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Biomedical subjects

D G Payne

Publications and source records attributed to D G Payne.

At least 37 records · Page 2Linked to original sources
PubMed1988

The effect of dose of thoracic irradiation on recurrence in patients with limited stage small cell lung cancer. Initial results of a Canadian Multicenter Randomized Trial.

Patients with limited stage small cell lung cancer were initially randomized to receive either three courses of Cyclophosphamide, Adriamycin, and Vincristine (CAV) followed by three courses of VP-16 and Cis-platin (VP-PT) or six courses of alternating CAV and VP-PT. Responding patients received prophylactic cranial radiation (PCI) after three courses of chemotherapy (CT) and loco-regional thoracic radiation (LRTR) after six courses. No maintenance chemotherapy was given. Patients receiving LRTR were randomized to receive either 25 Gy in ten fractions over 2 weeks (SD) or 37.5 Gy in 15 fractions over 3 weeks (HD). In both arms the pre-chemotherapy disease was treated with a 2 cm margin around the primary tumor volume. The mediastinum was included in the treatment volume and the supraclavicular nodes were also included if involved originally. The spinal cord was shielded after 32 Gy. Of the 333 patients enrolled by the time the trial closed in October 1984, 168 were eventually randomized to LRTR and are eligible for response assessment. The overall response rate after combined RT and CT was 94% (CR 67%, PR 27%). The CR rate for SD was 65% and for HD 69%. The combined treatment was well tolerated by most patients. Forty-nine percent of HD patients developed dysphagia compared to 26% of those SD (p less than 0.01). At the time of this analysis the median duration of follow-up since randomization to radiotherapy is 30 months. The median local progression-free survival on HD is 49 weeks. On SD it is 38 weeks (p = 0.05, one sided). The actuarial incidence of local progression by 2 years is 69% on HD and 80% on LD. There is as yet no significant difference in overall survival between the two arms. It appears that HD radiotherapy as administered in this study may have an impact on local control, but it is too early to determine if this will translate into a survival benefit.

Adult↗
PubMed1988

Non-small-cell lung cancer: should unresectable stage III patients routinely receive high-dose radiation therapy?

Non-small-cell lung cancer patients who have unresectable mediastinal disease have a poor prognosis regardless of therapy administered. The various rationales for high-dose radiation therapy with curative intent are reviewed in the context of treatment results reported in the literature. The case for a dose-cure relationship in a clinically practical dose range must be considered unproven. On the other hand, the evidence for dose-response effects suggests that higher dosages could result in improved quality of life. There is a need to further refine reproducible criteria, both anatomic (such as mediastinal involvement) and non-anatomic (such as performance status), to permit more appropriate selection of patients for high-dose treatment. Studies involving less rather than more treatment with appropriate endpoints might be both ethical and appropriate.

Carcinoma, Non-Small-Cell Lung↗
PubMed1987

Neurologic disorders in patients with small cell lung cancer.

In a series of 641 patients with small cell lung cancer, 189 (29.5%) had at least one neurologic disorder either at the time of presentation or during the subsequent clinical course of the cancer. The total number of neurologic disorders was 210, which included brain metastases (75.7%), meningeal carcinomatosis (6.7%), intramedullary metastases (2.4%), epidural metastases (11.0%), hyponatremia producing CNS symptoms (3.3%), and Eaton-Lambert syndrome (1.0%). The most common signs and symptoms were motor dysfunction and confusion. The overall survival of patients with any neurologic disorder was compared to that of patients without neurologic problems. There was no difference between the survival curves for the first year and a half, but patients without neurologic complications had a greater probability of long-term survival (log-rank P = 0.03). There were no statistically significant differences when this comparison was made according to stage of disease. When a neurologic disorder related to cancer occurred, the survival time from the date of that diagnosis was usually short. The neurologic disorder was the immediate cause of death in the majority of cases. In patients who achieved a complete remission, the administration of prophylactic cranial irradiation (PCI) significantly reduced the risk of developing brain metastases as the initial site of the relapse (log-rank P = 0.0034). After adjustment for performance status and extent of disease, the survival of complete responders treated with and without PCI was not significantly different. We conclude that neurologic complications are a frequent and serious problem in patients with SCLC.

Adult↗
PubMed1987

Hypermnesia occurs in recall but not in recognition.

Two experiments investigated the effect of encoding conditions and type of test (recall vs. recognition) on the phenomenon of hypermnesia (improved performance across repeated tests). Subjects in Experiment 1 studied a list of words using either imaginal or semantic elaboration strategies and then received three successive tests. Different groups of subjects received either free recall, four-alternative forced-choice recognition, or yes/no recognition tests. Reliable hypermnesia was found only in the recall conditions, with the recognition conditions showing either no change in performance levels across tests (forced-choice tests) or significant forgetting (yes/no tests). In Experiment 2, subjects studied a list of words, and encoding was manipulated using three orienting tasks. Once again, hypermnesia was found with the recall tests but not with the forced choice recognition tests. Finding hypermnesia in recall but not in recognition indicates that retrieval processes in recall play a major role in producing hypermnesia. Also, the finding that the magnitude of the recall hypermnesias increased with an increase in total cumulative recall levels across study conditions suggests that cumulative recall levels are an important factor in determining the presence or absence of recall hypermnesia.

Form Perception↗
PubMed1986

Superior vena caval obstruction syndrome in small cell lung cancer.

In a series of 643 patients with small cell lung cancer (SCLC), 55 patients (8.6%) had signs or symptoms of superior vena caval obstruction syndrome (SVCO). Relatively long intervals from the onset of the first symptoms of SVCO to the start of therapy were observed, and invasive diagnostic procedures were safely performed in most patients. The pretreatment characteristics of patients with SVCO were not significantly different from those of patients without signs of the syndrome, and survival was similar in both groups. Patients with SVCO were usually treated first with induction chemotherapy, and prompt resolution of signs and symptoms occurred in the majority. Radiation was effective in controlling SVCO at relapse or after failure of initial chemotherapy. It was concluded that SVCO in patients with SCLC should be treated initially with systemic chemotherapy, as for other presentations of this disease. The current data do not support the commonly held view that SVCO in SCLC should be approached as an oncologic emergency.

Adult↗
PubMed1986

A pilot study of mitomycin-C/5-fluorouracil infusion combined with split course radiation therapy for carcinomas of the larynx and hypopharynx.

Fifty-seven patients with advanced squamous carcinoma of the larynx and hypopharynx were entered on a pilot study of initial therapy using split course radiation therapy combined with simultaneous chemotherapy using mitomycin-C and 5-fluorouracil. The treatment was well tolerated with 90% of patients completing their planned radiation treatment. Seventy percent of this group completed their planned chemotherapy. Significant hematological toxicity was not observed. Survival and loco regional control at one and two years of follow-up were considered at least comparable to that achieved with conventional single-course radical radiation therapy as primary treatment. Based on these results a randomized trial of this radiation-chemotherapy regimen compared to radiation therapy alone as initial therapy is in progress.

Adult↗
PubMed1985

Carcinoma of the tonsil: the effect of dose-time-volume factors on local control.

Between 1970 and 1979, 372 patients with squamous cell carcinoma of the tonsil were treated with primary irradiation therapy, with salvage surgery for failures. The median age was 60 years and the male to female ratio was 2:1. The staging system used was the 1974 UICC TNM system. There were 47 T1 lesions (13%), 161 T2 lesions (43%), and 164 T3 lesions (44%). Regional nodes were not palpable in 173 (46%); 122 had N1 nodes (33%), 6 had N2 nodes (2%) and 71 had N3 nodes (19%). All patients received external beam radiation which was supplemented in 68 patients with a radioactive implant for disease into adjacent tongue. The overall survival for all patients was 38% at 5 years and 54% when corrected for intercurrent disease. Local control was 87% for T1 lesions, 68% for T2 lesions and 50% for T3 lesions. Regional control was 96% for N0, 67% for N1 and 37% for N2-3. A detailed dose-time-volume analysis revealed that increasing volume improved local control in T1 and T2 lesions (77% had local control if the volume was greater than 80 cm2 versus 53% if the volume was less than 80 cm2, p = 0.014), except for T3 lesions. Increasing the dose in the range of 5000 to 6500 rad had no significant effect on primary control in any stage of disease. The addition of a radioactive implant did not increase local control if disease extended into the tongue (57% local control if implant, 52% if no implant). This study demonstrates the significance of adequate treatment volume in local control for carcinoma of the tonsil. No significant dose response was found and subsequent surgery was not compromised when a moderate dose of radiation was used.

Adult↗
PubMed1985

Radiation therapy of tumours involving the skull base.

The author reviews the Princess Margaret Hospital (Ontario Cancer Institute) experience with radiation therapy in certain tumours involving the skull base including meningiomas, chordomas, craniopharyngiomas and other less common tumours. Radiation therapy offers an effective supplementary or alternative treatment for such lesions.

Brain Neoplasms↗
PubMed1984

The treatment of glomus tumors in the temporal bone by megavoltage radiation.

Forty-five patients with glomus tumors in the temporal bone region were treated by radiation therapy. Only three patients had recurrence or progression of tumor during the follow-up period of 3 to 23 years (median, 10 years). No patient died from uncontrolled glomus tumor. The majority of patients noted symptomatic relief after radiation, but objective neurologic deficits usually remained unchanged or showed only partial improvement. The most commonly used radiation dose was 3500 cGy tumor dose delivered in 15 fractions in 3 weeks by a homolateral wedge technique from megavoltage radiation apparatus. This dose is less than that usually recommended for glomus tumors. From these results and from review of the literature, it is suggested that a moderate radiation dose of 3500 cGy in 3 weeks is effective treatment for glomus tumors, even if complete tumor involution does not occur.

Adolescent↗
PubMed1984

Basal and squamous cell carcinoma of the eyelids and their treatment by radiotherapy.

We report 1,166 tumors of the eyelids that were treated by single or fractionated exposures to doses of 20-60 Gy. The five year tumor control rate was 95% for basal cell and 93.3% for squamous cell carcinoma. Irradiation was equally successful in primary cases and in those recurrent following surgery. Recurrence following irradiation was managed by surgery or further irradiation. The cosmetic and functional results were generally excellent and readily accepted by most patients. The overall complication rate was 9.6% with fewer than one-half rated as serious; these problems mainly occurred with large tumors that had destroyed normal tissues. In only 14 (1.2%) patients was death related to the tumor. Approximately one-half of the patients received a dose of 35 Gy in five daily fractions, one-quarter, 20 to 22.5 Gy in a single exposure and the others with larger tumors 42.5-60 Gy in 10 to 30 exposures in two to six weeks. Radiotherapy is a safe and cost effective treatment for eyelid tumors.

Adult↗
PubMed1984

Combined modality induction therapy without maintenance chemotherapy for small cell carcinoma of the lung.

One hundred fifty-three patients with limited and 167 with extensive small cell carcinoma of the lung (SCCL) were evaluable for response to treatment with six courses of chemotherapy (cyclophosphamide, doxorubicin, and vincristine), irradiation to intrathoracic disease, and prophylactic cranial irradiation (PCI). No maintenance chemotherapy was given. Fifty-two percent of patients with limited disease (LD) and 10% of extensive disease patients (ED) achieved a complete response. The median survival times for LD and ED patients were 49 and 34 weeks, respectively. These results were compared to a previous experience with 147 patients who were treated with three courses of similar induction chemotherapy and thoracic irradiation, as well as one year of maintenance chemotherapy (CCNU, procarbazine, and methotrexate) but without PCI. Although the use of PCI was found to reduce the frequency of brain metastases as the site of first relapse, detailed comparisons of response rates and survival showed no significant differences between the two study populations. Prolonged maintenance chemotherapy of the type used in the first study does not favorably influence outcome after intensive induction therapy for SCCL.

Adult↗
PubMed1983

Tubal microsurgery with the carbon dioxide laser.

Thirty New Zealand White female rabbits underwent tubal resection and reanastomosis for comparison of conventional microsurgery and laser microsurgical techniques. The rabbits were divided into three groups. The first group of 10 rabbits had 3 cm of tissue resected by knife from each uterine horn; the cut ends were then reanastomosed in one layer with 8-0 Vicryl sutures with the use of the operating microscope. The second group of 10 rabbits had 3 cm of tissue resected by laser from each uterine horn; the cut ends were then reanastomosed in one layer with 8-0 Vicryl. The third group of 10 rabbits had 3 cm of tissue resected by laser from each uterine horn; the cut ends were then reanastomosed by "welding" the tissues with the laser. All rabbits in the first group became pregnant. Only four in the second group became pregnant, but none in the third group became pregnant. It is concluded that the carbon dioxide laser beam as used in this study has no place in tubal resection and reconstruction.

Animals↗
PubMed1983

Management of early supraglottic laryngeal carcinoma by irradiation with surgery in reserve.

The results of radical radiotherapy with surgery in reserve for 136 patients with stage T1 and T2 NO supraglottic laryngeal carcinoma seen during a 20-year period are analyzed herein. Approximately one half of all patients were alive and well five years after treatment, while one fifth of patients died of supraglottic cancer. The cancer in two thirds of these patients was locally controlled by irradiation; of particular note was an 11% to 18% recurrence rate in patients whose necks were initially noted to be free of cancer. Analysis of the results of irradiation treatment disclosed a major reduction in nodal recurrence from the use of irradiation fields larger than 7 X 7 cm (3%, as compared with 19% with a smaller irradiation field). During the 20-year period of the study, there was a major reduction observed in tumor-related deaths; this is attributed to the use of larger irradiation fields and more aggressive use of surgery for irradiation failures. The results obtained are compared herein with the results of primary surgery, and conclusions are drawn as to the optimal management of early-stage supraglottic cancer.

Carcinoma, Squamous Cell↗
PubMed1983

Cancer of the tonsil: results of radical radiation therapy with surgery in reserve.

Three hundred seventy-two patients with squamous cell carcinoma of the tonsil were treated with primary irradiation of curative intent. Surgery was saved for subsequent treatment failure. The overall survival was 38 percent at 5 years. Local control was 63 percent for all patients. T1 and T2 lesions were controlled in 87 percent and 68 percent of patients, respectively, and T3 lesions were controlled in 50 percent of patients. Patients with healthy (N0) nodes and those with mobile nodes had a high degree of regional control, but fixed nodes were controlled in only 37 percent of patients with radiation alone. The most common site of treatment failure was in the primary tumor, which accounted for 45 percent of relapses, and isolated nodal relapses were present in only 24 percent of patients. Subsequent surgery was possible in 47 percent of patients in whom initial treatment failed. A higher degree of subsequent control was obtained with more aggressive surgery compared with simple local resection. There was a high rate of second respiratory tract malignancy, in fact, after 2 years, patients were dying more commonly of their second respiratory tract malignancies than of cancer of the tonsil.

Adult↗
PubMed1983

Carcinoma of the hypopharynx results of primary radical radiation therapy.

The results of radiation therapy as applied to patients with squamous cell carcinoma of the hypopharynx seen during the period 1972-1976 at the Princess Margaret Hospital are presented. Approximately 2/3 of the patient population presented with disease involving the regional lymph nodes or with systemic metastases. Ninety percent (127/141) of all patients registered were treated primarily with radiation therapy with surgery reserved for the management of residual or recurrent disease only. Seventy-seven percent (98/127) of those who received radiation therapy were treated with radical intent. The uncorrected actuarial 5 year survival rate for those patients treated radically was 19%. Five year actuarial survival rates by the UICC TNM (1974) staging system, showed that nodal disease was the most significant determinant of survival. Five year survival rates were as follows: N0 36%; N1 20%; N2N30%. When considered within each nodal category the survival of the combined T1T2 group was not significantly different from the T3 category. Forty-five percent of those patients who failed with local or regional disease had an attempt at salvage surgery. Of these, 6/24 ultimately achieved local and regional control. Comparisons with other series in the literature are discussed and reasons for differences in published results are considered.

Carcinoma, Squamous Cell↗