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Biomedical subjects

M L Griem

Publications and source records attributed to M L Griem.

At least 55 records · Page 3Linked to original sources
PubMed1977

Prognostic classification of Hodgkin disease in pathologic stage III, based on anatomic considerations.

Fifty-two patients with pathologic stage III Hodgkin disease were studied in an effort to determine whether location of involved abdominal nodes influenced survival. Treatment consisted of total nodal radiotherapy with or without subsequent combination chemotherapy. Th initial radiation field was the "extended mantle," which included supradiaphragmatic nodes, the splenic hilar area, and paraaortic nodes to the level of L2-L4. Subsequently, lower paraaortic and iliac regions were treated ("lower inverted Y"). Patients with disease limited to the spleen and/or splenic, celiac, or portal nodes ("anatomic substage" III1) had a more favorable 5-yr survival than did patients with involvement of paraaortic, iliac, or mesenteric nodes ("anatomic substage" III2): 93% versus 57%, respectively (p less than 0.05). The addition of combination chemotherapy to total nodal irradiation was associated with improved survival of patients in stage III2, but not of those in stage III1.

Hodgkin Disease↗
PubMed1976

The value of frequent treatment verification films in reducing localization error in the irradiation of complex fields.

Using treatment verification film to detect geometric miss or localization error (LE), a follow-up analysis of LE for patients treated with extended mantle fields was made for the period 1973-1974. There were 451 treatment verification films for 19 patients reviewed and 67 errors were detected for an error rate of 15%. This rate represented a continued decrease compared to the previous rate of 35% (330 errors for 902 films) during 1969-73. There was a continued reciprocal increase in number of films per patient per course of treatment which was thought, in part, to account for the improvement in technical precision. Reanalysis of localization error by site within the field showed a decrease in rate of error for the axillae from 1969-73 to 1973-1974 and a relative increase in rate of error for the upper abdominal nodes. The decrease in error rate for the axillae was ascribed to increased attention to leaving adequate margin between pulmonary shield and axilla and the increase in error rate for upper abdominal nodes was ascribed to inadequate margin between shield and spine. The relative increase in errors for the upper abdominal nodes correlated with the physicians who made the original decision about margin between spine and shield. Propagation of LE by site has been noted and can be prevented by monitoring treatment fields with verification film and correcting errors as they are noted.

Hodgkin Disease↗
PubMed1976

Results of involved field and extended field radiotherapy in patients with pathologic state I and II Hodgkin's disease.

A series of 44 previously untreated patients was found to have stage I or II Hodgkin's disease on the basis of a diagnostic workup which included laparotomy and splenectomy in 39 cases. The patients were randomized to either involved field or extended field radiotherapy. No difference was found in overall survival rates between the two groups. Regional recurrences were seen in four patients in the involved field group and in none of the extended field group. Regional recurrences were seen in four patients in the involved field group and in none of the extended field group. Radiotherapy to the extended field treatment port (generally an extended mantle) can be given with acceptable side effects. Staging laparotomy was of definite value, changing the classification and resulting therapy of two groups: (1) patients with clinical stage (CS) I or II, pathologic stage (PS) III involvement, who were treated with appropriately larger radiotherapy fields; and (2) patients with CS III, PS I or II, who were spared unnecessarily extensive radiotherapy.

Adolescent↗
PubMed1975

The effects of diagnostic X-ray exposure on the human fetus: an examination of the evidence.

Epidemiological studies have demonstrated an increased incidence of morbidity and mortality among children exposed prenatally or preconceptually to diagnostic x-rays, as compared to nonirradiated controls. In those studies radiation exposure occurred on a selective basis, as the examination was always medically indicated. Comparisons of those studies and comparable ones in which radiation exposure occurred on a nonselective basis (from routine pelvimetry examinations or atomic bomb radiation) indicate that the latter studies do not confirm the former and a significant discrepancy is present in each instance. Thus, some doubt is cast on the validity of the former studies.

Child↗
PubMed1975

Staging procedures in mycosis fungoides.

Mycosis fungoides (MF) in deep-seated lymph nodes, spleen or liver appears to be associated with a lack of response of the disease to topical external therapy. Fourteen patients with mycosis fungoides were clinically staged and had a staging laparotomy. Mycosis fungoides was found in the lymph nodes of 3 of these patients, in the spleen in 4 and in the liver in 2 cases. Patients with adenopathy, or with splenomegaly or abnormal spleen scans, should be considered for surgical staging to determine the extent of extracutaneous disease. The documentation of extracutaneous MF becomes necessary in the development of new therapeutic approaches.

Adenoids↗
PubMed1974

Extended mantle radiotherapy in Hodgkin's disease and malignant lymphoma.

The extended mantle field eliminates the necessity for splicing at the level of the diaphragm and thereby eliminates the potential for radiation-induced transverse myelitis. Our experience to date with 95 patients with H.D. or M.L. is described. Modifications in technique, including changes in the geometry of the field, shielding, time, dose, fractionation, and simulation are described. End results, an analysis of failures, and complications encountered are presented. Morbidity was acceptable despite the increase in integral dose, particularly in young patients who were not debilitated by disease. The danger of radiation-induced esophagitis, dehydration, hemoconcentration, and pulmonary embolism is stressed.

Blood Cell Count↗