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Biomedical subjects

J Newall

Publications and source records attributed to J Newall.

At least 19 recordsLinked to original sources
PubMed1992

Non-Hodgkin's lymphoma of the brain: can high dose, large volume radiation therapy improve survival? Report on a prospective trial by the Radiation Therapy Oncology Group (RTOG): RTOG 8315.

Between 1983 and 1987 the Radiation Therapy Oncology Group conducted a prospective phase II study to evaluate survival in primary non-Hodgkin's lymphoma of the brain treated with whole brain irradiation to 40 Gy and a 20 Gy boost to tumor plus a 2 cm margin. Forty-one patients are reported. Full follow-up is available on 35/41 who have died. Six are alive at 8.8-67.2 months from start of radiation therapy with a median followup of 53.9 months. Overall median survival was 11.6 months from start of radiation therapy and 12.2 months from diagnosis, with 48% surviving 1 year and 28% surviving 2 years. Karnofsky Performance Status and age were significant prognostic factors. Patients with a Karnofsky Performance Status of 70-100 had a median survival of 21.1 months compared to 5.6 months for patients with a status of 40-60 (p less than .001). Fourteen patients less than 60 years of age had a median survival of 23.1 months, while 27 patients greater than or equal to 60 years of age had a median survival of 7.6 months (log-rank p = .001). Disease recurred in the brain in 25/41 (61%) of the patients, (21/41 in the brain only and 4/41 in the brain plus distant metastases). Despite high dose and large volume irradiation, primary Central Nervous System lymphoma still exhibits excessive mortality, especially in older patients. This paradox of the relative radioresistance of primary Central Nervous System lymphoma remains unresolved.

Adult↗
PubMed1991

Prolactin reduction after combined therapy for prolactin macroadenomas.

The ability of surgery or bromocriptine to produce endocrine control of a prolactin macroadenoma decreases as the prolactin level increases. Guidelines for the use of multimodality therapy have not been developed for tumors associated with markedly elevated prolactin levels. We reviewed the records of 21 patients with prolactin levels greater than 200 ng/ml treated by transsphenoidal surgery and postoperative radiotherapy with or without a dopamine agonist. Values before and after treatment were available for 19 patients (13 men and 6 women). The mean basal prolactin level before treatment for the entire group was 2410 ng/ml. Surgery and radiotherapy resulted in a 90% reduction and serum prolactin levels within normal limits in 0 of 7 patients, versus the combination of surgery, radiotherapy, and dopamine agonist, which resulted in a 99.5% reduction and values within the normal range in 12 of 12 patients. Spontaneous physiological improvement was not often observed. One woman and two men were able subsequently to have children. A plan for these patients is discussed.

Adenoma↗
PubMed1990

Hyperfractionated radiotherapy for children with brainstem gliomas: a pilot study using 7,200 cGy.

Brainstem gliomas, constituting approximately 10% of all childhood central nervous system tumors, remain the most resistant of all brain tumors to therapy. A subgroup of high-risk patients with tumors that diffusely involve the brainstem or that microscopically demonstrate foci of anaplasia on biopsy specimens rarely survive after treatment. Conventional doses of radiotherapy result in temporary clinical improvement in the majority of these high-risk patients; however, few if any remain alive 18 months after treatment. Hyperfractionated radiotherapy, with delivery of larger numbers of smaller fractions of radiotherapy, is a possible way to increase tumor control without increasing neurological toxicity. In 1985, a multiinstitutional phase I/phase II trial, using 100 cGy of radiation therapy twice daily to a total dose of 7,200 cGy, was undertaken for patients with high-risk brainstem gliomas. At the time of writing, 24 (69%) had developed progressive disease and 11 remained in continuous progression-free remission. Actuarial progression-free survival at 20 months is approximately 30%. Twenty-three of 31 evaluable patients had an objective radiographic response to therapy. In comparison to both historical control patients and patients treated in a previous trial using 6,480 cGy of hyperfractionated radiation therapy, there was a statistically significant improvement in progression-free survival rate for patients treated with 7,200 cGy of hyperfractionated radiation therapy (p less than 0.01). To date no patient has died as a result of treatment. Six patients developed transient neurological deterioration or cystic intralesional changes, as demonstrated on magnetic resonance imaging, within 6 weeks of the completion of radiotherapy. Postmortem examination performed in 7 patients did not disclose significant radiation necrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Radiation therapy for intracranial germinoma: the case for limited volume treatment.

Although radiation therapy has been universally accepted as the treatment of choice for primary intracranial germinomas, the optimal treatment technique continues to be a matter of controversy. Some authors advocate routine prophylactic craniospinal irradiation for all patients with localized intracranial germinomas whereas others have recommended partial brain fields. A retrospective analysis was performed on all 30 patients with tumors of the pineal and suprasellar regions irradiated at our institution between 1967 and 1987. Definitive histology was obtained in 23 patients. There were 13 germinomas and 10 non-germinomatous germ cell tumors. The 13 patients with biopsy proven germinomas constitute one of the largest modern series and will form the basis of this report. In all 13 patients, the tumor was confined to a single site within either the pineal region (9 patients) or the suprasellar region (4 patients). One patient with a pineal germinoma had CSF cytology positive for malignant cells and this patient was treated with craniospinal irradiation. Twelve patients were treated using partial brain fields encompassing either the tumor plus margin (10 patients) or the entire ventricular system followed by a boost to the primary tumor (2 patients). With the exception of one patient, all patients received a total dose between 4900 and 5500 cGy to the primary (median 5040 cGy). The patient receiving less (3960 cGy) suffered from both local and spine relapse 26 months after diagnosis. The remaining 12 patients were free of disease at 81 months median follow-up time. We suggest that for patients with biopsy proven pineal or suprasellar germinomas, irradiation of partial brain is sufficient and craniospinal irradiation should be administered only to those patients with disease involving more than one intracranial site, demonstrated meningeal seeding, or positive CSF cytology.

Adolescent↗
PubMed1990

Neuro-ophthalmological assessment of vision before and after radiation therapy alone for pituitary macroadenomas.

Between 1972 and 1988, 25 patients were treated by radiation therapy (RT) alone for pituitary macroadenomas causing visual impairment. Twenty-three patients were evaluated by a neuro-ophthalmologist before treatment and at the time of follow-up review. Radiation treatment consisted of 4000 to 5000 cGy over 4 to 5 weeks. The median follow-up period was 36 months (range 2 to 192 months). Eighteen patients (78%) experienced visual field improvement. Deterioration occurred in four patients due to tumor recurrence, tumor hemorrhage, possible optic nerve necrosis, and optic chiasm herniation. Visual field improvement occurred predominantly in patients whose pretreatment visual field defects were less than a dense hemianopsia, who did not have diffuse optic atrophy, and who were younger than the median age of 69 years (p less than 0.001). Visual acuity improvement occurred in patients without diffuse optic atrophy, with only mild impairment of the visual acuity, and with only mild visual field loss prior to RT (p less than 0.002). It is concluded that there is a subset of patients with pituitary macroadenomas and visual impairment for whom primary RT is a treatment option.

Adenoma↗
PubMed1989

Pituitary adenoma: the efficacy of radiotherapy as the sole treatment.

The management of patients with pituitary adenomas by radiotherapy alone, using modern techniques of evaluation and current standards of treatment, has not been examined. This is a retrospective review of 29 such patients with nonfunctional or prolactin secreting pituitary macroadenomas. Patients were analyzed by visual fields, hormone levels, and CT scans. All but one patient received a tumor dose of 4500 cGy in 4 to 5 weeks. The tumor was controlled in 26 of 28 (93%) patients for an observed period of 3 to 14 years. Seventeen of 21 (81%) patients with visual impairment experienced normalization or improvement, and seven of ten (70%) patients with hyperprolactinemia achieved normalization of their serum prolactin levels. Post-treatment CT scanning revealed persistent tumor in nine of 17 patients despite clinical improvement. We conclude that: (a) radiotherapy is an effective treatment for these tumors; (b) doses need not exceed 4500 cGy in 25 fractions; (c) radiation is effective for improving vision; (d) radiation can normalize hyperprolactinemia; and (e) tumor regression is variable and unrelated to observed symptom regression.

Adenoma↗
PubMed1988

Glioblastoma in the older patient: how long a course of radiotherapy is necessary?

Eighteen patients over 60 years old with a histologically proven diagnosis of glioblastoma multiforme were treated by a short radiotherapy course (3000 cGy midline dose by two opposed portals to the whole brain). Results in terms of survival and function appeared to be as good as with the standard course of six to seven weeks as reported in the literature.

Age Factors↗
PubMed1988

Controversies in management of stages I and II testicular seminomas.

The general success in treating seminoma (Stages I and II) of the testicle has prompted questions regarding the extent of treatment that these patients require. We reviewed 79 patients treated at NYU/Bellevue Medical Center from 1965 to 1984 to establish a data base from which the controversies surrounding this disease can be viewed. Standard treatment involved a radical inguinal orchiectomy as primary therapy. Stage I patients received adjuvant radiation to para-aortic and ipsilateral iliac nodes, with additional radiation given routinely to the mediastinum of patients with Stage II disease. No major complications were observed. All Stage I patients remain free of recurrent tumor with a median follow-up of eight years. There were 4 deaths from seminoma among the Stage II patients. The use of prophylactic mediastinal radiation for Stage II patients, and observation only for Stage I patients are reviewed in light of our results and other published series. While early evidence suggests that both approaches may be reasonable, their adoption awaits confirmation by prospective trial.

Cobalt Radioisotopes↗
PubMed1988

The duration of local control of classic (non-AIDS-associated) Kaposi's sarcoma by radiotherapy.

We report the short- and long-term responses to radiotherapy of 82 classic Kaposi's sarcomas. Doses were prescribed ab initio and no attempt was made to discontinue treatment as soon as shrinkage was observed, as has been recommended by others. More than 50% of the lesions regressed completely and nearly all underwent some regression. Almost all recurrences were detected within 2 years of treatment and virtually all occurred in lesions that had not regressed completely within 2 weeks of radiotherapy. We conclude that classic Kaposi's sarcoma should be treated with sufficient radiotherapy from the beginning to provide long-term control.

Aged↗
PubMed1987

Irradiation of meningiomas of the intracranial anterior visual pathway.

Twenty patients with progressive visual loss caused by intracranial meningiomas involving the anterior visual pathway were treated with irradiation alone (n = 4) or with irradiation combined with tumor excision (n = 16). Improvement in visual performance occurred in 13 patients; 2 patients experienced temporary improvement; and 5 others maintained stable visual function for up to 9.5 years (mean follow-up, 4.0 years). Radiotherapy seemed to have no effect in 2 patients. One patient experienced temporary improvement, but eventually died from spread of tumor. Only one definite complication of radiotherapy occurred and was related to excessive radiation dose (greater than 7,000 cGy). Irradiation in the range of 5,000 to 5,500 cGy was effective either alone or in combination with surgical excision. Serial assessment of visual acuity and fields allowed us to demonstrate and quantify improvement in our patients following radiotherapy; in contrast, follow-up computed tomographic studies rarely demonstrated reduced tumor size.

Combined Modality Therapy↗
PubMed1986

Single-dose half-body irradiation for palliation of multiple bone metastases from solid tumors. Final Radiation Therapy Oncology Group report.

This is the final analysis of Protocol #78-10 which explored increasing single-doses of half-body irradiation (HBI) in patients with multiple (symptomatic) osseous metastases. When given as palliation, HBI was found to relieve pain in 73% of the patients. In 20% of the patients the pain relief was complete; over two thirds of all patients achieved better than 50% pain relief. The HBI pain relief was dramatic with nearly 50% of all responding patients doing so within 48 hours and 80% within one week from HBI treatment. Furthermore, the pain relief was long-lasting and continued without need of retreatment for at least 50% of the remaining patient's life. These results compare favorably with those obtained by the Radiation Therapy Oncology Group (RTOG) using several conventional daily fractionated schemes on similar patients in a prior study (RTOG #74-02). HBI achieves pain relief sooner and with less evidence of pain recurrence in the irradiated area than conventionally treated patients. The most effective and safest of the HBI doses tested were 600 rad for the upper HBI and 800 rad for the lower or mid-HBI. Increasing doses beyond these levels did not increase pain relief, duration of relief, or achieved a faster response; however, the increase in dose was associated with a definite increase in toxicity. Single-dose HBI was well tolerated with no fatalities seen among 168 treated patients. A comprehensive premedication program has proven to decrease the acute radiation syndrome to very acceptable levels. There were excellent responses found in practically all tumors treated, but especially breast and prostate among which over 80% of all patients experienced pain relief, 30% in a complete fashion. Single-dose HBI emerges as one of the safest, fastest, and more effective palliative tools for intractable cancer pain in modern radiation oncology.

Bone Neoplasms↗
PubMed1985

A role for radiotherapy in the treatment of solid and papillary neoplasms of the pancreas.

Solid and papillary neoplasms of the pancreas are rare tumors that usually occur in young women as enlarging abdominal masses. These lesions almost never metastasize but may be locally destructive. Although the usual treatment is surgery, the authors herein report a case that was treated solely by radiotherapy. They conclude that solid and papillary neoplasms of the pancreas are radiosensitive and can be successfully treated by radiation therapy.

Adolescent↗
PubMed1985

Combined preoperative and postoperative radiation for bladder cancer. Results of RTOG/Jefferson Study.

Ninety-two patients with bladder cancer have been treated with combined pre- and postoperative radiation in a Radiation Oncology Study Group (RTOG) Phase I-II study and at Thomas Jefferson University Hospital. Patients with invasive bladder cancer were entered into the study and given low-dose preoperative radiation (500 rad) to the whole pelvis, either on the day of or the day before cystectomy. Following surgery, patients were pathologically staged. Patients with stage B1 (T2) (grade 3 or 4), stage B2 and C (T3) tumors were given 4500 rad in 5 weeks postoperative radiation. Follow-up in the study ranges from a minimum of 24 months to 5 years, with a median of 36 months. Incidence of complications was 15% (14/92). The 4-year actuarial survival (Kaplan-Meier) by stage of disease is 68% for stage B1 (T2) (grade 3 or 4), 78% for stage B2, and 57% for stage C. These survival results appear to be better than those obtained with other approaches of adjuvant therapy and/or surgery in comparable histopathologically staged patients.

Carcinoma, Transitional Cell↗
PubMed1984

The carcinogenicity of radiation therapy.

Ionizing radiation as used for therapy for cancer is probably weakly carcinogenic at worst. The probability that cancers will be induced at a distance from the treatment volume is so small that it can only be inferred from experiences with large populations exposed to much higher radiation doses. The risk of cancer in and adjacent to the treatment volume also appears to be small, especially in adults. Intensive radiotherapy or radiotherapy of children 20 to 30 years ago appears to have induced secondary cancers in about 3 to 4 per cent of those treated, but modern practice has every expectation of reducing this incidence. No precise risk factor can be offered, but it seems likely that less than 3 to 4 per cent is a reasonable projection. The reason for the low carcinogenicity in the treatment volume probably lies in the fact that the irradiation dose is high and many cells are killed rather than transformed. The frequency of the induction of radiogenic cancer adjacent to or near the treatment volume is expected to vary according to the tissue exposed. It is not estimated to exceed a few per cent in the worst instances (for example, breast and thyroid gland) and is much less than 1 per cent in most tissues.

Adult↗
PubMed1983

Regional Stage IV carcinoma of the nasopharynx treated by aggressive radiotherapy.

Between January 1, 1969 and December 31, 1981, 45 patients received radiotherapy for advanced (Stage IV) carcinoma of the nasopharynx confined to the head and neck at New York University Medical Center. Forty of these 45 patients received at least 6000 cGy. The 5 and 10 year actuarial survival rates were 31 and 20%. Four patients are currently alive without evidence of disease at least 10 years after treatment. Local persistence or recurrence of tumor in the nasopharynx was the primary cause of failure and occurred in 42% of our patients. The likelihood of this type of treatment failure correlated with the initial "T stage" of disease. Inability to control nodal disease was less common, occurring in 23% of evaluable patients and was proportional to the "N stage." Distant metastases became apparent in 13% of our patients and correlated with the "N stage." More than 90% of recurrences were evident within two and all occurred within three years of treatment.

Adolescent↗
PubMed1983

Adjuvant postoperative radiation therapy for Dukes C adenocarcinoma of the rectum.

This study was designed to explore the effects of adjuvant postoperative radiation therapy on the course and survival of patients with Dukes C adenocarcinoma of the rectum. Moderate dose radiotherapy was offered to 64 patients. Twenty-four accepted and were treated, while the remainder refused. With a mean follow-up of 32.3 months, the overall survival rate was 63% (40/64) and the mean disease-free survival rate at the time of this report was 45%. The following variables were analyzed separately: operative procedure, distance of the tumor from the anal verge, tumor size, and transmural, vascular, lymphatic and perineural invasion of tumor. The most significant differences between irradiated and non-irradiated patients were found in the group of patients whose lesions were 6 cm or less from the anal verge. Of the 19 such patients with an average follow-up of 36.4 months, ten patients were irradiated and nine were not irradiated. The irradiated group had a 90% (9/10) survival rate and 70% (7/10) of them were disease free; the non-irradiated group had a 44% (4/9) survival rate and 22% (2/9) of them disease free. It is concluded that patients with adenocarcinoma of the rectum metastatic to lymph nodes, whose lesions' lower border is measured 6 cm or less from the anal verge, benefit significantly from adjuvant postoperative radiotherapy.

Actuarial Analysis↗