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Biomedical subjects

D G Payne

Publications and source records attributed to D G Payne.

45 records · Page 3Linked to original sources
PubMed1983

Supraglottic laryngeal carcinoma: an analysis of dose-time-volume factors in 410 patients.

Four hundred and ten patients with supraglottic laryngeal carcinoma treated with moderate dose radical radiotherapy with surgery for salvage (RRSS) were analyzed in detail to determine optimal dose-time-volume parameters to be used in the treatment of each stage of supraglottic carcinoma. In the RRSS group 41% are alive and well at 5 years, 38% died of their tumor and 21% of intercurrent disease. Presence or absence of nodal disease has a major impact on survival. Local control is approximately 70% in T1, T2N0 patients and approximately 50% in T3 and T4N0 patients. Seventeen percent of T1 and T2N0 patients failed in the initially negative neck. Ten major complications (2.4%) have been seen. Local control by irradiation was not influenced by dose or field size. Regional control in the initially negative neck was markedly increased with the use of larger irradiation field sizes. Field sizes of less than 7 X 7 cm resulted in an 18% neck failure rate as compared to 3% with larger field sizes (p = 0.00005). This particularly applied to early stage disease. As a result of the use of larger irradiation field sizes giving reduced neck failure rates, improvement in survival has been seen in early stage supraglottic patients. The results are compared with published results. There is no statistically significant dose response curve in any stage of supraglottic cancer over the dose range 1650-2300 ret. Optimal treatment factors for supraglottic cancer are discussed.

Carcinoma, Squamous Cell↗
PubMed1983

Upper half body irradiation (UHBI) for extensive small cell carcinoma of the lung.

Upper half body irradiation (UHBI) was given to 41 of 121 patients with extensive small cell carcinoma of the lung. All patients were treated with 6 courses of cyclophosphamide, doxorubicin, and vincristine (CAV). Responding patients also received prophylactic cranial irradiation and local irradiation to prechemotherapy intrathoracic disease. Among the 70% (85/121) of patients who responded to chemotherapy, 41 have received UHBI, given one to two months later. The single fraction midline dose given has been increased in successive patients from 300 to 720 cGy (uncorrected for inhomogeneities). Actual lung doses were higher by 9-22%, (determined in 31 patients by CT scanning and lung density measurements). Adverse effects seen were vomiting, fever, drowsiness, myelosuppression, liver dysfunction and dry mouth. All were transient, and no pneumonitis or treatment deaths occurred. Adverse effect rates were similar at all dose levels. UHBI is well tolerated in patients who have received chemotherapy and merits further study.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Carcinoma of the nasopharynx.

Carcinoma of the nasopharynx usually presents with widespread regional lymph node metastases, and there is frequently damage to important midline structures. The management of these patients in the multidisciplinary clinics of The Princess Margaret Hospital is outlined. Radiation therapy remains the mainstay of treatment. Experimental approaches combining chemotherapy and radical radiation therapy are being introduced. The results of treatment by radiation therapy in 140 patients seen in the period 1970-76 are reviewed. The overall five year survival rate (all causes) is 37%. Distant metastatic disease is present at relapse in 20%. Prognosis correlated generally with extent of disease by TNM staging.

Adolescent↗
PubMed1982

Malignant astrocytoma: hyperfractionated and standard radiotherapy with chemotherapy in a randomized prospective clinical trial.

A prospective randomized trial of 157 patients with malignant astrocytoma (Grade III or IV) was carried out at a single institution. The minimization technique ensured balanced distribution of prognostic factors between the treatment groups. All received oral lomustine (CCNU, 80 mg/m2) six weekly and hydroxyurea (HU, 3.5 gm/m2 over 5 days) three weekly, for one year or until recurrence, with doses adjusted for myelosuppression. Patients were randomized to daily (5000 rad in 25 fractions (fr) in 5 weeks) or Q3h (every 3 hours) Cobalt 60 irradiation (3600-4000 rad in 36-40 fr of 100 rad each, given 4 fr per day at 3-hour intervals over two weeks) Steroid therapy (up to 16 mg day dexamethasone) was permitted. Complications were moderate and equivalent in the two groups. No significant survival or toxicity differences were seen between the two groups. Age, initial performance status, and extent of surgical resection were found to be significant (P less than 0.01) prognostic factors for survival. Median survival of the whole group was 48 weeks with a minimum follow-up of one year. There was no advantage to large radiation fields. The hyperfractionation and daily regimens had similar efficacy and toxicity. Hyperfractionation with chemotherapy offers a useful alternative approach in the management of this disease.

Adult↗
PubMed1982

Hypermnesia: the role of repeated testing.

The present study was designed to determine whether the increased recall of pictures across repeated tests (hypermnesia) is due to increasing strength of imaginal traces during the retention interval or to increased retrieval practice from prior tests. Subjects studied 60 pictures and then recalled them after various delays that were filled with instructions and, in two cases, reading a passage. Recall on a first test showed no change with retention interval. With retention interval held constant, however, the number of pictures recalled varied directly with the number of prior tests subjects had been given. This finding points up the critical nature of retrieval factors in producing hypermnesia.

Form Perception↗
PubMed1982

Bacterial endocarditis in pregnancy.

Bacterial endocarditis in pregnancy is uncommon but serious. A case is presented of subacute bacterial endocarditis with severe aortic and mitral valvular insufficiency and with associated multiple systemic and cerebral emboli. Therapy consisted of cesarean section at 33 weeks' gestation followed by aortic and mitral valve replacement; there was no maternal or fetal mortality. The English literature on infective endocarditis complicating pregnancy is reviewed.

Adult↗
PubMedDate not supplied

Benign parotid adenomas: a review of the Princess Margaret Hospital experience.

BACKGROUND: The morbidity of treating benign parotid tumors is an important issue because the majority of patients are young. We therefore undertook this study to evaluate the outcome for these patients treated at the Princess Margaret Hospital. METHODS: A retrospective review was conducted on all patients registered with benign parotid tumors between 1970 and 1987. RESULTS: Seventy-six patients were included in this review; postoperative radiotherapy (XRT) was administered to 55 patients. Median follow-up time was 12.5 years. Postoperative XRT was particularly important for patients with recurrent disease. The risk of both temporary and permanent facial nerve paralyses increased with each operation. No patients in this study developed a malignancy. CONCLUSIONS: We recommend that all patients with benign parotid tumors be treated with a complete parotidectomy with preservation of the facial nerve. Consideration to postoperative XRT should be given to patients in whom there was tumor spillage, residual disease, or recurrences.

Adenoma↗