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J Boyages

Publications and source records attributed to J Boyages.

61 records · Page 4Linked to original sources
PubMed1988

Fat necrosis of the breast following lumpectomy and radiation therapy for early breast cancer.

Between January 1980 and December 1985, 121 patients with early breast cancer were treated in the Department of Radiation Oncology at Westmead Hospital by external beam irradiation and an iridium wire boost following "lumpectomy". After a median follow-up of 26 months, 14 patients have developed recurrent masses in the treated breast. In four, recurrent carcinoma was strongly suspected and subsequently confirmed by fine needle aspiration biopsy, but in only two was a subsequent salvage mastectomy possible. The remaining 10 patients developed a nodule which was usually tender. With three exceptions, the nodule was at the primary tumour site and developed 4-43 months after treatment. In seven, tumour recurrence was suspected but not confirmed by biopsy and the other three were accepted as having post-treatment "radiation fibrosis". Excision biopsy was undertaken in eight of the 10 patients. Another patient underwent partial mastectomy for presumed local recurrence. The histological appearance in all cases was similar, with areas of fat necrosis and fibrosis with atypical stromal fibroblasts. Suture material was present microscopically in eight patients and was noted macroscopically (that is, by mammogram) in the one patient who did not undergo surgery. This complication is most likely caused by a combination of surgical and radiation factors. The difficulty in management is differentiation between tumour recurrence and a benign condition.

Brachytherapy↗
PubMed1988

The efficacy of combined chemotherapy and radiotherapy in advanced non-metastatic breast cancer.

Thirty-five patients with locally advanced (inoperable) breast cancer have been treated based on a regimen of chemotherapy-radiotherapy-chemotherapy. At the completion of all treatment a complete remission rate of 86% was achieved with acceptable toxicity. At a median follow-up of 24 months (range 4-60), relapse at the site of bulk disease occurred in 17% (10% isolated loco-regional relapse) and relapse at distant sites in 34%. The median relapse-free survival was 36 months and the median survival has not yet been reached. Following initial promising results in terms of loco-regional disease control in this group of high-risk patients, the protocol was extended to include 34 patients defined as having locally extensive disease. All patients in this subgroup had undergone a modified radical mastectomy and were categorized as (a) patients in whom the pre-operative clinical findings merited (in our opinion) inclusion in the category of locally advanced (inoperable) disease, (b) patients in whom the primary was operable but in whom extensive involvement of axillary nodes was found (greater than 10 nodes positive or greater than or equal to 70% nodes positive if less than 10 nodes found) and (c) patients without the above characteristics with a primary tumor greater than 8 cm. At a median follow-up of 23 months (range 4-48), loco-regional recurrence occurred in one patient (3%) but distant relapse occurred in 21%. Relapse-free and overall survival was not significantly different to that found in patients with locally advanced disease who did not undergo mastectomy.

Adult↗
PubMed1988

Early breast cancer: cosmetic and functional results after treatment by conservative techniques.

Between January 1980 and December 1985, 121 patients with early breast cancer were referred to the Department of Radiation Oncology at Westmead Hospital for radiation therapy following initial tumour excision. After a median follow-up of 26 months, five patients developed a loco-regional recurrence (4%) and nine developed metastatic disease but with local control. There were 105 eligible patients who were sent a letter/questionnaire which included: a request to attend a clinic, to allow an objective assessment of the cosmetic result of the treated breast by two clinicians, questions regarding breast function as it affected quality of life, and a request that they undertake a self-assessment of the treated breast from a cosmetic point of view. Seventy-six patients attended for assessment of the following factors: whether surgery was optimal as determined by predefined criteria, measurement of breast oedema, arm oedema, breast retraction and telangiectasia, and an overall cosmetic assessment performed independently by both a radiation oncologist and surgeon. A physician not involved in management undertook a cosmetic assessment using standard photographs. Approximately 20% of patients replied that their choice of clothing had been affected by treatment, 10% were embarrassed and 70% experienced some continuing tenderness or discomfort in their treated breast. The extent of surgery was judged to be suboptimal in 22% but that proportion increased to 34% of cases referred from external clinics. The overall incidence of moderate or severe breast oedema was 9%, breast retraction 50%, telangiectasia 16% and arm oedema 21%. Those patients with longer follow-up (i.e., greater than 36 months) had a higher incidence of breast retraction (67%), telangiectasia (30%) and arm oedema (33%) but less breast oedema (7%). As expected, the patients rated the appearance of their breast more favourably than did clinicians. Overall, the result was rated as good or excellent by 75% of patients compared with 55% when the assessment was made by a surgeon or radiation oncologist. The main factor identified as contributing to a poor cosmetic result was the area of the iridium implant. The area of implant was larger when suboptimal surgery had been carried out, the main component of which was excessive length of scar.

Breast↗
PubMed1987

Cerebral hemisphere astrocytoma: treatment results.

Eighty two adult patients with histologically proven cerebral astrocytomas of grades I to IV received post-operative radiotherapy at Westmead Hospital between January 1980 and February 1985. The extent of surgery consisted of biopsy alone in 44%, subtotal tumour resection in 48%, and "complete" tumour removal in 8%. Seventy one patients completed a course of megavoltage irradiation, the majority having received a tumour dose of at least 60 Gy. Patients who underwent surgical resection (complete or incomplete) had a greater median survival (14 months) than those undergoing biopsy (8 months), but the difference was not statistically significant (p = 0.08). By grade, the difference reached statistical significance only for grade III tumours (p = 0.015). Patients with high grade tumours had a significantly lower survival than those patients with tumours of low grade. Median survival for patients with grades I and II, III and IV tumours was 42.0, 12.0 and 7.0 months, respectively. After adjustment for grade, various dosage levels (less than 60, 60 or greater than 60 Gy) did not significantly affect survival, although there was a trend towards improved median survival with higher doses in grade III tumours. Older patients (greater than 45 years) had a significantly lower median survival (25 months) than younger patients (8 months) (p less than 0.0001). When included in a multivariate analysis, the extent of surgery did not significantly influence survival, but increasing tumour grade and increasing age were significant adverse prognostic factors.

Adolescent↗
PubMedDate not supplied

Ductal carcinoma in situ. Part I: Definition and diagnosis.

The frequency of diagnosis of ductal carcinoma in situ (DCIS) has increased in Australia, largely because of the national screening programme. Ductal carcinoma in situ presents a dilemma because of problems with its diagnosis and variations in reporting pathological and radiological findings, making it difficult to define optimal treatment and communicate information in a way that helps the patient understand the problems and make decisions. There is considerable inter-observer variation, particularly in differentiating low-grade DCIS from ductal hyperplasia, with or without atypia, but pathologists who participate in regular pathological review sessions vary less in their opinions. Mammography remains the main investigative tool for DCIS and the American College of Radiology has recommended standardized reports. A team approach is required for the removal and diagnosis of possible DCIS. Although the team may be best co-located in the one facility, this is not practical in many community hospital settings which lack on-site radiology and pathology services. The decision about how much breast tissue to remove will need to be made for each patient and depends on the size of the microcalcification and how suspicious the mammogram is for DCIS. We recommend the use of synoptic reports for DCIS, and we document the minimum factors that should be reported by pathologists. The evaluation and management of DCIS by a multidisciplinary team will allow the patient access to information required to make often difficult treatment decisions. In this paper, we review the literature about the natural history, pathology, cytology and radiology of DCIS and document the 20 critical steps required for the diagnosis of impalpable, mammographic microcalcifications suspected to be DCIS.

Biopsy↗