Outpatient chemotherapy for breast cancer.
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Administration, Oral↗
Biomedical subjects
M Roach
Publications and source records attributed to M Roach.
Current status of androgen suppression and radiotherapy for patients with prostate cancer.
Analogous to the impact of anti-estrogen therapy in breast cancer, anti-androgen therapy may have a greater impact on the castrate male with non-metastatic disease. The use of castration or a LHRH drug alone, does not appear to adequately suppress intra-prostatic DHT (Dihydrotestosterone) levels. Normal prostate elements appear to be more efficient than metastatic elements at converting DHT precursors to active DHT. Thus, blocking this step may be more critical for clinically localized disease. Laverdiere et al. reported a 2 year positive (+) biopsy rate of 65% with XRT alone compared to 28% when 3 months of NHT preceded radiotherapy, but 5% if NHT was continued for a total of 10.5 months of combined androgen blockade (CAB). Bolla et al. incorporated one month of NHT prior to XRT followed by 3 years of an LHRH drug. An improvement in local control, disease free survival and overall survival of nearly 20% was noted at 5 years. Thus far, these important studies demonstrate that a survival benefit may require long term adjuvant hormonal therapy. There is a need for further studies to define the optimal timing and duration of CAB and the role of XRT. Long term data recently provided by the Radiation Therapy Oncology Group (RTOG) may provide insights into criteria for defining which patients are likely to benefit the most from long term CAB.
Androgen Antagonists↗
Three-dimensional conformal external beam radiotherapy or brachytherapy: which is the "best alternative" to radical prostatectomy?
The choice of treatment for clinically organ-confined prostate cancer is complicated by the fact that there are no studies demonstrating the clear superiority of one option. As a radiation oncologist who performs both external beam radiotherapy and brachytherapy, Dr. Roach provides a fascinating and balanced perspective on how he views the selection process, as well as how he approaches a decision.
Brachytherapy↗
Using Riehl's model in midwifery.
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Consumer Behavior↗
Race and survival from breast cancer: based on Cancer and Leukemia Group B trial 8541.
PURPOSE: The purpose of this research was to evaluate the prognostic significance of race and survival in stage II breast cancer among women treated with adjuvant chemotherapy in the Cancer and Leukemia Group B (CALGB) trial 8541. MATERIALS AND METHODS: A total of 1572 patients with node-positive breast cancer were entered in CALGB trial 8541. This study opened in January 1985 and randomized patients to receive "high-dose," "standard-dose," or "low-dose" adjuvant CAF (cyclophosphamide, doxorubicin, and fluorouracil) chemotherapy. Patients were stratified according to treatment of the primary lesion (mastectomy or breast conservation), menopausal status, number of positive lymph nodes, and estrogen-receptor status. Twelve percent of the patients entered in this study were African-American, 84% were white, and 4% were of other racial backgrounds. RESULTS: African-Americans and whites were evenly distributed on all three arms. In a univariate analysis, African-Americans were more likely to have a reduced survival and shorter time to relapse than other patients. Race was moderately associated with tumor size, receptor status, and type of surgery. In a multivariate analysis, after adjusting for the dose of chemotherapy, number of lymph nodes, estrogen-receptor status, and age, race was no longer of prognostic significance. DISCUSSION: After adjustment for other well-recognized prognostic factors, race appears to have no independent prognostic significance for survival from stage II breast cancer among women receiving adjuvant CAF chemotherapy.
Black People↗
Local control after the use of adjuvant electron beam intraoperative radiotherapy in patients with high-risk head and neck cancer: the UCSF experience.
PURPOSE: We assess the effect of electron beam intraoperative radiotherapy (EB-IORT) on local-regional control and any associated complications in patients with locally advanced or recurrent head and neck cancer. MATERIALS AND METHODS: The records of 30 patients with head and neck cancer who received EB-IORT from March 1991 to December 1994 were retrospectively reviewed. The indications for EB-IORT in 25 patients were recurrent or persistent disease despite previous treatment with full-course external-beam radiotherapy and/or one or more resections. In five other cases the indication was extensive primary disease with multiple high-risk factors for local recurrence, including extension into the base of the skull, advanced extensive disease, and perineural or bony invasion. All patients had a Karnofsky performance score > or = 70 prior to EB-IORT. Median age was 65 years. Final pathology revealed positive or close surgical margins in all patients. The areas treated were generally inaccessible to catheter placement for brachytherapy. The most common histology was squamous cell carcinoma. EB-IORT was given as a single fraction of 1500 cGy to the 90% isodose with 6 or 9 Mev electrons using cone sizes ranging from 2.5 to 7 cm in diameter. Data were analyzed to determine the local-regional control rate, survival, and complications after EB-IORT. RESULTS: With a median follow-up time of 30 months, nine patients (27%) had only local recurrence. Of these, only one recurrence was inside the EB-IORT field and eight were outside the EB-IORT field. Two patients (7%) developed distant metastases only and one patient (3%) had both local recurrence and distant metastasis. Seven patients died, five with disease. Twenty-two patients are known to be alive, 15 (68%) of whom have no evidence of disease. One patient was lost to follow-up after 12 months; when last examined he was free of disease. Five patients (16%) have had mild-to-moderate transient complications probably related to EB-IORT. The 3-year actuarial local-regional control rate was 60%. CONCLUSIONS: Our data suggest that EB-IORT may play an important role in decreasing local recurrence in patients with multiple high-risk factors. Despite previous full-course external beam radiotherapy and extensive resections, EB-IORT did not confer significant additional long-term morbidity. Although results are encouraging, randomized studies are required to definitively establish the role of EB-IORT in the management of advanced or recurrent head and neck cancer.
Adenocarcinoma↗
Nurses manage recombinant interleukin-2 side effects in elderly patients with leukemia.
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Aged↗
Candidates for prostate radioactive seed implantation treated by external beam radiotherapy.
PURPOSE: We report the prostate-specific antigen-based freedom from biochemical failure after conventional and three-dimensional conformal external beam radiotherapy for patients who would have been candidates for 125I implantation monotherapy. MATERIALS AND METHODS: Patients included in the study were required to have prostate-specific antigen values < or = 20, T stage < or = 2b, and Gleason score sum of 2 to 6. All patients underwent external beam irradiation with curative intent and a minimum follow-up from completion of treatment of at least 1 year. In addition, all patients had to have pretreatment and follow-up prostate-specific antigen measurements and no history of hormonal manipulation, orchiectomy, or radical prostatectomy. A total of 187 patients meeting these criteria were treated between March 1988 and June 1995, and they form the study group for this analysis. Freedom from biochemical failure was defined as prostate-specific antigen value that failed to be maintained at 1 ng/mL or less or an increase in prostate-specific antigen value of 0.5 ng/mL or more in 1 year even if prostate-specific antigen value was less than 1 ng/mL. RESULTS: Among the 187 patients, the median pretreatment prostate-specific antigen value was 7.4 ng/mL (0.3-19.9 ng/mL). The median follow-up was 34 months. Twenty-three percent of patients had a Gleason score sum of 2 to 4, and 77% had a Gleason score sum of 5 to 6. Clinical stages were T1 in 33% and T2 in 67%. One hundred twenty-five patients were treated by conventional external beam radiotherapy with a median dose of 69.5 Gy (60-71 Gy), and 62 patients were treated by three-dimensional conformal external beam radiotherapy with a median dose of 76.4 Gy (71.6-87 Gy). The overall freedom from biochemical failure was 75% at 4 years. Rates of freedom from biochemical failure by pretreatment prostate-specific antigen levels were 91% for prostate-specific antigen value < or = 4 ng/mL, 65% for prostate-specific antigen value > 4 but < or = 10 ng/mL, and 30% for prostate-specific antigen value > 10 ng/mL. Pretreatment prostate-specific antigen value was a statistically significant prognosticator, with lower values associated with favorable freedom from biochemical failure outcome in univariate and multivariate analyses. Conventional versus three-dimensional treatment, T1 versus T2 stage, and Gleason score sum 2 to 4 versus 5 to 6 did not show statistically significant difference in freedom from biochemical failure. CONCLUSIONS: Although our overall results after external beam radiotherapy for early-stage prostate cancer patients are less favorable than the best results published for 125I implantation monotherapy, our results are comparable to those in most other studies with implantation monotherapy. This most likely results from selection bias as well as our stricter definition of freedom from biochemical failure. In addition, for our subset of patients, there was no statistically significant improvement in the 4-year freedom from biochemical failure with the use of higher doses.
Brachytherapy↗
Identification of a high-risk clinically localized prostate cancer subgroup receiving maximum benefit from whole-pelvic irradiation.
PURPOSE: We recently identified a progression-free survival advantage for clinically localized high-risk prostate cancer patients receiving whole-pelvic irradiation. We now seek to identify a subgroup most likely to benefit from whole-pelvic irradiation. METHODS: Between October 1987 and December 1995, 506 clinically localized prostate cancer patients were treated with definitive radiotherapy consisting of whole-pelvic irradiation followed by a prostate-only boost, or prostate-only treatment (median follow-up, 35 months vs 30 months). Prostate-specific antigen (PSA) failure was defined as (1) a PSA value > or = 1 ng/mL or (2) a PSA value that rose > or = 0.5 ng/mL in < or = 1 year posttreatment on two consecutive measurements, with the first rise defined as the time of failure. The calculated risk of lymph node positivity (%rLN+) was defined as 2/3 (initial PSA) + 10(Gleason score - 6), with intermediate risk defined as 15% < or = %rLN+ < 35% and highest risk defined as %rLN+ > or = 35%. Univariate and multivariate analyses were performed. RESULTS: Intermediate-risk patients receiving whole-pelvic irradiation had significantly improved freedom from PSA failure compared with those receiving prostatic irradiation only (median progression-free survival 39.5 months vs 22.5 months; P < 0.0001); highest-risk patients did not (median progression-free survival 27.2 months vs 20.8 months, P = NS). Multivariate analysis revealed type of radiation treatment to be the most significant independent predictor of outcome (P < 0.0001). DISCUSSIONS: Whole-pelvic radiotherapy most significantly improves the PSA failure-free survival in patients with an intermediate calculated risk of lymph node positivity, suggesting that highest-risk patients may present with distant micrometastases.
Chi-Square Distribution↗