Biomedical subjects

James D Cox

Publications and source records attributed to James D Cox.

76 records · Page 5Linked to original sources

PubMedDate not supplied

Molecular response of follicular lymphoma to cyclophosphamide, doxorubicin, vincristine, prednisone C(H)OP or COP-based therapy as measured by polymerase chain reaction evidence of translocation (14;18)(q32;q21).

PURPOSE: Existing data suggest that conventional C(H)OP (cyclophosphamide, doxorubicin, vincristine, prednisone) regimen may not be intensive enough to achieve molecular response, as measured by polymerase chain reaction (PCR) evidence of translocation (14;18)(q32:q21) for follicular lymphoma. This study was undertaken to study the molecular response rate of follicular lymphoma to C(H)OP-based therapy and to analyze prognostic factors for molecular response. PATIENTS AND METHODS: Twenty patients with pretreatment PCR evidence of t(14;18)(q32; q21) and at least one posttreatment PCR analysis after the initiation of the treatment with C(H)OP with or without radiation therapy constituted the basis for this analysis. The random effects logistic model was used to analyze the data. The following factors were investigated for their relationship to molecular response: gender, age, beta2-microglobulin, use of radiation therapy, Ann Arbor stage, and international Prognostic Index for malignant lymphoma. RESULTS: Median follow-up was 56 months (range, 23-153 months). A total of 135 PCR results were available, 33 from bone marrow and 102 from peripheral blood. Overall, there was a clear and steady decreasing trend toward loss of PCR positivity with increasing time aftertreatment. By univariate analysis, stage > or = 3, stage = 4, International Prognostic Index > or = 2, and no radiation therapy were adverse factors for molecular response. On multivariate analysis, Ann Arbor stage IV and no radiation therapy were independent risk factors for PCR positivity, both for the peripheral blood data analyzed alone and for all data combined. DISCUSSION: It is possible to achieve molecular response with C(H)OP with or without radiation therapy in patients with follicular lymphoma. Response rate depends on the Ann Arbor stage and radiation therapy.

Adult↗

PubMedDate not supplied

Uncertainties in physical and biological targeting with radiation therapy.

Advances in radiation therapy over the past decade have resulted from increased accuracy of imaging and highly conformal three dimensional treatment planning and delivery of radiation therapy. Three-dimensional conformal radiation therapy (3D CRT) with higher doses than previously considered tolerable is now standard for many types of cancer. Intensity modulated radiation therapy (IMRT) with x-rays, proton beam treatments and intensity modulated proton therapy (IMPT) are major areas of research. Tumor motion between and even during radiation treatments represents a major uncertainty. Tumor heterogeneity results in additional uncertainties affecting tumor control with radiation therapy. Imaging the heterogeneous targets within tumors offers new opportunities for tumor delineation. Molecular therapeutic agents enhance the effects of ionizing radiations in murine systems. Clinical trials combining molecular targeting agents with conformal radiation therapy are being initiated.

Animals↗

PubMedDate not supplied

Target definition and contouring in carcinoma of the lung and esophagus.

The optimal treatment for intrathoracic tumors such as lung and esophageal cancer requires an improvement of therapeutic ratio to increase efficacy of the cancer-cell kill and decrease the normal-cell kill. This is not an easy task because sensitive normal cells such as alveoli and epithelial cells in the esophagus and bronchus surround these tumors. How to minimize the damage of such sensitive normal cells within irradiated fields without sparing cancer cells is a major issue for radiation oncologists, especially as concurrent chemoradiotherapy has become more standard treatment. One way to achieve this task is accurate delineation of the target volume, which will be emphasized here. Some other ways to achieve it are biological protection by ethyol, keratinocyte growth factors, biologically targeted treatments such as C225 and celecoxib, and anti-angiogenesis, which have been briefly addressed in Dr. Cox's article in this Journal. Molecular imaging is a new diagnostic and therapeutic modality that offers great potential for accuracy of target definition, although it is not quite ready for routine clinical use at the present time. Accurate target definition and contouring in cases of carcinoma of the lung and esophagus depend on expertise of diagnostic and therapeutic medical teams. There we review the normal anatomy, diagnostic methods, and tumor delineation of cancer of the lung and esophagus.

Carcinoma, Non-Small-Cell Lung↗

PubMedDate not supplied

Uncertainties in contemporary treatment of aggressive lymphomas.

Contemporary treatment of malignant lymphomas relies on systemic chemotherapy. The role of radiation therapy is often debated. Randomized clinical trials have shown that the addition of radiation therapy, following complete response (CR) to several cycles of combination chemotherapy for early stage diffuse large B-cell and immunoblastic lymphoma, increases disease-free survival. The dose required to achieve consistent control after complete response is uncertain, but the available data suggest a dose-response for tumor control after CR. The role of radiation therapy after partial response (PR) is uncertain as many such patients are advised to undergo high dose chemotherapy followed by bone marrow reconstitution. Involved field radiation therapy after PR is able to achieve durable freedom-from-relapse. The role of radiation therapy for peripheral T-cell lymphomas and mediastinal T-cell lymphoblastic lymphomas is also uncertain. Finally, in the era of combination chemotherapy and conformal irradiation, a uniform understanding of what constitutes "involved field" treatment volume is lacking. This issue is even more complex now that intensity-modulated irradiation has become widely available. It is unlikely that these questions will be addressed in randomized clinical trials.

Combined Modality Therapy↗