Biomedical subjects

Christopher G Morris

Publications and source records attributed to Christopher G Morris.

At least 19 recordsLinked to original sources

PubMed2005

Merkel cell carcinoma: treatment and outcomes.

BACKGROUND: The purpose of the current study was to determine the outcomes of patients with previously untreated Merkel cell carcinoma of the skin who were treated with curative intent. METHODS: Between October 1984 and January 2002, 34 patients were treated with radiotherapy alone (2 patients) or combined with surgery (32 patients). Nine patients received adjuvant chemotherapy. Patients had follow-up for a median of 3.0 years (range, 0.3 to 18.5 yrs). Follow-up on living patients ranged from 2.2 to 18.5 years (median, 7.1 yrs). RESULTS: The 5-year outcomes were as follows: local control, 94%, locoregional control, 80%; freedom from distant metastases, 60%; cause-specific survival, 52%; and survival, 37%. No patient experienced a severe complication. CONCLUSIONS: Patients treated aggressively with surgery and locoregional radiotherapy have about a 50% chance of cure. Limited data suggest that definitive radiotherapy alone or after incomplete macroscopic resection may control locoregional disease in a significant subset of patients. The dominant site of failure was distant.

Adult↗

PubMed2005

Minimizing local recurrence after breast conserving therapy using intraoperative shaved margins to determine pathologic tumor clearance.

BACKGROUND: This study analyzed survival, locoregional recurrence, and reexcision rates after breast conserving therapy, based on the margin analysis technique used at the University of Florida, which incorporates frozen section analysis of shaved breast tissue from the lumpectomy cavity. STUDY DESIGN: A retrospective review was done of 257 patients who underwent 267 consecutive lumpectomy operations and completed radiation therapy at our institution. Margins in 189 patients were assessed using frozen section analysis of shaved margins from the lumpectomy cavity. RESULTS: Breast conserving therapy was performed for 220 (83%) patients with early breast cancer (T1 and T2 tumors) and 47 (17%) with ductal carcinoma in situ. With a median followup of 5.6 years, the crude locoregional recurrence rates for patients who had margins analyzed intraoperatively by frozen section analysis or margins analyzed by permanent analysis were 1.9% (3 of 157) and 3.1% (2 of 63), respectively, for early breast cancer and 15.6% (5 of 32) and 6.6% (1 of 15) for ductal carcinoma in situ (p=NS). Survival rates were 97% and 78%, at 5 and 10 years, respectively, for the early breast cancer patients, and 98% and 98%, respectively, for ductal carcinoma in situ patients. Permanent intraoperative frozen section analysis reexcision rates were 33.3% (26 of 78) and 5.8% (11 of 189). CONCLUSIONS: Regardless of the technique used for margin analysis, breast conserving therapy led to low locoregional recurrence relative to national figures, pointing to the importance of the technique of radiation therapy at our institution. Reexcision rate was reduced with the use of frozen section analysis.

Adult↗

PubMed2005

Radiotherapy alone or combined with carbogen breathing for squamous cell carcinoma of the head and neck: a prospective, randomized trial.

BACKGROUND: The current study was performed to investigate the efficacy of carbogen (95% oxygen [O(2)] and 5% carbon dioxide [CO(2)]) breathing during definitive radiotherapy (RT) to enhance local control. METHODS: Between November 1996 and November 2002, 101 patients with previously untreated T2 to T4 squamous cell carcinomas of the oropharynx, larynx, and hypopharynx were entered onto a prospective trial and randomized to receive definitive hyperfractionated RT alone or combined with carbogen breathing. Patients were stratified according to T classification and primary tumor site. Follow-up ranged from 1-91 months (median, 38 months). All living patients had follow-up for more than 2 years. Outcomes analyses were performed according to intent to treat. RESULTS: Definitive RT alone was completed as planned in 50 of 51 patients (98%); 49 of the 50 patients (98%) who were randomized to receive carbogen breathing were able to complete the RT as planned. Three patients randomized to receive carbogen breathing declined carbogen. The 5-year outcomes after RT alone or combined with carbogen were as follows: local control, 83% versus 88% (P = 0.5155); locoregional control, 81% versus 83% (P = 0.7174); distant metastasis-free survival, 82% versus 86% (P = 0.5184); cause-specific survival, 73% versus 77% (P = 0.5866); and absolute survival, 53% versus 58% (P = 0.4856). CONCLUSIONS: The addition of carbogen breathing to definitive RT did not appear to improve the likelihood of local control significantly. However, because of the limited size of the current study, the authors cannot definitively conclude that carbogen breathing is ineffective.

Carbon Dioxide↗

PubMed2005

Does altered fractionation influence the risk of radiation-induced optic neuropathy?

PURPOSE: To analyze the parameters that influence the risk of radiation-induced optic neuropathy (RION) after radiotherapy for head-and-neck tumors. METHODS AND MATERIALS: Between 1964 and 2000, 273 patients with tumors of the nasopharynx, paranasal sinuses, nasal cavity, and hard palate adenoid cystic carcinomas were treated with curative intent and had radiation fields that included the optic nerves and/or chiasm. Patients were followed for at least 1 year after radiotherapy. RESULTS: Radiation-induced optic neuropathy developed in 32 eyes of 24 patients (9%). The 5-year rates of freedom from RION according to the total dose and once- vs. twice-daily fractionation were as follows: < or =63 Gy once daily, 95%; < or =63 Gy twice daily, 98%; >63 Gy once daily, 78%; and >63 Gy twice daily, 91%. Multivariate analysis revealed that the total dose affected the risk of RION (p = 0.0047), with patient age (p = 0.0909), once-daily vs. twice-daily fractionation (p = 0.0684), and overall treatment time (p = 0.0972) were marginally significant. The use of adjuvant chemotherapy did not significantly influence the likelihood of developing RION. CONCLUSION: The likelihood of developing RION is primarily influenced by the total dose. Hyperfractionation may reduce the risk of experiencing this complication.

Adrenal Cortex Hormones↗

PubMed2005

Radiotherapy alone or combined with surgery for salivary gland carcinoma.

BACKGROUND: The authors analyzed the outcomes of patients treated with radiotherapy (RT) alone or combined with surgery for carcinoma of the salivary glands. METHODS: Between October 1964 and June 2003, 224 previously untreated patients were treated with curative intent with RT alone (n = 64) or combined with surgery (n = 160) at the University of Florida College of Medicine (Gainesville, FL). The median follow-up period was 5.0 years (range, 0.4-31.6 years). RESULTS: The 10-year local control rate was 75%. Multivariate analysis of local control revealed that T classification (P < 0.0001) and treatment group (P < 0.0001) impacted this end point. Patients treated with surgery and adjuvant RT had improved local control compared with patients treated with RT alone. The 10-year locoregional control rate was 68%. Multivariate analysis of locoregional control revealed that overall stage (P < 0.0001) and treatment group (P = 0.0002) significantly influenced this end point. The 10-year distant metastasis-free survival rate was 68%. Multivariate analysis of distant metastasis-free survival revealed that overall stage (P < 0.0001) significantly influenced this end point. The 10-year cause-specific and overall survival rates were 57% and 44%, respectively. Multivariate analysis of cause-specific survival revealed that overall stage (P < 0.0001) significantly impacted this end point. Twenty-three patients (10%) experienced severe complications. CONCLUSIONS: A substantial proportion of patients with salivary gland carcinoma were cured with surgery combined with adjuvant RT. RT alone was used for patients with unresectable tumors and cured approximately 20% of those with advanced-stage disease. The probability of cure was influenced by the extent of disease and treatment group.

Adenocarcinoma↗

PubMed2005

Retromolar trigone squamous cell carcinoma treated with radiotherapy alone or combined with surgery.

BACKGROUND: Treatment outcomes were analyzed for retromolar trigone squamous cell carcinoma. METHODS: Between June 1966 and August 2003, 99 patients were treated with radiotherapy alone (35 patients) or radiotherapy combined with surgery (64 patients). Followup ranged from 0.2 to 23.8 years (median, 3.3 yrs). All living patients had followup for at least 1 year. RESULTS: The 5-year local-regional control rates after definitive radiotherapy versus surgery and radiotherapy were as follows: Stages I-III, 51% and 87%; Stage IV, 42% and 62%; and overall, 48% and 71%, respectively. The 5-year cause-specific survival rates after definitive radiotherapy compared with surgery and radiotherapy were as follows: Stages I-III, 56% and 83%; Stage IV, 50% and 61%; and overall, 52% and 69%, respectively. Multivariate analyses revealed that the likelihood of cure was better with surgery and radiotherapy compared with definitive radiotherapy. CONCLUSIONS: The likelihood of cure after treatment for retromolar trigone squamous cell carcinoma was influenced by the extent of disease and treatment. Patients treated with surgery and radiotherapy had a better outcome than those treated with radiotherapy alone.

Carcinoma, Squamous Cell↗

PubMed2005

Breast-conserving therapy in patients with bilateral breast cancer: do today's treatment choices burn bridges for tomorrow?

PURPOSE: To determine how often initial treatment choices limit treatment options for subsequent breast cancer management in patients undergoing breast-conserving therapy (BCT), in particular with treatment of internal mammary nodes. METHODS AND MATERIALS: Between January 1985 and June 2001, 464 women with pathologic Stage 0, I, and II (T0-2, N0-1) breast cancer underwent BCT at our institution. All 464 patients had computed tomography-based treatment planning. In patients with bilateral breast cancer, the planning computed tomography scans were used to determine the impact initial radiation therapy fields had on treatment options for subsequent contralateral breast cancer. RESULTS: There were 500 breast cancers diagnosed in 464 patients. Thirty-six patients (8%) had bilateral breast cancer with 9 (2%) synchronous and 27 (6%) metachronous primaries. In 80 patients, the ipsilateral internal mammary nodes were explicitly treated. Initial breast cancer treatment choices impacted subsequent treatment decisions for the contralateral breast in only 2 of 464 patients (0.4%) in the study: 2 of 80 patients (2.5%) whose internal mammary nodes were treated, and 2 of 27 patients (7.4%) who developed metachronous bilateral breast cancer. CONCLUSIONS: Initial BCT, including internal mammary node irradiation, rarely compromised future contralateral breast-conserving therapy.

Adult↗

PubMed2005

Impact of radiographic findings on prognosis for skin carcinoma with clinical perineural invasion.

BACKGROUND: The objective of the current study was to correlate pretreatment computed tomography and magnetic resonance imaging studies with outcomes for patients with squamous or basal cell carcinoma of the skin and clinical perineural invasion. METHODS: Between 1986 and 2002, 45 patients were treated with radiotherapy alone (21 patients) or combined with surgery (24 patients), and 4 patients received concomitant chemotherapy. Follow-up ranged from 0.85 years to 17.4 years (median, 3.8 years). Patients were stratified as follows: imaging negative, 10 patients; minimal or moderate peripheral disease, 14 patients; and central and/or macroscopic disease, 21 patients. RESULTS: The 5-year local control rates were as follows: imaging negative, 76%; minimal or moderate peripheral disease, 57%; and central and/or macroscopic disease, 25%. The 5-year absolute and cause-specific survival rates were as follows: imaging negative, 90% and 100%, respectively; minimal or moderate peripheral disease, 50% and 56%, respectively; and central and/or macroscopic disease, 58% and 61%, respectively. CONCLUSIONS: Patients who had symptomatic but imaging-negative perineural invasion had a relatively good prognosis after receiving definitive radiotherapy alone or combined with surgery. Patients who had imaging-positive minimal or moderate peripheral disease had a better local control rate but a similar survival rate compared with patients who had central and/or macroscopic disease.

Adult↗

PubMed2005

Preventing radiation retinopathy with hyperfractionation.

PURPOSE: The purpose of this study was to determine factors associated with the development of radiation retinopathy in a large series of patients with head-and-neck cancer. In particular, we addressed whether the use of hyperfractionated radiation therapy was effective in reducing the risk of retinopathy. METHODS AND MATERIALS: One hundred eighty-six patients received a significant dose to the retina as part of curative radiotherapy. Primary sites included: nasopharynx, 46; paranasal sinus, 64; nasal cavity, 69; and palate, 7. Prescription doses varied depending on primary site and histology. Hyperfractionated (twice-daily) radiation was delivered to 42% of the patients in this study, typically at 1.10 to 1.20 Gy per fraction. The remainder were treated once-daily. Retinal doses were determined from computerized dosimetry plans when available. For all other patients, retinal doses were retrospectively calculated using reconstructed off-axis dosimetry taken from contours through the center of the globes. Retinal dose was defined as the minimum dose received by at least 25% of the globe. The median retinal dose was 56.85 Gy. Patients were followed for a median of 7.6 years. RESULTS: Thirty-one eyes in 30 patients developed radiation retinopathy, resulting in monocular blindness in 25, bilateral blindness in 1, and decreased visual acuity in 4. The median time to the diagnosis of retinopathy was 2.6 years (range, 11 months to 5.3 years). The actuarial incidence of developing radiation retinopathy was 20% at both 5 and 10 years. The incidence of developing ipsilateral blindness due to retinopathy was 16% at 5 years and 17% at 10 years. Site-specific incidences varied considerably, with ethmoid sinus (9 of 25, 36%), nasal cavity (13 of 69, 19%), and maxillary sinus (6 of 35, 17%) being the most common sites associated with radiation retinopathy. Three of 72 patients (4%) receiving retinal doses less than 50 Gy developed retinopathy. Higher retinal doses resulted in a steady increase in the incidence of retinopathy, with 25 of the 30 cases occurring after 60 Gy or more. Of the patients receiving more than 50 Gy to the retina, hyperfractionation was associated with a significantly lower incidence of radiation retinopathy (37% vs. 13%; p = 0.0037). On multivariate analysis, retinal dose (p < 0.0001), fractionation schedule (p = 0.0003), age (p = 0.0365), and prolonged overall treatment time (p = 0.0213) were significant predictors of radiation retinopathy. CONCLUSION: The incidence of ipsilateral radiation retinopathy after treatment of nasal cavity/paranasal tumors is 20% at 5 and 10 years. Retinal dose and fractionation schedule are the strongest predictors of retinopathy. Hyperfractionated radiotherapy is associated with a significant reduction in the incidence of radiation retinopathy, especially when the retina receives more than 50 Gy.

Adolescent↗

PubMed2005

Impact of young age on prognosis for head and neck cancer: a matched-pair analysis.

BACKGROUND: : The purpose of this study was to review outcomes of young patients (age <40 years) treated with definitive radiotherapy alone for squamous cell carcinoma of the oropharynx, and larynx, and to compare these results with an older matched patient cohort. METHODS: : Since 1983, 30 previously untreated young patients underwent definitive radiotherapy at the University of Florida and were matched with an older group of patients (age >45 years) with respect to primary site, stage of disease, and sex. RESULTS: : There was no difference in cause-specific survival, locoregional control, or long-term complications between the two groups; however, there was a significant difference in overall survival favoring young patients (p = .0174). Older patients had twice as many second malignancies. CONCLUSION: : Young age does not confer a worse prognosis in patients treated with definitive radiotherapy for squamous cell carcinoma of the oropharynx and larynx.

Adult↗

PubMed2005

Pushing the limits of radiotherapy for atypical and malignant meningioma.

PURPOSE: The purpose of this study was to report the outcome of an extremely aggressive radiotherapy program in patients with atypical and malignant meningioma (60 Gy at 1.5 Gy per fraction twice daily +/- radiosurgery boost). METHODS AND MATERIALS: Thirty-six patients received radiotherapy with curative intent between 1984 and 1999 for atypical (27 patients) or malignant (9 patients) meningioma. All patients had a minimum of 2 years follow up. RESULTS: The overall 5-year local control, cause-specific survival, and absolute survival rates were 45%, 39%, and 36%, respectively. Accelerated hyperfractionated radiotherapy resulted in a local control rate of 45% compared with 50% for patients treated with less aggressive schedules (P = 0.99). A radiosurgery boost did not improve tumor control. The complication rate for those treated with accelerated hyperfractionated radiotherapy was dramatically higher (grade 3-5: 55% vs. 0%, grade 4-5: 27% vs. 0%. both P <0.05). CONCLUSION: Our data suggests that 50 to 60 Gy delivered with conventional, once-daily fractionation is probably the optimal schedule for atypical and malignant meningioma. More aggressive radiotherapy fractionation schedules and radiosurgery are unlikely to improve outcome.

Adult↗

PubMed2005

Long-term results of radiotherapy for early-stage testicular seminoma.

PURPOSE: We conducted an outcome and complications analysis of patients treated with adjuvant radiotherapy (RT) for early-stage testicular seminoma over a 35-year period at the University of Florida. METHODS AND MATERIALS: All 73 patients had the classic seminoma histology. No patient received chemotherapy as initial treatment. There were 57, 14, and 2 patients with Royal Marsden stage I, IIA, and IIB disease, respectively. All received RT to the paraaortic (PAN) and pelvic fields. One-third of the patients received prophylactic RT to mediastinal/supraclavicular fields. RESULTS: Median follow up was 15 years. Median RT dose to PAN and pelvic fields was 25 Gy. Local control and cause-specific survival at 20 years were 95% and 96%, respectively. Of the 3 recurrences, 1 was salvaged with chemotherapy. Subset analysis of 41 patients revealed 1 patient who developed peptic ulcer disease and 11 patients with gastrointestinal reflux symptoms after RT. Thirty-two patients fathered a child before or after RT. Cardiovascular complications were not greater in those treated with prophylactic RT to the mediastinal region. The rate of nontesticular second malignancy for the overall group was 8% at 15 years. CONCLUSIONS: Patients treated with adjuvant low-dose RT to the paraaortic and pelvic fields for treatment of early-stage seminoma enjoy an excellent long-term cure rate with minimal risk of late RT complications.

Adult↗

PubMed2005

Role of radiotherapy for pleomorphic adenoma.

The purpose of this article was to evaluate the role of radiotherapy (RT) in the treatment of pleomorphic adenoma. This is a retrospective analysis of 17 patients treated with RT alone (2 patients) or combined with surgery (15 patients). Follow up ranged from 1.8 to 27.1 years (median, 9.6 years). Local control was obtained in 8 of 10 patients (80%) with subclinical disease and 3 of 7 patients (43%) with gross disease. Overall local control was obtained in 11 of 17 patients (65%). The 5- and 10-year overall local control rates were 69% and 61%, respectively. One patient died secondary to tumor extension into the central nervous system, 1 patient had recurrence of carcinoma ex-pleomorphic adenoma and died of cancer at the primary site, 5 patients died free of disease, and 10 patients were alive at last follow up. RT is relatively effective at controlling subclinical disease in patients at high risk for developing recurrence after surgery for pleomorphic adenoma. Limited data suggest that RT may also occasionally control gross disease.

Adenoma, Pleomorphic↗

PubMed2005

Aggressive fibromatosis.

The purpose of this article is to review the pertinent literature and to define the optimal treatment of patients with aggressive fibromatosis. Data indicate the likelihood of local recurrence after surgery is high, particularly if margins are positive. Moderate-dose radiotherapy alone for gross disease or after a microscopically incomplete resection yields local control rates of approximately 75% to 80%. Treatment with pharmacologic agents results in objective response rates of approximately 40% to 50%; duration of response is variable. Thus, the optimal management for aggressive fibromatosis depends on tumor location and extent. Surgery is indicated if the lesion appears to be completely resectable with acceptable function and cosmesis. Radiotherapy is indicated for patients with unresectable tumors; those with positive margins after resection should be considered for adjuvant radiotherapy depending on the location and extent of the tumor. Pharmacologic treatment should be considered for patients with progressive disease after unsuccessful local-regional therapy.

Desmoid Tumors↗

PubMed2005

Neurotropic melanoma of the head and neck with clinical perineural invasion.

OBJECTIVE: The purpose of this article is to report our experience with neurotropic melanoma, a rare malignancy that sometimes produces neurologic symptoms because of a direct extension of the primary tumor. METHODS: We report 3 consecutive patients with neurotropic melanoma of the head and neck who presented with clinical perineural invasion. RESULTS: Two patients had incompletely resectable tumors and were treated with definitive radiotherapy (RT), and 1 patient received surgery and postoperative RT. One patient experienced recurrence in a regional lymph node 30 months after RT and underwent salvage surgery; he is disease-free at 45 months after initial treatment. The remaining 2 patients are disease-free 34 months and 14 months after treatment. CONCLUSIONS: Radiotherapy alone or combined with surgery may provide relatively long-term local control in patients who have neurotropic melanoma with clinical perineural invasion.

Adult↗

PubMed2005

Thyroid function should be monitored following radiotherapy to the low neck.

The purpose of this study was to determine whether the incidence of hypothyroidism following radiotherapy (RT) to the low neck is high enough to justify the routine monitoring of thyroid function in asymptomatic patients. A retrospective study of 504 patients with head and neck cancer whose RT fields included the thyroid gland was conducted. Patients were treated either with definitive or postoperative RT. Hypothyroidism was defined as a thyroid stimulating hormone (TSH) level > or =4.5 mIU/L, regardless of whether the patient had clinical symptoms. Of the 504 total patients, 206 had a serum TSH level checked at some point posttreatment. If we assume that patients who had no data did not have hypothyroidism, the actuarial freedom from hypothyroidism in the entire group was 78% at 5 years and 51% at 10 years. Of the 206 patients who had a documented posttreatment TSH, the actuarial freedom from hypothyroidism was 58% at 5 years and 26% at 10 years. Univariate analysis and multivariate analysis confirmed treatment modality to be a significant predictive factor. Definitive initial surgery that removed part of the thyroid gland increased the risk of developing hypothyroidism. Overall stage was also predictive on multivariate analysis. Head and neck irradiation results in biochemical hypothyroidism in at least 50% of patients. Thyroid function should be tested on a regular basis following RT to the low-neck region. Serum TSH should be checked every 6 months for the first 5 years and yearly thereafter. Thyroid hormone replacement should be initiated in any patient with a TSH of more than 4.5 mIU/L.

Actuarial Analysis↗

PubMed2005

Radiotherapy and radiosurgery for benign neurofibromas.

The purpose of this study was to evaluate the efficacy of radiotherapy (RT) and stereotactic radiosurgery (SRS) for neurofibromas. We studied 4 patients treated with RT (3 patients) or SRS (1 patient) and followed from 1.7 to 14.8 years. The tumor remained locally controlled in all patients. No significant complications related to treatment were observed. RT and SRS are likely to locally control neurofibromas in patients who require treatment and are not good candidates for complete resection.

Adult↗

PubMed2005

Adult head and neck soft tissue sarcomas.

PURPOSE: To analyze the outcomes of adult patients with head and neck soft tissue sarcomas. METHODS: Review of 39 patients treated with radiotherapy (RT) alone (6 patients) or combined with surgery (33 patients) with curative intent between December 1966 and February 2003. Follow-up for living patients ranged from 1 to 21 years (median, 8.7 years). RESULTS: Five-year outcomes were as follows: local control, 78%; distant metastasis-free survival, 85%; cause-specific survival, 69%, and overall survival, 63%. Three of 6 patients (50%) treated with definitive RT were locally controlled compared with 27 of 33 patients (82%) treated with surgery and RT. CONCLUSIONS: Approximately two thirds of patients with head and neck soft tissue sarcomas are cured with RT alone or combined with surgery. Local recurrence is a significant mode of treatment failure. Outcome is influenced by tumor extent, histologic grade, and resectability.

Adult↗