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Biomedical subjects

F A Greco

Publications and source records attributed to F A Greco.

At least 307 records · Page 17Linked to original sources
PubMed1976

Hodgkin's disease and granulomatous angiitis of the central nervous system.

Granulomatous angiitis of the central nervous system, a pathologic entity associated previously with a fatal prognosis, is reported in a patient with Hodgkin's disease. Viral isolation, indirect fluorescent antibody, and electron microscopic studies performed on fresh cerebral tissue were negative. The granulomatous angiitis of the central nervous system in this patient remitted following therapy for Hodgkin's disease. The epidemiologic, clinical and pathologic data in all reported cases of granulomatous angiitis of the central nervous system suggest that it: 1) may have more than one etiology; 2) may not always be fatal; 3) is associated with varicella-zoster virus and Hodgkin's disease; 4) is one of two granulomatous reactions found in association with Hodgkin's disease; and when found with Hodgkin's disease, 5) may remit with adequate therapy for the lymphoma.

Adult↗
PubMed1976

Adriamycin and enhanced radiation reaction in normal esophagus and skin.

Clinical evaluation of 10 patients with small cell carcinoma of the lung treated with radiotherapy and periodic cycles of combination chemotherapy with cyclophosphamide, vincristine, and adriamycin showed frequent and occasionally severe esophageal and skin reactions. Eight of the 10 patients had esophagitis, four required supportive intravenous fluids, and two subsequently developed esophageal narrowing and stricture formation. Recurrent esophagitis with augmentation of injury in the recently irradiated esophagus was observed 11 times in eight of the 10 patients after cycles of chemotherapy, and contributed to the sustained toxicity seen in two patients. Dermatitis in the form of moist desquamation was observed in five of the patients at very low doses of supervoltage radiation therapy. Acute pulmonary reactions was notably absent. This combination of chemotherapy, particularly adriamycin, potentiates the effect of radiotherapy on the normal esophagus and skin, and further implicates the radiosensitizing property of adriamycin.

Carcinoma, Small Cell↗
PubMed1976

Noninvasive monitoring of adriamycin cardiotoxicity by "Sphygmo-Recording" of the pulse wave delay (QKd interval).

Eighty patients with Ewing's sarcoma, bronchogenic carcinoma, and other neoplasms receiving adriamycin were monitored by a Sphygmo-Recording of the pulse wave delay (QKd time interval). The QKd interval, which is the sum of the cardiac pre-ejection period and the pulse transmission time, is sensitive to changes in myocardial contractility and stroke output. The patients were also followed by serial physical examinations, electrocardiograms, chest roentgenograms, serum enzymes, and thyroid function tests; none of these changed during the study period except in a few patients with congestive heart failure (CHF) and/or transient arrhythmias. QKd showed a significant prolongation (greater than 30 msec) within 1-3 weeks after adriamycin administration in a high percentage of patients followed closely. The QKd interval usually returned to pretreatment baseline levels within 4-7 weeks after adriamycin administration. The QKd often showed repeated and sustained elevations after courses of therapy at 3-week intervals. After adriamycin therapy was discontinued the QKd usually returned to normal levels. No statistically significant changes in the QKd were seen in a control group. There were no acute changes in QKd during adriamycin infusions. Of seven patients receiving cumulative doses of adriamycin greater than 550 mg/m2, three developed CHF. QKd intervals in all three of these patients had failed to return to the baseline values 2-3 months prior to any other evidence of CHF. This suggests that failure of QKd to return to pretreatment baseline levels may be of prognostic value. The QKd interval appears to reflect a high incidence of subclinical adriamycin cardiotoxicity. The technique is simple, noninvasive, rapid, and potentially useful for monitoring patients receiving adriamycin and other potentially cardiotoxic drugs.

Adult↗
PubMedDate not supplied

Tumors of unknown origin.

The recognition of subsets of very treatable patients within the large heterogeneous population of carcinomas of unknown primary site represents an advance in the management of these patients. These patients with responsive tumors can be defined with appropriate clinical and pathologic evaluation. A summary of the subsets and an outline of the evaluation necessary for their identification is illustrated in Table 5. A therapeutic trial remains the only method to determine if patients have responsive tumors, and several patients who do not conform to a defined subset do respond to cisplatin-based chemotherapy. Unfortunately, there is still a large group of patients with relatively insensitive tumors. Improved therapy for these patients will probably await advances in the treatment of non-small cell lung cancer, pancreatic cancer, and the other gastrointestinal cancers, since the majority of insensitive carcinomas probably arise from these occult primary sites. We have a registry at Vanderbilt and are attempting to register patients of other physicians around the country. We request pathology material and clinical summaries and follow-up data on all these patients. An unstained slide bank has also been established so that special stains developed in the future may be rapidly evaluated. These data may eventually enable us to better determine the frequency and spectrum of these neoplasms and may allow for more specific diagnoses and therapy.

Adenocarcinoma↗
PubMedDate not supplied

Preoperative combined modality therapy with paclitaxel, carboplatin, prolonged infusion 5-fluorouracil, and radiation therapy in localized esophageal cancer: preliminary results of a Minnie Pearl Cancer Research Network phase II trial.

PURPOSE: To evaluate the feasibility, toxicity, and therapeutic efficacy of 1-hour paclitaxel, carboplatin, continuous low-dose infusional 5-fluorouracil, and concurrent radiation therapy administered preoperatively in patients with localized esophageal cancer. PATIENT AND METHODS: Forty-nine patients with localized esophageal cancer, of either squamous cell carcinoma or adenocarcinoma histology, were enrolled into this phase II trial. All patients were candidates for surgical resection and received the following neoadjuvant therapy: paclitaxel, 200 mg/m2, 1 hour IV on days 1 and 22; carboplatin, AUC 6.0, IV on days 1 and 22; 5-fluorouracil, 225 mg/m2/day, continuous IV infusion on days 1 to 42; and radiation therapy, 45 Gy, administered by 1.8-Gy daily fractions beginning on day 1 of chemotherapy. Upon completion of this neoadjuvant regimen, patients were reevaluated, and all responding patients were resected within 6 weeks of completing neoadjuvant treatment. RESULTS: Administration of this combined modality regimen was associated with moderate toxicity and was tolerated by most patients. Leukopenia (65%) and esophagitis (31%) were the most common toxicities. Most patients did not require nutritional support. There were no treatment-related deaths during neoadjuvant therapy; however, three patients (9%) experienced postoperative death. Preliminary assessment of treatment efficacy is encouraging, with 17 of 37 evaluable patients (46%) achieving pathologic complete remission and an additional 11 patients (30%) having only microscopic residual disease. CONCLUSIONS: This novel, combined-modality neoadjuvant approach for the treatment of localized esophageal carcinoma is feasible and can be administered with toxicity that compares favorably to previously reported neoadjuvant regimens containing high-dose cisplatin. Preliminary assessment of efficacy is also encouraging, with 46% of patients having pathologic complete response. Further follow-up and larger numbers of patients are required to assess efficacy more definitively.

Adenocarcinoma↗
PubMedDate not supplied

One-hour paclitaxel infusions: review of safety and efficacy.

PURPOSE: Paclitaxel has emerged as one of the most active anticancer agents in clinical oncology. Hypersensitivity reactions encountered in the clinical development of this drug prompted the implementation of premedication regimens and prolonged infusions, later amended to a 3-hour infusion schedule. Now that paclitaxel is frequently used in outpatient therapy, optimum efficiency in delivery is an issue. A 1-hour drug infusion is more efficient for both the patient and the clinic staff and can help reduce administration costs. This article reviews the current experience with 1-hour paclitaxel infusions. METHODS: Published studies using 1-hour paclitaxel infusions, including weekly studies, trials of combination chemotherapy, and combined-modality studies, were reviewed. Studies were evaluated for both efficacy and toxicity. RESULTS AND CONCLUSIONS: Paclitaxel administered by 1-hour infusion as part of weekly or every-3-week treatment regimens is active in a variety of tumors, including breast, ovarian, and lung cancer and carcinoma of unknown primary site. Leukopenia, the most common serious toxicity, is usually manageable without hematopoietic growth factor support. The frequency of neurotoxicity appears comparable for 1-hour and 3-hour regimens, and there is no increased risk of hypersensitivity reactions. Infusion duration has been suggested to be an important predictor of response in some tumor types. Evaluation of this issue using a 1-hour paclitaxel infusion as reference is reasonable. One-hour infusions of paclitaxel should simplify outpatient administration, reduce administration costs, and reduce clinic time for patients. Practical information regarding administration of paclitaxel by 1-hour infusion is provided.

Antineoplastic Agents, Phytogenic↗
PubMedDate not supplied

Paclitaxel, carboplatin, and vinorelbine in the treatment of advanced non-small cell lung cancer: a phase II trial of the Minnie Pearl Cancer Research Network.

PURPOSE: To evaluate the feasibility, toxicity, and efficacy of adding vinorelbine to the paclitaxel/carboplatin combination in the treatment of advanced non-small cell lung cancer. PATIENTS AND METHODS: Patients with advanced (stage IIIB/IV) non-small cell lung cancer who had received no previous chemotherapy were treated with the following three-drug regimen: paclitaxel, 200 mg/m2, 1-hour i.v. infusion, day 1; carboplatin, AUC 6.0 i.v., day 1; and vinorelbine, 22.5 mg/m2 i.v. days 1 and either 8 or 15. Treatment was repeated every 21 days. This phase II trial was conducted in a multicenter, community-based setting. RESULTS: Eighty-nine patients were treated with a median of four courses of therapy (range, one to eight). Thirty-one patients (35%) had major responses (two complete, 29 partial), and 36 patients (40%) had a minor response or stable disease. Actuarial median survival was 8.6 months; 1 year survival was 43%. Leukopenia was the major toxicity: 73% of patients had grade 3/4 toxicity, and 32 patients (36%) were hospitalized for neutropenia/fever (11% of total courses administered). Treatment-related death due to infection occurred in four patients (4%). CONCLUSIONS: This three-drug regimen is feasible and efficacious in the treatment of advanced non-small cell lung cancer. The addition of vinorelbine increases the incidence of severe leukopenia substantially when compared with the paclitaxel/carboplatin regimen. However, other toxicities are not markedly increased. Ongoing randomized trials will define the role of this regimen in the treatment of non-small cell lung cancer.

Adenocarcinoma↗
PubMedDate not supplied

Taxane-based chemotherapy for patients with carcinoma of unknown primary site.

BACKGROUND: The purpose of this study was to determine the long-term follow-up on survival of patients with carcinoma of unknown primary site treated with taxane-based chemotherapy in a multicenter community-based setting. PATIENTS AND METHODS: Patients were treated with three sequential phase II trials between 1995 and 1998 as follows: Study I: paclitaxel 200 mg/m2 intravenously (i.v.) Day 1, carboplatin AUC = 6 i.v. Day 1, and oral etoposide 50 mg daily alternating with 100 mg daily days 1-10 every 3 weeks; Study II: docetaxel 75 mg/m2 i.v. Day 1, cisplatin 75 mg/m2 i.v. Day 1, repeated every 3 weeks; Study III: docetaxel 65 mg/m2 i.v. Day 1, carboplatin AUC 6 i.v. Day 1, repeated every 3 weeks. A total of 144 patients (71 on Study I, 26 on Study II, 47 on Study III) were treated (45% had well differentiated carcinoma, 48% had poorly differentiated carcinomas, and 6% poorly differentiated neuroendocrine tumors). The majority of the patients had multiple sites of metastatic disease. RESULTS: Thirty-six percent of all evaluable patients responded to therapy (27% partial and 9% complete responses). The median survival was 10 months with 1-, 2-, 3-, and 4-year survivals of 42%, 22%, 17%, and 17%, respectively. Follow-up ranges from 11 to 50 months. Women survived significantly longer than men. Thirty-one patients remain alive and 14 are progression-free. The primary toxicity was leukopenia with the carboplatin regimens and nausea and vomiting with the cisplatin regimen. A review of the survival of several large previously reported series of patients was compared to results after taxane-based chemotherapy. A compelling argument is made that chemotherapy is superior to best supportive care alone and that taxane-based chemotherapy is superior to other forms of chemotherapy. However, prospective randomized trials will be necessary to definitively demonstrate the superiority of this treatment compared to other therapies for these patients. CONCLUSION: Taxane-based chemotherapy for patients with carcinoma of unknown primary site appears to be clinically beneficial and is associated with long-term survival for a minority of patients at 2-, 3-, and 4-year follow-up.

Adenocarcinoma↗
PubMedDate not supplied

Cisplatin, vinblastine, and bleomycin in the treatment of metastatic melanoma: a phase II study of the Southeastern Cancer Study Group.

Fifty-one patients with metastatic melanoma were treated with cisplatin, vinblastine, and bleomycin. Of the 50 evaluable patients, 11 (22%) achieved an objective response, including three complete (6%) and eight partial (16%) responses. Four of the 11 responding patients had previously received dacarbazine; the remaining patients had received no prior chemotherapy. Responses were noted in cutaneous and lymph node sites as well as visceral metastases. However, with one exception, all responding patients with visceral involvement had lung metastases. Response durations were brief and toxicity was substantial. Nadir leukocyte counts less than 0.5 X 10(9)/L occurred in 28% of the patients. Debilitating neurotoxicity, primarily paralytic ileus, and severe nausea and emesis were experienced by 24% of the patients. The combination of cisplatin, vinblastine, and bleomycin is not sufficiently beneficial to warrant its use in metastatic melanoma.

Adult↗
PubMedDate not supplied

Phase I evaluation of a weekly schedule of anguidine. Southeastern Cancer Study Group Committee on Gastrointestinal Malignancies.

A phase I evaluation of a weekly schedule of anguidine was undertaken as an alternative to the present continuous daily schedules. The dose ranged from 1.5 to 7.5 mg/m2 given as an infusion over 3 hours. No myelosuppression was noted at any dose level. The toxic effects included nausea and vomiting, hypotension, CNS symptoms (confusion, hallucinations, and psychomotor seizures), chills, fever, and diarrhea. A dose of 5 mg/m2 of anguidine produced acceptable toxicity.

Antineoplastic Agents, Phytogenic↗
PubMedDate not supplied

Cyclophosphamide, doxorubicin, and cisplatin in the treatment of advanced non-small cell lung cancer.

Fifty-four patients with non-small cell lung cancer were treated with a combination of cyclophosphamide, doxorubicin, and cisplatin (CAP). A 35% response rate was seen, with a median survival of 380 days for the responders, compared to median survival times of 150 days for the nonresponders and 229 days for the group. Twenty-four percent of these patients had received prior treatment. All of the nonresponding patients had died by 438 days, whereas eight of 19 responders lived greater than 425 days. The survival curve the nonresponders was similar to that for a historical control group not given chemotherapy. These data indicate that this drug regimen has some efficacy in the treatment of non-small cell lung cancer.

Aged↗