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Biomedical subjects

C M Mansfield

Publications and source records attributed to C M Mansfield.

At least 37 records · Page 2Linked to original sources
PubMed1991

A review of the role of radiation therapy in the treatment of patients with breast cancer.

Irradiation has been used to treat cancer of the breast since 1895. Over the period between 1895 to the present, the therapeutic use of irradiation has evolved from a cauterizing agent to a sophisticated use of theory and practice to cause tumor cell death while at the same time producing maximum normal tissue sparing. The use of radiation has made it possible for the surgeon to use conservative breast sparing surgery to obtain excellent cosmetic results, while at the same time producing a local control equal to that of mastectomy. For the patient, conservative surgery becomes a better option than mastectomy because it not only produces local control equal to that of mastectomy, but gives the wonderful added benefit of a more superior and pleasing cosmetic result.

Antineoplastic Agents↗
PubMed1990

Comparison of lymphangiography and computed tomography scanning in evaluating abdominal disease in stages III and IV Hodgkin's disease. A Southwest Oncology Group study.

The authors reviewed the records of 139 patients who had laparotomy plus computed tomography (CT) and/or lymphangiograms (LAG) as part of a their staging workup for Hodgkin's disease, in accordance with Southwest Oncology Group (SWOG) protocol 7808. They evaluated the relative ability of CT and LAG to detect disease in the abdomen. Two regions of the abdomen were designated, the upper and the lower, to further examine the capabilities of CT and LAG in the lower abdomen and CT in the upper abdomen. A LAG was more sensitive (P less than 0.05) than CT in detecting positive lower abdominal nodes. In the upper abdomen, CT scan had low sensitivity for detecting positive nodes, liver, or spleen. This study suggests that LAG of the lower abdomen provided more information than CT, and therefore should not be abandoned as a valid method for detecting nodal disease.

Abdomen↗
PubMed1990

Intraoperative Ir-192 implantation for early breast cancer. Techniques and results.

Patients with early breast cancer (T1-2 N0-1) can be treated by lumpectomy and irradiation with a local control and survival equal to more radical surgery. Between 1982 and 1988, 323 patients with early breast cancer were treated, when possible, with Ir-192 implants at the time of lumpectomy to a local dose of 2000 cGy in 40-50 hours. Ten to 14 days later, the whole breast was treated to 4500 cGy at 180 per fraction in 5 weeks. The 6-year actuarial survival for stages I and II disease was 98% and 91%, respectively, and the recurrence-free survival was 96% and 98%, respectively. When these 323 patients were evaluated by T status, a local control of 97% was the same for T1 and T2 lesions. The cosmetic results were good to excellent in 95% of the patients. This approach has improved our ability to accurately place the boost dose in the breast.

Breast Neoplasms↗
PubMed1989

Treatment options in early breast cancer.

Conservative management of early breast cancer with limited surgical excision and radiotherapy is now being accepted as a viable alternative to mutilating surgical procedures. In this paper, the major steps in the historical development of conservative management are traced, and the results of the current randomized trials are summarized. An innovative method used at the University of Kansas Medical Center delivers a "boost" dose to the tumor bed with interstitial Ir-192 immediately following resection of the primary tumor mass. The results obtained in terms of local control and cosmesis with this technique are presented, and the current state of the art is discussed.

Adult↗
PubMed1988

Cosmetic results in early breast cancer treated with lumpectomy, peri-operative interstitial irradiation, and external beam radiation.

Patients with operable breast cancer were treated at the University of Kansas Medical Center with lumpectomy, peri-operative interstitial Iridium, and external beam radiotherapy, and concomitant adjuvant chemotherapy in a majority of node positive cases. Examination of the cosmetic results in 85 breasts followed for at least 2 years, at a median of 41 months revealed 20% to be excellent, 44% to be very good, 24% good, 9% fair, and 4% to have poor results. In this paper cosmesis is analyzed with reference to the size of the primary, its location, age of the patient, whether the patient received adjuvant chemotherapy, and whether the regional nodes were treated. In this group of patients, the size and the site of the primary, patient's age, and whether adjuvant chemotherapy was administered or not, did not adversely affect the aesthetic outcome. Treatment of the regional nodes gave a worse mean cosmetic score compared to the group in whom only the breast was treated (37.51 vs. 58.98 respectively, p less than 0.001). Among the 11 patients with fair/poor cosmesis, all had regional nodal treatment, 7/11 had inner quadrant lesions, and 7/11 had lesions greater than T1. Further follow-up and accrual would be needed to confirm our results and affirm if other factors would change.

Adult↗
PubMed1987

Intraoperative implantation radiation therapy plus lumpectomy for carcinoma of the breast.

The preponderance of evidence indicates that lumpectomy plus radiation therapy produces the same survival as modified radical mastectomy in patients with early breast cancer and further suggests that the local failure rate may be lower in the patients who undergo irradiation. In this series, patients were treated with immediate implantation of the tumor bed with iridium Ir 192. There have been two recurrences in the breast from 110 breast cancers (44% had a clinical stage greater than T1, and 41% had axillary-node involvement) in 107 patients followed up for four to 52 months (25.8 +/- 13.3 months [mean +/- SD]). These preliminary data suggest that local treatment failure can be minimized by aggressive, immediate intraoperative implantation of the tumor bed with iridium Ir 192.

Adult↗
PubMed1987

Perioperative interstitial irradiation in the conservative management of early breast cancer.

Conservation of the breast in early breast cancer with limited resection and radiation is proving to be as effective as modified radical mastectomy in survival and in loco-regional control. Management at the University of Kansas Medical Center consists of an interstitial implant at the time of lumpectomy to facilitate perioperative irradiation with Iridium-192 to the tumor bed. An axillary node dissection is also performed at that time. Two to 3 weeks later external beam irradiation is delivered to the entire breast. One hundred and twenty-three breasts in 120 patients have been treated between June 1982 and June 1986. There were 49 pathological Stage I, 63 Stage II, 8 Stage III carcinomas, and 3 carcinomas in situ, consisting of 72 T1, 43 T2, 5 T3, and 3 TIS lesions. Patients have been followed for a median of 30 months. One patient had a "true" recurrence in the breast. Another patient developed recurrence in a different quadrant. Ninety percent of the patients had good to excellent cosmetic results, 7% were considered fair, and 3% had poor results. Seven patients developed mild arm edema, 4 were found to have moderate edema, and 1 had severe arm edema. Our preliminary results indicate that interstitial irradiation immediately after excision results in excellent local control, with very satisfactory cosmesis and no morbidity due to the simultaneous excision and irradiation.

Adult↗
PubMed1987

Breast conservation treatment with perioperative interstitial irradiation.

Limited resection of the breast combined with radiation has proved to be as effective as more radical surgery in treating early breast cancer. At the University of Kansas Medical Center, the radiotherapy consists of an interstitial implant at the time of lumpectomy to deliver an interstitial boost dose to the tumor bed with iridium-192 immediately following the surgical procedure. An axillary node dissection is also performed at the time of lumpectomy. A dose of 2,000 cGy is delivered to the tumor bed between 40 and 60 h. Two to three weeks later, 4,500-5,000 cGy is delivered to the entire breast with external beam radiation over 5-5.5 weeks. One hundred breasts in 98 patients were so treated between June 1982 and February 1986, with 2 carcinomas in situ, 40 stage I, 51 stage II, and 7 stage III cancers, consisting of 2 TIS, 54 T1, 39 T2, and 5 T3 lesions. Locoregional control with a median follow-up of 31 months was 98%. One recurrence was in a different quadrant, and the other revealed predominantly the in situ component. Immediate implant did not compromise wound healing or cosmesis. The cosmetic result was graded as good to excellent in 88% of the breasts. Our preliminary results appear to suggest a better local control with immediate interstitial irradiation.

Adult↗
PubMed1986

Strontium 89 for palliation of bone metastases.

At the University of Kansas Medical Center, systemic use of strontium 89 ((89)Sr), a betaemitting radioisotope, was evaluated in the treatment of metastatic carcinoma to bone for relief of bone pain. Eighty-five patients were treated with systemic (89)Sr in the dosage of 30 to 40 μCi/kg. All patients had multiple bone metastases, the majority with primary breast or prostatic cancer. The response to treatment was evaluated by daily diary entries, changes in the amount of pain medication, periodic bone scans, and other laboratory values.In the patients who survived (47) and who were observed for three or more months, overall results showed 15 percent becoming pain free; 23 percent showed marked improvement with decreased consumption of pain medication; 53 percent showed mild but significant improvement in pain relief and decrease in pain medication requirement; and 9 percent showed no improvement. No patients noted a worsening of bone pain after the treatment. There was a combined favorable response in 91 percent (43/47) of patients with some meaningful palliation after (89)Sr therapy. This study, using (89)Sr systemic therapy, suggests that this isotope may be a valuable adjuvant therapy for palliation of pain from metastatic bone lesions.

Aged↗
PubMed1985

Dosimetric comparison of the Fletcher family of gynecologic colpostats 1950-1980.

The Fletcher gynecologic applicator was developed for irradiation of carcinoma of the uterine cervix in the early 1950's. Since that time, numerous modifications and changes have been made in the colpostat construction and in the location of the shields that provide a reduced dose to the bladder trigone anteriorly and to the rectal wall posteriorly. The original applicators include the preload radium double colpostat and the preload radium single colpostat. In the 1960's, afterloading colpostats were manufactured as the Fletcher-Suit and the Fletcher-Green devices. With the introduction of the Delclos mini-colpostat, a new generation of applicators followed in the 1970's. The Fletcher-Suit-Delclos colpostat recently manufactured by two companies can be used as a mini-colpostat. By adding a shield-containing cap, these applicators function as the original Fletcher colpostat. With the development of new applicators over the past 30 years, numerous changes in the position of the shields and, therefore, the dose transmitted to the surrounding tissues have been made. This paper describes dosimetric evaluation of all of these applicators and the various changes that have occurred through the generations of Fletcher colpostats in an attempt to provide information for radiation therapists and gynecologists who are using these instruments in their clinical practice.

Brachytherapy↗
PubMed1985

Contribution of radionuclide imaging to radiation oncology.

Radionuclide imaging has been helpful to oncologists in the initial evaluation and follow-up of patients with primary and metastatic disease. With the introduction of ultrasound and computed tomography, there has been some reduction in the number of radionuclide imaging procedures. These imaging modalities should be used to complement one another. With the introduction of single-photon emission computed tomography in clinical nuclear medicine, there will be a significant improvement in the sensitivity, accuracy, and quantitative ability to detect abnormal lesions. There are intensive efforts in the development of tumor imaging using new agents. Specific antibodies for surface tumor antigens can be labeled with radioisotopes and used as tools for screening primary tumors and metastatic lesions. Therefore, for the present, radionuclide imaging will continue to contribute to clinical oncology.

Abdominal Neoplasms↗
PubMed1985

Perioperative interstitial therapy followed by external radiation therapy in the preservative management of early breast cancer.

Treatment of early breast cancer by lumpectomy and irradiation is well accepted. The five- and ten-year results of preservative treatment are comparable to more radical procedures. The technique of perioperative interstitial radiation has several advantages: (1) more accurate placement of the tubes in the tumor bed at the time of surgery; (2) implant volume is kept to a minimum, which improves cosmetic results; and (3) elimination of second general anesthesia for patients considered for implant boost therapy.Modified external radiation to regional lymphatics by combining electron and photon therapy at the 50 percent level can reduce side effects, such as skin reaction and esophagitis, and the dose to the heart, lungs, and opposite breast.

Adult↗
PubMed1984

Randomized trial of radiotherapy versus radiotherapy plus metronidazole for the treatment metastatic cancer to brain. A Southwest Oncology Group study.

One hundred sixteen eligible patients with metastatic cancer to the brain were randomized to receive either radiotherapy 3000 rad/10 fractions (treatment 1) or the same radiotherapy plus metronidazole 6 gm/m2 (treatment 2). One hundred eleven patients were either fully or partially evaluable. The response rates (CR + PR) and survival showed no significant differences between treatments. Treatment 1: CR + PR 24%, median survival 14 weeks, Treatment 2: CR + PR 27%, median survival 12 weeks. There were no differences observed in response rates based on primary tumor site, neurologic performance status, or extent of metastatic disease. Metronidazole therapy was associated with substantial nausea and vomiting but no neurotoxicity was observed. Oral metronidazole given every other day during radiation therapy provided no clinical benefit for patients with brain metastases compared to radiotherapy alone.

Age Factors↗
PubMed1984

Ultrastructural evidence of cardiac damage resulting from thoracic irradiation and anthracyclines in the rat.

The effects of radiation combined with Adriamycin (ADR) or Dihydroxyanthraquinone (DHAQ, NSC 279836) on the induction of cardiomyopathy in the rat were investigated using electron microscopy. Rats were treated with ADR or DHAQ at 2.5, 5.0, or 10 mg/kg ip; thoracic irradiation at 12, 15, 18, 21, or 24 Gy of 25 MV X rays; or a combination of either drug at 5.0 mg/kg plus 15 Gy X rays. Survival times were observed to be linear, inverse functions of the dose of drug or radiation received. Combinations of ADR plus radiation produced an increased lethality while the combination of DHAQ and radiation produced similar lethality as DHAQ alone. Even for treatments that resulted in animal lethality, there was little histological evidence of abnormality observed in heart tissues by light microscopy. On the other hand, electron microscopic examination of cardiac tissues demonstrated dramatic decreases in mitochondrial number and destruction of mitochondrial structure. The treatments could be arranged in order of increasing severity of the damage produced as follows: 5 mg/kg ADR, 15 Gy X ray, 5 mg/kg DHAQ, 5 mg/kg ADR + 15 Gy X ray, 24 Gy X ray, and 5 mg/kg DHAQ + 15 Gy X ray. In several cases, mitochondrial abnormalities were sufficient so as to allow cardiomyopathy to be cited as the cause of death. These results indicate that electron microscopy can be used to document cellular changes that may only be functionally expressed as long-term normal tissue damage or animal lethality. The finding that DHAQ can produce significant cardiotoxicity, and that this cardiotoxicity is enhanced by concomitant thoracic irradiation, suggest caution while this drug is being investigated for clinical use.

Animals↗
PubMed1984

Development of normal tissue damage in the rat subsequent to thoracic irradiation and prior treatment with cancer chemotherapeutic agents.

The effect of combined modalities (radiotherapy-chemotherapy) on the development of long-term normal tissue damage was investigated in rats. Animals received single I.P. injections of Hank's balanced saline solution, adriamycin (ADR, 1.0 mg/kg), bleomycin (BLM, 10 units/kg), or dihydroxyanthraquinone (DHAQ, 3.0 mg/kg); and/or irradiation of the chest with 25 MV x-rays (12 Gy) at 0, 43, 93, or 199 days after drug treatment. Only animals treated with DHAQ displayed appreciable toxicity, with more animals dying at less than 200 days when radiation was added at 0 or 43 days. Although animals treated with BLM or radiation exhibited evidence of lung damage (histologically by 199 days and radiographically by 300 days), their survival was not compromised. The simultaneous administration of x-ray and BLM produced enhanced effects as compared to either agent alone. These results demonstrate an enhancement of normal tissue damage by combined treatment with radiation and chemotherapeutic agents, not only for acute toxicity but also for long-term effects. This damage was ultimately expressed as alteration of lung structure (histologically and radiographically) in the case of BLM, and as animal lethality in the case of DHAQ. In addition, there was a reduction in the degree of enhancement observed as a function of the separation in time between treatment with chemotherapeutic agents and subsequent irradiation. These factors should be considered when combined modality therapy is used for treatment of cancer in the thoracic region.

Animals↗
PubMed1984

Lumpectomy and level I axillary dissection prior to irradiation for "operable" breast cancer.

Between July 1, 1979 and March 1, 1984, we treated 154 women by irradiation as an alternative to mastectomy. Excision of the primary tumor without the sacrifice of a large volume of contiguous normal breast (lumpectomy) was performed, and all but ten women also underwent concomitant level I axillary node dissection. The mean node count in the level I dissection was 27 nodes, indicating that this dissection offered accurate information about axillary node status, so that the extent of radiation therapy and subsequent adjuvant chemotherapy could be planned appropriately. Subdivision of the level I nodes into anatomic groups and their separate histologic analysis suggested that less than a complete level I dissection might miss involved nodes in almost one-half the patients with clinically negative axillae but histologically positive nodes. Postoperative complications occurred in 13% of patients, not an insignificant number, most of them being either infections or the persistent accumulation of lymph in the axillary wound. Later complications, such as infection or arm edema, also occurred, just as after mastectomy. The median follow-up of these 154 patients has been only 12 months, the maximum being not quite 5 years, so that any long-term speculations are not justified. We believe that the continued use of this combination therapy is warranted preceding irradiation by lumpectomy and level I axillary dissection as described, with careful follow-up to assess the long-term results of this option.

Adult↗
PubMed1984

Radiation therapy for early glottic carcinomas.

From 1973 to 1978, 30 cases of early glottic cancers (TINOMO) were treated in the Department of Radiation Therapy, University of Kansas Medical Center. All 30 patients have a minimal follow-up of three years with a mean of 50.2 months, and 26 (86.7%) are alive with no evidence of disease. Radiation therapy failed in three (10%), two of whom were salvaged by subsequent surgery. Thus the overall control rate was 29/30 (96.7%). We recommend primary radiation therapy for these early lesions, reserving operation for cases of unsuccessful radiotherapy.

Carcinoma, Squamous Cell↗