Search PubMed⌕ Search

Biomedical subjects

G H Fletcher

Publications and source records attributed to G H Fletcher.

At least 91 records · Page 5Linked to original sources
PubMed1979

Conservation surgery and irradiation for the treatment of favorable breast cancer.

The results in 162 patients with clinically favorable breast cancer treated with conservation surgery and radiation therapy are presented. The surgical procedures were simple excision with and without positive microscopic margins, segmental mastectomy, and segmental mastectomy with axillary dissection. Details of the radiation techniques are described with an explanation of the modifications in technique depending on the prior surgical procedure. Excellent control of local and regional tumor (96%) gives support to the combined treatment without removing the breast.

Adult↗
PubMed1979

Preliminary report of the M. D. Anderson Hospital/Texas A & M variable energy cyclotron fast-neutron therapy pilot study.

The records of 248 patients treated with fast neutrons and of 102 comparable but nonrandomized control patients treated conventionally with photons, surgery, or combined surgery and photon irradiation were reviewed. Fast neutron therapy included treatment with neutrons alone, a neutron boost after photon therapy, or a schedule of alternating neutron and photon treatments (mixed beam). The results with mixed beam irradiation were superior to those obtained with the other neutron therapy techniques, and compared favorably with the results of standard treatment methods. However, the lack of a conclusive advantage for neutron therapy in this pilot study illustrates the need for on-going randomized clinical trials.

Adenocarcinoma↗
PubMed1979

Combination of irradiation and surgery.

Irradiation can eradicate the microscopic disease that radical surgical procedures cannot remove, but high doses of irradiation fail to control large volumes of cancer. The concept "either irradiation or surgery" for all clinical situations should be eliminated. If irradiation has no place as the sole treatment for a disease, for example soft-tissue sarcomas or parotid tumors, it does not mean that it has no place in the management of the disease. Conservatism in both disciplines is to be preferred. Not only are the chances for cure increased, but also the quality of life is improved. On theoretical grounds, preoperative irradiation is to be preferred, but the sequence of te modalities of treatment depends upon the structures involved, the extent of the surgical procedure, the dose of irradiation, and the volume irradiated. Examples and results of the combined treatment in various disease areas are given.

Adenocarcinoma↗
PubMed1979

Predominant parameters in the planning of radiation therapy of carcinoma of the cervix.

The radiobiological parameters at the basis of radiation are: randomness of cell killing by irradiation, hypoxia and reoxygenation, does response curves, relationship of histology and radiosensitivity, doses necessary to control sub-clinical disease and gross tumor, and the rationale for combining irradiation and surgery. The volume of cancer is the determining factor in treatment planning. Since there is no correlation between the volume of the tumor and 1971 FIGO staging, staging should not be used in treatment planning but instead the volume and extent of the tumor. For the "barrel-shaped" lesions originating in the endocervix, a simple extrafascial hysterectomy is very effective after somewhat diminished irradiation. Great interest has been given to irradiating not only the pelvic wall but also the common iliac and/or paraaortic lymphatics. Since the volume of tissues irradiated to high doses of external irradiation is a limiting factor, with fields extended to L4 or T12, the total external irradiation dose cannot exceed 4,500 rad.

Female↗
PubMed1978

The role of irradiation in the management of head and neck cancer: analysis of results and causes of failure.

The records of patients with squamous cell carcinoma of the oral cavity, oropharynx, supraglottic and glottic larynx, whose primary lesion was treated with radiation therapy from 1964 through 1973, were reviewed. End points of the study are local control rate at the primary site, ultimate control with surgical salvage, and causes of failure. The local control rate at the primary site was 90% for T1 lesions, 80% for T2 lesions, and approximately 70% for selected T3 lesions. The control rates for the advanced T3 and T4 lesions are unsatisfactory; therefore, preoperative or postoperative irradiation is combined with appropriate surgical procedures to improve the local control rates and in some instances survival rates. Analysis of cervical node metastases treatment shows that the incidence of local recurrence in the radically dissected neck can be significantly reduced with either pre- or postoperative irradiation. Elective irradiation of initially clinically uninvolved areas of the neck (both ipsilateral and contralateral) has almost eliminated subsequent nodal metastases.

Carcinoma, Squamous Cell↗
PubMed1978

Results of treatment of early stage I carcinoma of the uterine cervix with intracavitary radium alone.

A total of 151 patients with Stage I carcinoma of the uterine cervix received treatment with intracavitary irradiation alone between 1948 and 1971. All patients had a minimum follow-up of five years. There were no local failures. No patient with microinvasive carcinoma (Stage IA) had a regional failure. A maximum of 4% (4/93) of patients with invasive cancer less than 1 cm in diameter (Stage IB-Small Volume) had regional failures. The five year determinate survival rates for patients with Stage IA and IB (Small Volume) lesions were 100% and 96% respectively. The incidence of severe complications was low, with a fistula developing in only one patient. Treatment with intracavitary radium alone is sufficient for patients with invasive cancer less than 1 cm in diameter who have adequate anatomy that allows effective irradiation of the primary lesion and paracervical lymphatics.

Adult↗
PubMed1978

The evolution of the basic concepts underlying the practice of radiotherapy from 1949 to 1977.

In his overview of the history and theoretical developments of radiotherapy, the author stresses the following concepts: (a) sensitivity is not linked to histology but to the volume of cancer; (b) the dose must not necessarily be homogeneous in the target volume but related to varying volumes of cancer; (c) the fact that irradiation may not be the sole treatment in some tumors does not mean that it does not have a place in their management; (d) as a general rule, large tumors should not be treated with irradiation only, if gross cancer can be resected simply; (e) since there is a dose-response curve for control rates and for complications, an optimum dose level must be maintained; and (f) the patient's quality of life is a major concern.

Adult↗
PubMed1977

The place of irradiation in the management of the primary lesion in head and neck cancers.

Lesions of the skin are best excised except for specific locations where surgical excision would not likely produce disease-free margins and/or would require extensive plastic repair. A control rate of 90% for T1 lesions and 80% for T2 lesions is obtained with irradiation in the squamous cell carcinomas of the upper respiratory and digestive tract. Heavy smokers and/or severe alcoholics may be preferably treated surgically. The control rates in the T3 and T4 lesions are unsatisfactory with either irradiation or surgery alone. Pre- or postoperative irradiation combined with the appropriate surgical procedure improves the local control rates and to some extent the survival rates. Postoperative irradiation for the highly malignant tumors of the salivary gland reduces the local failure rate from 36% to 11%. The facial nerve can be preserved unless it is grossly involved.

Carcinoma, Squamous Cell↗
PubMed1977

Treatment of the neck in patients with squamous cell carcinoma of the head and neck.

A retrospective study of 702 patients with clinically positive nodes associated with squamous cell carcinoma of the oral cavity, supraglottic larynx, and hypopharynx observed from 1954 to 1968 was done. The policies of treatment for the neck were not standardized during those years. Three hundred eleven patients who survived 24 months with the primary lesion controlled were divided into two groups: 1) those whose neck was treated by surgery alone; and 2) those who had combined radiation therapy and surgery to the neck, to test the efficacy of the two forms of treatment. For the three sites, the recurrence rate in the necks for the surgically treated group was 14% for stage N1, 26% for N2 and 34% N3. Rates for the group receiving combined treatment were 2%, 11% and 25% respectively. Results of the study also showed that elective irradiation, 5,000 rads in five weeks, will prevent metastasis from occurring in the NO staged neck.

Carcinoma, Squamous Cell↗
PubMed1977

Hyperbaric oxygen as a radiotherapeutic adjuvant in advanced cancer of the uterine cervix: preliminary results of a randomized trial.

From September 1968 to March 1974, a randomized clinical trial was carried out, using conventional fractionation, i.e., five treatments per week, in 233 patients with advanced cancers of the uterine cervix--Stages IIB, IIA, IIIB and IVA. The age limit was 70 years and all patients had medical clearance. Lymphangiography and, in some patients, an exploratory laparotomy with selective lymphadenectomy, were done prior to treatment to determine the extent of nodal disease. The staging has not been changed either by lymphangiogram or lymphadenectomy findings. A few patients with bulky Stage I and IIA lesions were entered into the trial because of extensive nodal disease demonstrated either by lymphangiogram and/or lymphadenectomy. First, the patients were grouped according to the clinical stage. The secondary stratification was according to the lymphangiogram and/or selective lymphadenectomy findings. The patients were then randomized to air or hyperbaric oxygen within each group. The patients were pressurized in a Vickers chamber at 3 atmosphere absolute, using a 20-minute soak time prior to the irradition. The size of the external beam portal was determined by the status of the nodes. The difference in absolute NED (no evidence of disease) survival rates for both groups as a whole and by stages is not statistically significant. There is no difference in the incidence of failures in the irradiated area between the HPO and air patients. There is no increase in distant metastases in the HP group. It does not seem that the HPO has had an effect on the major complications. However, there was an increase in the incidence of complications with extended fields. The addition of lymphadenectomy had increased the incidence of fatal complications, even with routine pelvic portals. The negative results of this trial with conventional fractioantion should not lead to the conclusion that HPO could not be useful with schemes using a few high dose fractions.

Adult↗
PubMed1977

Treatment failure sites according to irradiation technique and histology in patients with endometrial cancer.

Three hundred and seventy-two patients with endometrial cancer treated from 1948 through 1969 and having complete follow-up were reviewed. All patients completed definitive therapy with preoperative irradiation and surgery or irradiation alone and have separated into two main groups: 1) those treated with irradiation by radium alone or 2) those treated with external irradiation plus diminished amounts of radium. Pathology material from each patient was reviewed by one pathologist. Treatment by radium alone led to fewer pelvic failures than did external irradiation plus diminished amounts of radium, when evaluated by stage, grade, and specific histology. Both irradiation modalities led to about the same incidence of failures due to distant metastasis only.

Adenocarcinoma↗
PubMed1977

An analysis of distant metastases from squamous cell carcinoma of the upper respiratory and digestive tracts.

The charts of 5,019 previously untreated patients with squamous cell carcinoma of the upper respiratory and digestive tracts who completed treatment for cure from January 1948 through August 1973, were reviewed. These patients had no evidence of distant metastases when initially evaluated. Five hundred and forty-six patients developed clinical evidence of distant metastases. The overall incidence of distant metastases was 10.9%, varying from 3.1% for vocal cord cancers to 28.1% for cancer of the nasopharynx. The lungs and bones were the most common first sites of metastases, accounting for 52% and 20.3% respectively, whereas metastases to the mediastinum (2.9%) were rare. Forty-eight percent of the metastases were detected within nine months after treatment and 80% were detected within two years. The rate of distant metastases increased with the stage (2% for Stage I to 19.5% for Stage IV). The rate also increased with the T and N classification; however, the N stage had greater influence on the rate of metastases than the T stage. The incidence of distant metastases was significantly higher when there was a recurrence above the clavicles (16.7%) than when there was no recurrence (7.9%, less than 0.001). In patients whose primary lesion was treated by radiotherapy or surgery alone, the incidence was essentialy the same. Patients receiving postoperative irradiation had double the incidence of the preoperative group (20.1% vs 9.9%--p less than .005); however, the sequence of modalities was not randomized.

Bone Neoplasms↗