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Biomedical subjects

M J Peckham

Publications and source records attributed to M J Peckham.

At least 37 records · Page 2Linked to original sources
PubMed1987

Surveillance following orchidectomy for stage I testicular cancer.

Surveillance following orchidectomy was introduced in the management of Stage I testicular nonseminoma in 1979 and Stage I seminoma in 1983. Of 132 nonseminoma patients followed for 12-84 months (median 43 months) the relapse rate is 27%. Relapses were diagnosed 2-44 months after orchidectomy with 90% of relapses appearing within the first year. Of the 132 patients, 131 are alive and disease-free. The pattern of relapse was as follows: 47% of relapses occurred in abdominal nodes, 13% in abdominal nodes and lung, 17% in the lung and 23% with elevated serum markers as the only evidence of disease; 26% of relapsing patients had normal serum AFP and hCG levels. The prognostic significance of thirteen clinical histopathological and biochemical factors has been analysed by multiple regression analysis. Histology and lymphatic invasion within the primary tumour are significant independent prognostic factors. A total of thirty-six patients had scrotal interference prior to removal of the primary tumour. This was not a contra-indication to surveillance. None has developed scrotal recurrence and the overall relapse rate (11%) is comparable to that observed in the surveillance series as a whole. Fifty-two patients with Stage I seminoma have been observed from 12-41 months after orchidectomy. Seven (13%) have relapsed and six of the seven relapses have been confined to retroperitoneal lymph nodes. Preliminary data suggests that pre-orchidectomy elevation of serum hCG is not a significant prognostic factor.

Carcinoma in Situ↗
PubMed1987

Surveillance after orchiectomy for stage I seminoma of the testis.

Between February 1983 and July 1985, 52 patients with Clinical Stage I seminoma were observed after orchiectomy without lymph node irradiation. Seven patients (13%) have relapsed, six in retroperitoneal lymph nodes and one with abdominal node and pulmonary metastases. Relapses were diagnosed 6 to 23 months after orchiectomy, four occurring in the first year and three in the second year. Of eight patients with raised serum concentrations of HCG prior to orchiectomy none has relapsed, whereas of 14 patients with normal HCG levels one has relapsed. The significance of these observations for future management policy is discussed.

Chorionic Gonadotropin↗
PubMed1987

Prognosis following chemotherapy for metastatic malignant teratoma.

A multiple regression analysis was performed of factors affecting the prognosis of 93 patients with metastatic malignant teratoma treated at the Royal Marsden Hospital between 1979 and 1981. In a subgroup of 53 patients, where exact tumour bulk could be calculated from sequential CT scan slices, a correlation was seen between tumour marker level and volume of metastatic disease. On analysis of the risk of relapse after initial chemotherapy, the independent adverse influence was detected of serum AFP greater than 500 micrograms/l and of bulky disease defined by clinical staging. An adverse influence of high serum HCG levels was not seen, probably due to the small number of patients in this series with this presenting feature.

Adult↗
PubMed1987

Treatment of favorable-prognosis nonseminomatous testicular germ cell tumors with etoposide, cisplatin, and reduced dose of bleomycin.

We have explored a dose reduction of bleomycin in combination with etoposide and cisplatin in the treatment of a good-prognosis subgroup of patients with nonseminomatous germ cell tumors. Twenty-two patients were treated with etoposide, cisplatin, and low-dose bleomycin. All patients achieved complete remission, but four relapsed. Three patients achieved long-term remission after salvage therapy. The disease-free survival rate of 82% (18 of 22 patients) at a median follow-up of 24 months (range, 17-33) was significantly worse compared to the 99% disease-free survival rate in 91 patients receiving full-dose bleomycin, etoposide, and cisplatin. These results are similar to a previously reported 82% disease-free survival rate of 17 patients treated with etoposide and cisplatin alone. The combined results of the 82% disease-free survival rate in the total group of 39 patients treated with etoposide and cisplatin and etoposide, cisplatin, and low-dose bleomycin suggest that the reduced bleomycin regimens in their present schedule constitute inadequate therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Medical options in the management of stages 1 and 2 (N0-N3, M0) testicular germ cell tumors.

Retroperitoneal lymph-node dissection or radiotherapy have long been known to provide equivalent survival for early stage I and stage II nonseminomatous germ-cell tumors. Review of the results from intensive radiological and biochemical surveillance with salvage chemotherapy for stage I tumors demonstrates that the long-term survival rate is equivalent to that achievable by conventional treatment (i.e., 98 per cent survival at 4 years). As relapses have continued to occur in the third and fourth years at the rate of 4 per cent annually, and 4 years is the limit of follow-up, further follow-up is required to be sure of the long-term picture. Prognostic factor analysis demonstrates that venous and lymphatic invasion, the absence of yolk sac differentiation, and the presence of undifferentiated cells are independently important in predicting the frequency of relapse. Using these factors, it was possible to define low-risk groups with relapse rates less than that seen after lymph-node dissection and high-risk groups with 58 per cent frequency of relapse who probably are suitable for adjuvant chemotherapy studies. Review of the results from the use of surveillance in stage I seminoma demonstrated no advantages over prophylactic radiotherapy. However, late toxicity is being demonstrated after radiotherapy and evidence is emerging that the less toxic cisplatinum analogue carboplatin may be as good as radiotherapy for metastatic disease. This offers for the first time a viable alternative to radiotherapy for consideration in the adjuvant setting in stage I seminoma.

Combined Modality Therapy↗
PubMed1986

Effect of age at orchidopexy on risk of testicular cancer.

69 (9.5%) of 724 patients with testicular cancer first seen at the Royal Marsden Hospital over the 10-year period 1975 to 1984 had a history of cryptorchidism. 11 patients had an uncorrected undescended testis when their testicular cancer was diagnosed, and 58 had had an orchidopexy or an orchidectomy for undescended testis. There are no general population data with which to compare the 15.9% (11/69) of testicular cancer patients with uncorrected cryptorchidism. However, the distribution of age at orchidopexy (or orchidectomy) of the 58 patients treated for undescended testis was almost identical to that expected on the basis of national rates. The age at treatment of undescended testis appears to have no effect on the risk of testicular cancer.

Adolescent↗
PubMed1986

Clinical presentation as a predictor of laparotomy findings in supradiaphragmatic stage I and II Hodgkin's disease.

Clinical presenting features, sex and histology have been correlated with laparotomy findings in 225 patients with clinical Stage I and II supradiaphragmatic Hodgkin's disease seen at The Royal Marsden Hospital between 1970 and 1979. Age, sex, and in Stage I disease, size and position of involved nodes were independent predictors of positive laparotomy. On the basis of these observations low risk (less than 15% positive laparotomy), high risk (greater than 50%) and intermediate risk categories can be defined. The observations form the basis of a policy employing laparotomy on a selective basis.

Adult↗
PubMed1986

Radiotherapy for stage I seminoma testis: results of treatment and complications.

The results of treatment by infradiaphragmatic lymph node irradiation and orchiectomy in 232 patients with Stage I testicular seminoma seen between 1963 and 1983 are reported. Of this group, only five (2%) patients relapsed and none died from seminoma. Contralateral testicular tumours occurred in 12 patients and five developed second non-testicular malignancies. The acute and late morbidity of radiotherapy was low although 15 patients developed peptic ulceration. There was a significant association between prior abdominal surgery and a history of dyspepsia with ensuing peptic ulceration. Future management policy is discussed on the basis of these observations.

Adult↗
PubMed1986

An analysis of prognostic factors in early stage Hodgkin's disease.

An analysis of prognostic factors has been carried out in 398 patients presenting with clinical Stage I and II Hodgkin's disease treated between 1963 and 1979. By life table analysis older age, lymphocyte depletion histology, systemic symptoms, mediastinal node bulk, and erythrocyte sedimentation rate (ESR) greater than 40 mm/h were associated with a significantly worse survival probability. On multiple factor regression analysis only age and stage were independent prognostic variables for survival, with systemic symptoms having borderline significance. Using this information, together with other analyses of prognosis in early Hodgkin's disease three groups of patients are defined. The first with a predicted 5-year survival of 78% would include patients possessing at least one of the following features; age greater than 60, lymphocyte depletion, greater than 3 sites involved, systemic symptoms, mediastinal/thoracic ratio of greater than 1/3. The second groups present with at least two of the following factors; ESR greater than 40 mm/h, male sex, 3 involved sites, or mixed cellularity histology, and the 5 year survival probability is 84%. The remaining Stage I and II patients would constitute a good prognosis group with a predicted 5-year survival of 92%.

Actuarial Analysis↗
PubMed1986

Results of radiotherapy for stage II testicular seminoma.

Of 53 patients with Stage II seminoma treated with radiotherapy between 1970 and 1984, 9 (17%) relapsed, 5 (9%) died of testicular cancer and 1 (2%) died of intercurrent disease. Relapse rates for IIA, IIB and IIC were 11, 18 and 28% respectively. Supradiaphragmatic irradiation was not advantageous; of 22 patients receiving infradiaphragmatic irradiation, 3 (14%) relapsed, compared with 6/31 (19%) of those who had supra- and infradiaphragmatic irradiation. Despite the radioresponsiveness of seminoma, 50% of IIC patients had residual masses 4 months after radiotherapy and 20% at one year, however, this finding did not predict eventual outcome. Serum human chorionic gonadotrophin (HCG) levels were raised prior to radiotherapy in 3/26 (11.5%) Stage IIA and IIB patients and 3/10 (30%) IIC patients. However, this did not influence the outcome of radiotherapy since only 0/6 patients with raised HCG levels relapsed compared with 7/30 (23%) of those with normal levels. Analysis of the pattern of relapse together with the fact that 2/6 patients who had the extent of tumour defined at laparotomy and/or who had total abdominal irradiation relapsed, suggests that further refinement of radiotherapy is unlikely to improve the results of treatment for IIC patients and that chemotherapy should be considered the treatment of choice.

Dysgerminoma↗
PubMed1986

The significance of scrotal interference in stage I testicular cancer managed by orchiectomy and surveillance.

Of 210 patients with clinical Stage I testicular tumours managed by orchiectomy and surveillance, 36 had scrotal interference at or prior to removal of their primary tumour. None developed inguinoscrotal relapse during a mean observation period of 37 months. The overall relapse rate of 4/36 (11%) compared favourably with that of the surveillance series as a whole (18%).

Follow-Up Studies↗
PubMed1986

Prognostic factors in stage I non-seminomatous germ-cell testicular tumors managed by orchiectomy and surveillance: implications for adjuvant chemotherapy.

Between February 1979 and March 1985, 126 patients with clinical stage I non-seminomatous germ-cell testicular tumors were entered into a surveillance study after orchiectomy. Of this group, 36 (28%) have relapsed. The prognostic significance of 13 clinical, histopathologic, and biochemical factors has been analyzed. Vascular invasion and lymphatic invasion (LI) within the primary tumor, histology, and involvement of the epididymis and rete testis were significantly associated with an increased risk of relapse. However, multiple regression analysis showed that only histology and LI were significant, independent prognostic factors. These findings provide the basis for the consideration of adjuvant chemotherapy for patients with apparent clinical stage I testicular non-seminoma who are at high risk of harboring occult metastases.

Adult↗
PubMed1986

Lhermitte's sign as a complication of cisplatin-containing chemotherapy for testicular cancer.

Lhermitte's sign is reported in 14 patients receiving chemotherapy for metastatic testicular cancer. In six patients the typical symptoms appeared during chemotherapy: in five patients within 1 month of treatment and in one patient at 2 months. The duration of symptoms ranged from 2 to approximately 8 months. No patient had received radiotherapy to the cervical or dorsal spinal cord. The complication is ascribed to cisplatin, the only drug common to all 14 patients.

Antineoplastic Combined Chemotherapy Protocols↗