Biomedical subjects
G D Steele
Publications and source records attributed to G D Steele.
Evaluation of palliative procedures for pancreatic cancer.
In a retrospective review of 51 patients undergoing palliative procedures for carcinoma of the pancreas from 1974 to 1979, cholecystoenterostomy was as effective as choledochoenterostomy. Patients with loops had the same incidence of cholangitis as those with Roux-Y limbs. Prophylactic gastroenterostomy was not performed routinely. Few patients needed a later gastroenterostomy for progressive cancer.
In vivo and in vitro effects of xenogeneic immune ribonucleic acid in patients with advanced renal cell carcinoma: a phase I study.
Based upon demonstration in our laboratory of repeated prevention of pulmonary metastases by adjuvant immune ribonucleic acid in animal preparations, xenogeneic immune ribonucleic acid was given in a phase I study to patients with advanced renal cell carcinoma. Six patients were treated with intravenous infusions of autologous lymphocytes incubated in vitro with immune ribonucleic acid extracted from splenocytes of guinea pigs immunized with the patient's own tumor. Serial peripheral blood lymphocytes were obtained during and after each treatment with immune ribonucleic acid for in vitro evaluation of cell-mediated cytolysis by 51chromium release assay and 125iodine iododeoxyuridine assay against allogeneic renal cell carcinoma targets and melanoma targets. Neither toxicity nor enhancement of tumor growth was observed. All patients demonstrated significantly increased cell-mediated cytolysis against allogeneic renal cell carcinoma targets but no change against melanoma targets. Increased cell-mediated cytolysis could be demonstrated in individual blood samples after incubation with immune ribonucleic acid. Further, progressive in vivo effect was demonstrated in in vitro assay of serial peripheral blood lymphocytes before each successive exposure to immune ribonucleic acid. Increased cell-mediated cytolysis persisted in peripheral blood lymphocytes up to 9 months after therapy. Although without controls 1 patient had complete response and 2 patients had partial responses (8 to 18 months). Two patients had stabilization of the disease for 3 to 4 months and 1 patient had progression of cerebral metastases. One patient is alive 24 months after therapy. These results would favor the institution of a randomized prospective trial in patients with advanced renal cell carcinoma or lesser tumor burdens.
Biochemical pharmacology in medical oncology.
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The use and limitations of serial plasma carcinoembryonic antigen (CEA) levels as a monitor of changing metastatic liver tumor volume in patients receiving chemotherapy.
Nine patients with liver-predominant or liver-only metastatic adenocarcinoma, who received hepatic intra-arterial and peripheral intravenous chemotherapy, were evaluated to determine if changes in plasma CEA accurately indicated changes in liver tumor volume as estimated from serial liver scan defect sizes, and if the two were quantitatively related. When selected periods of tumor remission or progression were studied during chemotherapy, the index of change of serial CEA values correlated positively (r = 0.764, P = 0.01) with the index of change of liver tumor volume in all 9 cases. Changes in absolute CEA values, however, aid not correlate significantly with changes in absolute liver tumor volumes when assessed either during these selected periods or throughout individual patient courses. Biologic and methodologic factors that influence the quantitative relation between liver tumor volume and plasma CEA are discussed.
Rat model for carcinogenesis in ureterosigmoidostomy.
A rat model is used to study the carcinogenesis that occurs when urine is surgically diverted into the fecal stream, as in ureterosigmoidostomy. Adenocarcinoma of the colon occurs adjacent to the urine inlet. It is completely prevented by proximal diversion of the feces, implying that fecal carcinogens are activated locally by the urine or the urothelium.
Radionuclide angiography to predict patient response to hepatic artery chemotherapy.
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Metastatic carcinoma of the penis: complete remission after high dose methotrexate chemotherapy.
A case of extensive metastatic epidermoid carcinoma of the penis is reported. Disseminated disease developed after penectomy and lymphadenectomy and it continued to progress while the patient received radiation therapy. Chemotherapy with high dose methotrexate followed by citrovorum factor rescue was instituted. After completion of 10 weekly cycles of treatment there was biopsy-proved complete regression of all lesions, which lasted 9 months when the patient suddenly died of pneumonia completely unrelated to the tumor or chemotherapy treatment. This chemotherapeutic approach deserves additional trial in patients with advanced stages of penile carcinoma.
Increased immunogenicity of B16 melanoma clones selected for their ability to metastasize from a heterogeneous primary tumor.
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Carcinoma in colonic urinary diversion in rats.
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Carcinoembryonic antigen (CEA) as a monitor of chemotherapy in disseminated colorectal cancer.
A rising CEA level is accepted as a sensitive indicator of recurrent colorectal carcinoma. In order to assess its efficacy in monitoring responses to chemotherapy in disseminated disease, 47 patients with documented metastatic colorectal cancer were studied. All had pretreatment CEA determinations and 40/47 (85%) patients had CEA levels greater than 4.0 ng/ml. Patients with hepatic metastases had the highest CEA values and none were found to have levels less than 4.0 ng/ml. Thirty patients received chemotherapy and had serial CEA determinations. 4/30 (13.3%) demonstrated probable tumor regression, 7/30 (23.3%) had stable disease, while 19/30 (63.3%) showed disease progression. CEA titers declined in all four responders, but in only one instance did the level fall to below 4.0 ng/ml and provide evidence of a tumor response not appreciated clinically. The only cytotoxic drugs effecting tumor regressions were 5-FU and 5-FUDR. CEA levels usually rose as disease progressed, but once elevated, absolute values did not correlate directly with tumor burden. The further usefulness of CEA assays in monitoring disseminated colorectal cancer awaits the development of improved chemotherapeutic agents.
Reinforced composite resin foundations for endodontically treated teeth.
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Sphincter-sparing treatment for distal rectal adenocarcinoma.
BACKGROUND: Studies suggest that the anal sphincter can be preserved in some patients with distal rectal adenocarcinoma (DRA), but this has not been validated in any prospective multi-institutional trial. METHODS: To test the hypothesis that the anal sphincter can be preserved in some patients with DRA, the Cancer and Leukemia Group B and collaborators reviewed 177 patients who had T1/T2 adenocarcinomas < or = 4 cm in diameter, which encompassed < or = 40% of bowel wall circumference, and were < or = 10 cm from the dentate line. Of the 177 patients, 59 patients who were eligible for the study had T1 adenocarcinomas and received no further treatment; 51 eligible T2 patients received external beam irradiation (5400 cGY/30 fractions 5 days/week) and 5-fluorouracil (500 mg/m2 IV d1-3, d29-31) after local excision. RESULTS: At 48 months median follow-up, 6-year survival and failure-free survival rates of the eligible patients are 85% and 78% respectively. Three patients died of unrelated disease. Two patients were treated for second primary colorectal tumors; both remain disease free (NED). Another eight patients died of disease, four with distant recurrence only. One T1 patient is alive with distant disease. Two T1 and seven T2 patients experienced isolated local recurrences; all underwent salvage abdominoperineal resection (APR). After APR, one T1 and four of seven T2 patients were NED at the time of last visit (2-7 years). One T1 patient died of local and distant disease. Three of seven T2 patients died with distant disease. CONCLUSIONS: We conclude that sphincter preservation can be achieved with excellent cancer control without initial sacrifice of anal function in most patients. After local recurrence, salvage resection appears effective, but longer follow-up time of local and distant disease-free survival is advised before extrapolation to patients with T3 primaries.
Regional differences in surgical management of breast cancer.
Data voluntarily submitted to the NCDB by 597 hospitals throughout the US indicate marked variations in the type of surgery used for the treatment of breast cancer. Patients in New England with early stage breast cancer are much more likely to be treated with partial mastectomy than are patients in the East South Central or West North Central regions.
Clinical highlights from the National Cancer Data Base: 1993.
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Clinical highlights from the National Cancer Data Base: 1994.
The National Cancer Data Base, a joint project of the American Cancer Society and the American College of Surgeons Commission on Cancer, provides a mechanism for periodic assessment of hospital-based cancer patient care. From the National Cancer Data Base's annual summary, health care professionals can evaluate trends in patient care to make more efficient treatment decisions. This article provides a first look at highlights from the 1994 annual summary.
Clinical highlights from the National Cancer Data Base: 1995.
The National Cancer Data Base, a joint project of the American Cancer Society and the American College of Surgeons Commission on Cancer, provides a mechanism for periodic assessment of hospital-based cancer patient care. From the National Cancer Data Base's annual summary, health care professionals can evaluate trends in patient care to make more efficient treatment decisions. This article provides a first look at highlights of the 1995 annual summary.
Evaluation of common breast problems: guidance for primary care providers.
The evaluation of common breast problems requires an assessment of the patient's risks and symptoms and a thorough physical examination. When indicated, appropriate imaging studies should be done, the patient should be referred to a surgeon or a breast specialist, and operative interventions should be used.