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Biomedical subjects

L M Fuller

Publications and source records attributed to L M Fuller.

At least 73 records · Page 4Linked to original sources
PubMed1985

A comparative analysis of lymphomas involving Waldeyer's ring and the nasal cavity and paranasal sinuses.

The two major extranodal sites for malignant lymphoma of the head and neck are Waldeyer's ring and the nasal cavity and paranasal sinuses. The clinical manifestations, treatment, and survival results are presented for 137 patients with primary lymphoma of Waldeyer's ring and 38 patients with primary lymphoma of the nasal cavity and paranasal sinuses. The similarities of and differences between the two sites are discussed and compared to their more common counterparts the carcinomas. The results of this study indicate that the TNMAJCC method of staging Ann Arbor stage IE and IIE non-Hodgkin's lymphoma is a reliable prognostic indicator for these sites and should be considered when determining treatment.

Adult↗
PubMed1984

Stages IE and IIE non-Hodgkin's lymphomas of the stomach. Comparison of treatment modalities.

Seventy-nine patients with Stages IE and IIE non-Hodgkin's lymphomas of the stomach were treated between 1953 and 1980. The histopathologic classification was as follows: diffuse large cell, 61 (of which 23 were immunoblastic sarcomas [plasmacytoid]); diffuse well-differentiated lymphocytic, 6; diffuse mixed, 1; undifferentiated non-Burkitt's, 1; nodular, 9; and unclassifiable, 1. Thirty-five patients had Stage IE disease and 44 had Stage IIE. Treatment modalities included surgery, radiotherapy, chemotherapy, and combinations thereof. Sixty-six patients had a laparotomy for diagnosis and/or management. Of these, only 42 had a gastrectomy. The stomach was considered to be unresectable in the other 24 patients. There were 5 postoperative deaths among 31 patients who had a laparotomy or gastrectomy at our institution. The overall 5-year actuarial survival was 56%; the disease-free survival was 54%. For patients with Stage IE disease the survival was 76%, and for those with Stage IIE, 42%. Promising results were obtained in 13 patients who were treated on a multimodality program consisting of four cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus bleomycin (Bleo), which was alternated with involved field radiotherapy. All 13 patients had no evidence of disease as of this report. Only one patient had a relapse (Waldeyer's ring), and he was salvaged with radiotherapy. Six of these 13 were diagnosed by endoscopic biopsy and did not have a laparotomy, 3 were found to have unresectable disease at laparotomy, and 4 had a resection. Biopsy with the flexible fiberscope and treatment with CHOP-Bleo and radiotherapy can avoid the morbidity and mortality of gastrectomy.

Adult↗
PubMed1984

Combined modality therapy in Stage III and Stage IIIE diffuse large cell lymphomas.

Combined modality therapy consisting of CHOP-Bleo (cyclophosphamide, Adriamycin [doxorubicin], vincristine (Oncovin), prednisone, and bleomycin) and limited-field radiotherapy was given to 47 patients with Stage III and IIIE diffuse large cell lymphomas. Overall 5-year survival and disease-free survival figures are 64% and 53%, respectively. Twenty-nine patients achieved and maintained a complete remission during treatment; 92% of these patients are alive at 5 years, and 87% are disease-free. Prognostic factors were assessed for the entire group. Age, "B" symptoms, extranodal involvement, and extensive abdominal involvement had little effect on survival. However, the presence of mediastinal involvement and extensive abdominal involvement was associated with a poor response rate and survival.

Abdominal Neoplasms↗
PubMed1984

Non-Hodgkin's lymphoma of the tonsil. A clinicopathologic study of 65 cases.

Sixty-five patients presenting to M. D. Anderson Hospital and Tumor Institute with Stages IE and IIE primary tonsillar lymphoma between 1954 and 1981 were reviewed. All cases were non-Hodgkin's lymphomas, with the majority being diffuse large cell lymphoma (85%). Initial therapy was radiotherapy alone in 54 patients, radiotherapy combined with chemotherapy in 8 patients, and chemotherapy alone in 3 patients. Stage was the most important prognostic factor, with 86% and 41% 5-year survivals for Stages IE and IIE, respectively (P = 0.006). Lymphangiography was crucial in staging patients with clinically positive cervical lymph nodes because 94% of clinically staged IIE patients developed recurrent disease, in comparison with only 50% of lymphangiogram-staged IIE patients. The incidence of large cell lymphoma was so high as to preclude analysis of survival by histologic type. From this limited series, radiotherapy alone would appear to be sufficient initial therapy for Stage IE patients, whereas Stage IIE patients probably benefit from the addition of prophylactic chemotherapy. Relapses were most common in nonirradiated lymph-node-bearing areas, with the majority presenting in the first 2 years following initial therapy. The salvage of relapsing patients has been disappointing, with the best hope residing in combination chemotherapy.

Adolescent↗
PubMed1984

Stages I and II non-Hodgkin's lymphomas of Waldeyer's ring and the neck.

In a previous communication we reported our results for patients with localized extranodal presentations of non-Hodgkin's lymphomas of the head and neck who were admitted between 1961-1969. This review describes our larger experience from 1947-1982 in treating 137 Stages I and II Waldeyer's ring patients whose slides were available for reclassification according to the modified Rappaport System. All of these patients were treated definitively as follows: radiotherapy only, 113 patients; radiotherapy and combination chemotherapy, 17 patients; chemotherapy only, seven patients. The overall 5-year survival was 50%. Significant differences were determined for specific subgroups. For patients staged after lymphangiography, the 5-year survival was 67% as compared with 32% for non-lymphangiogram staged patients (p = 0.002). Stage (Ann Arbor) also influenced results. The 5-year survival figure for Stage I was 70% as compared with 42% for Stage II (p = 0.002). The combination of extent of disease in Waldeyer's ring and the status of the neck had a major impact on survival. When the disease was staged according to the TNMAJCC System, the 5-year survivals were: 75% for T1-T2-TX N0; 53% for T1-T2-TX N+; 54% for T3-T4 N0; and 36% for T3-T4 N+. Also, results for tonsil (52%) and base of tongue (66%) disease were better than for disease involving the nasopharynx (39%) or multiple sites (25%). Treatment also influenced survivals and disease-free survivals. The best results were obtained in patients who were treated with radiotherapy and combination chemotherapy. The 5-year survival and disease-free survival figures were 78% and 69%, respectively.

Antineoplastic Agents↗
PubMed1984

Clinical features and results of management of superior vena cava syndrome secondary to lymphoma.

Thirty-six of 915 patients with non-Hodgkin's lymphoma presented with superior vena cava syndrome (SVCS). The histologic types associated with SVCS were diffuse large cell in 23 patients, lymphoblastic in 12, and follicular large cell in one patient. Radiotherapy alone appeared equal to chemotherapy alone or in combination with radiotherapy in achieving relief of SVCS symptoms. Chemotherapy alone or in combination with radiotherapy was superior to radiotherapy alone in prolonging relapse-free survival and overall survival. No differences in relapse-free survival and survival were found between the patients treated with chemotherapy alone and those treated with chemotherapy and radiotherapy, but the addition of radiotherapy appeared to prevent local relapses in the group with large-cell lymphoma. The presence of symptoms of involvement of other mediastinal structures such as dysphagia, hoarseness, or stridor (DHS), a higher grade of intensity, and a shorter duration of symptoms (less than or equal to 2 weeks) appeared to adversely influence relapse-free survival and survival. The following conclusions were made: (1) a histologic diagnosis before the onset of treatment is desirable and feasible in patients presenting with SVCS except in those with severe respiratory distress, (2) both chemotherapy and radiotherapy are equally effective in alleviating the symptoms of SVCS, and (3) combined modality treatment with chemotherapy and radiotherapy results in a lower frequency of local relapses compared to chemotherapy alone but survival was similar in both groups.

Combined Modality Therapy↗
PubMed1984

Recovery of spermatogenesis after treatment for Hodgkin's disease: limiting dose of MOPP chemotherapy.

The sperm production of 25 patients with Hodgkin's disease treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy was studied retrospectively. All but two patients also received radiotherapy treatment to pelvic and/or non-pelvic fields. Sperm counts were obtained from patients treated either with three or fewer (MOPP-2 group) or with five or more (MOPP-6 group) chemotherapy cycles. Recovery of spermatogenesis following treatment-induced azoospermia was significantly higher among the MOPP-2 patients (Mann-Whitney rank sum test, p = 0.001). Patients in this group who did not receive pelvic irradiation appeared to have greater recovery rates (p = 0.06). The results suggest that three cycles of MOPP chemotherapy represent a maximum exposure compatible with the recovery of spermatogenesis.

Adolescent↗
PubMed1984

Follicular large cell lymphoma: analysis and prognostic factors in 62 patients.

Sixty-two patients with follicular large cell lymphoma were treated between 1973 and 1981. The overall median survival was 78 months with a five-year survival of 62%. The complete remission rate was 76%, with a median relapse-free interval of 72 months for responders. Complete remission produced a significantly longer survival than partial response and failure. Patients who tolerated therapy with an intensive doxorubicin-containing regimen had a significantly longer relapse-free interval and survival. Patients with stage I-II disease treated with radiation therapy alone had a higher relapse rate than those treated with radiation and combination chemotherapy. The addition of radiation therapy to combination chemotherapy in stage III-IV disease decreased the incidence of relapse at irradiated sites, but did not translate into improved survival. Pretreatment prognostic factors associated with poor response were thrombocytosis and stage III-IV disease; those associated with shortened survival were thrombocytosis, elevated lactic dehydrogenase level, stage III-IV disease, and bulky abdominal disease. Follicular large cell lymphoma is an aggressive lymphoma. Treatment should be curative in intent, and should include intensive combination chemotherapy even in stage I-II disease. Knowledge of important prognostic factors can be useful for analysis of future trials and planning therapeutic strategies.

Adult↗
PubMed1984

Calcium status following neck radiation therapy in Hodgkin's disease.

Substantial evidence links the development of primary hyperparathyroidism with a medical history of neck radiation therapy for benign disease. This report concerns 220 patients with Hodgkin's disease seen at The University of Texas M. D. Anderson Hospital, Houston, treated with neck irradiation. Serum calcium levels had been analyzed two to 22 years after radiotherapy. Hyperparathyroidism was confirmed at surgery in one patient with hypercalcemia 15 years after radiotherapy. However, the maximum follow-up was 22 years and in a reported series the mean interval between irradiation and the development of hyperparathyroidism has ranged from 29 to 47 years. We conclude that patients who have received neck radiation therapy for malignant disease are not at an increased risk for the development of hyperparathyroidism in the first two decades following treatment but should continue to be screened for this development in subsequent decades.

Adult↗
PubMed1984

Complications related to 234 staging laparotomies performed in the Intergroup Hodgkin's Disease in Childhood study.

This is a study of 234 children and young adult patients entered in the Intergroup Hodgkin's Disease in Childhood (stage I-II) Study from November 1975 to June 1981 and followed for a mean of 3.8 years after laparotomy. All patients had a staging laparotomy with total splenectomy, liver biopsy, and sampling of abdominal lymph node groups. Four patients (1.7%) have had documented sepsis, and three have had possible sepsis. There has been no sepsis-related death. Intestinal obstruction requiring operation was noted in four patients (no intestinal resection required). Urgent operation was necessary in two patients, one with ureteral obstruction and one with ovarian torsion, following a repositioning procedure, neither of these patients died. Organisms in the four patients with positive blood cultures were Streptococcus pneumoniae (two) and Haemophilus influenzae (two). Of the 234 patients in the study, 194 (83%) had received polyvalent pneumococcal vaccine, and 174 (74%) were taking prophylactic antibiotics. One of the two patients with pneumococcal sepsis had not been vaccinated, and the second was vaccinated only during radiotherapy. Only one of the four patients with positive blood cultures was on a prophylactic antibiotic treatment regimen at the time of the septic episode. The liabilities in employing laparotomy-splenectomy for the evaluation of pediatric patients with Hodgkin's disease include both general surgical complications and an increase in the risk of hyperacute infection, specifically related to encapsulated species. The latter appears to be modified to a major degree by current prophylactic measures or therapy.

Adolescent↗
PubMed1983

Diagnosis and management of Hodgkin's disease in the adult.

Appropriate management of Hodgkin's disease is based on both the stage of disease and the specific anatomic sites of involvement within each stage. As a result of the combination of sequential staging and effective treatment, histopathologic subclassification has become less important. Although not generally appreciated, this is also true for constitutional symptoms. During the past 15 years, differences in survival between early and advanced stages have diminished progressively with refinements both in management of newly diagnosed patients, and in management of relapsing disease. Currently, our five-year survival figure for laparotomy-Staged I and II patients is 95%. The corresponding result for Stages IIIA and IIIB patients is 85%; and 67% of our Stage IV patients, who were treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) are projected to be surviving at five years. With the anticipation of a high probability for cure, quality of life including the possibility for parenthood has become increasingly important. In the past, the trend has been to increase treatment for patients with poor prognostic factors. However, very little attention has been paid to the possibility of administering less treatment for very precisely staged patients with good prognostic factors. In this review, management is discussed by stage. Emphasis is placed on the indications for less treatment as well as for more intensive therapy in adult patients with Hodgkin's disease.

Antineoplastic Agents↗
PubMed1983

Stage III nodular lymphomas. Preliminary results of a combined chemotherapy/radiotherapy program.

Since 1975, all histologic subtypes of Stage III and IIIE nodular lymphoma patients were treated with a combination of radiotherapy and multiple-agent chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-Bleo). Fifty-eight patients were treated through 1979. Treatment consisted of two cycles of CHOP-Bleo alternating with sequential radiotherapy to clinically involved regions, and further CHOP-Bleo to a total of ten cycles. Radiotherapy doses ranged between 3000 and 4000 rad delivered in three to four weeks. Forty-six patients completed treatment. In the other 12 patients, treatment was interrupted because of progressive disease in seven, and myelosuppression in five. Overall five-year survival and disease-free survival results were 82% and 47%, respectively. Survival for those patients who completed therapy was 93%. By histopathology, survivals for all patients were: poorly differentiated lymphocytic, 100%; mixed cell, 80%; and histiocytic, 39%. Disease-free figures for all 58 patients were: poorly differentiated lymphocytic, 44%; mixed cell, 65%; and histiocytic, 35%. The extent of abdominal disease influenced five-year survival as follows: 100% for those who had only occult disease at staging laparotomy; 88% for those who were Stage III on the basis of a positive lymphangiogram; and 50% for those who had a palpable mass or required an exploratory laparotomy for symptoms. Five of seven patients with progression during protocol therapy have died. No patients died as a result of myelosuppression. A number of patients developed complications during treatment, none of which were fatal. Eight patients developed herpes zoster, four patients developed transient radiation hepatitis, and four patients had miscellaneous complications.

Age Factors↗
PubMed1982

Treatment of patients with stages I and II nonmediastinal Hodgkin's disease.

In this study, 95 patients with laparotomy-staged I and II nonmediastinal Hodgkin's disease were treated with involved fields (41 patients), mantle (17), extended fields (26), or involved fields followed by 6 cycles of MOPP (11). Eighty-five patients had upper torso presentations. Seventy had Stage I disease and 25 had stage II. Pathologic findings were nodular sclerosing, 33; mixed cellularity, 41; lymphocyte predominance, 20; and unclassified, one. Five-year overall survivals were excellent regardless of stage, pathologic findings, or treatment: 98% for involved fields or mantle, and 100% for both extended fields and involved fields followed by 6 cycles of MOPP. Corresponding disease-free survivals were 77%, 82%, and 86%, respectively. For patients with upper torso presentations, disease-free figures for the mantle (94%) were better than those for involved fields alone (67%). In addition, regression analysis proved involved fields to be a prognostic factor for a lower disease-free survival. No difference between extended fields or mantle radiotherapy could be detected using this model. Relapses usually occurred in nonirradiated upper torso sites. Only three of the 36 patients treated with involved fields and one of 21 treated with extended fields relapsed in the abdomen alone. Most patients in relapse were salvaged. Rescue treatment was most often radiotherapy and adjuvant combination chemotherapy. Based on this study, the use of mantle radiotherapy is recommended in treating laparotomy-staged I and II patients with nonmediastinal presentations, and the use of extended fields or adjuvant chemotherapy as primary prevention is not recommended.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1982

The roles of staging laparotomy, chemotherapy, and radiotherapy in the management of localized diffuse large cell lymphoma: a study of 75 patients.

A retrospective study of 75 laparotomy-studied Stage I and II patients with diffuse large cell (histiocytic) lymphoma was conducted to determine the relative contributions of laparotomy, radiotherapy, and combination chemotherapy to their management. The treatment programs were radiotherapy alone, radiotherapy followed by adjuvant chemotherapy, and alternating chemotherapy-radiotherapy. Treatment selection was based on disease presentation, with limited therapy used for favorable patterns and intensive therapy used in prognostically unfavorable settings. Disease-free survival was best in those treated with initial chemotherapy, even though these patients comprised the least favorable prognostic group. A select subset of patients, those with extranodal head and neck disease, obtained good results with radiotherapy alone, but for other presentations this was not a successful approach. Differences in results for the three treatment programs are discussed in relation to future treatment decisions.

Abdominal Neoplasms↗
PubMed1982

EOE-13 in the detection of hepatosplenic lymphoma.

Thirty-nine patients with lymphoma were evaluated prospectively to determine the usefulness of Ethiodol-Oil-Emulsion-13 (EOE-13) in the detection of hepatosplenic lymphoma by computed tomography. The detection rate in the spleen increased from 8% (before EOE-13 infusion) to 92% (after EOE-13 infusion). In ten of 39 patients (25%) in this series, lymphomatous disease was recognized only on the postinfusion computed tomographic scan. The postinfusion EOE-13 study demonstrated additional visceral abnormalities in 38% of the patients. The potential usefulness, limitations, and toxicity of this hepatosplenic-specific imaging agent are discussed.

Ethiodized Oil↗
PubMed1982

Importance of initial mediastinal adenopathy in Hodgkin disease.

The importance of initial mediastinal disease was studied retrospectively in 189 patients with stages I, II, and III Hodgkin disease treated at the M. D. Anderson Hospital and Tumor Institute between 1969 and 1976. Stages I and II patients with mediastinal disease at presentation had an 88% 5 year survival rate compared with a 98% survival rate for those without mediastinal disease. Disease-free survival was 66% versus 78%. Stage III patients with and without initial mediastinal disease showed essentially the same 5 year survival rate (75% versus 78%), but showed a lower disease-free survival of 60% in those with mediastinal disease as compared with 74% in those without mediastinal disease. Because of the prognostic importance of mediastinal disease and its extent at initial presentation, computed tomography is recommended to evaluate patients with low neck or supraclavicular adenopathy in whom there is no obvious mediastinal adenopathy and in all Hodgkin disease patients in whom there is questionable mediastinal disease or suggestion of lung extension on routine radiographs. Treatment plans have been altered to include chemotherapy and low-dose irradiation to the lungs in those patients with mediastinal mass diameters of 7.5 cm or greater, regardless of stage.

Adolescent↗
PubMed1982

Intergroup Hodgkin's disease in children study of stages I and II: a preliminary report.

The intergroup study of involved-field (IF) radiotherapy, IF radiotherapy plus MOPP chemotherapy, and extended-field (EF) radiotherapy for treatment of Hodgkin's disease in children has assessed 305 patients. Of these, 279 were "not ineligible" (no mediate cause for disqualification). Among 223 randomized patients, 144 were evaluable, 131 had documentation of complete or partial remission, 20 of the remitters relapsed, and two died. Among 62 nonrandomized patients with favorable presentations (unilateral upper neck, unilateral inguinal, or massive mediastinal disease), 29 had documented remission, two relapsed, and none died. Length of initial disease control (LIDC) was used to measure duration of response. LIDC was best in patients given IF plus MOPP, and 95% are disease free. EF was better than IF radiotherapy (P = 0.004). Of the disease characteristics prognostic for response (stage, histologic subtype, and presence of symptoms), only the last factor had a statistically significant effect on LIDC (P = 0.004). Ninety-six percent of the patients survive. Using criteria developed by the committee, 23% of the staging procedures reviewed were nonevaluable and 28% of the radiotherapy treatments were nonevaluable. The necessity for criteria for evaluation of staging and treatment is certain. Length of followup is too short for correlations of treatment with significant late effects and for relevant therapeutic recommendations.

Antineoplastic Agents↗