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Biomedical subjects

J D Cox

Publications and source records attributed to J D Cox.

At least 217 records · Page 12Linked to original sources
PubMed1980

Locally advanced adenocarcinoma of the endometrium: results of irradiation with and without subsequent hysterectomy.

From 1965 through 1977, 54 patients with locally advanced adenocarcinoma of the endometrium were treated at the Medical College of Wisconsin Affiliated Hospitals. According to the FIGO-AJC staging system, 39 had Stage II and 15 Stage III disease. Stage II was subdivided into II A-microscopic (28 patients) and II B-clinical (11 patients) involvement of the cervix. Patterns of failure were evaluated, viz. central pelvic, lateral pelvic, and distant. The results confirm an association of increasing grade with increasing stage. Disease-free survival rates at five years are better for Stage II (78%) than Stage III (34%), but are no different for Stages II A (77%) and II B (81%). Pattern of failure and disease-free survival data support the combined irradiation-surgical approach over irradiation alone. Central pelvic failures are reduced by subsequent hysterectomy (6% vs. 20%). Lateral pelvic failures are less frequent when the dose of external pelvic irradiation is 5000+ rads/5-6 weeks compared to less than 5000 rads (4% vs. 20%). In Stage II (corpus et collum) the prognosis is better with preoperative irradiation and abdominal hysterectomy than with irradiation alone (89% vs. 63%). Whenever possible, patients with Stage III disease should be offered irradiation and hysterectomy.

Adenocarcinoma↗
PubMed1980

Clinical versus pathologic stage I and II Hodgkin's disease.

During an 11-year period, 76 patients with pathologic stage (PS) and 69 with clinical stage (CS) I and II Hodgkin's disease were irradiated. The PS and CS patients were comparable by sex, age, stage, and histopathologic types. Treatment group 1 received a mantle of I and II A lymphocyte predominant and nodular sclerosis plus paraaortic for I-II A mixed cellular and lymphocyte-depleted or B symptoms; group 2 received mantle plus paraaortic for I-II A lymphocyte predominant and nodular sclerosis, and total nodal irradiation for the unfavorable group. The disease-free survival is 47% for the PS and 64% for CS patients in group 1. For group 2, 85% of PS and 83% of CS patients are disease free. Analysis of infradiaphragmatic failures fails to show any advantage for PS over CS. Laparotomy does not obviate infradiaphragmatic irradiation for stage I and II Hodgkin's disease.

Adolescent↗
PubMed1979

Influence of cell type on failure pattern after irradiation for locally advanced carcinoma of the lung.

Patterns of failure after treatment for carcinoma of the lung were analyzed by the major WHO cell types. Only diagnoses of the review panel of the Veterans Administration Lung Group were used. First sites of progression were analyzed for 185 patients in a clinical trial, and cause of death was evaluated in 300 consecutive autopsies from VALG studies. Clinical progression was similar for all cell types--20% failed locally and 30% developed metastases. Carcinomatosis or brain metastasis caused death in only 27% of patients with squamous, in over half with large cell and adenocarcinoma, and in 70% of patients with small cell carcinoma. Complications of the local tumor (infection, hemorrhage, and respiratory failure) caused death in 50% of patients with squamous, in 1/3 with large cell and adenocacrinoma, and in 21% of those with small cell carcinoma. These clinical and autopsy data suggest the need for aggressive treatment of the local tumor in all cell types, and systemic therapy for small cell carcinoma. Both local and systemic approaches are needed for large cell and adenocarcinoma.

Adenocarcinoma↗
PubMed1979

Adenocarcinoma of the lung: recent results from the Veterans Administration Lung Group.

Adenocarcinoma has become the most common type of cancer of the lung. Its distinct natural history necessitates separation from the other cell types. Results from recent Veterans Administration Lung Group studies show that local-regional failure occurred in 59% of patients after irradiation for adenocarcinoma limited to the thorax. Data from 300 consecutive autopsies reveal that death was caused by intrathoracic complications of the tumor in 38%, and by metastases in 57% of patients. Adenocarcinoma has an intermediate risk of local and distant failure when compared to squamous and small-cell carcinoma. However, brain metastases are most frequent with adenocarcinoma. Preliminary results suggest that prophylactic brain irradiation decreases the frequency of brain metastases. Patients with adenocarcinoma are more likely than those with other cell types to have metastases only in the brain. Prophylactic brain irradiation may make the greatest contribution to improved survival in pateints with adenocarcinoma of the lung.

Adenocarcinoma↗
PubMed1979

Interaction of thoracic irradiation and chemotherapy on local control and survival in small cell carcinoma of the lung.

The records of all patients with small cell carcinoma of the lung seen in the Division of Therapeutic Radiology at The Medical College of Wisconsin from 1971 through 1977 were reviewed. Of 69 patients (34 with limited disease and 35 with extensive disease), 35 received irradiation only, nine received local plus total-body irradiation, and 25 received irradiation plus chemotherapy. In spite of the prompt response of the tumor, 16 of 35 patients who were only irradiated failed locally. Two patients who received local plus total-body irradiation failed in the chest. Only four of 25 irradiation plus chemotherapy patients failed locally in spite of much lower doses of thoracic irradiation. Limited-disease patients who had local control by irradiation had a slight increase (29 vs 22 weeks) in median survival. Patients receiving irradiation plus chemotherapy (three with limited and 22 with extensive disease) survived for a median of 56 weeks if the local tumor was controlled and for a median of 28 weeks if there was local failure. Regardless of therapy, survival beyond the median is greatly influenced by local tumor control.

Adult↗
PubMed1978

Central lymphatic irradiation to low dose for advanced nodular lymphoreticular tumors (non-Hodgkin's lymphoma).

Total central lymphatic irradiation (2500-3000 rads in 3 to 6 weeks) including the entire abdomen, the supradiaphragmatic nodal areas, and Waldeyer's ring is being investigated as a potentially curative approach to patients with Stage III disease. Twenty-two patients have been treated (24-month minimum observation). All evidence of disease has disappeared in every patient. Three patients have developed local recurrence; 2 of them received 2000 rads or less. Three patients had marginal recurrences, and 5 developed generalized disease involving viscera. Fourteen patients (64%) are alive and free of any evidence of disease from 24-90 months (median, 54 months). Absolute survival is 82% (18/22).

Adult↗
PubMed1978

Dose-time relationships and the local control of small cell carcinoma of the lung.

Since 1971, 66 patients with small cell carcinoma of the lung--32 with limited and 34 with disseminated disease--have received irradiation to the primary tumor. There were 20 local failures, 90% of which were apparent within 30 weeks of the start of irradiation. Patients were treated with local irradiation only (32), irradiation plus combination chemotherapy (25), or local plus total body irradiation (9). With local irradiation alone, tumor control increased with increasing biologic dose. When chemotherapy or total body irradiation was added, doses of irradiation that were otherwise insufficient for local control proved to be effective.

Adult↗
PubMed1977

The significance of needle biopsy after irradiation for stage C adenocarcinoma of the prostate.

The presence of malignant cells in needle biopsy specimens following irradiation for adenocarcinoma of the prostate has been used to criticize or defend this treatment. At Walter Reed Medical Center, 38 consecutive patients with Stage Cadenocarcinoma underwent definitive irradiation between August 1970 and March 1973. The median dose to the pelvis was 7000 rads in 31 fractions in 43 days (2030 ret). Post treatment examination included palpation of the prostate and transperineal biopsy of the most suspicious areas. Gradual disappearance of the palpable tumor occurred in all patients. Two men have had clinical evidence of re-growth of prostatic cancer. Thirty-three patients have had up to seven biopsies each for a total of 139, an average of four biopsies per patient. There were 49 positive and 90 negative biopsies. Positive biopsy rate correlated only with the interval after irradiation--60% at six months, 37% at one year, 30% at 18 months, and approximately 19% after two and one-half years. There was no correlation of biopsy results with pre-irradiation estrogen or orchiectomy, with time-dose-fractionation relationships, or with prognosis. These biopsies provide interesting data about the regression rate of prostatic adenocarcinoma, but they have no significance for the individual patient. They have, therefore, been eliminated from follow-up studies.

Adenocarcinoma↗
PubMed1977

Hodgkin's disease stage I and II. A comparison between two different treatment policies.

A retrospective analysis was performed on 145 patients with Stage I and II Hodgkin's disease treated over an 11-year period. Sixty-two patients (Group I) received a mantle field without systematic irradiation of the para-aortic lymph nodes. Eight-three patients (Group II) received radiotherapy according to the folowing policy: all Stage IB and IIB and all mixed cellularity and lymphocytic depletion types received total nodal irradiation while stage IA and IIA nodular sclerosing and lymphocytic predominance cases received irradiation to a mantle field and to the para-aortic lymph nodes. The characteristics of the two groups were roughly comparable in age range, sex, staging, histopathologic subtypes and total irradiation doses. All patients had lymphangiograms although not all underwent staging laparotomies. The staging laparotomy did not appear to have an influence within each group. The extent of irradiation did significantly affect both the incidence of further manifestation of disease as well as survival rates. The frequency of lymph node extension, organ extension and local recurrence for Group I was 24%, 14%, and 3%, while for Group II it was 4%, 6%, and 6%, respectively. The seven-year absolute survival rate for Group I was 57% while for Group II it was 93%.

Adolescent↗
PubMed1977

Cardiac localization of 99mTc-(Sn)-pyrophosphate following irradiation of the chest.

Of 70 consecutive cancer patients referred from radiotherapy for bone scans, 32% showed cardiac uptake of 99mTc-(Sn)-pyrophosphate; only 9% of a control group showed this uptake. Of those with prior left hemithorax irradiation, 60% showed cardiac uptake; only 12% of those with irradiation elsewhere showed this phenomenon (p less than .01). The patients who had no increased uptake tended to have shorter irradiation-to-scan time intervals (less than 10 months) than those who did show increased uptake (mean of 22 months).

Adult↗
PubMed1976

Irradiation for bronchial carcinoma: reasons for failure. I. Analysis of local control as a function of dose, time, and fractionation.

Radiation therapy is the only potentially curative form of therapy for patients with carcinoma of the lung who are not surgical candidates. Previous studies have evaluated response by evaluating survival. Evaluation of local control of disease is essential if one is to understand and modify therapeutic approaches in an effort to increase survival. Clinical data are presented on 197 patients with primary epithelial tumors of the lung. An analysis of local control data is presented using the concept of nomial standard dose (NSD). If local failure is to occur, it is manifest by 15 months. Survival is affected by the ability or inability to achieve local control. Above a dose of 1450 ret, no correlation between increasing ret dose and increasing local control is observed.

Adenocarcinoma↗
PubMed1976

Initial evaluation of reduced fractionation in the irradiation of malignant epithelial tumors.

From July, 1971, through June, 1974, 170 patients underwent radiation therapy with reduced fractionation at the Milwaukee County General Hospital and the Wood Veterans Administration Hospital. One or two fractions per week were delivered for five to seven weeks to a total dose based on the tolerance of normal tissues predicted by the nominal standard dose (NSD) hypothesis of Ellis. Three groups of patients were selected from this heterogeneous population for detailed analysis--carcinomas of the skin, breast, and lung. The 72 patients evaluated provide useful data in regard to acute and subacute reactions. Short term assessment of local tumor control in relation to surrounding normal tissue response is similar to that with conventional fractionation for each of these malignant epithelial tumors.

Breast Neoplasms↗