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Biomedical subjects

J D Cox

Publications and source records attributed to J D Cox.

At least 199 records · Page 11Linked to original sources
PubMed1982

Microcystic ganglioglioma treated by partial removal and radiation therapy.

A 35-year-old woman presented with visual hyperacuity and seizures. Radionuclide and CT scans revealed a frontal lobe mass lesion consistent with an astrocytoma. Subtotal removal was necessary due to proximity of the tumor to the motor strip. Initial histopatho logic interpretation was malignant glioma (astrocytoma Grade 2 or 3). Megavoltage irradiation was delivered to a midsagittal dose of 6300 rad in seven weeks. Subsequent review of the slides revealed the tumor to be a microcystic ganglioglioma. The patient is well five and one-half years after treatment. It is important to separate these low grade neoplasms from the more ominous astrocytomas in regard to prognosis after resection and irradiation.

Adult↗
PubMed1982

Local control and survival after external irradiation for adenocarcinoma of the prostate.

From 1966 through 1978, 128 patients with biopsy-proven adenocarcinoma of the prostate underwent external irradiation to the entire pelvis followed by additional irradiation with a field that encompassed the entire prostate with generous margins. Local recurrence was diagnosed when palpable regrowth occurred and was confirmed by biopsy. Eighteen patients (14%) had local recurrence. Actuarial (life table) local recurrence rates, however, were 24% for both for Stage B and C patients. Actuarial five year survival was 100% for the 10 Stage A patients, 91% for the 25 Stage B, and 78% for the 93 Stage C patients. Actuarial five year disease-free survival was 59% for Stage B and 69% for Stage C patients. Local recurrence was affected by the total dose to the whole pelvis and the dose at the center of the prostate. Disease-free survival was influenced by differentiation. High dose external irradiation to the prostate and regional lymph nodes offers the greatest probability of long-term disease-free survival for patients with localized disease. Late bowel complications were seen in 14 patients (11%), two of whom required colostomies. Late urinary tract complications were observed in five patients (4%).

Adenocarcinoma↗
PubMed1982

The role of thoracic and cranial irradiation for small cell carcinoma of the lung.

Since 1974, 120 previously untreated patients with small cell carcinoma of the lung seen in Therapeutic Radiology at The Medical College of Wisconsin have been entered into one of 4 successive studies. Study I used thoracic irradiation (TI) alone (4500-6000 rad in 3-6 weeks) with chemotherapy at progression. Study II randomized patients with limited disease to TI (3000 rad in 2 weeks) plus either cyclophosphamide, doxorubicin, vincristine (CAV) or total body irradiation (TBI); patients with extensive disease received TI + CAV. Study III employed prophylactic cranial irradiation (PCI) plus CAV and withheld TI unless there was incomplete response or recurrence. Of 93 evaluable patients from the first three studies, 55 had limited and 38 extensive disease. Study I (37 patients) showed a 62% complete response (CR) rate; 43% failed in the chest, 14% had brain metastases, and the median survival was only 22 weeks in spite of a preponderance of limited disease patients. Study II (27 patients) showed a CR of 59%; 30% had brain metastases and the median survival was 48 weeks. Study II patients (29) had a 69% rate; 72% failed in the chest, 4% with PCI developed brain metastases, and the median survival was 50 weeks. In March, 1979, Study IV was initiated; patients receive PCI (2500 rad in 2 weeks) plus high dose CAV, methotrexate and leucovorin. After 6 cycles, consolidation TI (3750 rad in 3 weeks) is given to patients with complete response. Preliminary results with 27 patients treated on this study show a 67% CR rate, a 41% chest failure rate (but only 11% for the patients who received thoracic irradiation) and no intracranial failures, but a 13% extracranial CNS failure rate. PCI, TI and spinal irradiation may be necessary to maximize the probability of long term disease free survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1982

The role of consolidation irradiation in combined modality therapy of small cell carcinoma of the lung.

Forty-four patients with small cell carcinoma of the lung (SCCL) were treated with a program of combined chemotherapy and radiation therapy. Prophylactic cranial irradiation was given concurrent with the first of six planned cycles of chemotherapy consisting of Cyclophosphamide, Adriamycin, Vincristine and high dose Methotrexate (CAV-M). All patients judged as complete responders (CR) received consolidative thoracic irradiation (CTI) to the locoregional primary lung involvement. The CR rate to chemotherapy alone was 84% for patients with limited disease (LD) and 44% for extensive disease. In comparison to a prior trial, which used similar chemotherapy, but with irradiation withheld until primary site relapse, the actuarial primary site relapse rate at 2 years was reduced by CTI from 92% to 18% (P less than .01). The median primary site remission duration has not yet been reached in the CTI group and was 34 weeks without CTI (P less than .01). CTI increased the 2 year actuarial survival from 6% to 66% (P less than .01) in the chemotherapy CR patients. Median survival has not yet been reached in the CTI group, but was 48 weeks without CTI (P less than .01). Leptomeningeal spinal cord relapse in patients with no prior central nervous system (CNS) involvement occurred in 16% of patients relapsing.

Aged↗
PubMed1982

Integration of chemotherapy and radiation therapy for small cell carcinoma of the lung.

Two chemotherapy trials using cyclophosphamide, doxorubicin hydrochloride and high-dose vincristine sulfate with or without methotrexate have induced a 93% incidence of complete remission in limited disease presentation of small cell bronchogenic carcinoma of the lung and 39% incidence in extensive disease. The first trial without consolidation radiotherapy had a local failure rate of 65%, which dropped to 17% with consolidation radiotherapy to the primary and mediastinum. Prophylactic whole brain radiotherapy prevented local recurrence in 98% of evaluable patients. One carcinomatous meningitis and 5 intraspinal recurrences were noted among the 38 patients in the CAV-M trial. We conclude that high-dose vincristine sulfate is associated with an improved incidence of complete remission; that prophylactic whole brain radiotherapy has been highly successful; that prevention of intraspinal recurrence will necessitate the use of craniospinal axis radiation therapy and consolidation radiation therapy improves local control of primary and mediastinum.

Antineoplastic Agents↗
PubMed1982

Computerization of medical and exposure records.

An interdisciplinary team of occupational health professionals and computer engineers at Digital Equipment Corporation have developed a computerized system for maintaining employee medical and exposure records. The Industrial Health Monitoring System (IHMS) was designed to meet the occupational and public health needs of employees engaged in semiconductor manufacturing operations where exposure to potentially hazardous chemicals and physical agents exists. The purpose of the IHMS is to systematically retrieve and analyze data collected from industrial hygiene, health services, and clinical diagnostic testing in order to monitor the general health of the working community.

Computers↗
PubMed1982

Advanced carcinoma of the nasopharynx. A clinical study of 274 patients.

A total of 274 patients with a diagnosis of nasopharyngeal carcinoma was treated in eight Veterans Administration Hospitals over a period of 22 years. Of the 274 patients, 256 (93%) had squamous-cell carcinoma, while 18 (7%) had other tumors. Most of the squamous-cell carcinoma patients (82%) had Stage IV disease; cervical lymph node metastases were found in 193 (75%), and distant metastases were present in 22 (9%). The actuarial 5-, 10-, and 15-year survival rates for the 256 squamous-cell carcinoma patients were 15%, 10%, and 7%, while they were 49%, 42%, and 35% for the 18 patients with other tumors (p = 0.006). There was a progressive decrease in 5-year survival with the increase in the stage of tumor. The survival of the 63 patients without metastases was better than the survival of the 193 patients with cervical metastases (24% vs. 12% at 5 years, p = 0.03). The presence of T4 disease or Initial Performance Status of less than 80 on the Karnofsky Scale indicated a poor prognosis (p = 0.0001). Treatment failure occurred in 83% of the patients by 2 years after therapy and was due to the lack of tumor control at the primary site. Advanced (N3) cervical lymph node metastases indicated that systemic tumor dissemination of the nasopharynx is an uncommon malignancy.

Adult↗
PubMed1981

Radiotherapy in the management of locally advanced lung cancer of all cell types: final report of randomized trial.

Between 1975 and 1978, 343 evaluable male patients with a diagnosis of locally advanced lung cancer of all cell types were entered in Protocol 15. The patients had unresectable or inoperable tumor limited to one hemithorax and no evidence of distant metastases. The cell-type distribution was as follows: squamous cell carcinoma (Sq CC) 137 (40%); positive cytology 66 (19%); large cell carcinoma 57 (17%); small cell carcinoma (SCC) 46 (13%) and adenocarcinoma 37 (11%). An intermediate course of irradiation (ICI) of 5000 rads in 25 fractions, 200 rads each, in 5 weeks was compared with a short course of irradiation (SCI) of 4200 rads in 15 fractions, 280 rads each, in 3 weeks (equal Nominal Standard Dose). The effectiveness of low dose irradiation to control subclinical brain metastases was studied and was reported separately. The median survival for all 343 patients was 38 weeks. There was no significant difference in survival, response and control rate between the 191 ICI and the 152 SCI patients. The following factors had a significant individual influence on survival: initial performance status, ambulatory vs. nonambulatory, P = 0.006; histology, Sq CC vs. other cell types (OCT), P = 0.0007; prior surgery, less than 6 weeks vs. greater than 6 weeks, p = 0.04; tumor size, diameter less than 6 cm vs. greater than 6 cm, P = 0.05 and weight loss less than 5% vs. greater than 5% in the previous 6 months, P = 0.01. The overall response rate (CR or PR) was 38%. The median duration of response was shorter for the ICI group when compared with the SCI group, 18.4 vs. 34.4 weeks, P = 0.02. The presence of partial or complete response enhanced the median survival 50 vs. 31 weeks. Cell type, Sq CC vs. OCT was an important factor for the duration of response, 49 vs. 21 weeks, P = 0.0006. The complication rate was similar for the 191 ICI patients when compared with the 152 SCI patients. There were however, two patients with radiation myelopathy among the SCI patients and none among the ICI patients.

Adenocarcinoma↗
PubMed1981

Local control of intrathoracic disease with chemotherapy and role of prophylactic cranial irradiation in small-cell carcinoma of the lung.

Between 1978 and 1979, 39 consecutive patients at the Medical College of Wisconsin were seen with small-cell carcinoma of the lung; of these, 31 were treated with chemotherapy and prophylactic CNS irradiation (2500 rad/10 fractions) and were evaluable after 22 month median follow-up. The intrathoracic primary was not irradiated unless there was no response to chemotherapy or subsequent recurrence. Of the 31 patients, 12 had limited disease (LD) and 19 had extensive disease (ED). Twenty, including all the patients with LD, had a complete response, eight had a partial response, and three were nonresponders. Of 24 patients with complete response at the primary site, 20 subsequently displayed local failure of the intrathoracic primary tumor, most developing disseminated extrathoracic disease simultaneously with or shortly after primary failure. The median survival time (MST) of the evaluable group was ten months with an actuarial one-year survival of 39%. Patients with LD had a median remission duration of 13 months and a MST of 16 months. Three patients are still alive with no evidence of disease at 14, 20, and 27 months. Of 26 patients receiving prophylactic cranial irradiation, all are free of CNS relapse. Chemotherapy alone appears insufficient to permanently control the bulky intrathoracic tumor, leading to the use of "consolidation" irradiation of moderate dose (3750 rad/15 fractions) to follow chemotherapy. Prophylactic CNS irradiation should be used routinely.

Antineoplastic Agents↗
PubMed1981

Stage III nodular lymphoreticular tumors (non-Hodgkin's lymphoma): results of central lymphatic irradiation.

Since 1969, 29 previously untreated patients with Stage III nodular malignant lymphoreticular (MLT) have received total central lymphatic (TCL) irradiation. The volume irradiated included the entire abdomen, Waldeyer's ring, and preauricular nodes in addition to the usual regions encompassed by total nodal irradiation. Doses of 2000--3000 rads in three to six weeks were delivered to the nodal regions, liver, and spleen; fraction sizes ranged from 100 to 180 rads. Patients have been followed from one to ten years (median six years). The actuarial survival is 78% at five years, and the disease-free survival is 61%. There is no difference in disease-free survival of the patients with poorly differentiated lymphocytic vs. those with "histiocytic" or mixed cytology. Men and women had disease-free survivals of 82% and 43%, respectively. The long-term follow-up of these patients indicates that prolonged disease-free intervals are common after TCL irradiation, and some patients may be cured.

Abdominal Neoplasms↗
PubMed1981

Cranial irradiation in cancer of the lung of all cell types.

The Veterans Administration Lung Group conducted a prospective study of irradiation for subclinical brain metastases in patients with inoperable carcinoma of the lung between 1975 and 1978. Patients were randomized to receive whole-brain irradiation (2,000 rads in two weeks) or no brain treatment, and to receive one of two regimens of thoracic irradiation. Three hundred twenty-three patients with normal radionuclide brain scans were able to be evaluated. The rate of clinical brain metastasis was 26% for patients with small cell carcinoma vs 10% for the "non-small-cell" group. A statistically insignificant decrease in the rate of brain metastasis was found among irradiated patients with small cell carcinoma. The frequency of brain metastasis in the non-small-cell patients was reduced from 13% to 6% by irradiation. Prophylactic cranial irradiation can decrease morbidity from non-small-cell carcinoma of the lung.

Brain↗
PubMed1981

Patterns of failure in treatment of stage I and II diffuse malignant lymphoid tumors.

Fifty-nine patients with Stage I and II diffuse malignant lymphoid tumors were irradiated between 1966 and 1979. Seventeen had primary lymph node disease and 42 had extranodal presentations. Local recurrence was noted in 1 of 14 evaluable lymph node presentations and 8 of 36 extranodal distributions. Failures occurred in unirradiated lymph nodes (contiguous or transdiaphragmatic) in 3 of 17 patients with lymph node disease and 6 of 42 with extranodal disease. Dissemination occurred in 4 of 17 lymph node presentations and 6 of 42 extranodal tumors. Local recurrence was low, particularly among lymphatic tumors. There was no identifiable dose effect for local control. Extension to contiguous or distant lymph nodes occurred in 15% of cases. The authors suggest that the transdiaphragmatic lymph nodes be included when treating patients with lymph node tumors. The role of adjuvant chemotherapy remains unproved.

Adolescent↗