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Biomedical subjects

K A Prem

Publications and source records attributed to K A Prem.

At least 37 records · Page 2Linked to original sources
PubMed1986

Effect of cis-platinum on tolerance to radiation therapy in advanced cervical cancer.

Women with advanced carcinoma of the uterine cervix are at high risk for the development of local, regional, and distant metastases. Thus, both effective systemic agents and radiosensitizers could be useful adjuvants. However, because a substantial fraction of women with advanced cervical neoplasms are cured with radiation therapy, such experimental agents must not compromise the administration of conventional therapy. Cis-platinum is particularly appealing as it has both radiosensitizing properties and activity in metastatic cervical cancer. The present study examined the effect of weekly cis-platinum on radiation tolerance in 29 women with advanced cervical cancers. Although toxicity was acceptable, no marked enhancement in survival could be demonstrated.

Adult↗
PubMed1986

Cytoplasmic estrogen and progesterone receptors as prognostic parameters in primary endometrial carcinoma.

Eighty-six cases of primary endometrial carcinoma were assayed for the presence or absence of cytoplasmic estrogen and progesterone receptors by the saturation point dextran-coated charcoal assay. The levels of cytoplasmic progesterone receptors and estrogen receptors were analyzed according to clinical stage, histologic type and grade of the tumor, presence or absence of lymph node metastases, myometrial invasion, and survival. The cases were divided into positive and negative receptor groups with levels chosen of greater than 10 fmol/mg of cytosol protein for progesterone receptor and 5 fmol/mg of cytosol protein for estrogen receptor as discrimination points. Statistically significant survival differences were found between estrogen receptor positive versus estrogen receptor negative patients, progesterone receptor positive versus progesterone receptor negative patients, and estrogen positive-progesterone receptor positive versus estrogen negative-progesterone receptor negative patients. Mean cytoplasmic estrogen and progesterone receptor levels were inversely proportional to grade. This report suggests that treatment protocols should be devised to reflect the prognostic significance of receptor status.

Adenocarcinoma↗
PubMed1985

Therapeutic implications of the natural history of advanced cervical cancer as defined by pretreatment surgical staging.

From 1978 to 1983, 112 women with advanced cervical carcinomas received radiotherapy after pretreatment surgical staging. Five-year actuarial relapse-free survival rates were a strong function of lymphatic spread: 40% with periaortic node metastases, 50% with pelvic node metastases, and 84% without node metastases. Primary treatment failure had a distant component in 75% of recurrences (50% of recurrences with negative nodes and 85% of recurrences with positive nodes). It was concluded that adjuvant systemic therapy is necessary to substantially raise the probability of cure.

Adult↗
PubMed1985

Role of whole abdominal radiation therapy in the management of endometrial cancer; prognostic importance of factors indicating peritoneal metastases.

From 1973 through 1983, 27 women received postoperative open-field external beam abdominal radiotherapy as primary treatment of endometrial carcinoma. The 5-year survival rate was 71%. Two distinct prognostic groups were demonstrated. Patients with spread to the adnexa, peritoneal fluid, or both, had a 5-year relapse-free rate of 90%. Patients with macroscopic spread of cancer beyond the adnexa had a 5-year relapse-free rate of 0%. Guidelines are suggested for the radiotherapeutic management of endometrial cancer metastatic to the peritoneal cavity.

Adenocarcinoma↗
PubMed1985

Paraaortic lymph node radiotherapy in cancer of the uterine corpus.

From 1973 through 1982, 48 women received 4500 to 5075 rads to the paraaortic lymph nodes as part of their primary management for cancer of the uterine corpus. One patient developed severe enteric morbidity. Five-year survival rates were 52% in the total group, 57% in clinically staged patients, and 47% in surgically staged patients. Patients with surgically confirmed pelvic lymphatic spread had a five-year survival rate of 67%. Patients with surgically confirmed paraaortic spread alone or pelvic and paraaortic spread had five-year survival rates of 47 and 43%, respectively. Eighty-eight percent of recurrences were outside of the radiation portals. In contradistinction to much of the last decade's literature, radiation therapy has salvaged a substantial fraction of patients with nodal metastases, and morbidity rates have been acceptable.

Adult↗
PubMed1984

Carcinoma of the cervix, FIGO Stage IB: treatment failures.

All patients with carcinoma of the cervix, FIGO Stage IB, treated at the University of Minnesota Hospitals during a 10-year period were reviewed. Of the 220 patients 31 (14.0%) developed recurrent disease and did not survive. Thirteen patients had pelvic wall recurrences, with concurrent cervical involvement. No patient had a resectable pelvic recurrence. Hysterectomy was subsequently performed on 10 of the 172 patients who received radiation therapy. Carcinoma was not present in any of the operative specimens although two patients with adenocarcinoma later died of metastatic cancer. Median time of recurrence was 9 months, with median survival following recurrence of 6 months. Cervical cytology was not of value in the early diagnosis of recurrent disease. The 5-year adjusted actuarial survival rate for patients with adenosquamous carcinoma was significantly lower than that for patients with squamous cell carcinoma. The median age of patients not surviving with adenosquamous carcinoma was significantly lower than that for patients not surviving with squamous cell carcinoma. Patients with invasive carcinoma presumably confined to the cervix may have disseminated disease. It is essential such selected patients receive primary treatment that includes systemic therapy.

Actuarial Analysis↗
PubMed1984

The impact of extraperitoneal surgical staging on morbidity and tumor recurrence following radiotherapy for cervical carcinoma.

From 1971 through 1981, 83 nonsurgically staged women with cervical cancer received extended-field radiotherapy on the basis of abnormal lymphangiogram, obstruction on intravenous pyelogram, or extensive pelvic tumor volume. From 1978 through 1981, 61 surgically staged patients underwent radiation therapy; of these, the 21 with positive lymph nodes received periaortic radiation. No increase in morbidity was found in these patients. Survival, relapse rate, and sites of treatment failures were similar in the positive lymphangiogram group and in the surgically staged patients with positive nodes.

Adult↗
PubMed1984

Treatment of endometrial adenocarcinoma complicated by previous Watkins transposition operation: a report of three cases.

Three patients with endometrial adenocarcinoma complicated by previous Watkins transposition operations were treated at the University of Minnesota. Adequate diagnostic uterine dilatation and curettage necessary for proper staging was difficult or impossible because of the anatomic distortion caused by the prior surgery. Moreover, in one patient in whom the anatomic changes were not recognized, surgical treatment resulted in incomplete removal of tumor. The Watkins transposition operation should be considered a possible cause of technical difficulty during dilatation and curettage of any patient with a history of vaginal surgery. If the transposition surgery has been performed, difficulty in removing the uterus should be anticipated.

Adenocarcinoma↗
PubMed1983

Logistic models for prediction of enteric morbidity in the treatment of ovarian and cervical cancers.

To identify patients at high risk for the development of enteric injury, an analysis was made of 212 women who received extensive pelvic and abdominal radiotherapy at the University of Minnesota from 1970 through 1981. One hundred one patients with cervical carcinomas received 8,000 to 8,500 rads to point A, 6,000 rads to point B, and 4,500 to 5,075 rads to the periaortic lymph nodes. One hundred eleven women with ovarian cancers received 2,000 rads to the entire abdomen, followed by an additional 2,975 to 3,000 rads to the pelvis. The overall complication rate was 6.6% (14/212). The only patients who sustained chronic radiation morbidity had thin physiques. The maximum likelihood multiple logistic model was utilized to predict the probability of enteric injury as a function of thin physique, previous operations, and hypertension for individual patients. The usefulness of predictive models is discussed, and possible reasons for the susceptibility of thin women to ionizing radiation are explored.

Adolescent↗
PubMed1983

Cytoplasmic estrogen and progesterone receptors in primary cervical carcinoma: clinical and histopathologic correlates.

From 1977 to 1981, 39 cases of primary cervical carcinoma were assayed for the presence or absence of cytoplasmic estrogen (ERc) and progesterone (PRc) receptors by a saturation point dextran-coated charcoal assay. The levels of ERc and PRc were compared with clinical stage, histologic type, histologic grade, menstrual status, age, and survival. Carcinomas were divided into positive and negative receptor groups with the use of greater than 5 fmol/mg of cytosol protein for ERc and 10 fmol/mg of cytosol protein for PRc as discrimination points. Survival of the patients studied was computed by means of the product-limit analysis according to Kaplan-Meier. A statistically significant difference in survival in the PRc + group versus the PRc - group in the total group of patients was noted with the Mantel-Cox test (P = 0.049). When patients were stratified according to menopausal status, a statistically significant difference in survival was noted between the PRc + group versus the PRc - group in the premenopausal patients only.

Adenocarcinoma↗
PubMed1981

Adenocarcinoma of the sweat gland of the vulva: light and electron microscopic study.

A sweat gland carcinoma, a rare tumor of the skin which arose in the posterior fourchette in a 53-year-old white woman, was studied by light and electron microscopy. The tumor formed cords or small acini infiltrating into the stroma with foci of Pagetoid appearance. The cells showed poor intercellular cohesions. PAS and mucin strains were negative. Ultrastructurally the tumor cells in the periphery of the acini were firmly attached to the collagenous matrix with a few pseudopodia. A basal lamina was seen in some areas. The cytoplasm was filled with many ribosomes and moderately developed mitochondria. The bundles of microfilaments in the perinuclear zone were characteristic findings in this tumor. The ultrastructure of this tumor confirmed that this was carcinoma of the sweat gland, which closely resembled intraductal carcinoma of the breast.

Adenocarcinoma↗
PubMed1980

Postirradiation mixed müllerian tumors of the uterus: a comparative clinicopathologic study.

Nine patients with mixed müllerian tumors (MMT) of the uterus associated with a history of prior pelvic irradiation were compared clinically and pathologically with 8 nonirradiation-associated MMT control patients. Patients with postirradiation tumors presented at a younger age and with symptoms indicative of extensive intraabdominal disease while the nonirradiation-associated control patients were initially evaluated for abnormal uterine bleeding only. Two-thirds of the postirradiation patient's neoplasms were classified as heterologous MMT (mixed mesodermal tumor) whereas 62% of the control patient's neoplasms were homologous MMT (carcinosarcoma). Regardless of clinical presentation or histologic composition both groups fared equally poorly with average survival times of six and seven months, respectively. We were unable to substantiate that some histologic components of uterine MMT denote a poorer prognosis than others or that the postirradiation MMT behaves any differently, in the course of time, from the sporadic type. When uterine MTT is encountered in a patient under 55 years of age, the possibility that pelvic irradiation was administered some years before should be raised.

Adult↗
PubMed1979

The evolution of a treatment program for adenocarcinoma of the endometrium.

Previous studies at the University of Minnesota suggest that overall survival rates after treatment for adenocarcinoma of the endometrium are related to increased surgical applicability, that vaginal recurrence is frequently related to cervical involvement, and that virtually all women can safely undergo abdominal hysterectomy and radical irradiation therapy. In this program a simple abdominal hysterectomy was applied to as many women with this disease as possible. High-risk patients also received preoprative or postoperative irradiation. This program increased the survival rate for all stages from 58% to 69.7%. The survival rate among women with Stage I high-risk disease treated with supplementary irradiation was significantly lower when compared to that among women with low-risk disease who were treated by surgery alone. No vaginal recurrences were observed in either group and 98.4% were operated upon. The survival rate of women with Stage II disease treated with irradiation and surgery improved significantly. The rate of vaginal recurrence was 2.2%.

Adenocarcinoma↗