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Biomedical subjects

J E Marks

Publications and source records attributed to J E Marks.

At least 55 records · Page 3Linked to original sources
PubMed1983

Floor of mouth cancer: patient selection and treatment results.

Retrospective review of 126 primarily treated floor of mouth (FOM) cancers was done to study patient selection and to search for more optimum treatment strategies. Small surface lesions were treated by local excision (LE); small lesions invading FOM without lymph nodes were treated by radiation alone (RA), while larger lesions and those with palpable nodes were treated by preoperative irradiation and surgery (R + S). Ultimate control of the FOM cancer and nodes was achieved for 100% of the LE, 71% of the RA, and 75% of the R + S patients. The majority of primary tumor and nodal recurrences developed by 15 months and 35% of the failures were salvaged by additional treatment. Change in treatment strategies are suggested for surface lesions because of a poor rate of initial tumor control (43%), for patients treated by RA because of a high rate of complications (41%), and for patients without palpable lymph nodes who can be successfully treated by elective neck irradiation.

Brachytherapy↗
PubMed1983

Treatment of epidermoid and undifferentiated carcinomas from occult primaries presenting in cervical lymph nodes.

We treated 83 patients with epidermoid or undifferentiated carcinoma in cervical neck nodes without an obvious primary at our institution between 1964 and 1979. All patients received radiotherapy and 29 patients had radical neck dissection (RND) or total excisional biopsy (TEB) as well. Actuarial survival was 38% at 5 years for the entire group and 25% at 10 years. Fifty-four patients with neck control had significantly better survival (p = .0001) at 5 and 10 years than those whose neck was uncontrolled. Factors associated with improved neck control were initial size of the neck mass and the addition of surgery (RND or TEB). Analysis of failures showed that 50% of patients failed only in the primary or neck and 50% developed distant metastases. Tumor was the major cause of death. We recommend more aggressive treatment with both XRT and neck dissection in patients with large resectable neck masses to prevent regrowth of tumor in the neck.

Actuarial Analysis↗
PubMed1983

Comparative cost analysis of hemilaryngectomy and irradiation for early glottic carcinoma.

The cost of hemilaryngectomy (15 patients) was compared to that of radiation treatment (18 patients) in epidermoid carcinoma confined to the true vocal cord with normal mobility (T1N0). An average of $3,495 was saved if radiation therapy was chosen; savings in terms of working hours were also substantial. We maintain that, if different treatment methods yield the same cure rate and quality of life, then cost should be the next strong consideration in choosing a particular treatment method.

Carcinoma, Squamous Cell↗
PubMed1983

Role of radiation in the management of early vocal cord carcinoma.

From 1952-1978, 177 patients with epidermoid carcinoma confined to the true vocal cords with normal mobility (T1NO) were treated with radiation alone. Five- and 10-year adjusted actuarial survival rates for all patients were 97 and 95%, respectively. The tumor recurred in the larynx and/or neck in 16% of patients with T1a (one cord involved) and 23% of the patients with T1b (both vocal cords involved) disease. Radiation failures were surgically salvaged in 89% of patients with T1a disease without anterior commissure involvement, in 60% of those with T1a disease with anterior commissure involvement and in 57% of those with T1b disease. Tumor was ultimately controlled in 97% of the patients with T1a and 90% of the patients with T1b disease. Voice was preserved in 93% of the patients with T1a disease and 77% of patients with T1b disease. Of 121 patients evaluated for voice quality, 77% had good and 22% had fair voice, while only one patient had poor quality of voice. Patients with fair or poor quality voice usually had had salvage hemilaryngectomy. We recommend radiation for all patients with early vocal cord carcinoma.

Adult↗
PubMed1982

Dose-response analysis for nasopharyngeal carcinoma: an historical perspective.

Historical review of 118 patients with nasopharyngeal cancer treated in our institution from 1950--1978 showed a 20% improvement in tumor control for patients irradiated during the most recent period (1974--1978). This improvement was attributed to prescription of higher doses of radiation as well as improvements in technical accuracy and dose delivery to the tumor during that period. Rates of severe and mild complications were comparable and survival was not significantly altered over time despite improved tumor control. Within the range of doses delivered, there was no improvement in tumor control with increasing doses of radiation for small or large nasopharyngeal carcinomas. The dose-response analysis for tumor control was less than ideal because a number of prerequisites were lacking and because the study extended over a 28-year span during which there were significant changes in technology and physician orientation.

Follow-Up Studies↗
PubMed1982

A comparative study of ependymomas by site of origin.

Sixty-one patients with histologically proven ependymoma were irradiated between 1954 and 1976. Supra-and infratentorial tumors occurred more often in children and spinal cord--cauda equina tumors more often in adults. Local control was achieved in four of 20 supratentorial, 13 of 26 infratentorial, three of seven intramedullary spinal cord, and seven of eight cauda equina tumors. Improved local control of infratentorial tumors was noted for patients who received higher biologically effective doses of radiation but no dose-response for supratentorial, spinal cord or cauda equina tumors could be found. Five-year actuarial survival was 56% for all patients, 35% for supratentorial, 59% for infratentorial, 57% for spinal cord and 83% for cauda equina tumors. Spinal metastases were pathologically documented in 5 of 46 (11%) patients with ependymomas above the foramen magnum. They were clinically evident in two patients and most common in patients with infratentorial tumors whose spines had not been irradiated. One patient who was irradiated externally for cauda equina tumor developed radiation myelopathy 1-1/2 years later; three of eight patients who received intrathecal gold 198 developed myelopathy and/or cauda equina syndrome 3-1/2 to 17 years later.

Adolescent↗
PubMed1982

The use of thermal plastics for immobilization of patients during radiotherapy.

A new orthopedic casting material has been adapted to use for immobilizing patients undergoing radiation therapy. The material has proven to be less cumbersome and time-consuming than other products currently in use. The necessary equipment and procedures required to form a immobilization cast using thermal plastic material are described.

Humans↗
PubMed1982

Age as a criterion for eligibility in a lung cancer clinical trial.

The results of a clinical trial can be generalized only if the study sample is representative of the population with the disease entity under study. A prerequisite for patient participation in a clinical trial is that all the eligibility criteria be met. In many cooperative group trials, it is common practice to use age as a criterion for eligibility on the premise that advanced age is an unfavorable prognostic factor. In this paper, we evaluate the bias introduced in a sample when this practice was followed in a lung cancer protocol. Of 653 lung cancer cases reviewed, 77 met the eligibility criteria; an additional 23 patients were ineligible for the trial solely on the basis of age. There was no significant difference in survival between these two groups of patients. This indicates that age is not an unfavorable prognostic factor for patients with lung cancer and should not be used as a criterion for eligibility in a clinical trial.

Adenocarcinoma↗
PubMed1981

Comparison of symptomatic and prophylactic irradiation of brain metastases from oat cell carcinoma of the lung.

In this analysis, the results of brain irradiation of 39 patients with symptomatic brain metastases from oat cell carcinoma of the lung were compared with the published results of patients whose brains were irradiated prophylactically. The goals were: (1) to substantiate a clinical impression that patients with symptomatic brain metastases respond well to radiation and often experience no further neurologic deterioration until death; and (2) to compare the outcomes of symptomatic and prophylactic radiation of the brain for oat cell carcinoma of the lung. Of 39 patients with proven brain metastases who received cranial irradiation, 25 (64%) achieved complete palliation and remained free of neurologic symptoms, 4/4 (100%) achieved complete palliation; for moderate symptoms, 12/15 (80%); and for severe symptoms, 9/20 (45%). A summary of 12 reports from the literature shows that for patients with oat cell carcinoma of the lung receiving prophylactic cranial irradiation, the incidence of brain metastases is 28/525 (5%), while for patients receiving no prophylactic therapy it is 51/223 (23%). When the results of symptomatic and prophylactic cranial irradiation were compared, it was found that symptomatic irradiation controls central nervous system disease, as well as prophylactic therapy, while eliminating the need for brain irradiation in three-fourths of the patients.

Brain Neoplasms↗
PubMed1981

Prognostic significance of contrast enhancement in low-grade astrocytomas of the adult cerebrum.

Between 1974 and 1977, 22 adults with low-grade (Grade I or II) astrocytomas of the cerebrum underwent initial computed tomography (CT) and craniotomy followed by irradiation of 5,000 to 6,000 rad (50 to 60 Gy). The four-year actuarial or life table survival rate was 58% for the eight patients whose initial CT scans showed contrast enhancement and 65% for the 14 patients whose tumors did not enhance (p = 0.8). Prognostic factors were comparable for the two groups. It is concluded that contrast enhancement has no prognostic significance for low-grade astrocytomas of the adult cerebrum.

Adolescent↗
PubMed1981

Carcinoma of the oral tongue: a study of patient selection and treatment results.

Retrospective review of 118 primarily treated cancers of the oral tongue was done to study patient selection and to search for improved treatment strategies. Small surface lesions were treated by local excision (LE); most small lesions invading muscle of the tongue without lymph node metastases were treated by radiation alone (RA) while larger lesions and those with palpable nodes were treated by preoperative radiation and surgery (R + S). Ultimate control of the primary tumor and lymph nodes after initial treatment and surgical salvage was high for the lesions by LE (91%), the T1N0 lesions treated by RA (88%) and for the TxN+ lesions treated by R + S (57%). Improved treatment strategies are suggested for T2N0 lesions treated by RA because of poor tumor control (53%) and a high rate of radiation complications (25%), and for T3N0 lesions because so many of these patients died from causes other than cancer within two years. Second primary cancers were most common in those patients with a good prognosis.

Aged↗
PubMed1980

Carcinoma of the pyriform sinus: predictors of TNM relapse and survival.

To determine predictors of TNM relapse and survival for 108 patients with epidermoid carcinoma of the pyriform sinus, the histopathologic features of tumor-related and host-related characteristics were correlated with primary and/or cervical nodal failure, distant metastases, and actuarial three-year survival. Patients in this study received preoperative irradiation and partial laryngopharyngectomy (PLP) or total laryngopharyngectomy (TLP) with en bloc radical neck dissection. Higher rates of local failure were observed in patients with keratinizing tumors (34 vs. 15%), with tumors having an "infiltrating" tumor-stromal interface (30 vs. 14%), with positive surgical margins in PLP or TLP specimens (30 vs. 16%), and with extranodal extension of tumor (39 vs. 22%). The development of distant metastases was significantly correlated with nonkeratinizing carcinomas (30 vs 11%, P = 0.02), and was observed more often in patients with positive lymph nodes (17 vs. 7%). Patients with negative surgical margins in PLP or TLP excision (50 vs. 21%, P = 0.01) survived significantly longer.

Adult↗