Search PubMed⌕ Search

Biomedical subjects

M Roach

Publications and source records attributed to M Roach.

At least 91 records · Page 5Linked to original sources
PubMed1996

A pilot survey of sexual function and quality of life following 3D conformal radiotherapy for clinically localized prostate cancer.

PURPOSE: To assess the impact of high dose three-dimensional conformal radiotherapy (3D CRT) for prostate cancer on the sexual function-related quality of life of patients and their partners. METHODS AND MATERIALS: Sixty of 124 consecutive patients (median age 72.3 years) treated with 3D CRT for localized prostate cancer were surveyed and reported being potent prior to treatment. The answers to survey questions assessing the impact of quality of life related to sexual function from these 60 patients and their partners forms the basis for this retrospective analysis. RESULTS: Following 3D CRT, 37 of 60 patients (62%) retained sexual function sufficient for intercourse. Intercourse at least once per month was reduced from 71 to 40%, whereas intercourse less than once per year increased from 12 to 35%. Following treatment, 25% of patients reported that the change in sexual dysfunction negatively affected their relationship or resulted in poor self-esteem. This outcome was associated with impotence following treatment (p < 0.01). Patients who had partners and satisfactory sexual function appeared to be at a higher risk of having a negatively affected relationship or losing self-esteem if they become impotent (p < 0.05). Partners of patients who reported a negatively affected relationship or loss of self-esteem appear to be less likely to return the survey instrument used (p = 0.02). CONCLUSIONS: More work is needed to evaluate the impact of radiotherapy and other treatments on the quality of life of patients and their partners to allow adequate informed consent to be given.

Adenocarcinoma↗
PubMed1996

Prostate volumes defined by magnetic resonance imaging and computerized tomographic scans for three-dimensional conformal radiotherapy.

PURPOSE: To compare the prostate volumes defined on magnetic resonance imaging (MRI), and noncontrast computerized tomographic (CT) scans used for three-dimensional (3D) treatment planning. METHODS AND MATERIALS: Ten patients were simulated for treatment using immobilization and a retrograde urethrogram. 3D images were used to compare prostate volumes defined by MRI (4-6 mm thick slices) and CT images (5 mm thick slices). Prostate volumes were calculated in cm(3) using the Scanditronix 3D planning system. MRI/CT images were merged using bony anatomy to define the regions of discrepancy in prostate volumes. RESULTS: The mean prostate volume was 32% larger (range-5-63%) when defined by noncontrast CT compared to MRI. The areas of nonagreement tended to occur in four distinct regions of discrepancy: (a) the posterior portion of the prostate, (b) the posterior-inferior-apical portion of the prostate, (c) the apex due to disagreement between a urethrogram based definition and the location defined by MRI, (d) regions corresponding to the neurovascular bundle. CONCLUSION: There is a tendency to overestimate the prostate volume by noncontrast CT compared to MRI. Awareness of this tendency should allow us to be to more accurately define the prostate during 3-D treatment planning.

Humans↗
PubMed1996

The "critical volume tolerance method" for estimating the limits of dose escalation during three-dimensional conformal radiotherapy for prostate cancer.

PURPOSE: To describe the "Critical Volume Tolerance" (CVT) method for defining normal tissue tolerance during 3D-based dose escalation studies for prostate cancer. METHODS AND MATERIALS: The CVT method predicts the tolerance to radiation for "in series"-type functional units based on the assumption that tolerance depends on a critical threshold "low-volume high-dose region." The data used for describing this model were generated from 3D analysis of randomly selected patients with prostate cancer. Commonly used coplanar four-and six-field conformal (SFC) techniques were chosen as the comparison techniques. For purposes of comparison, rectal tolerance was assumed to be reached following whole pelvic irradiation using a four-field box technique to 50 Gy, followed by a conedown boost to 70 Gy using bilateral 9 x 9 cm 120 degree arcs as popularized by investigators from Stanford University (SUH). RESULTS: Based on the average dose volume histograms for the patients studied, the maximum safe increase in dose for the SFC technique compared to the SUH technique, would be 10% if 30% of the rectal volume was the critical dose limiting volume (CVT = 30%), 5% if the CVT = 10%, or greater than 20% if the CVT = 40%. Commonly used four-field conformal techniques would not be expected to allow significant escalation of the dose without increasing the risk of complications. CONCLUSIONS: The CVT method is relatively simple, and data generated based on it can be used to support normal tissue complication probability equations. The CVT method can be verified or modified as partial tolerance data become available. Based on the CVT model, sophisticated treatment techniques should allow a modest increase in the total dose of radiation delivered to the prostate without an increase in late complications.

Dose-Response Relationship, Radiation↗
PubMed1996

Flutamide-induced liver toxicity including fatal hepatic necrosis.

PURPOSE: To describe hepatic injuries in three patients who received flutamide prior to and during radiation treatment to make radiation oncologists aware of the need for careful monitoring of liver function during use of this drug. METHODS AND MATERIALS: The records of three patients who developed abnormal liver function tests while undergoing total androgen suppression (TAS), as well as the literature concerning flutamide toxicity were reviewed and summarized. RESULTS: Three of 34 patients treated with a TAS regimen incorporating flutamide developed significant hepatic abnormalities: elevated transaminases [2] and fatal hepatic necrosis [1]. Following the discontinuation of flutamide, two patients recovered fully. Unfortunately, the third patient's hepatic function continued to deteriorate, which culminated in his death. Transient elevations in serum transaminases, which do not exceed four times the upper limits of normal, are common and apparently without clinical significance. Unfortunately, idiosyncratic serious and/or fatal liver damage can occur. Significant liver toxicity may be obviated by monitoring of liver function tests (LFT) early in the course of flutamide therapy. CONCLUSION: The incidence of hepatic toxicity associated with flutamide may be higher than previously suggested. To prevent the development of serious hepatic dysfunction, all patients receiving flutamide should be monitored clinically for signs and symptoms referable to hepatic injury and with serial LFT. We recommend baseline LFT followed by serial LFT at weeks 2, 4, 6, and 8 from the start of treatment with flutamide. Flutamide should be stopped promptly if significant liver abnormalities are detected.

Adenocarcinoma↗
PubMed1996

Multimodality therapy in stage III non-small cell lung cancer.

BACKGROUND: Non-small cell lung cancer commonly presents as locally advanced disease. This category of tumors is heterogeneous. Although some patients clearly benefit from operative management alone, the vast majority (more than 90%) will succumb to their disease within 5 years. In the past decade a large clinical research effort has been undertaken in an attempt to improve on this outcome using a combination of chemotherapy, radiotherapy, and operation. METHODS: The English-language literature was reviewed using the headings for lung neoplasms and text words combined modality therapy and multimodality therapy. In addition, the bibliographies of relevant articles were reviewed. Emphasis was placed on prospective randomized trials and large phase II studies. We review the rationale, design, and outcome of these trials, including both operative and nonoperative approaches. RESULTS: Several prospective, randomized trials now demonstrate an advantage to combined modality management over radiotherapy or operation alone when a cisplatin-based chemotherapy regimen is incorporated into the treatment plan. This advantage was seen using both operative and nonoperative approaches. CONCLUSIONS: Combined modality therapy offers an improved outcome for patients with stage III non-small cell lung cancer. Whether both operation and radiotherapy are needed for local control, the best sequence of treatment and the optimal chemotherapy regimen remain to be defined.

Carcinoma, Non-Small-Cell Lung↗
PubMed1996

The impact of isocenter placement errors associated with dose distributions used in irradiating prostate cancer.

Historically, four perpendicular treatment fields or bilateral arcs have been used in the treatment of prostate cancer. "New techniques" including four conformal fields, seven conformal fields, 120 degrees bilateral conformal coplanar, and non-coplanar arc'ed beam arrangements, are replacing the "older" approaches. These techniques result in a reduction in doses to adjacent critical structures while covering the clinical target volume (CTV). This study, analyzes the impact of random or systematic isocenter displacement errors (IDE) associated with the delivery of radiotherapy, using the best of these "newer techniques". Dose Volume Histograms (DVH) were used to evaluate the dose to the prostate and surrounding normal tissues with 0.3 cm, 0.5 cm and 0.8 cm IDE. It was determined that IDE associated with fixed coplanar treatment techniques could reduced the prescribed dose to the prostate by 0-8%, the coplanar are technique reduced the prescribed prostate dose by 3-10%, and the noncoplanar conformal arc technique could lower the prescribed prostate dose by 0-5%. Predictably, 0.3 cm IDE found in the posterior and inferior direction increase the dose to the rectum by 5-12% and lowered the dose to the bladder by 4-8%. Errors in the superior and anterior direction increased the dose to the bladder by 4-8% and decreased the dose to the rectum by 8-10%. Errors in the right to left direction slightly increased the dose to the ipsilateral femoral head. Doses to the rectum and bladder associated with 0.5 cm and 0.8 cm IDE are significantly larger. The frequency and magnitude of IDE must be accounted for before higher doses can be delivered safety. Recognizing the impact of IDE on our ability to deliver the prescribed dose to the planning target volumes (PTV) could incorporate the impact of IDE during the planning process.

Femur Head↗
PubMed1996

Three dimensional comparison of blocked arcs vs. four and six field conformal treatment of the prostate.

PURPOSE: The purpose of this study is to compare five different techniques for treatment the prostate without seminal vesicles. Dose volume histograms and a time survey are the tools that were used for this analysis. METHODS AND MATERIALS: For this study we compared 3D techniques using four and six field conformal treatments, to open and blocked 8 x 8 cm2 120 degrees bilateral arcs. All the plans were normalized to deliver 100% to the central axis, and full 3D calculations were performed. Blocked arcs were created using the 'average beam's eye view' (A-BEV) technique. RESULTS: Analysis of the dose volume histograms revealed: (1) Arcs with blocks result in an improved dose distribution compared to standard arcs and four field 3DCRT techniques, (2) The DVH associated with blocked arcs, using block margins of 1.3 cm, resulted in a somewhat lower dose to the rectum but a 'tighter' margin around the prostate compared to the DVH generated using the six field 3DCRT technique. CONCLUSION: This technique is for treatment of the prostate only, when treatment of the seminal vesicle is not required. The use of blocked arcs significantly improved the dose distribution compared to using standard arcs and 4-field conformal techniques. The DVHs associated with using blocked arcs is comparable to the SFC technique. It is likely to be less expensive, faster to set-up and may allow for safe dose escalation when only the prostate is receiving treatment.

Humans↗
PubMed1996

Neoadjuvant total androgen suppression and radiotherapy in the management of locally advanced prostate cancer.

The combination of radiation therapy and total androgen suppression shows potential for improving the outcome in patients with locally advanced prostate cancer. Both radiation and androgen ablation induce apoptosis through different mechanisms, and a synergistic interaction has been reported between the two modalities in vitro. Studies of neoadjuvant hormonal therapy before radical prostatectomy have shown considerable tumor shrinkage, a change that would greatly facilitate subsequent radiotherapy. A recent randomized trial involving patients with bulky disease has shown that the use of androgen ablation therapy before and during radiation therapy substantially improved local control and decreased the time to biochemical failure. Still another randomized trial performed in patients with locally advanced disease has shown that the positive biopsy rate was strikingly lower in patients who received neoadjuvant hormonal therapy before radiation than in those who underwent radiotherapy alone, and was even lower in patients who were treated with both neoadjuvant and adjuvant total androgen suppression. The combination of hormonal therapy and radiation has not yet been proven to prolong survival. Nevertheless, given the limitations of conventional radiotherapy, it is recommended that patients at high risk for failure be entered into one of the ongoing Radiation Therapy Oncology Group (RTOG) trials. These trials are attempting to clarify such questions as the role of adjuvant therapy following neoadjuvant therapy and radiation, the optimal timing of hormonal therapy, and the role of whole pelvic irradiation.

Androgen Antagonists↗
PubMed1996

Radiotherapy for high grade clinically localized adenocarcinoma of the prostate.

PURPOSE: We defined the efficacy of radiotherapy for the treatment of high grade (Gleason scores 8 to 10) adenocarcinoma of the prostate. MATERIALS AND METHODS: A total of 50 patients underwent radiotherapy with curative intent for clinically localized prostate cancer with Gleason scores of 8 to 10 at 1 of 4 facilities affiliated with the University of California San Francisco. Patients were considered to have biochemical failure if they had a significant increase in prostate specific antigen (PSA) of 0.5 ng./ml. per year, an increase in PSA to greater than 1.0 ng./ml. or a positive biopsy. RESULTS: Among the 50 patients median PSA was 22.7 ng./ml. (range 1.3 to 93.4). Tumors were clinical stage T1 or T2 in 46% of the cases and stage T3 or T4 in 54%. The overall actuarial probability of freedom from biochemical failure at 4 years was 23%. In a multivariate analysis including all patients pretreatment PSA was the only predictor of PSA failure, with 64% free of progression if the pretreatment PSA was 10 ng./ml. or less compared to only 16% at 3 years if PSA was more than 10 ng./ml. (p = 0.01). In a multivariate analysis restricted to patients with PSA less than 20 ng./ml. 83% of those treated to more than 71 Gy. were free of progression compared to 0% for those treated to less than 71 Gy. (p = 0.03). In a multivariate analysis PSA 10 ng./ml. or less (related risk 11.4, p = 0.02), T stage 1 or 2 (relative risk 3.8, p = 0.05) and radiation dose more than 71 Gy. (relative risk 4.0, p = 0.06) were associated with a favorable outcome. CONCLUSIONS: At 4 years the freedom from PSA failure following radiotherapy for high grade prostate cancer was comparable to previously reported surgical series. The high failure rate among patients with PSA greater than 20 ng./ml. suggests that these patients should be considered for investigational approaches. The apparent improvement in freedom from progression with the use of higher doses provides reason for optimism.

Actuarial Analysis↗
PubMed1996

The role of PSA in the radiotherapy of prostate cancer.

Pretreatment prostate-specific antigen (PSA) level is the single most important prognostic factor for patients undergoing radiotherapy for clinically localized prostate cancer. When combined with Gleason score and T-stage, pretreatment PSA enhances our ability to accurately predict pathologic stage. Patients with pretreatment PSA levels > 10 ng/mL are at high risk for biochemical failure when treated with conventional radiation alone. A PSA nadir of > 1 ng/mL and a post-treatment PSA > 1.5 ng/mL are associated with a high risk of biochemical failure. Postoperative radiotherapy delivered while the tumor burden is low (eg, PSA < 1 ng/mL) predicts a favorable outcome. Many of these conclusions about the usefulness of pretreatment PSA are based on the assumption that PSA can be used as a surrogate end point for disease-free and overall survival from prostate cancer. However, this assumption still remains to be validated by phase III trials.

Antineoplastic Agents, Hormonal↗
PubMed1996

Modified pubovaginal sling for treatment of intrinsic sphincteric deficiency.

PURPOSE: We report on 63 women undergoing modified pubovaginal fiscal sling construction for treatment of intrinsic sphincteric deficiency. We specifically evaluated duration of postoperative urinary retention, persistence of urinary incontinence and incidence of detrusor instability. MATERIALS AND METHODS: Preoperative questionnaires, fluoro-urodynamic studies, hospital and clinical records, and postoperative questionnaires were reviewed to assess comparative outcome among the patients. Failed procedures were studied with fluoro-urodynamics. Patient follow up ranged from 3 to 27 months (mean 11.7). RESULTS: Of the 63 patients 2 (3.2%) remained in long-term urinary retention, 4 (6.3%) had persistent stress incontinence and 3 (4.8%) had long-term detrusor instability. Two patients (3.2%) required reoperation for relief of persistent urinary retention (1) and for repair of anteriorly disrupted suspensory sutures (1). Review of preoperative fluoro-urodynamic studies did not provide insight into patients who would experience the aforementioned outcomes. CONCLUSIONS: Our study confirmed the success of the modified pubovaginal fascial sling for treatment of intrinsic sphincteric deficiency. We were unable to obtain useful preoperative information from fluoro-urodynamic studies to predict which patients would experience failure to return to normal voiding.

Adult↗
PubMed1995

Potency following high-dose three-dimensional conformal radiotherapy and the impact of prior major urologic surgical procedures in patients treated for prostate cancer.

PURPOSE: To assess the impact of high-dose three-dimensional conformal radiotherapy (3DCRT) on potency in patients treated for clinically localized prostate cancer and to identify factors that might predict the outcome of sexual function following treatment. METHODS AND MATERIALS: One hundred twenty-four consecutive patients treated with 3DCRT for localized prostate cancer at UCSF between 1991-1993 were included in this retrospective analysis. Patient responses were obtained from a mailed questionnaire, telephone interviews, or departmental records. Medial follow-up was 21 months. RESULTS: Sixty patients reported having sexual function prior to 3DCRT, including 47 who were fully potent and 13 who were marginally potent. Of the remaining 64 patients, 45 were impotent, 7 were on hormones, 1 was status-postorchiectomy, and 11 were not evaluable. Following 3DCRT, 37 of 60 patients (62%) retained sexual function sufficient for intercourse. Of those with sexual function before irradiation, 33 of 47 (70%) of patients fully potent and 4 of 13 (31%) of patients marginally potent maintained function sufficient for intercourse (p < 0.01). Potency was retained in 6 of 15 (40%) patients with a history of a major urologic surgical procedure (MUSP) and in 31 of 45 (69%) with no history of a MUSP (p < 0.04). Transurethral resection of the prostate was the MUSP in eight of these patients, with four (50%) maintaining sexual function. CONCLUSIONS: Patients who receive definitive 3DCRT for localized prostate cancer appear to maintain potency similar to patients treated with conventional radiotherapy. However, patients who are marginally potent at presentation or who have a history of a MUSP appear to be at increased risk of impotence following 3DCRT.

Aged↗
PubMed1995

The value of nonuniform margins for six-field conformal irradiation of localized prostate cancer.

PURPOSE: Evaluate the hypothesis that by combining nonuniform margins with a technique for limiting the possible extent of posterior motion of the prostate during the delivery of six-field conformal radiotherapy (SFCRT) of the prostate, it is possible to adequately treat the clinical target volume (CTV) and minimize dose to normal structures. METHODS AND MATERIALS: Serial computed tomography (CT) scans of prostate patients were taken at 0.5 cm intervals for treatment planning purposes. The initial treatment planning scans were performed with the rectum empty and the bladder full. Subsequent scans were taken at the end of the first week of treatment with the bladder full, but with no attempt to empty the rectum, to mimic the typical treatment situation. The gross tumor volume (GTV), consisting of the prostate and seminal vesicles, as well as the CTV, were defined on the CT images with the aid of a urethrogram to define the inferior border (apex) of the prostate. Variable blocking margins were designed around the CTV using the University of Michigan three dimensional (3D) treatment planning system (UM-PLAN). Isodose distributions displayed on axial, sagittal, coronal, and oblique slices were used to evaluate the adequacy of the various margins applied. Nonuniform margins varying from 0.75 cm posteriorly to 2.0 cm anteriorly and inferiorly were compared to uniform margins of 1.0, 1.5, and 2.0 cm for each patient. Dose volume histograms (DVH) were used to compare doses to the GTV, CTV, rectum, and bladder. RESULTS: In a series of 10 patients scanned with the above protocol, treatment plans with nonuniform margins were compared with uniform margins of 1.0, 1.5, and 2.0 cm. Dose-volume histograms showed that nonuniform and 1.0 cm uniform margins deliver the lowest doses to the rectum and bladder, but the use of 1.0 cm uniform margins resulted in inadequate coverage of the CTV in 40% of the cases. The 1.5 and 2.0 cm uniform margins adequately covered the CTV but resulted in significantly higher doses to the bladder and rectum. CONCLUSIONS: The use of nonuniform margins, when combined with CT scans performed with the rectum empty and bladder full, can improve tumor control probability while minimizing the risk of morbidity to adjacent critical structures.

Humans↗
PubMed1995

3D conformal radiotherapy in the sagittal plane for centrally located thoracic tumors.

One hundred patients, recently treated at the University of California, San Francisco (UCSF) with radiotherapy for lung and esophageal cancer, were studied. Three subsets of these patients were defined based on tumor location to test how commonly the use of three-dimensional (3D) conformal radiotherapy (3DCRT) could improve significantly the delivery of high dosages. Comparisons were made between isodose distributions and dose volume histograms (DVHs) of patients' prior computed tomography (CT)-based treatment plans and newly generated 3D-based treatment plans. The use of beam angles outside the conventional horizontal plane did not significantly improve the dose distribution for patients if a peripheral mass was the target volume. Patients with a target volume involving the central thorax represented a subset (> 40% of the patients) who would have benefited the most from the use of nonconventional beam angles. In these patients, sagittal coplanar beams (sagittal Y technique) reduced the dose to 30% of the lung volume from 30% to 5%. Doses to the spinal cord and heart were slightly higher than with conventional techniques but were within the tolerance of normal tissues. The sagittal Y technique allows an escalation in total dose to the tumor without increasing dose to normal tissues beyond their tolerance.

Esophageal Neoplasms↗
PubMed1995

Radiation pneumonitis following combined modality therapy for lung cancer: analysis of prognostic factors.

PURPOSE: To identify factors associated with radiation pneumonitis (RP) resulting from combined modality therapy (CMT) for lung cancer. MATERIALS AND METHODS: Series published before 1994 that used CMT for the treatment of lung cancer and explicitly reported the incidence of RP are the basis for this analysis. Factors evaluated included the radiation dose per fraction (Fx), total radiation dose, fractionation scheme (split v continuous), type of chemotherapy and intended dose-intensity, overall treatment time, histology (small-cell lung cancer [SCLC] v non-small-cell lung cancer [NSCLC]), and treatment schedule (concurrent v induction, sequential, or alternating CMT). RESULTS: Twenty-four series, including 27 treatment groups and 1,911 assessable patients, met our criteria for inclusion in this analysis. The median total dose of radiation used in the trials analyzed was 50 Gy (range, 25 to 63 Gy). The median daily Fx used was 2.0 Gy (range, 1.5 to 4.0 Gy). Nineteen series included 22 treatment groups and 1,745 patients treated with single daily fractions. Among these patients, 136 received a daily Fx greater than 2.67 Gy. Five series used twice-daily radiotherapy and included 166 patients (Fx, 1.5 to 1.7 Gy). The incidence of RP was 7.8%. In a multivariate analysis, only daily Fx, number of daily fractions, and total dose were associated with the risk of RP (P < .0001, P < .018, and P < .003, respectively). CONCLUSION: In this analysis, the use of Fx greater than 2.67 Gy was the most significant factor associated with an increased risk of RP. High total dose also appears to be associated with an increased risk, but twice-daily irradiation seems to reduce the risk expected if the same total daily dose is given as a single fraction. High-Fx radiotherapy should be avoided in patients who receive CMT with curative intent.

Antineoplastic Combined Chemotherapy Protocols↗