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Biomedical subjects

H T Barkley

Publications and source records attributed to H T Barkley.

At least 37 records · Page 2Linked to original sources
PubMed1982

Fifteen year radiotherapy experience with chondrosarcoma of bone.

A retrospective analysis of 20 patients with chondrosarcoma of bone treated for cure between 1961 and 1976 using supervoltage radiotherapy and/or neutrons is presented. Radiotherapy was used alone or in combination with other modalities. The 20 patients were divided into four groups: 1) 11 patients who received radiotherapy alone, 2) three patients who received postoperative radiotherapy following less than radical local excision, 3) three patients who received radiotherapy with chemotherapy but without surgery, and 4) three patients who received radiotherapy for tumor recurrent after surgery. Typical tumor doses ranged from 4000 to 7000 rad at 1000 rad/week using parallel-opposed fields. Failure of radiotherapy was indicated by progression of symptoms and increasing tumor size. At 53 months, the average follow-up, the survival rate is 65% (13/20), including one patient with distant metastases, and two patients who developed local recurrent disease after radiotherapy and were surgically salvaged. Seven patients died with uncontrolled local disease; six of them also had distant metastases. Five patients developed severe complications. All four patients treated with a combination of neutron and photon beam alone show no evidence of local failure, compared with only one of the seven patients treated with conventional radiotherapy alone.

Adult↗
PubMed1982

Combined ultrasound and radiation therapy treatment of human superficial tumors.

Ultrasound, used to generate local tumor hyperthermia, was combined with radiation therapy in a pilot study to determine efficacy and toxicity of this combined-modality therapy. Twenty-one lesions in eighteen patients were treated at graded doses from 2400-4000 rads (24-40 Gy) with ultrasonic hyperthermia administered immediately prior to irradiation at 43.5 degrees C +/- 0.5 degrees C for one hour. The overall response rate was 100%, with a 62% complete response rate. Of those lesions that responded completely and were followed for periods of three to twenty-two months, there have been no recurrences of the lesions treated with the combined modalities. The response rate for control unheated lesions in the same patient in the same radiation field was markedly lower (30% overall and no complete responses). Heat treatment alone in the same patients also showed lower response rates (50% overall and 10% complete) with a short response duration. Toxicities were minimal, consisting of one case with long-term treatment-associated sequelae. It is concluded that this combined modality of therapy is safe and effective where applied in human superficial tumors and that further development is warranted.

Hot Temperature↗
PubMed1981

Chemoimmunotherapy of small cell bronchogenic carcinoma with VP-16-213, ifosfamide, vincristine, adriamycin, and Corynebacterium parvum.

Thirty-five consecutive patients with small cell bronchogenic carcinoma (SCBC) received chemoimmunotherapy with VP-16-213, Ifosfamide, vincristine, Adriamycin, and Corynebacterium parvum. Of 33 evaluable patients, 26 (79%) responded with complete (55%) or partial (24%) remissions. Complete remissions were more common among patients with limited disease (11/14 patients, 79%) compared with those with extensive disease (7/19 patients, 37%) and among patients (11/14 patients, 79%) compared with those with extensive disease (7/19 patients, 37%) and among patients who were ambulatory prior to therapy (16/25 patients, 64%) compared with those who were nonambulatory (2/8 patients, 25%). Myelosuppression consisted primarily of neutropenia. Eight percent of the treatment courses in 29% of the patients were associated with hematuria and/or documented episodes of infection during neutropenia. There were three deaths possibly related to treatment, in two of which there was no evidence of disease at post-mortem examination. Six patients relapsed in the central nervous system (CNS). In four instances, CNS relapse was the only site of tumor progression. Central nervous system relapse was more common among evaluable patients who did not receive prophylactic brain irradiation (5/17 patients, 29%, vs. 1/15 patients, 7%; P = 0.23). The median survival duration for all patients was 63 weeks, being slightly longer for patients with limited disease than for those with extensive disease (70.9 weeks vs. 56 weeks; P = 0.18). This was also true for patients who achieved complete rather than partial remissions (71 weeks vs. 50 weeks; P = 0.09). Patients receiving prophylactic brain irradiation experienced longer survival (100.8 weeks vs. 48 weeks; P = 0.01).

Adult↗
PubMed1981

Conservative surgery and postoperative radiotherapy in 300 adults with soft-tissue sarcomas.

From January 1963 through December 1977, 300 adults with soft-tissue sarcomas were treated by a conservative surgical excision and postoperative radiotherapy. The absolute two- and five-year disease-free survival rates are 74% (222/300) and 61.3% (103/168), respectively. The five-year survival rate varies with: (1) anatomic site, e.g., 69.4% (75/108) for extremity lesions vs. 33% (5/15) for abdominal lesions; (2) histopathologic diagnosis, e.g., 86.4% (19/22) for fibrosarcoma vs. 50% (15/30) for neurofibrosarcoma; and (3) stage of the lesion. The overall local recurrence rate was 22.3% (67/300) and 27% (81/300) of the patients developed distant metastases. The incidence of lymph node metastases as an initial site of spread was only 2.7% (8/300); therefore, elective treatment of the regional lymphatics is not indicated. The 6.5% incidence of significant complications in extremities is low and might be further diminished by careful treatment planning. The combination of conservative surgery and postoperative radiation therapy maintains a functional limb in 84.5% (169/200) of patients with extremity lesions. This rate is comparable to the five-year survival rate attained with radical surgery.

Abdomen↗
PubMed1981

Role of intravenous hyperalimentation as an adjunct to intensive chemotherapy for small cell bronchogenic carcinoma.

Forty-nine patients with small cell bronchogenic carcinoma (23 limited and 26 extensive disease) received their first two of three courses of intensive remission induction chemotherapy with (21 patients) or without (28 patients) intravenous hyperalimentation (IVH). The chemotherapy included six remission induction courses with ECHO (epipodophyllotoxin VP-16-213, cyclophosphamide, hydroxydaunorubicin, oncovin), followed by six courses of maintenance with PRIME (procarbazine, ifosfamide, methotrexate). Prophylactic brain irradiation (3000 r/2 weeks) was given to all patients and those with limited disease received chest irradiation (5000 r/5 weeks) at the completion of ECHO. Thus far, all 30 patients who have completed three courses of ECHO have responded with complete (70% CR) or partial (30% PR) remissions. The CR rate was higher for patients receiving IVH (85% vs 59%, P = 0.25). Myelosuppression was pronounced and predominantly in the form of neutropenia. Median lowest neutrophil counts were zero during each of the three courses of ECHO and lasted a median of 5 days at levels less than 500/mm3. Major infections occurred in 21% of courses. The administration of IVH did not ameliorate the hematologic, gastrointestinal, and infectious morbidity of ECHO chemotherapy. However, it resulted in preservation of body weight (P less than 0.01) and improved skin reactivity to a battery of six skin antigens (P = 0.03). The administration of intensive therapy with ECHO +/- IVH was well tolerated and resulted in high CR rates in patients with small cell bronchogenic carcinoma. The administration of IVH was most helpful in preventing severe weight loss and augmenting response to a battery of skin antigens. The long term survival effects of these observations are yet to be determined.

Adult↗
PubMed1977

Combination chemotherapy and radiation therapy for small cell carcinoma.

A three-drug combination of the chemotherapeutic agents cyclophosphamide, vincristine sulfate, and doxorubicin hydrochloride was given to 45 patients with small cell bronchogenic carcinoma. In addition, patients with limited disease received radiation therapy to the primary tumor. The complete response rate was 44%, with a median survival of 50 weeks. The partial response rate was 29%, with a median survival of 35 weeks. Patients who did not respond to therapy showed a median survival of only 12 weeks. Twenty percent of the patients had their first recurrence in the brain, and the median survival from the time of disease recurrence was ten weeks. Bone marrow metastasis was encountered in 24% of the patient population, but this did not adversely affect survival.

Brain Neoplasms↗
PubMed1977

The significance of residual disease after external irradiation of squamous-cell carcinoma of the oropharynx.

366 patients with squamous-cell carcinoma of the oropharynx treated by external irradiation were studied to see whether residual disease at the end of treatment influences control. The frequency of recurrence was found to be significantly greater when residual disease was present. When the total dose was determined by the degree of regression of the primary lesion during treatment rather than the initial tumor volume, recurrence was significantly more frequent. Forcing the dose beyond a level suitable for the original volume of disease failed to prevent recurrence in patients with residual disease, most likely due to the hypoxic state of the remaining tumor cells.

Carcinoma, Squamous Cell↗
PubMed1976

Volume and time factors in interstitial gamma-ray therapy.

The two suppositions which have dictated time-dose and volume relationships in interstitial gamma ray implantation have been examined in the light of recent publications. The first of these assumptions, that total dose reduction is required when the dose rate exceeds 6,000-7,000 rads in seven days, does not appear to be substantiated by clinical experiences. It appears that total dose is the critical treatment parameter and that dose rate may be increased by a factor of two or three without requiring alteration of the total dose. Although the second classical assumption, "volume increase requires dose decrease," has been shown throughout radiation therapy experience to be generally correct, it should not be applied rigidly to interstitial gamma-ray therapy. In fact, recent experiences seem to indicate that compensation with respect to volume is not an absolute necessity. Larger lesions require, if anything, higher doses than small ones. To obtain a high percentage of controlled, lesions there must be no dose reduction, regardless of increased volume treated.

Animals↗
PubMed1975

Total-lung irradiation in the treatment of pulmonary metastases.

Sixty-two patients with pulmonary metastases from a variety of primary malignant neoplasms were treated with total-lung irradiation. The incidence of radiation pneumonitis was 21%(13/62) overall, rising to 23% (9/39) in those receiving a tumor dose of 1,500 rads or more. Nine patients with radiation pneumonitis were given chemotherapy (actinomycin D) together with irradiation, and in this group the incidence of radiation pneumonitis was 25%. Five survivors, including 4 treated for metastatic Wilms' tumor, were treated more than 13 months prior to analysis without evidence of disease thus far. Total-lung irradiation for primary malignant neoplasms other than Wilms' tumor does not presently appear to be indicated. A dose of 1,500 rads in 2 weeks in conjunction with actinomycin D is recommended for metastatic Wilms' tumor.

Adolescent↗
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↗