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Biomedical subjects

G H Fletcher

Publications and source records attributed to G H Fletcher.

At least 127 records · Page 7Linked to original sources
PubMed1976

Indications for combination of irradiation and surgery.

1) The concept "either irradiation or surgery" for all clinical situations should be eliminated. In many clinical situations, one must think of the combined treatment both for the primary lesion and the regional metastases. Conservatism in both disciplines is to be preferred. 2) 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. 3) The sequence of the modalities of treatment depends upon the structures involved and the extent of the surgical procedure. If one has to choose between a relatively low dose preoperative irradiation, like 3,000 to 4,000 rads or 5,000 to 6,000 rads postoperatively, the theoretical advantages of preoperative irradiation are outweighed by the proven effectiveness of postoperative irradiation in controlling the locoregional disease.

Breast Neoplasms↗
PubMed1975

Clinical course of patients with squamous cell carcinoma of the upper respiratory and digestive tracts with no evidence of disease 5 years after initial treatment.

Eleven hundred sixty-three patients with squamous cell carcinoma of the upper respiratory and digestive tracts, treated from January 1948 through December 1965, had no evidence of disease five years after the initial treatment and no other manifestation of squamous cell carcinoma within the first five years. After five years, the incidence of disease at the initial location, in the vicinity, or in remote sites was found to be identical in the surgical and irradiation groups. There is a correlation between severe late complications in the irradiated patients and the volume of tissue irradiated.

Carcinoma, Squamous Cell↗
PubMed1975

Radiological manifestations of radiation-induced injury to the normal upper gastrointestinal tract.

Radiation-induced injury to the normal esophagus, stomach, and duodenum in patients with advanced cervical carcinoma who received high para-aortic lymph-node irradiation to an average tumor dose of 5,000 rads is discussed. Radiation esophagitis is usually the result of mediastinal irradiation for bronchogenic carcinoma. The most consistent radiological finding is abnormal motility, with esophageal stricture and/or ulceration occurrring less frequently. Radiation gastritis usually presents as pyloric ulceration or irregular contractions of the antrum, simulating gastric carcinoma. Postbulbar duodenal mucosal thickening, ulceration, and strictures may occur. Pertinent clinical features, pathogenesis, and pathological correlations are discussed.

Adolescent↗
PubMed1975

Analysis of sites and causes of failures of irradiation in invasive squamous cell carcinoma of the intact uterine cervix.

An analysis of the records of 916 patients who received radiotherapy for invasive squamous cell carcinoma of the intact uterine cervix from January 1964 through December 1969 revealed that 94% of the central and regional failures will occur within 3 years of treatment. Survival rates were as follows: Stage I, 91%; Stage IIA, 82%; Stage IIB, 65%; Stage IIIA, 54%; and Stage IIIB, 40%. The incidences of central and regional failures in Stages I through III are: Stages I and IIA; central 2% and regional 4.5%; Stage IIB; central 5% and regional 13%; Stage III: central 14% and regional 19%. In stages IIB, IIIA, and IIIB, the main cause of failures, either centrally or in the parametria, is the presence of massive disease.

Adult↗
PubMed1975

Optimal treatment for the technically resectable squamous cell carcinoma of the supraglottic larynx.

The charts of 431 patients with squamous cell carcinoma of the supraglottic larynx observed at the M.D. Anderson Hospital between January, 1954, and June, 1971, were analyzed. This study is concerned with those patients who had a technically resectable lesion. Emphasis is directed to the analysis of the effectiveness of primary irradiation instead of partial laryngectomy for those lesions which are technically suitable for a partial resection and to define the groups of patients which are best treated by combining surgery and planned postoperative irradiation. One hundred forty-seven patients with T1 and T2 lesions, selected exophytic T3 lesions of the suprahyoid epiglottis received irradiation for their laryngeal lesion. A satisfactory control of the laryngeal disease has been obtained with preservation of a normal voice ranging from 88.5 percent for T1 lesions to 60 percent for T4 lesion. Comparing the groups of patients who had surgery alone or postoperative irradiation an NED rate of 63 percent was found in the latter group which is clearly superior to the 37 percent found in the surgery only group. There is no difference for the five-year NED rates, because the patients who had surgery and postoperative irradiation had more advanced neck disease which is a cause for distant metastases. The incidence of recurrences above the clavicles is clearly less in patients having had surgery and postoperative irradiation than in those who had surgery alone. Correlating in the two groups, surgery only and surgery followed by planned irradiation, the surgical staging of the neck metastases with recurrences above the clavicles within 24 months after treatment, it was found that the planned combined treatment has reduced the recurrence rate from 45 percent to 15 percent in the N2 and N3 patients. Postoperative irradiation should be given routinely after resection for all T4 lesions and for any T3 lesion which extends to the pharyngeal wall(s), vallecula, base of tongue, and pyriform sinus. Postoperative irradiation should also be given for any patient whose nodal classification is greater than N1. Irradiation should be given within six weeks (preferably three to four weeks) after the surgical procedure. To achieve this goal, the operation need only remove grossly detectable disease.

Aged↗
PubMed1975

Reasons for irradiation failure in squamous cell carcinoma of the larynx.

The reasons for irradiation failure in squamous cell carcinoma of the larynx can be: 1. Geographical miss because of undiagnosed extensions is the exception. Almost all of the recurrences were well within the treatment portals. 2. Specific extensions with an unfavorable tumor bed. Extension of disease into poorly vascularized structures and/or deep infiltration with fixation are causes of failure. 3. Low dose for the volume cancer. Higher doses delivered in longer treatment time are necessary for 90 percent control of bulky exophytic supraglottic lesions. 4. Techniques which do not assure daily coverage of the tumor. With carefully drawn and checked anatomical portals, geographical misses should be nonexistent. 5. Sigmoid response curve. There is an 85 percent control of the T1 glottic tumors. The control rate is 90 percent of the T1 and T2 supraglottic tumors, and the 10 percent failures have no obvious explanation except that the plateau of the sigmoid response curve has been reached. A negligible yield would be obtained by increasing doses which would not be justified because of concomitant increase in frequency and severity of complications and lessening of the quality of voice. 6. New cancer. Probably 25 percent of the so-called recurrences on the vocal cords are actually new primary lesions. The ultimate failure rates respectively are 2 percent for T1 lesions and 10 percent for T2 lesions after a rescue surgical procedure. All patients with T1 vocal cord lesions who did not experience a failure or a complication, have a normal voice. In the patients with T2 lesions in whom the cancer had completely replaced the cord(s), some hoarseness is present; but most of these lesions would have been suitable only for a total laryngectomy. In the 15 failures in T1 and T2 supraglottic lesions, surgery was not attempted in only three patients, one of whom was salvaged by re-irradiation. Following 12 laryngectomies there is only one definite failure and two patients died within two years NED locally. Except in the patients who had severe edema and/or necrosis, the voice has been normal or near normal. In patients with lesions of the suprahyoid epiglottis which had amputated the suprahyoid epiglottis swallowing difficulty has not developed.

Carcinoma, Squamous Cell↗
PubMed1975

Control by irradiation alone of nonfixed clinically positive lymph nodes from squamous cell carcinoma of the oral cavity, oropharynx, supraglottic larynx, and hypopharynx.

The records from 1948 through 1967 of 344 previously untreated patients with squamous cell carcinoma of the oral cavity, oropharynx, supraglottic larynx and hypopharynx who had clinically positive cervical lymph node metastases staged N1, N2A, or N2B, and whose initial neck treatment consisted of external radiation therapy alone were reviewed. After appropriate exclusions the study group consists of 183 patients. The dose to the lymph node(s) was calculated retrospectively. The control rates for N1 lymph nodes are 91.5 per cent (76/83) and for N2 lymph nodes 78.5 per cent (55/70) in the patients whose lymph node(s) were well included in the irradiated volume and received a known dose. A dose response analysis shows that doses in the range of 6,500 rads to a single lymph node, 3 cm. or less in diameter, produce 90 per cent control. When a nonfixed metastatic lymph node of 3 cm. or more in diameter of multiple lymph nodes are present or there is questionable coverage, external irradiation alone cannot be relied upon for control and a neck dissection should follow.

Carcinoma, Squamous Cell↗
PubMed1975

Aggressive surgery in treatment for parotid cancer: the role of adjunctive postoperative radiotherapy.

A 7 year follow-up of 120 patients with malignant parotid cancers revealed parotidectomy to be an adequate procedure for low-grade, nonaggressive lesions. The addition of radiation therapy postoperatively will improve local and regional control of high-grade, aggressive lesions. Postoperative radiation therapy may also make the removal of the facial nerve unnecessary in certain clinical presentations.

Adenocarcinoma↗
PubMed1975

The management of soft tissue sarcomas in adults: surgery and postoperative radiotherapy.

Traditionally soft tissue sarcomas have been managed by surgery, because they were considered radioresistant. Experience has shown that the local recurrence rate after a simple excision is 90 per cent and 30 per cent after radical surgical procedures. The treatment of soft tissue sarcomas by radical ratiation therapy alone is also unrewarding-the local recurrence rate being 66 per cent. In order to preserve a functional limb, a selected group of patients was treated using a conservative surgical excision of the gross tumor (usually a simple "shelling out"), and immediate postoperative radiation therapy. The rationale for removing all gross tumor by conservative surgical excision is that the remaining subclinical disease can be destroyed with moderate doses of postoperative irradiation. In 70 patients with soft tissue sarcomas of the extremities, all local failures occurred in tumors of the fleshy parts with a recurrence rate of 17.2 per cent, independent of the histological type. In spite of generous radiation fields, 4 of the 12 local recurrences were outside of the irradiated volume, some more than 5 cm from the margin of the field. This documents the tendency of soft tissue sarcomas to spread along the fascial planes for a great distance. To avoid complications only part of the entire circumference of an extremity must be irradiated since a severe constricting fibrosis may result with varying degrees of edema distal to the irradiated volume when all of most of the circumference is irradiated. This retrospective review of patients treated for extremity lesions by conservative excision and postoperative radiotherapy shows that a functionnal limb can be preserved in 80 per cent of the patients.

Cobalt Radioisotopes↗