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Biomedical subjects

J E Marks

Publications and source records attributed to J E Marks.

At least 37 records · Page 2Linked to original sources
PubMed1992

Carcinoma of the nasopharynx: factors affecting prognosis.

This is a retrospective analysis of 143 patients with histologically confirmed epidermoid carcinoma of the nasopharynx treated with definitive irradiation. Patients were treated with a combination of Cobalt-60, 4 to 6 MV X rays, and 18 to 25 MV X rays to the primary tumor and the upper necks, excluding the spinal cord at 4000 to 4500 cGy to total doses of 6000 to 7000 cGy. At 10 years the actuarial primary tumor failure rate was 15% in T1, 25% in T2, 33% in T3, and 60% in T4 lesions. The corresponding failure rate in the neck was 18% for N0, 14% for N1, and 33% for N2 and N3 lymphadenopathy. The incidence of distant metastasis was related to the stage of the cervical lymphadenopathy: 16% in patients with N0-N1 nodes compared with 40% in the N2-3 node group. The actuarial 10-year disease-free survival rate was 55% to 60% for T1-3N0-1 tumors, 45% for T1-3N2-3 tumors, 35% for T4N0-1, and 20% for T4N2-3 lesions. The overall 10-year survival rate was about 40% for patients with T1-2N0-1 tumors, 30% for those with T3 any N stage tumors, and only 10% for the patients with T4 lesions. Multivariate analysis showed that tumor stage and histological type, cranial nerve involvement, patient age, and doses of irradiation to the nasopharynx were significant prognostic factors for local/regional tumor control. Increasing doses of irradiation resulted in nasopharynx tumor control in 80% of the patients receiving 6600 to 7000 cGy and 100% of those receiving over 7000 cGy in the T1, T2, and T3 tumors. However, the tumor control rate did not rise above 55% even for doses over 7000 cGy in the T4 lesions. Local tumor control was higher in patients who had simulation (55/78 = 71%) compared with those on whom simulation was not performed (34/61 = 56%) (p = 0.10). Moreover, patients with more than 75% of the reviewed films judged as adequate had 69% primary tumor control (66/96) compared with 53% (23/43) for those with fewer than 75% adequate portal films (p = 0.07).

Carcinoma, Squamous Cell↗
PubMed1990

Childhood cerebellar astrocytomas: is there a role for postoperative irradiation?

Eighty children with astrocytomas of the cerebellum were treated at Washington University Medical Center in St. Louis, Missouri from 1928-1980. The most important predictor of recurrence was completeness of surgical removal. Of 40 patients whose tumors were totally removed, only one recurred (2.5%). Forty cases were subtotally removed and 14 subsequently recurred (35%). Postoperative irradiation did not significantly improve survival in the patients with incompletely excised tumors; however, there was lack of uniformity in the radiation therapy. Although a survival advantage could not be demonstrated, there was a trend toward a lowering of the recurrence rates in patients with subtotally excised solid tumors who received radiation therapy.

Adolescent↗
PubMed1990

Total atelectasis of the lung secondary to malignant airway obstruction. Response to radiation therapy.

From 1980 to 1986, 48 patients with bronchogenic carcinoma were diagnosed to have total atelectasis of the lung as a result of tumor obstructing the mainstem bronchus. These patients were treated with external beam radiotherapy with doses ranging from 30 to 60 Gy given in 2-6 weeks. Bronchial obstruction was relieved in 74% of patients, resulting in complete or partial reexpansion of the lung. Seventy-one percent of patients irradiated within 2 weeks after radiological evidence of atelectasis had complete reexpansion of their lungs, whereas only 23% of those irradiated after 2 weeks showed a similar response. Atelectasis recurred in 12% of those who initially responded to radiation therapy with complete or partial reexpansion.

Airway Obstruction↗
PubMed1990

Tulip fingers.

Tulip fingers, an allergic contact dermatitis from handling tulip bulbs, is a common occupational problem among workers in the European tulip industry. We describe five of nine workers who sort and package flower bulbs at a central Pennsylvania bulb distribution center; all five had tulip fingers confirmed by positive patch tests to pieces of tulip bulbs and to tuliposide A, the allergen in tulips. The diagnosis of tulip fingers should be considered in any patient with a hand dermatitis who works in the flower industry, especially those who frequently handle bulbs.

4-Butyrolactone↗
PubMed1989

Radiation treatment of brain tumors: concepts and strategies.

Ionizing radiation has demonstrated clinical value for a multitude of CNS tumors. Application of the different physical modalities available has made it possible for the radiotherapist to concentrate the radiation in the region of the tumor with relative sparing of the surrounding normal tissues. Correlation of radiation dose with effect on cranial soft tissues, normal brain, and tumor has shown increasing effect with increasing dose. By using different physical modalities to alter the distribution of radiation dose, it is possible to increase the dose to the tumor and reduce the dose to the normal tissues. Alteration of the volume irradiated and the dose delivered to cranial soft tissues, normal brain, and tumor are strategies that have been effective in improving survival and decreasing complications. The quest for therapeutic gain using hyperbaric oxygen, neutrons, radiation sensitizers, chemotherapeutic agents, and BNCT has met with limited success. Both neoplastic and normal cells are affected simultaneously by all modalities of treatment, including ionizing radiation. Consequently, one is unable to totally depopulate a tumor without irreversibly damaging the normal tissues. In the case of radiation, it is the brain that limits delivery of curative doses, and in the case of chemical additives, it is other organ systems, such as bone marrow, liver, lung, kidneys, and peripheral nerves. Thus, the major obstacle in the treatment of malignant gliomas is our inability to preferentially affect the tumor with the modalities available. Until it is possible to directly target the neoplastic cell without affecting so many of the adjacent normal cells, the quest for therapeutic gain will go unrealized.

Adenoma↗
PubMed1988

Results of surgery and irradiation or irradiation alone for pituitary adenomas.

A retrospective analysis was performed on the clinical course of all patients with pituitary adenomas treated at the Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, Missouri. Of 212 patients treated from April 1954 through December 1982, 70 were treated with radiotherapy alone (XRT), 121 began immediate post-operative XRT (2-6 weeks) and 20 received XRT following surgical failure. Several sub-groups of adenomas were identified and analyzed, including secreting versus non-secreting adenomas (33.0% secreting) and by clinical syndrome; 27% with amenorrhea/galactorrhea, 18.4% acromegalic, Cushing's disease in 6.1% and 3.3% with Nelson's syndrome. The median follow-up time from the data of diagnosis for those patients alive at the time of last follow-up was 11.9 years (range 3.0 to 30.0 years). Actuarial overall and disease-free survival was analyzed up to 25 years. The 10-year overall and disease-free survival was 77.8 and 75.3% for those patients treated with XRT alone, 86.4 and 87.2% for those treated with immediate post-operative XRT and 100.0 and 87.5% for those who were irradiated after surgical failure. Complications related directly to XRT occurred in only five patients. One patient had documented central nervous system radionecrosis, two had visual complications, and tumor necrosis with hemorrhage occurred in the other two patients. In conclusion, overall survival for all patients did not significantly differ from an age, sex and race matched population. Control of local disease was greater for those patients receiving surgery and post-operative XRT than for those receiving XRT only. XRT salvage of surgical failures was possible. Treatment with XRT results in a low complication rate.

Adenoma↗
PubMed1988

Prognostic factors and results of radiotherapy alone in the management of pituitary adenomas.

Prognostic factors and results of therapy were analyzed in a retrospective review of 70 patients with pituitary adenomas treated with radiotherapy alone from January 1954 through December 1982 at the Radiation Oncology Center, Mallinckrodt Institute of Radiology. The 10-year overall and disease-free survival was 77.8 and 76.0%. The expected survival for an age-, sex-, and race-matched population was not significantly greater at 87.2%. The 10-year disease-free survival for the distinct tumor types was 100% for Cushing's disease, 82.3% for patients with amenorrhea/galactorrhea, 79.6% for non-functioning adenomas, 69.0% for acromegaly, and 66.7% for Nelson's syndrome. Prognostic variables analyzed were age, race, sex, tumor type, tumor extent, visual field defects at diagnosis, and volume irradiated. Only the presence of visual field defects at diagnosis conferred a poor prognosis (p less than 0.001). There was a tendency toward superior tumor control with radiation doses greater than 4500 cGy (p = 0.15). The median time to progression of disease was 4.2 years, with the last failure occurring at 12 years following the completion of radiotherapy. Severe complications were apparent in 5 patients (7.1%), including one death from central nervous system radionecrosis.

Acromegaly↗
PubMed1988

Treatment of locally advanced, high-grade, malignant tumors of major salivary glands.

A retrospective review of 45 patients with Stage III and IV malignant tumors of the major salivary glands was undertaken to determine tumor control and patient survival after treatment with surgery and conventional ionizing-radiation therapy. Eight of the 23 patients received early postoperative radiotherapy after initial surgical resection, with a local control rate of 75%. Twelve of 23 patients had surgery as definitive treatment and the tumor recurred locally in all; seven of these 12 patients were subsequently salvaged by further surgery plus postoperative radiotherapy or by radiotherapy alone, with 58% ultimate local control. The remaining three patients had unresectable tumors at diagnosis and received radiation alone, with a local tumor control rate of 33%. Patients were also analyzed according to the extent of surgical resection prior to radiation therapy and according to radiation dose. Eighty-eight percent of completely resected, 50% of partially resected, and 44% of unresected tumors were locally controlled for an overall local control rate of 61%. The 5-year survival rate was significantly higher for patients with local tumor control than for patients who failed locally (31% vs. 0%).

Adult↗
PubMed1987

Suprasellar germinoma: radiation therapy.

From 1974 to 1984, nine patients with suprasellar germinoma were treated with megavoltage radiation therapy. The entire craniospinal axis was irradiated in all patients, with median doses of 45.6 Gy, 31.6 Gy, and 25.2 Gy delivered to the tumor volume, whole brain, and spinal cord, respectively. Two patients have died (14, 11.5 months) without evidence of tumor: one of uncontrolled endocrine dysfunction due to patient noncompliance, the other of hyperosmolar coma. There have been no tumor recurrences with a median 68-month follow-up among seven survivors. The dose usually recommended for treatment of intracranial germinoma is 50-55 Gy. Our data suggest that 45 Gy may be sufficient, if treatment volume is adequate. Posttherapy endocrine testing is also essential.

Adolescent↗
PubMed1986

A technique for treatment of advanced carcinomas of the larynx and hypopharynx using low-megavoltage X-rays.

An isocentric three-field technique is described for irradiation of advanced lesions of the larynx and hypopharynx with low-megavoltage (less than or equal to 6 MV) X-rays. The technique has been designed to eliminate field junctures. Two anterior oblique fields and a single posterior field with central spinal cord block are used. With Ellis filters to compensate for tissue deficits, dose homogeneity is assured throughout the upper and lower neck; in particular, the dose at the anterior aspect of the spinal cord is seen to vary by less than 5%. Using this technique, it is possible to deliver 52 Gy to the primary tumor and regional nodes, while restricting the maximum spinal cord dose to 45 Gy. Computed dose distributions are presented and compared with point-dose thermoluminescent measurements made on a humanoid phantom.

Humans↗
PubMed1985

The value of radiation therapy in addition to surgery for astrocytomas of the adult cerebrum.

A retrospective review of 86 adults (age 15 years or older) treated from 1950 to 1979 for well-differentiated astrocytoma or anaplastic astrocytoma of the cerebrum at Washington University Medical Center-Barnes Hospital was undertaken to determine the influence of postoperative radiation therapy on survival and neurologic function. Analysis was facilitated by a temporal change in treatment approach, with reliance on surgery alone before 1960 and routine use of postoperative irradiation after 1970. Six patients had astrocytomas with a juvenile pilocytic histologic pattern. Outcome was uniformly favorable in these cases regardless of therapy (100% survival; median follow-up, 14 years). Actuarial survival for the 80 patients with diffusely infiltrating astrocytoma was significantly better with the addition of postoperative irradiation than with surgery alone (median survival, 5 versus 2.2 years, respectively; 5-year survival, 50% versus 21%, respectively). Posttreatment neurologic function was also superior in the group managed with surgery and postoperative irradiation. The relationship to survival of age, degree of histologic anaplasia, extent of surgical resection, tumor size, and radiation dose was also investigated.

Adolescent↗
PubMed1985

Pharyngeal wall cancer. A reappraisal after comparison of treatment methods.

We retrospectively examined 89 patients with pharyngeal wall cancer treated in our institution between 1964 and 1981, to compare the results of treatment after low-dose preoperative irradiation and surgery (R + S) with those achieved with radiation therapy alone (RA). Age, sex, and stage of tumor were comparable for the 41 patients who had R + S and the 34 who had RA. Treatment outcome, survival, and tumor and nodal control were better for the R + S treatment group than for the RA treatment group. Patterns of relapse differed for the two treatment methods and suggested that each might complement the other. Low-dose preoperative irradiation and surgery more often controlled the pharyngeal tumor than did RA, while high-dose irradiation more often controlled nodal disease than did low-dose irradiation and surgery. Our experience suggests that surgical treatment combined with high doses of radiation might improve treatment results for pharyngeal wall cancer.

Aged↗
PubMed1985

Delayed effects of ionizing radiation on the ear.

The question of damage to the ear from exposure to ionizing radiation was addressed by exposing groups of chinchillas to fractioned doses of radiation (2 Gy per day) for total doses ranging from 40 to 90 Gy. In order to allow any delayed effects of radiation to become manifest, the animals were sacrificed two years after completion of treatment and their temporal bones were prepared for microscopic examination. The most pronounced effect of treatment was degeneration of sensory and supporting cells and loss of eighth nerve fibers in the organ of Corti. Damage increased with increasing dose of radiation. The degree of damage found in many of these ears was of sufficient magnitude to produce a permanent sensorineural hearing loss.

Animals↗
PubMed1984

Transglottic carcinoma.

The cases of 152 patients with transglottic carcinoma were reviewed. There were 31% T2, 39% T3, and 30% T4 lesions. Twenty-six percent of patients had neck node metastases at initial presentation, and 19% with no neck dissection or radical irradiation to the neck subsequently developed neck metastases. Patients treated with voice conservation surgery +/- neck dissection +/- radiation (VCS +/- ND +/- R) had small transglottic carcinomas, whereas total laryngectomy +/- neck dissection +/- radiation (TL +/- ND +/- R) was used for patients with larger lesions. The reason for radiation alone (RA) was the patient's poor general condition or refusal of surgery. The total failure rate (primary, neck, and distant metastases) was 39%. Patients treated with TL +/- ND +/- R had fewer primary and stomal failures (12%) than those treated by VCS +/- ND +/- R (23%) and RA (33%), but ultimate failure after salvage treatment was the same (12%-13%). Sixty percent of patients treated with VCS and 67% with RA had their voices preserved. The major complication rate (overall, 16%) was highest in the group treated with VCS +/- ND +/- R. Five-year observed and adjusted survival for the entire group was 47% and 55%, respectively. The lower survival in the RA group was attributable to a high death rate from intercurrent disease. The incidence of second tumors was 14%. Unfavorable prognostic factors were older age, pretreatment tracheostomy, advanced stage and the presence of tumor in surgical specimen, and lymph nodes.

Adult↗
PubMed1984

Interstitial thermoradiotherapy in the treatment of recurrent/residual malignant tumors.

From October 1981-November 1983, a total of 31 recurrent and/or persistent tumors in 29 patients were treated with interstitial radiotherapy in combination with interstitial hyperthermia. All patients had undergone extensive previous treatments by surgery and/or radiation therapy. In the present series, radiation used was administered by iridium 192 implant, with doses varying from 4000-6000 cGy, delivered at the rate of 1000 cGy +/- 10%/day. Hyperthermia was delivered by radiofrequency (8 lesions) and microwave (25 lesions) in two sessions, each raising tumor temperature to a minimum of 42 degrees C over 60 minutes. Of 26 lesions with at least one satisfactory heating session, there were 18 (69%) complete responses, five (19%) partial responses, and three with less than 50% regression. None of the five lesions with unsatisfactory heating resulted in complete response. Of the total group, two patients developed a cutaneous sinus and one patient developed a fistula. The detailed methodology and results are presented and recommendations for future improvements are discussed.

Adult↗
PubMed1983

Retreatment of recurrent carcinoma of the head and neck by afterloading interstitial 192Ir implant.

From January 1975 to December 1980, 25 patients with persistent or recurrent carcinomas of the head and neck were retreated for palliation at the Division of Radiation Oncology, Mallinckrodt Institute of Radiology. These patients had all undergone extensive previous treatment by surgery and/or radiation. All were retreated with 192Ir interstitial implant with or without external radiation and/or surgical excision. Of 25 patients, 13 had complete response (CR) and 6 had partial response for a follow-up period of 1 to 7 years. Of 13 patients with CR, 6 are alive with no evidence of disease (NED) and two died NED. We present detailed results and discuss our new strategy for such patients.

Aged↗