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Biomedical subjects

M Wollin

Publications and source records attributed to M Wollin.

At least 37 records · Page 2Linked to original sources
PubMed1989

Prognostic factors for recurrence and cosmesis in 393 patients after radiation therapy for early mammary carcinoma.

Between 1978 and 1985, 393 of 2,765 (14%) patients with operable cancer of the breast (clinical stage T0-3N0-2M0) were irradiated after excisional biopsy and staging axillary dissection. Of 77 patients with microscopic axillary metastases, 68 received systemic adjuvant therapy. Treatment failed locally in 26 cases, and there were seven patients with distant metastasis. The three major factors for increased local treatment failure were (a) age below 40 years (P = .003), (b) negative estrogen receptor assay result (P = .03), and (c) failure to deliver a radiation boost dose when tumor was present at the margin of the specimen (P = .002). The size of the tumor, the nodal status, the progesterone receptor assay result, and the presence of ductal carcinoma in situ mixed with infiltrating carcinoma did not show a significant influence on local recurrence. In 274 of 393 (70%) patients, cosmesis was evaluated. The four major factors affecting cosmesis favorably were (a) utilization of a wedge (P less than .0001); (b) treatment of two fields a day (P less than .0001); (c) failure to use a separate treatment port to the regional lymph nodes, so as to avoid field junctions (P = .0003); and (d) small size of specimen (less than 50 cm2) (P = .0171). A second or third cancer was found in 39 of the 393 (10%) patients; contralateral breast cancer was the most common form (n = 23), followed by genitourinary cancer (n = 5). The most frequent complication was arm edema (6%).

Adult↗
PubMed1987

Aberrant epididymal tissue: a significant clinical entity.

Epididymal anomalies are relatively rare and usually they are associated with an undescended testis. A 33 to 66 per cent incidence of epididymal anomalies has been noted in male subjects with cryptorchidism. An increased incidence of epididymal anomalies also has been noted in association with cystic fibrosis, von Hippel-Lindau's syndrome and in male offspring of women treated with diethylstilbestrol. The frequency and anatomical spectrum of epididymal anomalies among men with normal descended testes are not known. We describe 3 patients with bilaterally descended testes, who were found to have aberrant epididymal tissue at scrotal or inguinal exploration. The variable presentations of aberrant epididymal tissue in these 3 patients can be explained best by understanding the embryology and anatomy of the epididymis and its associated vestigial structures. In all likelihood the structures encountered in our patients were the ductus aberrans inferior and the paradidymis. These structures, which rarely are included in urological anatomical descriptions of the epididymis, can be significant clinically. Therefore, it is important that the urologist be aware of their existence and their means of presentation.

Adolescent↗
PubMed1987

Observations on the treatment of mediastinal masses in Hodgkin's disease emphasizing site of failure.

Of 244 patients with Hodgkin's disease, 126 (52%) had an abnormal mediastinum. Sixty-four patients were treated with radiation, 36 with radiation and chemotherapy, and 25 with chemotherapy alone as an initial treatment. Twenty of 52 (38%) with stage I or II who received initially radiation alone relapsed, and 70% (14 of 20) of them were salvaged with chemotherapy. Therefore, the ultimate failure rate was 12% (6 of 52). Forty percent (8 of 20) of these patients failed within or at the margin of the radiation portal, and 60% failed predominantly outside of the radiation field. Even though we did not treat the whole lung prophylactically, there was only one true peripheral lung recurrence. Nine of 20 (45%) recurred in more than one site. Of 36 patients treated with combined radiation and chemotherapy, 21 patients had stage I, II, or IIIA disease. Of these, two patients relapsed. Of 86 patients with accessible x-ray films, 30 patients had large masses with a ratio of mass to transverse diameter greater than .33 at the broadest level. Fifty-six patients had small masses. Survival at 96 months in patients with stages I-IIIA with either large or small masses is 94% (p = 0.80). Their relapse-free survival at 96 months is 79% for large masses and 95% for small masses (p = 0.18). The site of relapse is discussed in detail in the text. There were five treatment-related deaths; three patients died of acute myelogenous leukemia. Our data do not support the role of whole-lung prophylactic irradiation or initial combined radiotherapy and chemotherapy in patients with large mediastinal masses.

Adolescent↗
PubMed1986

Proposed method to study the factors affecting local control with combined external beam and interstitial implantation of mobile tongue and floor of mouth.

Twenty-seven patients with squamous cell carcinoma of the mobile tongue and floor of the mouth were treated with external beam and interstitial radiation. Good prognostic factors were T1N0, T2N0, superficial tumors, tumor shrinkage by 75% with external beam, and no apparent tumor clinically 2 months after treatment. On the other hand, T3N0, T1-3N1, and deeply necrotic tumors had a poor prognosis. We recommend using a flexible afterloading system to implant the initial local tumor volume (not just the residual nidus) that does not exceed 45 cm3. The minimum (reference) dose was prescribed to a surface 1/2 cm beyond the most peripheral rim of radioactive sources. For acceptable local control and complication rates, our suggested minimum (reference) doses are less than or equal to 7,500 rads for T1 (or a time-dose-fractionation [TDF] of 131-140), less than or equal to 8,000 rads for T2 (TDF of 131-140), and probably less than 8,500 rads for T3 (TDF of less than or equal to 150). These guidelines should be considered preliminary.

Brachytherapy↗
PubMed1984

Reassessment of technical and biological factors in paranasal sinus carcinoma.

Twenty-seven patients with paranasal sinus carcinoma were analyzed. Local control with radiation alone was poor, with most patients failing centrally within the primary site. With preoperative radiation local control is 60%. Previous reports have emphasized failure at superior sites--particularly the orbit. The pattern of local failure in our series is predominantly various medial sites inclusive of intact or exenterated orbit. The surgically nonremovable medial structures are best encompassed by a three-field radiotherapy technique (weighted anterior and two laterals).

Adult↗
PubMed1984

Management of gastrointestinal lymphoma.

A study was made of 65 patients with primary gastrointestinal (GI) lymphoma. The occurrence was 40 (62%) in stomach, 15 (23%) in the small intestine, and 10 (15%) in colorectum. The majority of patients had their histology classified according to Rappaport's classification. Diffuse histiocytic type had the worst prognosis (median survival 13.8 months), and nodular histology had the best prognosis. A modified staging system proposed by Blackledge et al. was used. Patients who had their disease confined to one viscus (Stage I) or with spread to regional lymph nodes (Stage II) had an excellent prognosis, with a 5-year survival of 87 and 67%, respectively. However, those who had distant nodal involvement (Stage III, e.g., para-aortic nodes) or spread to adjacent organs within the abdomen (Stage IV) had worse prognosis, with 5-year survival of 40 and 13%, respectively. In Stage I, radiotherapy alone was as effective as surgical resection. None of the 11 patients treated by radiotherapy alone had perforation or bleeding. The 5-year disease-free survival was 51%.

Adolescent↗
PubMed1981

The relationship of dose to prognosis in squamous-cell carcinoma of the aerodigestive tract.

How much does radiation dose determine prognosis of patients requiring radiotherapy for squamous-cell carcinoma of the aerodigestive tract? Using a statistical test of the correlation of dose versus outcome, several results of radiation treatment reported in the literature were examined. The radiation dose received was found to be a poor predictor of which patients would be cured.

Carcinoma, Squamous Cell↗
PubMed1979

Interface radiation dosimetry in mandibular reconstruction.

When a beam of radiation crosses the interface between two substances, secondary electrons are generated. This results in enhancement of the absorbed dose of radiation roughly proportional to the difference in atomic numbers. Interfaces are created in reconstruction of the mandible with implantable trays containing hematopoietic bone marrow and cancellous bone chips. Radiation was measured in tissue-equivalent material surrounding mandibular tray implants of titanium, vitallium, stainless steel, and Dacron/polyetherurethane. The absorbed dose was enhanced by 29% to 36% adjacent to the metallic trays; 1% dose enhancement was noted adjacent to the Dacron/polyetherurethane tray. We conclude that, when radiation therapy is necessary following mandibular reconstruction, homogeneity of dose is maintained and local soft-tissue reactions to excessive irradiation may be avoided by using a nonmetallic tray.

Biocompatible Materials↗