve palsy. All have had good functional results. With careful selection of patients by rigid criteria, limb salvage procedures can be a viable alternative to amputation.

Adolescent↗
PubMed1983

Fatal congestive heart failure following mitoxantrone treatment in two children previously treated with doxorubicin and cisplatin.

Two children, who had received chemotherapy with doxorubicin and cisplatin for disseminated chondrosarcoma and recurrent rhabdomyosarcoma, developed congestive heart failure following treatment with mitoxantrone (DHAD); the total doses of DHAD were 128 and 90 mg/m2, respectively. The patient with chondrosarcoma had relief of his cardiac symptoms with digitalis and furosemide. The patient with rhabdomyosarcoma, whose tumor responded following treatment with DHAD, died 2 weeks after development of congestive heart failure. For patients who have received prior treatment with potentially cardiotoxic agents, administration of DHAD should be followed by careful monitoring of cardiac function.

Anthraquinones↗
PubMed1982

The natural history of colorectal carcinoma in adolescents.

The symptoms, histology, extent, and course of disease of 24 adolescents with colorectal carcinoma who were admitted to St. Jude Children's Hospital between 1964 and 1980 are presented. Twenty of the patients were referred between October 1974 and June 1980. Most patients presented with vague abdominal complaints. Twenty-one of the 24 patients had poorly differentiated mucin-producing adenocarcinoma. Extensive disease at diagnosis and unresponsiveness to medical management was reflected in the eight-month median survival from diagnosis. Only two of the 24 patients survive free of disease 15 and 130 months from diagnosis. Two other patients survive with disease at four and 24 months.

Adenocarcinoma, Mucinous↗
PubMed1982

Metastatic epidural tumors in children.

Spinal cord compression is a rare but serious complication of malignant diseases in children. Epidural cord compression was noted in 81 patients within the past 17 years at this center. The complication developed at different times during the course of the primary disease. For 29 of our patients, cord dysfunction was one of the initial signs of cancer--Ewing sarcoma, neuroblastoma, Hodgkin disease, and malignant lymphoma. By contrast, for most of the patients with osteosarcoma and rhabdomyosarcoma, it appeared later in their clinical course. The treatment outcome of patients who were paraplegia with complete loss of sensory function for greater than or equal to 48 hours was poor. Only four of 22 in this group became ambulatory. Ten patients with osteosarcoma did not undergo laminectomies because they all had multiple metastases and terminal disease. Paraplegia developed in all ten. There was no difference in ambulatory rates among other patients, with or without laminectomies.

Child↗
PubMed1982

Pharmacokinetic modeling of cisplatin disposition in children and adolescents with cancer.

A flow-limited physiologic pharmacokinetic model using volume terms, flow rates, distribution ratios, metabolic rate constants, and clearance terms restricted to physiologic or measured values was used to simulate the disposition of cisplatin in children and adolescents. Physiologic model simulations of parent cisplatin and total platinum serum concentrations were not statistically different from concentrations of these platinum species measured in 14 patients. A simplified first-order multicompartment operational model was also developed, and produced comparable simulations of parent cisplatin disposition but less accurate simulations of total platinum serum concentrations. These data provide further clarification of cisplatin disposition in humans and provide the basis for previously observed changes in the renal clearance of total platinum.

Adolescent↗
PubMed1982

Clinical pharmacology of bleomycin and cisplatin.

Bleomycin (Blenoxane) and cisplatin (Platinol) are two anticancer drugs, with activity for head and neck tumors, that were introduced into clinical use in the past ten years. Bleomycin is used primarily in the chemotherapy of squamous cell carcinomas, lymphomas, and testicular carcinoma, while cisplatin possesses significant activity against testicular and ovarian carcinoma, head and neck cancer, bladder cancer, and neuroblastoma. Bleomycin is rapidly excreted renally (terminal phase half-life = 2-4 h), although enzymatic inactivation also occurs in many tissues. Cisplatin is nonenzymatically converted to highly protein bound metabolites, which then undergo renal elimination, but total body clearance occurs much more slowly than with bleomycin (terminal phase half-life = 40-50 h). Both agents have acute and chronic toxicities; the acute toxicities are generally reversible but cause a great deal of patient discomfort, while the chronic toxicities are often irreversible and dose-limiting. For bleomycin, the acute toxicities are mucocutaneous are pyretic; severe nausea and vomiting represents the major acute toxicity of cisplatin therapy. Cumulative dose-related pulmonary toxicity is the most serious chronic toxicity of bleomycin. The clinical, radiographic, and pathologic presentations are nonspecific, although identification of high risk patients may be possible with serial pulmonary function tests. Cumulative nephrotoxicity occurs with cisplatin use, and its incidence and severity can be reduced by maintaining adequate hydration and diuresis during and following administration of the drug.

Bleomycin↗