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Biomedical subjects

G E Sheline

Publications and source records attributed to G E Sheline.

At least 37 records · Page 2Linked to original sources

Medulloblastoma: treatment results and effect on normal tissues.

Thirty-three children under age 20 with medulloblastoma, treated between 1962 and 1976, at the University of California and the Claire Zellerback Saroni Tumor Institute of Mount Zion Hospital, San Francisco, were retrospectively studied. A relationship between dose and local control rate was suggested by an improved five-year survival in those patients receiving doses greater than 5000 rads to the posterior fossa. The posterior fossa, either alone or with the spinal cord, was the most frequent site of failure. Results of re-irradiation for failure were encouraging and no significant complications were noted. A study of the effects of craniospinal irradiation on the hematopoietic and immune system demonstrated a marked decrease in the peripheral lymphocyte population at the completion of therapy and suggested a functional impairment of the remaining lymphocytes. Other side effects of irradiation included suppression of the hypothalamic-pituitary axis and one instance of brain necrosis. Current treatment policy and proposals for future modifications are discussed.

Adolescent↗

Radiation therapy of brain tumors.

Results of radiation therapy obtained at the University of California, San Francisco, over approximately the past 20 years for various histologic types of brain tumors are presented. Included are astrocytomas, malignant gliomas, medulloblastomas, ependymomas, oligodendrogliomas, and brain stem tumors. Degree of malignancy and tendency to disseminate within the central nervous system are also reviewed. For each tumor type and grade considered, the survival rate appeared improved when incomplete resection was followed by irradiation. The increase in survival rate for glioblastomas was only evident for 1-2 years, but for the remainder the improvement extends to 5-10 years. Since many patients were still alive at the time of review, it is possible that permanent control of many intracranial neoplasms may be induced by radiation therapy.

Astrocytoma↗

Radiation therapy for pineal tumors and suprasellar germinomas.

Data on all patients with pineal body tumors and suprasellar germinomas seen at the University of California--San Francisco over a 25-year period were reviewed. Of 19 patients treated, 15 are still alive. Although treatment techniques varied, all patients received irradiation to the primary tumor site but not to the spinal cord. The tumor dose ranged from 4,000 to 5,500 rads using megavoltage equipment. The authors recommended a dose of 4,500-5,000 rads given over a period of five to six weeks.

Adolescent↗

The treatment of meningiomas in childhood.

Thirteen cases of meningiomas in the pediatric age group seen at the University of California are reviewed. Four of these patients are alive; one had complete surgical resection of tumor and three had subtotal resection followed by irradiation, with total tumor doses of 4500 to 5500 rads. On the basis of these data, together with our total experience in the treatment of 188 patients with meningiomas, we conclude that patients who have complete surgical resection need no further treatment but patients who have subtotal removal may have recurrences delayed or prevented by the addition of postoperative irradiation to their therapeutic regimens.

Adolescent↗

Delayed onset of hypopituitarism: sequelae of therapeutic irradiation of central nervous system, eye, and middle ear tumors.

Four children with short stature who received irradiation to the head in conventional doses had clinical and laboratory evidence of hypothalamic-pituitary hormone deficiencies several years later. Growth hormone was deficient in all. One patient also had evidence of TSH, ACTH, and gonadotropin deficiency. Basal prolactin levels and prolactin response to synthetic TRF were normal in all patients tested. Treatment with human growth hormone significantly increased growth rate. We suggest that children should have the hypothalamic-pituitary area shielded from irradiation. Periodic measurements of hypothalamic-pituitary function should be performed in children who have had irradiation to the head, in order to detect and treat hormonal deficiencies before growth and development are seriously compromised.

Brain Neoplasms↗

Radiation therapy of tumors of the central nervous system in childhood.

The results of radiation therapy for CNS tumors of childhood are presented and discussed according to histologic type. In this material the 5-year recurrence-free survival rates were about 35% for medulloblastomas, 48% for the hypothalamic and brain stem tumors, 86% for lowgrade ependymomas, and 57% for germinomas. Complications or CNS injury from irradiation were rare and the quality of life in survivors was generally good. Current methods of radiation therapy may possibly improve these results. Tumors of the CNS in children do not necessarily carry a hopeless prognosis; aggressive therapy is indicated.

Astrocytoma↗

The role of radiation therapy in the treatment of astrocytomas.

One hundred forty-seven patients with astrocytoma were treated between 1942 and 1967. There were 25 postoperative deaths. The 14 patients in whom the tumor was thought tohave been completely removed were not irradiated and all survived 5 years or longer. Seventy-one of the 108 patients with imcompletely excised lesions received radiation therapy. The 5-year survival rate for those with imcomplete resection alone was 19%, compared to 46% when irradiation was given. Based on observations up to 20 years, after incomplete removal postoperative irradiation significally prolonged useful life and may have lead to permanent control in some. There was no evidence of radiation damage. Most of these tumors were fibrillary astrocytomas, and the results apply particularly to this histologic type. Only 1 of 11 patients with gemistocytic astrocytoma survivied 5 years. The survival rate for Grade i tumors was appreciably greater than for Grade iilesions; in both grades, it was improved by irradiation.

Adolescent↗

Radiation tolerance of the spinal cord.

A series of nine cases of radiation myelopathy seen at the University of California, San Francisco (UCSF) is reviewed, and their treatment data converted into nominal single doses (NSD) and equivalent single doses (ED). The 1% incidence level of myelopathy in the thoracic cord is 1015 rets (ED), and the 50% incidence level is 1476rets (ED). Caution should be used when utilizing a rapid fractionation schedule; it appears that 2000 rads in 5 fractions and 3000 rads in 10 fractions is a safe regimen for the thoracic spinal cord.

Dose-Response Relationship, Radiation↗