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Biomedical subjects

K M Greven

Publications and source records attributed to K M Greven.

50 records · Page 3Linked to original sources
PubMed1992

Local recurrence after cystectomy alone for bladder carcinoma.

Although the role of preoperative irradiation in the treatment of bladder carcinoma is questioned, patterns of failure after cystectomy alone are not well documented. Local failure patterns were analyzed retrospectively in 83 patients (67 men and 16 women) treated with cystectomy without adjuvant therapy at three institutions. The follow-up period ranged from 0 to 167 months. Disease was assessed preoperatively by clinical stage and postoperatively by pathologic stage. Thirteen patients had pelvic recurrences, a 5-year actuarial failure rate of 18%. Pathologic stage was the only significant predictor of local recurrence, which ranged from 6% in patients with pT2 tumors to 51% in patients with pT3b tumors. The median time to local recurrence was 9 months (range, 3 to 62 months). Clearer documentation of failure patterns will provide a basis for evaluating survival with combined treatment methods, including preoperative radiation therapy, surgery, and chemotherapy.

Aged↗
PubMed1992

The occurrence and management of esophageal fistulas resulting from Hodgkin's disease.

At their radiation therapy (RT) department, the authors saw a young woman with an esophageal fistula from Hodgkin's disease that was not responsive to chemotherapy; this prompted a review of the literature concerning such patients. Twenty-two patients with Hodgkin's disease and esophageal fistula were found to have been reported previously. Most patients had active disease at the fistula site, and most who were treated with RT or chemotherapy had prompt fistula closure. Fistula formation as a complication of RT for Hodgkin's disease was found to be an extremely unusual occurrence.

Adult↗
PubMed1992

Secondary malignant neoplasms in patients with bladder carcinoma.

At the University of Pennsylvania and its affiliates, 292 patients with bladder carcinoma treated with a variety of definitive regimens were observed for the incidence of secondary malignancies. The cumulative incidence at fifty-four months, including synchronous primary neoplasms, was 24 percent. Hazard function analysis reveals a relatively constant risk of new neoplasms to be approximately 1.5 percent per year over a period of forty-eight months after diagnosis.

Humans↗
PubMed1992

Endometrial cancer with para-aortic adenopathy: patterns of failure and opportunities for cure.

PURPOSE: To examine the outcome of patients with advanced endometrial cancer whose para-aortic involvement was diagnosed pathologically or lymphographically. METHODS AND MATERIALS: Fifty patients from four institutions were treated between 1959 and 1990 with preoperative, post-operative, and primary radiotherapy. Para-aortic disease was diagnosed pathologically in 26 patients and lymphographically in the remaining 24 patients. Pathologically diagnosed patients underwent debulking of grossly involved nodes. All patients received external beam treatment through pelvic and para-aortic portals. Median prescribed dose to the pelvic and para-aortic fields was 50 and 47 Gy, respectively. Those treated with primary or pre-operative irradiation also received intrauterine brachytherapy. RESULTS: The actuarial 5-year disease-free survival was 46% for all patients. Para-aortic failure was significantly decreased among patients undergoing lymph node resection (13% versus 39%, respectively). Relapse-free survival and pelvic control tended to improve among patients receiving surgery plus irradiation in comparison to those treated by irradiation alone. Distant metastases were most common among patients with high grade lesions. CONCLUSIONS: Long-term disease-free survival is achievable in endometrial cancer patients with para-aortic lymphadenopathy who are treated with extended-field radiotherapy. Cure is mot attainable among patients with well differentiated, early clinical stage disease who receive combined modality treatment. Survival and local failure are similar for radiologically and pathologically diagnosed patients; however, para-aortic failure as a component of local failure was increased in patients who did not undergo surgical debulking of the adenopathy.

Adenocarcinoma↗
PubMed1991

Analysis of complications in patients with endometrial carcinoma receiving adjuvant irradiation.

We analyzed the complications in 310 patients with pathologically documented endometrial carcinoma who received adjuvant radiation therapy (RT) at Fox Chase Cancer Center between 1970 and 1986. Variables included timing of treatment, technique, total dose, age, diabetes, previous abdominal surgery, hypertension, prior bowel pathology, and lymphadenectomy. According to the FIGO (1985) system, 258 patients had Stage I disease, 48 had Stage II, and one had Stage III. One hundred seventy patients received preoperative (preop) RT, 138 received postoperative (postop) RT, and 2 received preop and postop RT. A 4-field technique was used for 212 of 235 patients receiving external-beam (EX) RT, and 75 patients were treated with intracavitary (IC) RT only. Median follow-up was 5.5 years. Actuarial survival of all 310 patients was 78% at 5 years. Thirty-two complications occurred, involving the rectum, small bowel, femur, or lower extremity. Complications were graded according to the ECOG scoring system as grade 2 (mild) and grades 3, 4, or 5 (serious). One of 75 patients treated with IC RT only experienced a grade-2 complication (proctitis). Of 71 patients receiving 4-field EX RT only, 25 preop (16%) and 14 postop (14%) patients had complications. Of 139 patients treated with both EX and IC RT, grade-2 complications were seen in 5% of 87 preop patients and 12% of 52 postop patients (p = 0.17), whereas serious complications were observed in 4% of each group. Univariate analysis of the variables of interest revealed that the incidence of complications was associated with a lymphadenectomy (p = .03), use of external RT (p less than .01), and decreasing age (p = .04). Multivariate analysis confirmed that use of external RT was the most significant predictor for complications. In conclusion, similar complication rates were found in patients treated with either preop or postop 4-field EX RT. While pelvic RT clearly decreases pelvic relapse in patient with endometrial carcinoma, the risk benefit ratio for treatment of these patients should be carefully considered when recommending adjuvant RT for pelvic control.

Adult↗
PubMed1990

Prognostic factors in patients with bladder carcinoma treated with definitive irradiation.

An analysis was performed of 116 patients with bladder carcinoma who completed definitive radiotherapy at a single institution. Patients were analyzed for survival and local control. The overall 5-year survival rate was 34%. A multivariate analysis of survival showed disease stage, hemoglobin level, histologic grade, and total dose to be significant factors in outcome. The local control rates for Stage A, B, C, and D patients were 26%, 36%, 18%, and 0%, respectively. The multivariate analysis revealed disease stage and pretreatment hemoglobin level to be significant predictors of local control. In patients unsuitable for surgery or current combined technique protocols, high-dose irradiation may offer some patients survival and local control. Furthermore, prognostic factors in this study may aid in the stratification necessary for current protocol designs.

Aged↗
PubMed1990

Influence of grade, histologic subtype, and timing of radiotherapy on outcome among patients with stage II carcinoma of the endometrium.

In 1988, the Federation of International Gynecologic Oncologists (FIGO) adopted a new staging system mandating preradiotherapy surgical staging in endometrial cancer. To evaluate the potential impact of this recommendation on patients with cervical involvement (stage II), an analysis of 184 consecutive patients with clinical or pathologic stage II carcinoma of the endometrium treated with definitive intent at three institutions was performed. Median follow-up time was 5.7 years. Treatment consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy with preoperative radiation therapy (RT) (54%), postoperative RT (37%), or both (1%); definitive RT (7%); or radical hysterectomy (1%). The median total RT dose for combined intracavitary and external beam or either alone was 70.6 Gy with a range of 32.4-105.0 Gy. The overall 5-year survival rate and disease-free survival (DFS) rate at 5 years were 70 and 79%, respectively. Of patients treated with surgery and adjuvant radiation, 13% (22/168) had infield pelvic failure (PF) and 18% (31/168) had distant metastases (DM). Patterns of failure in patients receiving preoperative and postoperative radiotherapy are presented. Univariate analysis of pretreatment and treatment factors, including histology, grade, clinical stage, extent of cervical involvement, and timing of adjuvant radiation, revealed histology and grade to be significant predictors of DFS, PF, and DM. Clinical stage was a significant predictor of DFS only in univariate analysis. Multivariate analysis found only histology (P less than 0.001) and grade (P = 0.002) to be predictors of DFS. From this review, we conclude that histology and grade are independent predictors of DFS, and more aggressive treatment should be directed at patients with stage II endometrial cancer found to have high grade adenocarcinoma or papillary serous/clear cell histologic variants. The timing of radiotherapy was not an independent predictor of outcome; therefore, preradiotherapy surgical staging should not impact on DFS and should provide surgicopathologic information to tailor treatment and predict prognosis. The FIGO clinical staging system used in this analysis was not an independent predictor of outcome, and future multivariate analyses will be necessary to test the predictive value on outcome of the new 1988 FIGO surgical staging.

Female↗
PubMed1990

Patterns of failure in patients with stage I, grade 3 carcinoma of the endometrium.

Patients with high grade, early stage endometrial carcinoma are reported to have worse survival and local control rates than those with low grade carcinomas. To define failure patterns further in patients with FIGO Stage I, grade 3 endometrial carcinomas, the patients from three institutions who received adjuvant or definitive radiation (RT) were analyzed. Of 119 patients meeting the criteria of Stage I, grade 3 endometrial carcinoma, 57 patients received preoperative radiation, 49 patients received postoperative radiation, and 10 patients received definitive radiation with 5-year actuarial survival rates of 64%, 73%, and 65%, respectively. Three additional patients received both preoperative and postoperative treatment. The overall local control rate was 88% with a median follow-up of 70 months. Of 36 patients who failed, 14 had a component of local failure, and 31 had a component of distant failure. Eighteen of 31 distant failures involved metastatic spread to the abdominal cavity. Recurrence patterns by method of treatment are documented. Patients with high grade tumors do have a propensity for distant metastasis. Clinical investigation into the value of systemic therapy is necessary.

Adenocarcinoma↗
PubMed1989

Analysis of failure patterns in stage III endometrial carcinoma and therapeutic implications.

The poor outcome of certain patients with Stage III endometrial carcinoma has led some investigators to direct adjuvant therapy to the abdominal cavity. To better define failure patterns, a review of 126 patients with Stage III endometrial carcinoma treated at four institutions was performed. Seventy-four patients were diagnosed at surgery with pathologic Stage III disease, whereas 52 patients presented with clinical Stage III disease. Most patients received external beam irradiation to the pelvis with a variety of boost techniques. Site of disease, grade, depth of invasion, and pathology were examined for prognostic significance. Actuarial techniques were used to analyze survival and recurrences. For the 52 clinical Stage III patients, 5-year survival was 36%. The median survival of 20 patients who were treated with radiation therapy (RT) following biopsy was 9 months. Pelvic control was poor in these patients, with 16/18 evaluable patients failing locally. Thirty-two patients who underwent resection with adjunctive RT had a 5-year survival of 48%. Local failure occurred in 40% of patients, whereas 38% of patients had abdominal failure. Isolated abdominal failure was infrequent with 6% failing as isolated recurrence, and 16% failing as the only site of distant disease. For 74 pathologic Stage III patients, 5-year survival was 54%. Local failure resulted in 20% of patients, and isolated abdominal failure occurred in 7% of patients. The subset of patients with ovarian or tubal involvement included 42 patients, with a 5-year survival of 60%. Further analysis of this subset by grade and depth of myometrial penetration was found to be prognostically significant. Twenty-four patients who were Stage III because of parametrial or pelvic peritoneal involvement had a 5-year survival of 44%. Local control and survival is improved in Stage III patients treated with surgical resection. The high rate of distant metastases in both abdominal and extra-abdominal sites has significant therapeutic implications.

Adult↗
PubMed1988

Single high dose-large field irradiation in drug resistant non-Hodgkin's lymphoma.

Single high dose-large field irradiation (SHD-LFI), also described as half-body irradiation (HBI), has previously been reported as an effective modality for the palliation of symptoms in a number of solid tumors. This report concerns the ability of SHD-LFI to produce palliation of symptoms and/or objective response in patients with drug resistant non-Hodgkin's lymphoma (NHL). From 1981 to 1984, 34 patients with advanced drug resistant NHL were treated with SHD-LFI either to the whole abdomen (24 patients) or to the upper half body (10 patients). Overall, 19 of 23 patients achieved symptomatic improvement, while objective response was noted in 23 of 30 patients. We noted subjective and objective response in all histologies, and duration of response was not significantly different. Our results suggest a beneficial role for the early and judicious use of SHD-LFI in NHL.

Dose-Response Relationship, Radiation↗
PubMedDate not supplied

Endometrial cancer.

Carcinoma of the uterine corpus (endometrial cancer) remains the gynecologic malignant disease with the highest annual prevalence in the United States. The most common histologic type is adenocarcinoma, although more aggressive variants (e.g., papillary serous carcinoma and clear cell carcinoma) have been identified. Risk factors that are strongly associated with the development of endometrial cancer include tamoxifen therapy, obesity, and stimulation from unopposed estrogen (from exogenous sources or endogenously secreting ovarian tumors). The current staging system of the International Federation of Gynecology and Obstetrics is based on surgical-pathologic findings. Survival has been directly correlated with tumor stage in this staging system. The cornerstone of therapy is total abdominal hysterectomy with bilateral salpingo-oophorectomy. Pelvic and para-aortic lymphadenectomy may provide additional prognostic information but probably does not confer a therapeutic advantage. Moreover, such nodal dissections predispose to the development of complications, especially in women who subsequently receive pelvic irradiation. Other than surgical treatment, irradiation is the single most active therapy for endometrial carcinoma. In fact, some women who are not candidates for hysterectomy because of medical contra-indications can be cured with radiation alone. Adjuvant therapy following hysterectomy is based on patient- and tumor-related features that provided prognostic information for incidence and pattern of recurrence. Adjuvant treatment usually includes pelvic irradiation for selected patients. Current investigational strategies are directed at the role of whole-abdomen irradiation, extended-field irradiation, and systemic chemotherapy. The most active systemic agents include cisplatin, doxorubicin, paclitaxel, and progestins.

Antineoplastic Agents↗
PubMedDate not supplied

Can positron emission tomography distinguish tumor recurrence from irradiation sequelae in patients treated for larynx cancer?

PURPOSE: Distinguishing persistent or recurrent tumor from post-radiation edema or soft-tissue/cartilage necrosis in patients treated for carcinoma of the larynx can be difficult. Because recurrent tumor is often submucosal, multiple deep biopsies may be necessary before a diagnosis can be established. Positron emission tomography with F-18 fluorodeoxyglucose was studied for its ability to aid in this problem. PATIENTS AND METHODS: FDG PET scans were performed on 31 patients who were suspected of having persistent or recurrent tumor after radiation treatment for carcinoma of the larynx. Patients underwent thorough history and physical examinations, scans with computed tomography (23 patients), and pathological evaluation when indicated. PET scans were interpreted by each of the two radiologists, who were blinded to patient outcome and the other's report. RESULTS: The time between completion of radiation treatment and positron emission tomography examination ranged from 2 to 61 months with a median of 6 months. Fifteen patients had pathological evidence of tumor in the larynx, while 16 have remained without evidence of disease. The overall sensitivity and specificity of the positron emission tomography interpretations were 80% and 81%, respectively. The sensitivity and specificity of the computed tomography scan interpretations were 58% and 100%, respectively. Of the 23 patients with computed tomography scans, eight patients acquired useful information from the positron emission tomography, three patients had incorrect positron emission tomography interpretations and correct computed tomography interpretations, and one patient had positive tumor despite a negative positron emission tomography and computed tomography. DISCUSSION: Positron emission tomography is useful in distinguishing benign from malignant changes in the larynx after radiation treatment. This noninvasive technique can supplement information provided by computed tomography scans. It is reasonable to delay biopsy, which could traumatize radiation-damaged tissues and precipitate necrosis, for those patients with negative positron emission tomography scans who have clinical signs and symptoms associated with recurrence.

Diagnosis, Differential↗