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Biomedical subjects

John A Ridge

Publications and source records attributed to John A Ridge.

17 recordsLinked to original sources
PubMed2006

Phase I trial of concurrent hyperfractionated split course radiotherapy (HFx RT), cisplatin (cDDP), and paclitaxel in patients with recurrent, previously irradiated, or treatment-naïve locally advanced upper aerodigestive malignancy.

PURPOSE: Phase I study to determine the maximally tolerated dose (MTD) of cisplatin (cDDP), paclitaxel (P), and concurrent split course hyperfractionated (BID) RT in advanced squamous cell carcinoma of the head and neck (SCCHN) and other upper aerodigestive tumors. MATERIALS AND METHODS: Eligibility stipulated ECOG performance status 0-2 and either Tx-naïve, locally advanced, or locally recurrent, previously radiated, surgically unresectable upper aerodigestive cancer. Metastases were permitted if disease was predominantly locoregional. RT-naïve patients received 150 cGy bid x 5 d Q 2 wks x 4. Previously radiated patients received 150 cGy bid x 5, wk 1; then 120 cGy bid x 5 Q 2 wk x 3 (later increased to 150 cGy BID for the entire treatment). Treatment fields included recurrent tumor only with 2 cm margins. Whenever possible, conventional and 3-D conformal techniques were used. Elective nodal radiation was not administered. Starting doses of cDDP and P were 12 mg/m2/d x 5 and 15 mg/m2/d x 5, respectively, Q 2 wk x 4, each given on RT days only. At dose level 2, cDDP was increased to 15 mg/m2/d x 5. At dose level 3, P was increased to 20 mg/m2/d x 5. Granulocyte colony stimulating factor (G-CSF) days 6-12 (off treatment week) was added if cumulative neutropenia precipitated treatment delays. RESULTS: Thirty-one patients (21 men, 10 women) were treated. Eight had received prior chemotherapy, 27 prior RT. At dose level three, regular treatment delays of >or=1 week due to slow neutrophil recovery occurred. Addition of G-CSF (dose level 3b) reduced treatment delays from 100 percent to 28 percent and decreased the incidence of Grade >or=2 neutropenia and mucositis. Six of 7 patients at this dose level completed all 4 cycles of treatment and all received full dose RT (60 Gy). No other dose-limiting toxicities occurred. Of 22 assessable patients with locally recurrent SCCHN, 12 (55 percent) responded. Median time to progression in this group was 6 months, with median and one-year survival of 9.5 mos and 41 percent, respectively. CONCLUSION: Concurrent daily cisplatin/paclitaxel and split course hyperfractionated RT (60 Gy) is feasible in previously radiated patients. G-CSF, administered between each cycle, reduces the incidence of treatment delays. Activity is promising and toxicity acceptable.

Adult↗
PubMed2005

Toxicity and outcome analysis of patients with recurrent head and neck cancer treated with hyperfractionated split-course reirradiation and concurrent cisplatin and paclitaxel chemotherapy from two prospective phase I and II studies.

BACKGROUND: Patients with local recurrences or new head and neck primary tumors in previously irradiated tissues have few options for salvage treatment. One option for select patients is to undergo reirradiation with concurrent chemotherapy. The purpose of this study is to report the initial clinical results of the Fox Chase phase I and II prospective reirradiation and chemotherapy studies. METHODS: Between July 1996 and January 2002, 38 patients with locally recurrent unresectable squamous cell carcinoma of the head and neck were treated with concurrent chemotherapy and reirradiation on two prospective trials. All patients had received prior radiation therapy to the head and neck region (median dose, 64.2 Gy). Patients received cisplatin and paclitaxel along with hyperfractionated external beam radiation therapy to the site of recurrence. RESULTS: The median follow-up was 10 months. The median survival was 12.4 months, with actuarial rates of overall survival of 50% and 35% at 1 and 2 years, respectively. During follow-up, 63% of patients experienced local progression of disease, all in the irradiated field. Actuarial progression-free survival at 1 year was 33%, with a median time to progression of 7.3 months. Acute grade 3 to 4 toxicity included neutropenia, nausea, emesis, and mucositis. CONCLUSIONS: Hyperfractionated split-course reirradiation and concurrent cisplatin and paclitaxel chemotherapy demonstrates durable locoregional control in select patients, although late toxicity may occasionally be significant. Only sites of disease recurrence need to be covered in the reirradiation fields.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

A randomized pilot study of cognitive-behavioral therapy versus basic health education for smoking cessation among cancer patients.

BACKGROUND: Previously, we have linked theoretically based cognitive and emotional variables to the ability of cancer patients to quit smoking. PURPOSE: In this study, we evaluated the impact of cognitive-behavioral therapy (CBT), which addressed these theoretically derived cognitive and emotional variables linked to tobacco use in this population, for promoting smoking cessation in a sample of cancer patients and assessed longitudinal predictors of smoking cessation. METHODS: Cancer patients (N=109) were randomized to either the theoretically based CBT intervention or to a general health education (GHE) condition, and all patients received nicotine replacement therapy. RESULTS: Contrary to our expectation, no significant difference in 30-day point-prevalence abstinence between the CBT and GHE conditions was detected at either a 1-month (44.9 vs. 47.3%, respectively) or 3-month (43.2% vs. 39.2%, respectively) follow-up evaluation. Higher quit motivation and lower cons of quitting were related to smoking cessation. CONCLUSIONS: Implications for the implementation of smoking cessation behavioral treatments in the oncologic context are discussed, as are directions for future research in this area.

Cognitive Behavioral Therapy↗
PubMed2005

Thyroid carcinoma.

Explore the source record for details and available documents.

Biomarkers, Tumor↗
PubMed2004

Comparing cancer patients who enroll in a smoking cessation program at a comprehensive cancer center with those who decline enrollment.

BACKGROUND: Despite the availability of smoking interventions for cancer patients, many eligible patients decline enrollment into such programs. We examined reasons patients provide for declining smoking treatment and compared treatment decliners to enrollees. METHODS: Eligible cancer patients (N = 231) were offered smoking cessation treatment. During recruitment, demographic, medical (eg, cancer stage), and smoking-related behavioral (eg, readiness to quit) data were collected, and decliners stated a reason for refusal. Patients who enrolled in the cessation program (N = 109) were compared with those who declined (N = 122) in terms of recruitment data, and reasons for declining were compiled. RESULTS: Decliners were significantly more likely to: (1) have head and neck cancer (vs lung cancer); (2) exhibit fewer physical symptoms (eg, shortness of breath); (3) report a lower readiness to quit smoking; (4) indicate no intention to quit smoking; and (5) smoke fewer cigarettes. A preference to quit without professional assistance was the most common reason for declining treatment. CONCLUSIONS: Our findings highlight important differences between patients who enroll in a smoking cessation program and those who decline and underscore the need for motivational interventions to facilitate enrollment into smoking interventions for cancer patients.

Attitude to Health↗
PubMed2004

Characteristics of cancer patients entering a smoking cessation program and correlates of quit motivation: implications for the development of tobacco control programs for cancer patients.

Even though survival and quality of life are adversely affected by smoking among cancer patients, about one-third of cancer patients who smoked prior to their diagnosis continue to smoke. One barrier to the provision of smoking cessation treatments to cancer patients is the paucity of data on the characteristics of cancer patients who continue to smoke and a lack of data on correlates of quit motivation in this population. This descriptive study assessed demographic, medical, smoking history, and psychological characteristics of cancer patients in a smoking cessation program (N=111) and examined these characteristics as correlates of quit motivation. Methods used by patients to quit smoking were also queried. We found that: (1) most patients are Caucasian, married, diagnosed with head and neck (versus lung) cancer, highly addicted to nicotine, and in the contemplation or preparation stage of change; (2) most patients attempt to quit smoking without formal treatment, although 33-50% have used the transdermal nicotine patch, nicotine gum, or bupropion; (3) depressive symptoms, low quitting self-efficacy, low perceived risk, and low perceived benefits of quitting are prevalent among patients, but most patients do not endorse the perceived disadvantages of quitting or fatalistic beliefs; and (4) quit motivation is associated with higher quitting self-efficacy, risk perceptions, and perceived benefits of quitting, lower tobacco use and nicotine addiction, and shorter time since diagnosis. These findings can help guide the development of smoking cessation interventions for cancer patients.

Aged↗
PubMed2004

Methemoglobinemia: early intraoperative detection by clinical observation.

OBJECTIVES/HYPOTHESIS: Head and neck surgery patients often receive topical anesthetics in the office for examination or in the operating room for nasotracheal intubation. Benzocaine (a component of many topical preparations) is frequently employed for this purpose. Acute methemoglobinemia is a rare but potentially lethal complication of benzocaine administration. Early recognition and treatment may prevent complications or death. We report a case of acute intraoperative methemoglobinemia, caused by benzocaine spray, which was diagnosed (and reversed) quickly after the clinical observation of "chocolate brown blood" in the surgical field.

Adult↗
PubMed2003

Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer.

BACKGROUND: Induction chemotherapy with cisplatin plus fluorouracil followed by radiotherapy is the standard alternative to total laryngectomy for patients with locally advanced laryngeal cancer. The value of adding chemotherapy to radiotherapy and the optimal timing of chemotherapy are unknown. METHODS: We randomly assigned patients with locally advanced cancer of the larynx to one of three treatments: induction cisplatin plus fluorouracil followed by radiotherapy, radiotherapy with concurrent administration of cisplatin, or radiotherapy alone. The primary end point was preservation of the larynx. RESULTS: A total of 547 patients were randomly assigned to one of the three study groups. The median follow-up period was 3.8 years. At two years, the proportion of patients who had an intact larynx after radiotherapy with concurrent cisplatin (88 percent) differed significantly from the proportions in the groups given induction chemotherapy followed by radiotherapy (75 percent, P=0.005) or radiotherapy alone (70 percent, P<0.001). The rate of locoregional control was also significantly better with radiotherapy and concurrent cisplatin (78 percent, vs. 61 percent with induction cisplatin plus fluorouracil followed by radiotherapy and 56 percent with radiotherapy alone). Both of the chemotherapy-based regimens suppressed distant metastases and resulted in better disease-free survival than radiotherapy alone. However, overall survival rates were similar in all three groups. The rate of high-grade toxic effects was greater with the chemotherapy-based regimens (81 percent with induction cisplatin plus fluorouracil followed by radiotherapy and 82 percent with radiotherapy with concurrent cisplatin, vs. 61 percent with radiotherapy alone). The mucosal toxicity of concurrent radiotherapy and cisplatin was nearly twice as frequent as the mucosal toxicity of the other two treatments during radiotherapy. CONCLUSIONS: In patients with laryngeal cancer, radiotherapy with concurrent administration of cisplatin is superior to induction chemotherapy followed by radiotherapy or radiotherapy alone for laryngeal preservation and locoregional control.

Adult↗
PubMed2003

Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11.

OBJECTIVE: To evaluate the incidence of morbidity, mortality, and disease control for patients requiring salvage total laryngectomy (TL) following organ preservation therapy. DESIGN: Patients entered into a 3-arm randomized prospective multi-institutional trial for laryngeal preservation who required TL following initial treatment. SETTING: The Radiation Therapy Oncology Group 91-11 trial for laryngeal preservation. PATIENTS: From 1992 to 2000, 517 evaluable patients were randomized to receive chemotherapy followed by radiation therapy (arm 1), concomitant chemotherapy and radiation therapy (arm 2), or radiation therapy alone (arm 3). RESULTS: Overall, TL was required in 129 patients. The incidence was 28%, 16%, and 31% in arms 1, 2, and 3, respectively (P =.002). Of these, 7 patients (5%) required TL for aspiration or necrosis. Following TL, the incidence of major and minor complications ranged from 52% to 59% and did not differ significantly among the 3 arms. Pharyngocutaneous fistula was lowest in arm 3 (15%) and highest in arm 2 (30%) (P>.05). There was 1 perioperative death. Local-regional control following salvage TL was 74% for arms 1 and 2 and 90% for arm 3. At 24 months, the overall survival was 69% (arm 1), 71% (arm 2), and 76% (arm 3) (P>.73). CONCLUSIONS: Laryngectomy following organ preservation treatment is associated with acceptable morbidity. Perioperative mortality is low but up to one third of patients will develop a pharyngocutaneous fistula. Local-regional control is excellent for this group of patients. Survival following salvage TL was not influenced by the initial organ preservation treatment.

Carcinoma, Squamous Cell↗
PubMed2003

Longitudinal predictors of continued tobacco use among patients diagnosed with cancer.

Even though continued smoking by cancer patients adversely affects survival and quality of life, about one third of patients who smoked prior to their diagnosis continue to smoke after their diagnosis. The implementation of smoking cessation treatments for cancer patients has been slowed by the lack of data on correlates of tobacco use in this population. Thus, this longitudinal study assessed demographic, medical, addiction, and psychological predictors of tobacco use among 74 head, neck, and lung cancer patients. Multivariable binary logistic regression analyses, with outcome categorized as smoker or nonsmoker, indicated that the likelihood that patients would be a smoker was associated with lower levels of perceived risk and a higher level of quitting cons. Multivariable nominal logistic regression, with outcome classified as continuous smoker, continuous quitter, relapser, or follow-up quitter, indicated that: (a). patients categorized as continuous smokers reported significantly lower quitting self-efficacy than follow-up quitters and continuous quitters, (b). relapsers reported a significantly lower level of quitting self-efficacy than either follow-up quitters or continuous quitters, and (c). continuous smokers exhibited a significantly lower level of risk perceptions than continuous abstainers. These findings can be useful for the development and evaluation of treatments to promote smoking cessation among cancer patients.

Adult↗
PubMed2002

A novel regulatory element determines the timing of Mos mRNA translation during Xenopus oocyte maturation.

Progression through vertebrate oocyte maturation requires that pre-existing, maternally derived mRNAs be translated in a strict temporal order. The mechanism that controls the timing of oocyte mRNA translation is unknown. In this study we show that the early translational induction of the mRNA encoding the Mos proto-oncogene is mediated through a novel regulatory element within the 3' untranslated region of the Mos mRNA. This novel element is responsive to the MAP kinase signaling pathway and is distinct from the late acting, cdc2-responsive, cytoplasmic polyadenylation element. Our findings suggest that the timing of maternal mRNA translation is controlled through signal transduction pathways targeting distinct 3' UTR mRNA elements.

3' Untranslated Regions↗
PubMed2002

Tumor above the spinal accessory nerve in papillary thyroid cancer that involves lateral neck nodes: a common occurrence.

OBJECTIVE: To describe the nature and extent of lateral neck node metastases from papillary thyroid cancer in relation to presenting physical examination and staging radiologic studies. DESIGN: Retrospective study. SETTING: Tertiary referral cancer center. PATIENTS: Consecutive patients who underwent comprehensive neck dissection with or without concurrent thyroidectomy for well-differentiated thyroid cancer between 1991 and 2001. Excluded were patients with well-differentiated thyroid cancer diagnosed incidentally at the time of treatment of other primary head and neck cancer, those with previous neck dissection for nonthyroid malignancies, and those undergoing surgery for medullary thyroid cancer. INTERVENTIONS: All pathology and operative and preoperative radiology reports for patients undergoing comprehensive neck dissection for well-differentiated thyroid malignancy were reviewed. Data were collected on previous procedures, preoperative evaluation, operative details, and pathologic findings. MAIN OUTCOME MEASURE: Identification of metastatic thyroid cancer in one or more nodes in anatomically defined drainage basins of the central and lateral neck. RESULTS: A total of 51 neck dissections were performed. All patients had preoperative evidence of metastatic disease. In addition to the usual comprehensive node dissection encompassing all lymphatic tissue in levels II through V, level I nodes and level II nodes above the spinal accessory nerve were labeled as distinct regions in 16 (31%) and 34 (67%) specimens, respectively. Disease was confined to a single nodal level in 20 (39%) of 51 specimens and was present in 4 or more levels in 7 (14%) of 50 neck dissections. There was cancer at 2 or 3 levels in 16 (31%) and 15 (29%) cases, respectively. Seven (21%) of the 34 patients undergoing separate analysis of nodes from above the spinal accessory nerve had cancer there. In 3 of the 34 it was the sole disease in level II. CONCLUSIONS: Tumor involvement at multiple nodal levels occurs in most cases when patients have lateral cervical node metastases. "Skip" metastases and cancer above the spinal accessory nerve are common. Neck dissections should include all node stations likely to be involved because selective node excision is likely to leave metastatic disease in situ.

Accessory Nerve↗
PubMed2002

Correlates of tobacco use among smokers and recent quitters diagnosed with cancer.

Smoking after a cancer diagnosis shortens survival time, increases risk of recurrence and the development of another primary tumor, reduces treatment efficacy, and increases treatment complications. Nevertheless, many patients who smoked prior to their illness continue to smoke after diagnosis and treatment. The development of effective smoking cessation interventions for cancer patients has been slowed by the lack of data concerning psychological correlates of smoking in this population. This study, with 74 cancer patients, showed that smoking and lower readiness to quit was associated with: having relatives at home who smoke, a longer time between diagnosis and assessment, completion of medical treatment, greater nicotine dependence, lower self-efficacy, quitting pros, and risk perceptions, and higher quitting cons, fatalistic beliefs, and emotional distress. Thus, smoking cessation treatments for cancer patients should include pharmacotherapy, relapse prevention, and counseling designed to facilitate self-efficacy, quitting pros, and risk awareness and to reduce the quitting cons, fatalism, and distress.

Female↗
PubMedDate not supplied

Processes of change related to smoking behavior among cancer patients.

PURPOSE: The purpose of this study was to examine the degree to which transtheoretical model processes of change (methods and strategies for cessation) were associated with smoking status and quitting behavior (ie, intentions and attempts to quit) among patients with head and neck or lung cancer. The relationship between medical variables and processes of change was also explored. DESCRIPTION OF STUDY: Twenty-nine smokers and 45 abstainers who were recruited from treatment clinics within a comprehensive cancer center completed a brief survey. Multivariate analysis of variance and Pearson correlation procedures were used to evaluate hypothesized relationships. RESULTS: As hypothesized, quitters used behavioral processes such as counter-conditioning and reinforcement management significantly more than smokers and used self-reevaluation, an experiential process, significantly less than smokers. Contrary to the hypothesis, however, quit attempts and intentions were associated with both experiential (ie, consciousness raising and self-reevaluation) and behavioral (ie, reinforcement management and self-liberation) processes of change. Use of the processes of change was not influenced by medical variables, including cancer type, illness phase, disease stage, type of current medical treatment, and duration of illness. CLINICAL IMPLICATIONS: These findings suggest that behavioral counseling to promote smoking cessation for patients with cancer should involve assisting the patient to do the following: develop an awareness of the health risks related to continued smoking; devise and use alternative behaviors; implement the use of reinforcement strategies for cessation successes; and develop a sense of confidence and commitment about quitting as well as healthy lifestyle values. These strategies are discussed within the context of models and guidelines for smoking cessation in clinical practice.

Female↗
PubMedDate not supplied

P53 alteration in oral tongue cancer is not significantly associated with age at diagnosis or tobacco exposure.

AIMS AND BACKGROUND: The tumor suppressor gene P53 is mutated in almost half of head and neck cancers. The current work assessed the prognostic significance of P53 alteration in patients with squamous cell carcinoma of the oral tongue treated with a curative intent, its association with age at diagnosis (using 45 years as a cut point), and risk exposure as defined by tobacco and/or alcohol consumption. METHODS: P53 alteration was determined immunohistochemically in 45 patients with tongue cancer treated with a curative intent. RESULTS: P53 alteration occurred in 20 of 45 tumors (44%) and was more common among younger patients (58% versus 36% for younger versus older patients, respectively) and those lacking tobacco/alcohol exposure (53% versus 40% for "no-risk" and "risk" groups, respectively), but the differences were not statistically significant. With a median follow-up of 56 months, 5-year progression-free survival rates were 48% and 66% in patients with and without P53 detection, respectively (P = 0.22). CONCLUSIONS: Despite a trend of a younger age at diagnosis in P53-altered tumors, results did not reach statistically significant differences. A trend of a worse clinical outcome with P53 alteration was noted.

Age Factors↗