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M I Saunders

Publications and source records attributed to M I Saunders.

At least 19 recordsLinked to original sources
PubMed1992

Tumor cell kinetics, local tumor control, and accelerated radiotherapy: a preliminary report.

The local tumor control achieved in patients treated in a pilot study of continuous, hyperfractionated, accelerated radiotherapy has been related to the tumor cell kinetics evaluated by in vivo administration of bromodeoxyuridine and flow cytometry. In 42 of 50 patients with advanced squamous cell carcinomas in the head and neck region it was possible to sample the primary tumor prior to treatment. In three further cases, involved regional nodes were studied: in the remaining five, tissue was obtained subsequently either from a local recurrence or from a distant metastasis. Successful cell kinetic measurements were made in 38 (90%) of the 42 primary tumors. The median values of the labelling index, the duration of the DNA synthetic phase and, thus, the potential doubling time for all primaries were 7.1%, 9.8 hr, and 3.9 days, respectively. Complete regression was achieved in 28 (74%) of the primary tumors and in 23 (61%) this was maintained to the time of observation for this report. There was no significant influence of any of the cell kinetic parameters upon the immediate or longer term local tumor control. This result is compatible with the overcoming of cellular repopulation by the acceleration of radiotherapy.

Aneuploidy↗
PubMed1992

The role of radiotherapy in carcinoma of the thoracic oesophagus: an audit of the Mount Vernon experience 1980-1989.

All 244 patients with carcinoma of the thoracic oesophagus registered at the Mount Vernon Centre for Cancer Treatment during the decade from 1 January 1980 to 31 December 1989 have been audited. We have made a detailed analysis of 110 (45%) with localized disease considered unsuitable for surgery, who completed treatment solely by radiotherapy. The median survival of this group of patients was 8.2 months (range 0.2-54 months). Dysphagia was improved by radiotherapy in 77.3% of cases, the median duration of relief was 24 weeks (range 0-208 weeks) and was maintained until death in 40%. Life table analysis showed that radical compared with less than radical regimens of radiotherapy gave significantly superior relief of dysphagia. This result is unlikely to be due to case selection.

Age Factors↗
PubMed1992

The problem of cigarette smoking in radiotherapy for cancer in the head and neck.

Smoking cigarettes during radiotherapy prolongs the period of reaction and may reduce the chance of cure. Of a group of 48 patients with advanced head and neck cancer 35 were smoking at the time of diagnosis, but 17 were persuaded to stop, although 7 relapsed later. Interviews conducted in 35 of the 48 patients revealed the problems which must be overcome if such patients are to cease smoking.

Adult↗
PubMed1992

Chest radiography or computed tomography in the assessment of lung cancer prior to radiography.

A series of 93 patients with lung cancer were considered for intensive radiotherapy, and investigated by chest radiography and computed tomographic (CT) scan. Spread of tumour was detected radiologically to lymph nodes, pleura or chest wall on 98 occasions. Of these, 16 were shown by both investigations, but in 82 the spread was revealed only by CT examination. Clear visualization of the tumour prior to radiotherapy is important to select those patients who would benefit from radical radiotherapy, to allow accurate treatment planning, and to allow, in subsequent follow-up, monitoring of the response to radiotherapy. In this study tumour was clearly visualized in 59 patients treated, but in 31 (53%) of these only by the use of computed tomography.

Aged↗
PubMed1992

Chest radiography or computed tomography to assess the response of lung cancer to radiotherapy.

In 58 patients with lung cancer the response of the primary tumour to treatment with CHART was followed by both chest radiograph and computed tomographic (CT) scan. Clear evidence of complete response was seen by chest radiograph in 11 patients and by CT scan in 20. If all studies showing no definite tumour, regardless of the quality of the study, were included then complete response was considered to have occurred in 25 as indicated by chest radiograph and in 22 by CT scan. The validity of the observations was tested by life table analysis comparing the survival of those showing complete regression with those whose response was incomplete. Comparison based on the CT scan findings showed the greatest significance (P = 0.0001), while that based on the chest radiograph findings showed the least (P = 0.044).

Aged↗
PubMed1992

A case of lung carcinoma induced by radioactive iodine given for disseminated thyroid carcinoma.

We report a case of a patient who at the age of 32 developed a squamous carcinoma arising in the thorax. At 7 years of age he had received aggressive treatment with 131I for a thyroid carcinoma with multiple pulmonary metastases. Radiation induced malignancy, in sites such as the bone marrow or bladder, after 131I therapy is recognized; however, tumours arising in the thorax after such treatment have not been described.

Adult↗
PubMed1992

Tumour proliferation assessed by combined histological and flow cytometric analysis: implications for therapy in squamous cell carcinoma in the head and neck.

The two techniques of flow cytometry analysis (FCM) and immunohistochemical localisation of bromodeoxyuridine (BrdUrd) incorporation after in vivo administration, were combined to study proliferation in squamous cell carcinoma of the head and neck region. Care was taken in this study to ensure that similar material was processed using both techniques such that comparisons could be made. FCM underestimated the labelling index (LI) in tumours classified as diploid compared to the histological evaluation of the tumour cells within those tumours (4.6% vs 17.1%). However, in aneuploid tumours, the FCM LI (10.7%) was similar to that obtained from histology (13.5%). Indeed, proliferation assessed by the combination of histology LI and FCM duration of S-phase (Ts) indicated that diploid tumours had a shorter median potential doubling time (Tpot) of 2.1 days compared to aneuploid (2.8 days). Despite the heterogeneity of proliferation evident histologically within the specimens, there was not a wide variation in the results of FCM analysis when multiple samples from resections were studied. Using FCM data alone, 46% of the tumours showed a Tpot of less than 5 days. When the Ts from the FCM data was combined with the average histological LI, 84% were less than 5 days and with the maximum LI, 99% were within this time interval. Compared with previous estimates, the proportion of tumours possessing proliferative characteristics which may indicate the need for acceleration of treatment seems to be much larger.

Aneuploidy↗
PubMed1991

A comparison of the late radiation changes after three schedules of radiotherapy.

The late radiation change observed in 15 patients treated for carcinoma of oral cavity or oropharynx using continuous hyperfractionated accelerated radiotherapy (CHART) was compared to that seen in 15 similar patients treated with conventional radiotherapy. The average follow up was, 31 and 33 months, respectively. A new dictionary for the recording of radiation morbidity, developed in our centre, was employed and proved highly satisfactory in the recording of the changes observed in these patients and also in a third group treated by a combination of chemotherapy and hypofractionated radiotherapy in hyperbaric oxygen. The dictionary was able to record all the morbidity clinically seen with these three treatment schemes. The late changes observed in skin and mucosa with CHART were similar to those observed with conventional radiotherapy, but hair regrowth was observed in six out of 10 men treated with CHART compared with persistent, partial or complete hair loss in all nine men treated with the conventional scheme; after CHART there was also a trend towards less taste impairment and less severe dryness of mouth.

Adult↗
PubMed1991

The morbidity of salvage surgery following conventional radiotherapy and continuous, hyperfractionated accelerated radiotherapy (CHART).

A comparison was made of the morbidity of surgery for loco-regional recurrence in patients with advanced cancer of the head and neck region following continuous hyperfractionated accelerated radiotherapy (CHART), after conventional radiotherapy, and also in a group following surgery only as the primary treatment. Post-surgical morbidity occurred in 14 (77%) of the 18 patients treated with CHART, of whom 11 (78%) required a further surgical procedure. In the conventional group, morbidity occurred in 14 (58%) of the 24 patients, of whom 9 (64%) required further surgery. Finally, in the surgical group morbidity occurred in 13 (48%) of the 27 patients, of whom 7 (54%) required further surgery. Because of the many factors that may influence the chance of morbidity and of the small number of cases, considered statistical analysis is not meaningful and there must be caution in the interpretation of results. When allowance is made for the greater frequency of more advanced tumors and for sites in the oropharynx and oral cavity, where procedures associated with greater risk of complication were performed, the morbidity seen after surgery was performed upon CHART patients appeared to be no greater than when conventional radiotherapy had been given. As expected, the surgery only group showed less morbidity than either of the radiotherapy groups.

Adult↗
PubMed1991

Experience with CHART.

Continuous, hyperfractionated, accelerated radiotherapy (CHART) has been used at the Mount Vernon Cancer Treatment Center since January 1985. Patients with head and neck tumors and those with locally advanced non-oat cell carcinoma of the bronchus have formed the large majority of the 263 patients treated. Early reactions in the mucosae of the mouth and pharynx have been pronounced, but all have healed, while those in the skin have been less severe than with conventional radiotherapy. An unexpected late morbidity was radiation myelitis in four patients, but in other tissues including the skin, mucosae, the connective tissues, and the salivary glands, late changes appear reduced compared to those after conventional radiotherapy. In 92 patients with squamous cell carcinoma of the major sites in the head and neck region, of whom 71 were in Stages T3 and T4, a complete regression at the primary site and nodes was achieved in 90%. This can be compared with 62% in similar patients previously treated with curative intent at Mount Vernon between 1980 and 1985; the difference was maintained in follow-up (p = 0.003). Of 76 assessable patients with non-oat cell carcinoma of the bronchus, a complete radiological response has been achieved in 40%, compared to 12% in a retrospective group; again the difference has been maintained in follow up (p = 0.0001). A 1-year survival of 60% can be compared to 40% in the retrospective group and a 2-year survival of 29% compared to 12% (p = 0.01). With a reduction of permitted dose to the spinal cord, CHART gives promise for improvement in tumor control and a reduction in late morbidity. These promising results have led to multi-center randomized controlled clinical trials in carcinoma at the head and neck and in non-oat cell carcinoma of the bronchus. In these studies, CHART is being compared with conventional fractionated radiotherapy.

Aged↗
PubMed1991

Is control of the primary tumour worthwhile in non-oat cell carcinoma of the bronchus?

In the United Kingdom most patients with locally advanced non-small cell lung cancer are given treatment with palliative intent only, even when there is a good performance status and an absence of evidence for distant metastasis. It has, however, been shown that after radical radiotherapy prolonged survival can result, but only when complete regression of tumour is achieved. Research has, therefore, been directed toward an increase in primary tumour control. In pilot studies a combination of chemotherapy and radiotherapy has given improvement in tumour clearance and survival. Another approach has been to use a short intensive course of radiotherapy in which three treatments are given each day for 12 consecutive days--Continuous, Hyperfractionated, Accelerated Radiotherapy (CHART); an increase in local tumour control and survival has been shown in a comparison with the results achieved in previous cases. CHART and the combination of chemotherapy and radiotherapy are both the subject of multicentre randomized controlled trials in the United Kingdom. Patients with locally advanced non-small cell carcinoma of the bronchus should be considered for entry into these studies.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Lung function and radiation response.

This study investigated whether impaired respiratory function affected the response to radiotherapy. A prospective study was performed in which lung function, arterial oxygen and haemoglobin concentration were examined, before treatment with radical radiotherapy, in 141 patients with advanced non-small cell lung cancer and head and neck cancer. The findings were considered to reflect the physiological conditions present at the time of radiotherapy and these were related to acute normal tissue reactions and tumour control. Although 53% of the patients showed some impairment of lung function and 47% demonstrated a haemoglobin oxygen saturation below the normal range, oxygen partial pressure was below expected levels in fewer patients (27%) and total arterial oxygen content was below normal in only 12% of patients. No correlation was found between the tests performed and the severity of acute morbidity or with local tumour control. In the patients with carcinoma of the bronchus, there was a trend for incomplete tumour control to be associated with a lower haemoglobin level, but this did not reach statistical significance. In patients selected for curative radiotherapy, lung function would not appear to be an important factor influencing the response of normal tissues or tumour to irradiation.

Adult↗
PubMed1990

Continuous, hyperfractionated, accelerated radiotherapy (CHART) in non-small cell carcinoma of the bronchus.

Between January 1985 and December 1988, 62 patients with locally advanced carcinoma of the bronchus were treated by radiotherapy using continuous, hyperfractionated, accelerated radiotherapy (CHART). With this regime on each of 12 consecutive days 3 fractions were given with a time interval of 6 hr between each. Initially a dose fraction of 1.4 Gy was used and a total of 50.4 Gy was achieved in 23 patients. As tolerance was good, the dose increment was raised to 1.5 Gy and the total to 54 Gy in the subsequent 39 patients. Esophagitis was the only immediate complication, and although most patients were reduced to a fluid diet for a period, recovery was complete and only one patient required endo-esophageal tube feeding for a short time. The results observed so far have been assessed against those in a previous trial of a radiosensitizer in cases similarly accepted for treatment. Complete regression, as observed radiologically, was achieved by 42%; this can be compared with 15% of the previously treated series. At 1 year the survival probability was 64% compared with a previous 44% and at 2 years 34% compared with a previous 12%. A randomized controlled clinical trial is now planned.

Carcinoma, Bronchogenic↗
PubMed1990

The rationale for continuous, hyperfractionated, accelerated radiotherapy (CHART).

Continuous, hyperfractionated, accelerated radiotherapy (CHART) was devised to give the maximum chance of improving clinical radiotherapy and was based upon available radiobiological evidence. A pilot study, begun in 1985, has now included 210 patients. When comparison is made with previously treated cases, improved results have been seen in the two main groups included, that is, advanced head and neck and bronchial carcinomas. Multi-center randomized controlled clinical trials are planned.

Humans↗
PubMed1990

An audit of head and neck cancer treatment in a Regional Centre for Radiotherapy and Oncology.

All patients with head and neck cancer attending the Regional Centre for Radiotherapy and Oncology at Mount Vernon hospital during the 8-year period from 1 January 1980 to 31 December 1987 have been included in this review. The 545 patients presenting a new primary carcinoma without evidence for metastasis outside the locoregional area, who were treated primarily by radiotherapy are the subject of this present audit. The characteristics of the patients, of the tumours and of the treatment given have been related to outcome. Early tumours (T1 and T2 which were node-negative) showed a complete response (CR) rate of 94% whereas more advanced tumours (T1 and T2 with palpable lymph nodes) showed a CR of 59%. The probability of local tumour control at 5 years was 77% in those without nodes and 20% in those with nodes. For more advanced disease (T3 and T4 tumours), initial CR was 72% in node-negative disease and 32% when the nodes were positive. At 5 years, the probability of local tumour control fell to 37% and 0 respectively. CR, freedom from recurrence and survival were statistically significantly related to T stage, N stage and site of primary tumour. The results compare favourably with those reported by other institutions. The development of medical audit and its influence on treatment policy are considered.

Adolescent↗
PubMed1990

Smoking and mucosal reactions to radiotherapy.

The pattern of cigarette smoking of 41 patients receiving continuous, hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer was examined to determine any relationship with the duration of mucositis. The uniformity of the treatment given made it possible to perform an analysis of the factors influencing the duration of the mucositis. There was no correlation with age, sex or weight loss prior to treatment. A highly significant correlation was shown with smoking during and/or after treatment (p = 0.014) and with the volume of mucosa irradiated (p = 0.025). Both appeared to act independently. It is important to encourage patients to cease smoking totally, prior to radiotherapy, to minimize the duration of mucositis associated with radiotherapy.

Adolescent↗
PubMed1989

Continuous, hyperfractionated, accelerated radiotherapy (CHART): an interim report upon late morbidity.

Continuous, hyperfractionated, accelerated radiotherapy (CHART) has given high levels of tumour control in advanced head and neck and bronchial carcinomas. In general, late changes have appeared less than after conventional radiotherapy but despite a prediction of reduced risk of spinal cord damage, two cases of radiation myelitis have presented. The possible causes are considered and a reduction in permitted spinal cord dose has been made.

Aged↗