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Biomedical subjects

J K Martin

Publications and source records attributed to J K Martin.

At least 37 records · Page 2Linked to original sources
PubMed1989

Oncological aspects of immediate breast reconstruction following mastectomy for malignancy.

One hundred eighteen women treated with mastectomy and immediate breast reconstruction for carcinoma were evaluated for recurrence of disease and survival. Fourteen women (12%) suffered relapse of their cancer and 10 patients (9%) died of their disease during a median follow-up of 2.3 years. All seven local recurrences (6%) were detected at an early stage and treated without removal of the prosthesis. Recurrence of disease occurred more frequently in patients with involved axillary lymph nodes and larger tumors. Patient survival was adversely affected by nodal metastasis and the absence of tumor estrogen receptors. Adverse outcome in this series correlated to known prognostic factors for breast cancer. Disease-free and overall survivals were comparable with our previous experience with mastectomy alone for breast carcinoma. In the absence of any apparent negative impact on patient outcome, and because of the well-documented positive psychosocial benefit of immediate reconstruction, this procedure should be routinely offered to women with operable breast cancer.

Adult↗
PubMed1988

External beam versus intraoperative and external beam irradiation for locally advanced pancreatic cancer.

One hundred fifty-nine patients with unresectable but localized pancreatic cancer, as defined at exploratory laparotomy, were treated at the Mayo Clinic between February 1974 to April 1985. Postoperative therapy consisted of 4000 to 6000 cGy external beam irradiation (XRT) alone in 122 patients or 4500 to 5500 cGy XRT in combination with an intraoperative electron boost in 37. In addition, 132 (both groups) received 5-fluorouracil (5-FU) chemotherapy. Local control (LC) at 1 year was 82% with XRT + intraoperative radiation therapy (IORT) versus 48% with XRT and 66% versus 20% at 2 years respectively (P less than 0.0005). Due to the high incidence of hematogenous and/or peritoneal spread in both groups (abdominal failure in 54 and 56% of patients at risk), the decreased frequency of local progression did not translate into an improved survival. Neither median nor long-term survival of the two treatment groups (XRT versus XRT + IORT) was statistically different (median 12.6 months versus 13.4 months, P = 0.25). With tumor arising in the head of the pancreas, survival at 2 years was 18% as opposed to 0% for other locations (P less than 0.01). On the basis of a Cox multivariate analysis, no other treatment or prognostic factor significantly altered survival. Until the problem with systemic failure (usually abdominal) can be resolved, the median and long-term survival of patients with pancreatic carcinoma is likely to remain unchanged. Since IORT appears to improve local control, we will continue to utilize IORT in phase 1, 2 studies which also attempt to decrease the incidence of abdominal failures. Even with IORT + XRT combinations, the incidence of local progression is excessive and radiation dose modifiers need to be evaluated.

Adenocarcinoma↗
PubMed1988

Intraoperative and external beam irradiation for locally advanced colorectal cancer.

In view of poor local control rates obtained with standard treatment, intraoperative radiation (IORT) using electrons was combined with external beam irradiation and surgical resection, with or without 5-fluorouracil (5FU), in 51 patients with locally advanced colorectal cancer (recurrent, 36 patients; primary, 15 patients). Patients received 4500-5500 cGy (rad) of fractionated, multiple field external beam irradiation and an IORT dose of 1000-2000 cGy. Thirty of 51 patients (59%) are alive and 22 patients (43%) are free of disease. In 44 patients at risk greater than or equal to 1 year, local progression within the IORT field has occurred in 1 of 44 (2%) and within the external beam field in 8 of 44 (18%). All local failures have occurred in patients with recurrence or with gross residual after partial resection, and the risk was less in patients who received 5FU during external irradiation (1 of 11, 9% vs. 6 of 31, 19%). The incidence of distant metastases is high in patients with recurrence, but subsequent peritoneal failures are infrequent. Acute and chronic tolerance have been acceptable, but peripheral nerve appears to be a dose-limiting structure. Randomized trials are needed to determine whether potential gains with IORT are real.

Colonic Neoplasms↗
PubMed1988

Randomized trial of observation versus adjuvant therapy with cyclophosphamide, fluorouracil, prednisone with or without tamoxifen following mastectomy in postmenopausal women with node-positive breast cancer.

Following mastectomy for node-positive breast cancer, 261 postmenopausal women were randomized to observation or adjuvant treatment with cyclophosphamide, fluorouracil, prednisone (CFP) alone or combined with tamoxifen (T). Doses used were: C, 150 mg/m2 intravenously (IV) days 1 to 5; F, 300 mg/m2 IV days 1 to 5; P, 10 mg by mouth 3 times daily on days 1 to 7; and T, 10 mg by mouth 2 times daily. A total of ten courses of treatment, administered every 6 weeks, was planned and T was stopped 6 weeks after the last course of CFP. Two hundred thirty-four patients were fully eligible and evaluable. With a median observation time slightly in excess of 5 years, the proportion of recurrences on each arm were: CFP, 29 of 75 (39%); CFPT, 29 of 71 (41%); and observation, 50 of 88 (57%). Relapse-free survival distributions for both CFP and CFPT were superior to observation (both two-sided P = .01). Considering prognostic factors in covariate analysis revealed two-sided P = .0006 for CFP v observation and P = .0003 for CFPT v observation. No substantial difference was identified between CFP and CFPT. Survival data are not yet mature with 31% dead; and, although slight separations of the curves exist in favor of the treatment arms, no significant differences in survival have been seen. Both adjuvant therapy programs are well tolerated and there were no treatment-related deaths. Further maturation of the data is required to determine if the advantages in relapse-free survival will be translated into any overall survival benefit which must be considered the goal of primary interest.

Aged↗
PubMed1988

Pharmacist management of antiemetic therapy under protocol in an oncology clinic.

The development of a program for pharmacist prescribing of antiemetic agents for nausea and vomiting induced by antineoplastic agents given to ambulatory patients is described. The oncologist and the pharmacists developed a protocol and submitted it to the Washington State Board of Pharmacy, which can authorize a pharmacist to initiate or modify drug therapy in accordance with written guidelines or protocols. The protocol was approved and the pharmacists developed algorithms for antiemetic therapy, based on the emetic potential of the various antineoplastic agents. The oncologist writes an order for the pharmacist to prescribe antiemetic therapy for an individual patient, and the pharmacists selects an algorithm for each patient based on the antineoplastic agent that has the highest potential for causing emesis. The pharmacist writes orders for antiemetic agents to be administered in the clinic and at home, phones the patient 24 hours after antineoplastic drug therapy, and, if necessary, modifies the antiemetic therapy. Pharmacists have managed antiemetic therapy for more than 1200 patient visits and were able to use the first-line therapy in the selected algorithm in 78% of the cases without serious adverse effects. Pharmacist management of antiemetic therapy for nausea and vomiting associated with antineoplastic drug treatment has been well accepted by patients and professionals in this oncology clinic.

Antiemetics↗
PubMed1987

Intraoperative and external beam irradiation +/- 5-FU for locally advanced pancreatic cancer.

Because of the poor local control rates obtained with external beam irradiation +/- chemotherapy for locally advanced pancreatic cancer, our institution has used intraoperative radiation therapy (IORT) with electrons to deliver a single "boost" dose of radiation in 52 patients with biopsy-proven adenocarcinoma (primary, unresectable-49; primary, residual-2; and recurrent, unresectable-1). Patients received 4500-5000 rad of fractionated external beam irradiation and an IORT dose of 1750 rad (2 patients) or 2000 rad (50 patients). Acute and chronic tolerance have been acceptable. Documented local progression within either the external beam or IORT fields has been infrequent (3 of 42 evaluable patients or 7%), but there has been little, if any, change in median or long-term survival from that seen in external beam series. This is probably because of a high incidence of liver and peritoneal metastases with pancreatic cancer. A phase II pilot trial, which combines upper or total abdominal irradiation and infusion 5-FU with tumor nodal irradiation plus IORT, is in progress in our institution to evaluate tolerance and the relative incidence of abdominal failures.

Adenocarcinoma↗
PubMed1987

Surgical technique and pitfalls of breast reconstruction immediately after mastectomy for carcinoma: initial experience.

Breast reconstruction immediately after mastectomy is being used with increasing frequency. In a study of the first 100 consecutive patients at our institution who underwent this procedure, with (21 patients) or without (79 patients) later nipple reconstruction, 85% responded affirmatively on a follow-up questionnaire when asked whether they would recommend the procedure to other patients. Moreover, 32% rated their cosmetic results as "perfect." No deaths occurred in the immediate postoperative period, but 13 patients had major complications--most commonly, wound infection or displacement or partial extrusion of the implant. All infections, however, occurred early in the study, and with increasing experience and improved selection of patients, the associated morbidity decreased. For the entire group, the mean duration of hospitalization was 7.8 days, similar to that for patients who undergo mastectomy without reconstruction (7.5 days). The high patient acceptance and the overall good results in this preliminary study support the use of breast reconstruction immediately after mastectomy.

Adult↗
PubMed1987

Is an aggressive surgical approach to the patient with gastric lymphoma warranted?

At the Mayo Clinic, from 1970 through 1979, 84 patients (52 males and 32 females) had abdominal exploration for primary gastric lymphoma. All patients were observed a minimum of 5 years or until death. The histologic findings for all 84 patients were reviewed. Forty-four patients had "curative resection," and 40 patients had either biopsy alone or a palliative procedure. The probability of surviving 5 years was 75% for patients after potentially curative resection and 32% for patients after biopsy and palliation (p less than 0.001). The operative mortality rate was 5% overall and 2% after potentially curative resection. Increased tumor size (p less than 0.02), increased tumor penetration (p less than 0.01), and lymph node involvement (p less than 0.02) decreased the probability of survival, whereas histologic classification did not affect survival. Radiation therapy after surgery did not significantly affect the survival rate for the entire group or the survival rate for patients who had potentially curative resection. Resectability was associated with increased patient survival--independent of other prognostic factors--when our experience was analyzed by the Cox proportional-hazards model (p less than 0.005). It was concluded that an aggressive surgical attitude in the treatment of primary gastric lymphoma is warranted. The role of radiotherapy remains in question.

Humans↗
PubMed1986

Is modified radical mastectomy really equivalent to radical mastectomy in treatment of carcinoma of the breast?

Evaluation of any therapeutic modality for carcinoma of the breast requires prolonged follow-up. Between 1965 and 1968, 870 women with primary unilateral breast cancer were treated surgically at our institution. To achieve a study group that could be meaningfully analyzed, the authors identified and excluded all patients with pre-existing life-threatening disease, incomplete (palliative) operation, multiple lesions, or fixed lesions. There remained 530 patients (322 treated with radical and 208 treated with modified radical mastectomy). No overall statistical difference in 5-year survival to death from breast cancer was noted between the radical (82.1%) and the modified radical (87.0%) mastectomy group. Recently, the authors updated that series, now with 10 to 16 years of follow-up (minimum, 10 years). Two hundred eighty-one patients were alive at 10 years. The 10-year survival from breast cancer after radical (74.5%) and modified radical (74.2%) mastectomy was almost identical. The 10-year node-negative survival was 86.0% and the node-positive survival was 56.3% (P = 0.0001). Results were compared according to age, tumor site, absolute number of involved nodes, histologic features, grade, size, and adjuvant treatment. A numeric combination of these variables was constructed and used as a prognostic score. These results suggest that, with equal long-term efficacy in the treatment of breast cancer, the cosmetically and functionally superior modified radical mastectomy should remain the procedure of choice in the surgical treatment of carcinoma of the breast.

Adult↗
PubMed1986

Splenectomy for hairy cell leukemia. A clinical review of 63 patients.

To further define the role of splenectomy in hairy cell leukemia (HCL), 63 patients who underwent splenectomy for symptomatic cytopenias or splenomegaly associated with HCL were reviewed. Hematologic response to splenectomy was assessed 6 months postsplenectomy by a modification of Catovsky's criteria. The prognostic value of individual clinical findings, hematologic parameters, spleen size, and Jansen stage were examined by the Cox proportional hazards model. Twenty-one patients were excluded from hematologic response analysis for the following reasons: eight patients died between 1 and 6 months after splenectomy was performed; in seven patients hematologic data were unavailable; and six patients did not have significant preoperative cytopenias. Of 42 remaining patients, hematologic response was complete in 67%, partial in 19%, and there was no response in 14%. Overall, 44% of patients had disease progression within 5 years of splenectomy. Thirteen patients had a leukemic progression 1 year after splenectomy was performed. Overall 5-year survival was 61%. There was no operative mortality (30-day), and only 9% of patients had complications. Survival rates after complete, partial, and no response were 62%, 57%, and 75%, respectively at 5 years. Preoperative clinical findings, hematologic data, spleen size, or Jansen stage were not predictive of survival. Despite the absence of identifiable prognostic criteria, splenectomy continues to be advocated for symptomatic cytopenias and splenomegaly of hairy cell leukemia because of its safety and efficacy.

Adult↗
PubMed1986

Angiosarcoma of the breast.

The clinical histories, operative reports, and pathologic slides of 20 patients seen between 1907 and 1984 with diagnoses of angiosarcoma, hemangiosarcoma, and hemangioendothelioma were reviewed. The mean age of the 19 female patients and one male patient was 40.05 years (range, 16 to 67 years). Ten patients had the right breast involved, and five patients had contralateral breast involvement. Presenting symptoms included a mass in 20 patients, pain in ten patients, and breast discoloration in six patients. Before referral, ten patients had the misdiagnosis of a benign breast lesion. Because of the deceptively benign appearance of many angiosarcomas, these lethal tumors are often misdiagnosed as benign hemangiomas. Simple mastectomy is the treatment of choice, while adjuvant therapy remains to be evaluated.

Adolescent↗
PubMed1986

Local control and survival in locally advanced gastrointestinal cancer.

When conventional modalities (external beam irradiation and chemotherapy +/- resection) are used in the treatment of locally advanced gastrointestinal malignancies, although useful palliation can be achieved in many patients, local control and long-term survival are infrequent. In recent trials, investigators have used fractionated external beam doses of 4500-5000 rad in 180 rad fractions in combination with irradiation boost techniques of intraoperative electrons, or intraoperative or transcatheter brachytherapy (+/- chemotherapy and resection). With colorectal and biliary cancer, both local control and long-term survival appear to be improved, compared to results achieved with conventional treatment. With pancreatic cancer, an apparent improvement has been noted with local control and median survival, but long-term survival has not been altered. For partially resected gastric cancer, the use of intraoperative irradiation has yielded five year survival rates of approximately 20%. With unresectable or residual gastric cancer, accelerated fractionation alone or in combination with chemotherapy has yielded excellent local control, but patients have died as a result of abdominal failure or lung metastases. Prevention of abdominal failures will be necessary to improve long-term survival with pancreatic and gastric cancer. Randomized trials by site are needed to determine if the observed differences seen in prospective nonrandomized trials are real or due to differences in case selection.

Bile Duct Neoplasms↗
PubMed1986

Quality control parameters of intraoperative radiation therapy.

We have tried to outline many of the factors which must be considered in the technical delivery of IORT and in subsequent evaluation of these patients. Unless careful attention is given to details of patient selection, surgery, pathology, radiation therapy and follow-up, it is likely that a vast morass of data will be obtained which will be very difficult to interpret. It is the hope of the IORT Working Group that other institutions using IORT will employ our recommendations with regard to dosimetry, follow-up, and the general technical approach. This will likely lead to an earlier understanding of the exact role of this modality in cancer therapy today.

Combined Modality Therapy↗
PubMed1986

Fine-needle aspiration of the breast.

One of the numerous controversial issues related to the clinical management of breast cancer is the role of fine-needle aspiration (FNA). Despite its enthusiastic use in the diagnosis of thyroid nodules, its application to breast abnormalities has been accepted reluctantly. Breast FNA necessitates technical and interpretative skill and continual practice and is not 100% accurate. It also entails an additional, although moderate, expense. To assess the accuracy and determine the possible role of FNA at our institution, we performed both FNA and excisional biopsy in 100 unselected women with palpable breast nodules and correlated the cytologic and histologic findings. Our results were similar to those in previously published studies. FNA had a false-negative rate of 6%, no false-positive results, and an accuracy of 94%. After reviewing the potential assets and liabilities of this technique, we believe that breast FNA may add a measure of confidence in the diagnosis of benign breast lesions, provides a safeguard for preventing misdiagnosis of malignant lesions, and might expedite and reduce the cost of managing both primary and recurrent breast cancer.

Biopsy, Needle↗
PubMed1986

Management of recurrent rectal cancer.

In an effort to treat the difficult problem of recurrent rectal cancer more successfully, we embarked on an aggressive therapeutic course involving a combination of field irradiation, surgical debulking, and intraoperative radiation therapy. On the basis of our study of 24 patients treated with this regimen, we estimated the local effectiveness to be as high as 85%. Prolonged survival was achieved in 67% of our patients.

Combined Modality Therapy↗
PubMed1986

Abdominal fluid cytology in patients with gastrointestinal malignant lesions.

In a group of 76 patients with various gastrointestinal malignant lesions, we found that peritoneal washings contained tumor cells in 43% of patients with gastric cancer, 22% of those with pancreatic cancer, and 3% of those with colonic cancer. Aside from tumor site, we were unable to identify any criteria that would help to predict the presence of malignant cells in peritoneal fluid specimens. We found no malignant cells on cytology in patients with early localized cancer. The ease of obtaining such data, coupled with the fact that the test is inexpensive, makes cytologic assessment attractive. Furthermore, the results of cytology have been shown to bear a direct relationship to prognosis in some cancers and may serve as an indication for more intensive therapy. The results of sequential cytology tend to support the theory that tumor manipulation may be a source of intraperitoneal spread in certain tumors.

Adenocarcinoma↗