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Biomedical subjects

J Horton

Publications and source records attributed to J Horton.

At least 127 records · Page 7Linked to original sources
PubMed1985

A randomized prospective comparison of methotrexate with a combination of methotrexate, bleomycin, and cisplatin in head and neck cancer.

Combination chemotherapy with methotrexate, bleomycin, and cis-diamminedichloroplatinum (II) was compared to weekly therapy with methotrexate alone in a randomized prospective trial in 163 patients with recurrent or metastatic squamous cancer of the mucous membranes of the head and neck. The combination produced responses in 48% compared to 35% for methotrexate alone, with 16% complete remissions versus 8%, respectively. The difference in overall and complete remission rates is significant (P = 0.04) using a one-sided binary regression test. Median time to disease progression among responders was 5.8 months for the combination and 5 months for methotrexate, and median survival was 5.6 months in each group. Toxicity was similar in the two groups. Ambulatory patients, those without fixed neck nodes and those without distant metastases, responded more often. Poor performance status, distant metastases, history of heavy smoking, and adjacent organ invasion by the primary tumor were associated with shorter survival, as were weight loss, the presence of tumor in the neck, and heavy alcohol consumption. The addition of bleomycin and cisplatin to methotrexate produces more remissions, and especially complete remissions, but has not made a major impact on the course of far-advanced head and neck cancer.

Adult↗
PubMed1985

Comparison of CAF versus CMFP in metastatic breast cancer: analysis of prognostic factors.

One hundred fifty-five eligible women with metastatic breast cancer were randomly allocated to receive monthly cycles of either CMFP (cyclophosphamide, methotrexate, 5-fluorouracil, prednisone) or CAF (cyclophosphamide, doxorubicin, 5-fluorouracil), and 12 patients were studied to evaluate the effects of additional Corynebacterium parvum immunotherapy. Overall response rates of 53% were seen with CMFP and CAF. CAF was associated with significantly more complete responses than CMFP (17% v 5%). However, CAF therapy was administered for eight months and CMFP for six months. Only 13% of the CAF patients had a complete response during the first six months of chemotherapy, and this was not significantly different from the complete response rate on CMFP. The median response durations (CMFP, 6.3 months; CAF, 11.0 months), times to treatment failure (CMFP, 5.7 months; CAF, 7.8 months), and survival times (CMFP, 15.8 months; CAF, 18.6 months) were not statistically different. Other investigators who have compared CAF to CMF-containing regimens have reported a large advantage in CAF therapy among patients with "good risk" sites of metastases (local-regional recurrence, bone, lung nodules). Such a finding was not confirmed by our study: in multivariate analyses the groups associated with an advantage for CAF tended to have a poorer prognosis than the groups associated with an advantage for CMFP. There was significantly more nausea and vomiting after CAF treatment, and CMFP treatment was associated with significantly more edema, Cushingoid features, fever, and eye symptoms.

Adult↗
PubMed1985

Intensive induction chemotherapy for small cell anaplastic carcinoma of the lung.

The role of intensive induction chemotherapy in small cell cancer of the lung remains unclear. Twenty-eight newly diagnosed patients with small cell lung cancer were randomized to receive either high-dose or standard-dose cyclophosphamide, vincristine, and semustine in a trial where the dose of induction chemotherapy was the sole treatment variable. Complete responses (CR) were achieved in 57% of patients receiving high-dose therapy as compared to 21% of patients receiving standard-dose therapy (P less than 0.05). There was a higher rate of severe toxicity in the high-dose group (P less than 0.01). The overall median survival was not improved (36 weeks for the high-dose group vs 43 weeks for the standard-dose group); however, the median survival in patients achieving CR was prolonged (92 weeks for the high-dose group vs 50 weeks for the standard-dose group). These effects were most pronounced in patients with extensive disease; a CR after induction was achieved in five of nine patients treated with high doses but not in any of those treated with standard doses (P less than 0.05). A small group of patients appear to benefit by achieving a long-term remission with intensive induction chemotherapy, but this effect may be offset by increased morbidity.

Aged↗
PubMed1985

Cardiac response to fluid resuscitation from hemorrhagic shock.

The choice of fluid for volume replacement in hemorrhagic shock remains controversial. This study was done to compare the cardiac hemodynamic and metabolic effects of several regimens of fluid resuscitation. Thirty nonsplenectomized dogs subjected to two hours of hemorrhagic shock were resuscitated with shed blood alone or in combination with plasma, saline solution or Ringer's lactate solution. All regimens of volume replacement were equally effective in the initial resuscitation from severe shock. Furthermore, correction of metabolic acidosis and decreased lactate production were comparable in all groups. During late resuscitation (180 to 200 minutes), cardiac hemodynamic and myocardial efficiency were significantly lower in the shed blood, plasma and saline solution groups. Our data show that Ringer's lactate solution is singularly effective in maintaining left ventricular performance despite similar preload, coronary blood flow and myocardial oxygen delivery after all regimens of volume replacement.

Animals↗
PubMed1985

Biological considerations for treating alternate fields versus all fields daily with high and low LET radiation.

The rationale for treating all fields every day with photons was reviewed. Since the effects of neutron radiation are much less dependent on alterations of fractionation schedules, and since preferential sparing for late effects is not obtained by fractionation of neutron dose, less convincing reasons exist for treating all fields every day with neutrons. Treating one field/day would not alter the physical dose distribution or overall treatment time, yet still maintain biological homogeneity. Preliminary in vitro experiments support this conclusion.

Animals↗
PubMed1984

Comparison of melphalan with cyclophosphamide, methotrexate, and 5-fluorouracil in patients with ovarian cancer.

Melphalan (L-PAM) was compared to (C) cyclophosphamide, (M) methotrexate, and (F) 5-fluorouracil (CMF) in 413 patients with advanced ovarian carcinoma. L-PAM was given 3.5 mg/m2 twice daily for 5 days every 5 weeks. CMF doses were: C, 400 mg/m2; M, 15 mg/m2; and F, 400 mg/m2 IV on days 1 and 8 every 28 days. Three hundred seventy-five patients have been analyzed (L-PAM, 190; CMF, 185). One hundred fifty-three patients (41%) had measurable disease, 109 (29%) had evaluable disease, and 113 (30%) had nonmeasurable, nonevaluable disease. Response rates for patients with measurable and evaluable disease combined were similar: L-PAM, 32/130 (24%) (15% complete response); CMF, 47/132 (35%) (18% complete response). Patients with Stage IV measurable disease had a greater response rate to CMF, 22/52 (42%) versus L-PAM, 6/39 (15%). Survival and time to treatment failure were similar for both treatment regimens. Survival was improved in responders. Medians are: complete response, 28.1 months; partial response, 12.3 months; and no response, 6.7 months. Disease stage, performance status and age were identified as important prognostic variables for both survival and time to treatment failure.

Adenocarcinoma↗
PubMed1984

Follow-up of breast cancer patients.

Follow-up of patients with breast cancer is often pursued in an irregular, haphazard, and costly way. For patients who have had potentially curative treatment for localized breast cancer, effort should be concentrated for the life time of the patient on early detection of persistent or new breast cancers, and early detection of endometrial and large bowel cancers in order to maximize the chance of cure. The patient-physician interaction is the dominant factor in such follow-up. Bone and other scans and carcinoembryonic antigen levels do not detect curable disease, so these are not indicated for routine follow-up of patients with early stage disease. For patients with metastasis, follow-up has a different emphasis and is geared to defining the extent and activity of metastasis and early detection of treatable complications so as to optimize palliation. For all patients it is necessary to continually evaluate their social and emotional requirements and to evaluate the family for risk of cancer and other problems. A follow-up team, led by the physician, is required to best fulfill these multiple needs.

Breast Neoplasms↗
PubMed1984

The effects of auranofin and parenteral gold in the treatment of rheumatoid arthritis: an X-ray analysis.

X-rays from patients in comparative studies of auranofin and parenteral gold were obtained before and during treatment, and analysed using a modification of the method of Larsen. One hundred and nineteen auranofin-treated and 113 parenteral gold-treated patients contributed data, which were analysed for changes from 0-6 months, 0-12 months and from 0-6 and 12 months. Progression of erosive processes and of joint grade occurred with both treatments, but the proportion of patients with progression in the first six months was greater with auranofin treatment. However, there was evidence that both treatments produced slowing of the erosive process during the second six months of treatment.

Adult↗
PubMed1984

Phase II study of methyl-glyoxal bis-guanylhydrazone (NSC 3296) in advanced ovarian cancer.

Thirty-nine patients received 600 mg/m2 OF MGBG intravenously every week for the treatment of advanced refractory ovarian cancer. Twenty-seven of these received adequate trials, and only two had partial remissions lasting 3 1/2 and 4 months each. Toxicity was substantial, with severe hematologic toxicity in 26%, diarrhea in 22% (severe in 7%), skin rash in 26% (severe in 7%), and vomiting in 70% (severe in 11%). Fatigue, facial paresthesias, and flushing during drug administration were frequent. It appears that MGBG in this dose and schedule has little activity against advanced ovarian cancer.

Blood↗
PubMed1984

Effectiveness of pentostatin (2'-deoxycoformycin) in refractory lymphoid neoplasms.

Pentostatin (2'-deoxycoformycin, DCF) was administered to 17 patients with a variety of lymphoid neoplasms, both T- and B-cell, that were refractory to conventional treatments. Several responses and 2 complete remissions occurred. Toxic effects were less severe than previously described: this may be attributable to relatively low doses of DCF or to precautions taken to prevent tumour lysis syndrome. DCF appears valuable as a second-line treatment in non-Hodgkin's lymphomas and as initial treatment in T-cell chronic lymphocytic leukaemia and mycosis fungoides. Although myelosuppression is mild, immunosuppression and superinfection are potential hazards of treatment with DCF. The ocular toxicity of DCF, previously described as conjunctivitis, appears to be a keratitis of moderate severity which requires further study.

Adult↗
PubMed1984

BCVPP chemotherapy for advanced Hodgkin's disease: evidence for greater duration of complete remission, greater survival, and less toxicity than with a MOPP regimen. Results of the Eastern Cooperative Oncology Group study.

Two chemotherapy regimens for treatment of patients with advanced Hodgkin's disease, BCVPP (carmustine, cyclophosphamide, vinblastine, procarbazine, and prednisone) and MOPP (mechlorethamine hydrochloride, vincristine, procarbazine, and prednisone), were compared in a randomized prospective study. Two hundred ninety-three patients were evaluable in the induction phase of this study. The complete remission rate with BCVPP was 76% (112/147) and with MOPP, 73% (106/146) (p = 0.51). The duration of complete remissions for previously untreated patients given BCVPP was significantly longer than that for previously untreated patients given MOPP (p = 0.02). Although hematologic toxicities were similar, BCVPP caused less gastrointestinal (p = 0.0001) and neurologic toxicity (p = 0.01) than MOPP. Previously untreated patients achieving complete remission with BCVPP survived significantly longer than those receiving MOPP (p = 0.03). As primary induction chemotherapy for advanced Hodgkin's disease, BCVPP is an effective alternative to MOPP, having equal or greater therapeutic benefit with less toxicity.

Adult↗
PubMed1984

Sequential methotrexate and 5-FU in CMFP (cyclophosphamide, methotrexate, 5-FU, and prednisone) therapy for breast cancer.

Forty-one women with advanced breast cancer were treated with cyclophosphamide, methotrexate, 5-FU, and prednisone. Methotrexate (200 mg/m2) was given iv 1 hour before administering 5-FU (600 mg/m2). Leucovorin (10 mg orally every 6 hours for six doses) was begun 24 hours after the methotrexate. The response rate was 43%, with 19% of patients having a clinically complete remission. This overall objective response rate is lower than that achieved when this drug combination is given at standard doses of methotrexate and with no interval before 5-FU. Toxicity was primarily related to bone marrow suppression; eight women had wbc counts that fell to less than 1500/mm3.

Adult↗
PubMed1983

Comparison of postoperative radiotherapy and combined postoperative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas. A joint Radiation Therapy Oncology Group and Eastern Cooperative Oncology Group study.

Recently, the RTOG and ECOG concluded a joint randomized study on malignant gliomas that was in progress for the past five years. A total of 626 patients entered this protocol. Sixty-seven percent of the 535 evaluable patients have died and thus this represents a preliminary report of a major joint clinical trial. The objective of this study was to evaluate the efficacy after neurosurgery of three new treatment options as compared with control treatment of radiotherapy alone. The four options were: (1) control radiation; 6000 rad/6-7 weeks to whole brain; (2) a higher radiation dose; Control dose plus a booster dose of 1000 rad/1-2 weeks to the tumor; (3) control radiation dose plus BCNU (80 mg/m2/day IV X 3 and repeat BCNU every 8 weeks); (4) Control radiation dose plus combination methyl-CCNU (125 mg/m2/day orally X 1 and repeat methyl-CCNU every 8 weeks), and DTIC (150 mg/m2/day IV X 5 and repeat DTIC every 4 weeks). All pertinent patient characteristics were studied and several important prognostic factors have been identified. Notably, age, histologic type (Astrocytoma with anaplastic foci, versus glioblastoma multiforme), initial performance status, time since first symptoms and presence or absence of seizure. At this time, it appeared that there was no treatment option which was significantly better than the control. The study identified that age was the most important prognostic factor. Patients who were younger than age 40 years had an 18-month survival of 64%, patients who were age 40-60 years had an 18-month survival of 20%, and patients who were older than age 60 had an 18-month survival of 8%. The study also demonstrated that a modified histologic classification of anaplastic astrocytoma versus glioblastoma provided better prognostic information than the astrocytoma grading system of Kernohan. Patients with anaplastic astrocytoma had a median survival of 27 months as compared to 8 months for patients with glioblastoma. In further evaluation of any beneficial effect of chemotherapy, it was identified that only among the 40-60-year-old groups, BCNU treated patients appeared to have significantly increased survival than patients in the control groups (P = 0.01, one-sided). Similarly, methyl-CCNU + DTIC was suggestively better than the control (P = 0.08, one-sided). The higher radiation dose, 7000 rad/8-9 weeks appeared to give no significantly better survival over the control dose option. Both BCNU and methyl-CCNU + DTIC produced some toxicity. The combination of methyl-CCNU + DTIC was more toxic than BCNU, producing severe or worse thrombocytopenia in 23% of the patients as compared to 6% on BCNU.

Adult↗
PubMed1983

Abnormal cardiovascular regulation in the mitral valve prolapse syndrome.

Studies of patients with mitral valve prolapse syndrome have suggested autonomic nervous system dysfunction, but a precise definition of mechanisms is lacking. We measured supine and standing heart rate, blood pressure, cardiac output, oxygen consumption, plasma catecholamines, and blood volume in 23 symptomatic women with both echocardiographic and phonographic signs of MVP and in 17 normal control subjects. An analysis of the results revealed 2 distinct subgroups of patients: those with normal heart rates but increased vasoconstriction (Group I, n = 10) and those with orthostatic tachycardia (Group II, n = 13). Group II patients had heart rates at rest supine of 97 +/- 3 compared with 79 +/- 2 in Group I patients and 78 +/- 8 in control subjects. Estimated total blood volumes were lowest in Group I patients, intermediate in Group II patients, and highest in control subjects (p less than 0.05). Other measurements at rest supine were similar in patients and controls. After standing for 5 minutes, patients had a higher mean plasma epinephrine value, diastolic blood pressure (81 +/- 2 versus 74 +/- 3 mm Hg, p less than 0.05), and peripheral resistance (1,878 +/- 114 versus 1,414 +/- 92, dynes s cm-5, p less than 0.01), wider arteriovenous oxygen difference (6.7 +/- 0.4 versus 5.3 +/- 0.5 vol%), and lower stroke volume index (26 +/- 2 versus 33 +/- 2 ml/m2, p less than 0.01) than did the control subjects. Cardiac output was normal in Group II patients but reduced in Group I patients, who demonstrated marked vasoconstriction. No patient had evidence of a "hyperkinetic" circulatory state. A cycle of decreased forward stroke volume, vasoconstriction, and blood volume contraction appears to be present in at least some symptomatic patients with MVP.

Adult↗
PubMed1983

Evaluation of hemostatic agents in experimental splenic lacerations.

Avitene, Collastat, Gelfoam, and Surgicel were evaluated for their effectiveness in the control of hemorrhage from an experimental splenic laceration. Effectiveness was determined by measuring the amount of blood loss per kilogram of body weight until complete hemostasis was achieved and by determining mortality from hemorrhage. The study group in which Collastat, a collagen hemostatic sponge, was used had the smallest amount of blood loss. This group was also the only one with no deaths from breakthrough bleeding. The degrees of reaction in the spleens of the surviving animals 3 weeks after treatment were not significantly different when each of the various agents were compared. We believe that Collastat is the preferred topical hemostatic agent.

Animals↗