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Biomedical subjects

D Easton

Publications and source records attributed to D Easton.

89 records · Page 5Linked to original sources
PubMed1987

Prognosis following chemotherapy for metastatic malignant teratoma.

A multiple regression analysis was performed of factors affecting the prognosis of 93 patients with metastatic malignant teratoma treated at the Royal Marsden Hospital between 1979 and 1981. In a subgroup of 53 patients, where exact tumour bulk could be calculated from sequential CT scan slices, a correlation was seen between tumour marker level and volume of metastatic disease. On analysis of the risk of relapse after initial chemotherapy, the independent adverse influence was detected of serum AFP greater than 500 micrograms/l and of bulky disease defined by clinical staging. An adverse influence of high serum HCG levels was not seen, probably due to the small number of patients in this series with this presenting feature.

Adult↗
PubMed1986

Risk of lymphoedema following the treatment of breast cancer.

The incidence of lymphoedema was studied in 200 patients following a variety of treatments for operable breast cancer. Lymphoedema was assessed in two ways: subjective (patient plus observer impression) and objective (physical measurement). Arm volume measurement 15 cm above the lateral epicondyle was the most accurate method of assessing differences in size of the operated and normal arm. Arm circumference measurements were inaccurate. Subjective lymphoedema was present in 14 per cent whereas objective lymphoedema (a difference in limb volume greater than 200 ml) was present in 25.5 per cent. Independent risk factors contributing towards the development of subjective late lymphoedema were the extent of axillary surgery (P less than 0.05), axillary radiotherapy (P less than 0.001) and pathological nodal status (P less than 0.10). The risk of developing late lymphoedema was unrelated to age, menopausal status, handedness, early lymphoedema, surgical and radiotherapeutic complications, total dose of radiation, time interval since presentation, drug therapy, surgery to the breast, radiotherapy to the breast and tumour T stage. The incidence of subjective late lymphoedema was similar after axillary radiotherapy alone (8.3 per cent), axillary sampling plus radiotherapy (9.1 per cent) and axillary clearance alone (7.4 per cent). The incidence after axillary clearance plus radiotherapy was significantly greater (38.3 per cent, P less than 0.001). Axillary radiotherapy should be avoided in patients who have had a total axillary clearance.

Axilla↗
PubMed1986

Radiotherapy for stage I seminoma testis: results of treatment and complications.

The results of treatment by infradiaphragmatic lymph node irradiation and orchiectomy in 232 patients with Stage I testicular seminoma seen between 1963 and 1983 are reported. Of this group, only five (2%) patients relapsed and none died from seminoma. Contralateral testicular tumours occurred in 12 patients and five developed second non-testicular malignancies. The acute and late morbidity of radiotherapy was low although 15 patients developed peptic ulceration. There was a significant association between prior abdominal surgery and a history of dyspepsia with ensuing peptic ulceration. Future management policy is discussed on the basis of these observations.

Adult↗
PubMed1986

An analysis of prognostic factors in early stage Hodgkin's disease.

An analysis of prognostic factors has been carried out in 398 patients presenting with clinical Stage I and II Hodgkin's disease treated between 1963 and 1979. By life table analysis older age, lymphocyte depletion histology, systemic symptoms, mediastinal node bulk, and erythrocyte sedimentation rate (ESR) greater than 40 mm/h were associated with a significantly worse survival probability. On multiple factor regression analysis only age and stage were independent prognostic variables for survival, with systemic symptoms having borderline significance. Using this information, together with other analyses of prognosis in early Hodgkin's disease three groups of patients are defined. The first with a predicted 5-year survival of 78% would include patients possessing at least one of the following features; age greater than 60, lymphocyte depletion, greater than 3 sites involved, systemic symptoms, mediastinal/thoracic ratio of greater than 1/3. The second groups present with at least two of the following factors; ESR greater than 40 mm/h, male sex, 3 involved sites, or mixed cellularity histology, and the 5 year survival probability is 84%. The remaining Stage I and II patients would constitute a good prognosis group with a predicted 5-year survival of 92%.

Actuarial Analysis↗
PubMed1986

Prospective randomised trial of single and multifraction radiotherapy schedules in the treatment of painful bony metastases.

A prospective randomised trial comparing a single fraction of 8 Gy with 30 Gy in 10 daily fractions for the relief of metastatic bone pain was performed. In 28 months, 288 patients were randomised. Pain was assessed using a questionnaire completed by the patient at home on a daily basis. No difference was found in the speed of onset or duration of pain relief between the two treatment regimes, and pain relief was independent of the histology of the primary tumour.

Bone Neoplasms↗
PubMed1986

Estimation of risk of glucose 6-phosphate dehydrogenase-deficient red cells to ozone and nitrogen dioxide.

It has been suggested that the more than 1 million black Americans with the A- variant of glucose-6-phosphate dehydrogenase deficiency (G6PD) are at risk for adverse hematologic effects due to inhalation of ambient levels of oxidant gases. To evaluate this hypothesis studies were performed that included direct exposure of human G6PD-deficient red cells, and of mouse strains with different G6PD levels, to the oxidant gases ozone and nitrogen dioxide. Using the oxidant drug phenylhydrazine in part as a point of comparison, conservative extrapolation of the data indicates that exposure to levels of ozone or nitrogen dioxide at least one and probably two orders of magnitude above the LD50 would be required for any hematologic effect to be observed of pertinence to G6PD deficiency. It is concluded that there is no reason to remove or preclude from the workplace black employees with the common A- variant of red cell G6PD deficiency who potentially are exposed to oxidant gases.

Animals↗
PubMed1986

Prognostic factors in stage I non-seminomatous germ-cell testicular tumors managed by orchiectomy and surveillance: implications for adjuvant chemotherapy.

Between February 1979 and March 1985, 126 patients with clinical stage I non-seminomatous germ-cell testicular tumors were entered into a surveillance study after orchiectomy. Of this group, 36 (28%) have relapsed. The prognostic significance of 13 clinical, histopathologic, and biochemical factors has been analyzed. Vascular invasion and lymphatic invasion (LI) within the primary tumor, histology, and involvement of the epididymis and rete testis were significantly associated with an increased risk of relapse. However, multiple regression analysis showed that only histology and LI were significant, independent prognostic factors. These findings provide the basis for the consideration of adjuvant chemotherapy for patients with apparent clinical stage I testicular non-seminoma who are at high risk of harboring occult metastases.

Adult↗
PubMed1986

Models for respiratory cancer in nickel refinery workers.

Lung and nasal sinus cancer death rates among employees of a nickel refinery in South Wales were examined from the standpoint of quantifying the relationship between exposure and the risk of these two cancers. Areas in the refinery associated with high risk were identified by using a matched case-control approach, and a simple index of exposure for each man was constructed accordingly based on the duration of time spent in these areas. The dependence of relative risk and absolute excess risk for lung and nasal sinus cancers on age at first employment, calendar period of first employment, time since first employment, and duration of exposure in high-risk areas was then analyzed. The relative risk for nasal sinus cancer increased sharply with increasing age at first exposure but remained roughly constant throughout the period of follow-up, while that for lung cancer was independent of age at first exposure and dropped sharply with increasing time since first employment. The implications and limitations of these analyses are discussed in relation to the multistage theory of carcinogenesis and occupational risk assessment.

Adult↗
PubMed1986

A double blind randomised clinical trial of adjuvant aminoglutethimide versus placebo given to post menopausal patients with histologically confirmed stage II breast cancer.

A multicentre double blind trial is underway to evaluate aminoglutethimide (AG) (Orimeten, Ciba) 1.000 mg/day with hydrocortisone (HC) 20-40 mg/day versus placebo for adjuvant treatment of post menopausal patients with histologically confirmed stage II breast cancer. An interim analysis in February 1985 indicates that of 338 patients randomised 165 received AG + HC and 173 received placebo. At this time 143 AG + HC patients and 141 placebo patients were eligible and assessible for analysis. Of those who received AG + HC 41 have developed metastases and 27 died compared to placebo patients, 53 of whom have developed metastases (p = 0.04) and 34 have died (p = 0.21). These results are similar to the reported advantages for adjuvant tamoxifen given for stage II breast cancer.

Aged↗
PubMed1986

Response of nitrosomethylurea-induced rat mammary tumor to endocrine therapy and comparison with clinical response.

We have compared the response of the N-methyl-N-nitrosourea-induced rat mammary tumor to various endocrine agents with response in patients with breast cancer. To do this, we have induced tumors in 228 animals (65% of intact rats developed tumors but only 14% of ovariectomized rats developed tumors). In intact rats, 4-hydroxyandrostenedione, tamoxifen, and a combination of tamoxifen, aminoglutethimide (AG), and danazol induced significant tumor regression (P less than 0.001, P = 0.01, P = 0.04, respectively), whereas danazol, AG, and trilostane were ineffective when used singly. Further investigation showed that the inactivity of AG in the rat was due to extensive acetylation of this compound. In order to mimic postmenopausal breast cancer, we ovariectomized rats after N-methyl-N-nitrosourea administration. In ovariectomized animals, AG was again ineffective in inducing tumor regression but 4-hydroxyandrostenedione was highly active when compared to controls (P = 0.002). Comparison with response of this model to endocrine therapy with response in patients indicates that this has good predictive capacity since it shows that agents which have minor activity in human breast cancer such as danazol and trilostane are inactive in the model. The intact rat model does not, however, predict whether a drug will be useful for pre- or postmenopausal patients. We recommend that before committing large numbers of patients to clinical trials on the basis of this model, the metabolism of new compounds should be compared in humans and rats.

Aminoglutethimide↗
PubMed1985

Risk factors and clinical data related to oestrogen receptor status in women presenting with breast cancer.

Oestrogen receptor (ER) content was measured in 257 patients presenting with 'operable' breast cancer. Difference in age, menopausal status, parity, age at first pregnancy, breast feeding habit and details of past and family history were compared with oestrogen receptor status. The symptoms and their duration together with the extent of the disease both clinically and pathologically were also compared with receptor status. Association both for increasing age and postmenopausal status was found when oestrogen receptors were present in the primary tumours in significant quantities. No separation between the effect of age and menopausal status on oestrogen receptor status could be distinguished. No relationship was demonstrated between oestrogen receptor status and the other clinical and pathological factors examined.

Adult↗
PubMed1984

Response to aminoglutethimide and cortisone acetate in advanced prostatic cancer.

Forty patients with metastatic adenocarcinoma of the prostate were evaluated for response to treatment with aminoglutethimide plus cortisone acetate. All had relapsed from or failed to respond to primary endocrine treatment with orchidectomy or stilboestrol. Nineteen patients (48%) showed subjective response, in most cases relief of bone pain. Side effects limited treatment in only 3 patients. We conclude that aminoglutethimide plus cortisone acetate is a useful addition to the treatment available for this difficult group of patients. The mechanism by which this treatment has a beneficial effect remains unclear.

Adenocarcinoma↗
PubMedDate not supplied

Bulky mediastinal Hodgkin's disease management and prognosis.

Of a total of 235 Stage I and II Hodgkin's disease patients treated between 1970 and 1979, 103 (43.8 per cent) had mediastinal involvement in 45 of whom the disease was bulky and in 58 non-bulky. This report concentrates on bulky disease patients of whom 45 per cent did not relapse after therapy and 71 per cent are alive. Patients with mediastinal disease were treated with radiotherapy (63), sequential chemo-radiotherapy (37) or chemotherapy alone (3). In the radiotherapy group the relapse rate for bulky disease was significantly higher (65 per cent) than for non-bulky disease (44 per cent) (P less than 0.05) although there was no significant difference in survival. Neither relapse rate nor survival differed significantly in bulky disease patients treated with radiotherapy compared with combined chemo-radiotherapy although there was a 20 per cent difference in relapse-free survival rate in favour of the combined treatment group at five years. Treatments were not allocated randomly and the chemo-radiotherapy group contained a disproportionate number of patients with adverse features (greater than 3 node areas involved, limited lung extension) compared with the irradiated group; 11/25 and 2/17 respectively. The number of lymph node areas involved appeared to influence the relapse rate in the radiotherapy group. There was no correlation between mediastinal mass size and number of node areas involved suggesting that these two features may be independent prognostic factors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

The management of early-stage aggressive non-Hodgkin's lymphoma.

Sixty-one patients with stage I or II non-Hodgkin's lymphoma of aggressive histological subtype were treated at the Royal Marsden Hospital between 1972 and 1984. The overall 5-year survival probability was 69 per cent (60 per cent continuously relapse-free). The 5-year survival probability was 80 per cent for stage I disease and 55 per cent in stage II (p = 0.05). Survival was significantly higher in non-bulky than bulky presentations (85 per cent versus 44 per cent at 5 years, p = 0.003). There was no significant 2-year survival difference between those treated initially with chemotherapy and those treated with radiotherapy alone (65 per cent versus 83 per cent), however chemotherapy had been employed predominantly in patients with adverse presentations. The 2-year survival in 41 patients treated initially with doxorubicin-containing chemotherapy combinations was 76 per cent. Combined modality treatments should be considered especially in patients with stage II or bulky disease.

Antineoplastic Combined Chemotherapy Protocols↗