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Biomedical subjects

N Jaffe

Publications and source records attributed to N Jaffe.

At least 181 records · Page 10Linked to original sources
PubMed1976

Multidisciplinary treatment for macrometastatic osteogenic sarcoma.

Using a co-ordinated multidisciplinary approach with surgery, radiation therapy, and chemotherapy, 14 out of 21 patients with metastases from osteogenic sarcoma were rendered free of disease for over two to over 18 months. Most patients had pulmonary metastases, two had bony metastases, and one had metastases in the iliac nodes. As part of this multidisciplinary approach weekly high-dose methotrexate was given and caused tumour regression in seven out of 15 patients. After all clinical evidence of disease had been removed high-dose methotrexate was administered every two to three weeks as maintenance treatment. To assess the efficacy of treatment the results were compared with those in a historical control group of 82 consecutive patients who developed pulmonary or other metastases. The results in the study group were significantly better. This experience may be similar to that in Wilms's tumour, where actinomycin D has increased the cure rate when administered as adjuvant therapy after treatment of localised or overt metastatic disease.

Adolescent↗
PubMed1976

Decreased risk of radiation-associated second malignant neoplasms in actinomycin-D-treated patients.

One hundred two long-term survivors of childhood cancers with second malignant neoplasms (SMNs) were collected from 10 institutions. Forty-seven cases fulfilling study criteria were studied to determine the risk of developing a SMN in irradiated fields after exposure to various chemotherapeutic agents. The case control method was used. The risk of developing such tumors was decreased by a factor of 7 in patients receiving actinomycin-D (AMD). The "protective" effect of AMD was more pronounced in patients receiving repeated courses of the agent. No change in relative risk was found for children given antifolates, the vinca alkaloids, or alkylating agents. AMD "protection" is an unexpected finding because the agent is an oncogen in animals and an enhancer of radiation, the latter being a known carcinogen. Possible mechanisms, which remain speculative, are discussed. These results indicate the need for careful long-term observation of cancer survivors to gain understanding of the late effects of multimodal treatments.

Child↗
PubMed1976

The role of irradiation in central nervous system treatment and prophylaxis for acute lymphoblastic leukemia.

The results of central nervous system (CNS) treatment with craniocervical irradiation and intrathecal methotrexate in 117 children with ALL achieved at the Joint Center for Radiation Therapy. The Children's Hospital Medical Center, and The Sidney Farber Cancer Center are presented. A classification related to meningeal disease which correlated with prognosis is presented and the patients are analyzed within these groups. Of 80 patients classified in the most favorable groups (I and II), no child has suffered primary CNS relapse. Of the remaining 37 patients in less favorable groups (III, IV, and V), eight patients have experienced CNS relapse, five following or in conjunction with bone marrow relapse. The technical features of irradiation are reviewed and related to success of the treatment.

Adolescent↗
PubMed1976

New multiple-agent chemotherapy (B-DOPA) for advanced Hodgkin's disease.

B-DOPA (Bleomycin (B), D-imidazole carboxamide (D), Oncovin (O), Prednisone (P), Adriamycin (A) is a program developed for the treatment of Hodgkin's disease resistant to MOPP therapy. Twenty unselected patients were treated by the following dose schedule: B, 4 mg/m2 days 2 and 5; D, 150 mg/m2 days 1 to 5; O (vincristine), 1.5 mg/m2 days 1 and 5; P, 40 mg/m2 days 1 to 6; A, 60 mg/m2 day 1. Each course, was repeated at 3 to 4 week intervals to maximum adriamycin dose of 450 mg/m2. All patients had received prior MOPP therapy and six had received prior radiotherapy. Fifteen of the 20 patients entered into the study were evaluable for response. There were nine (60%) complete responders and three (20%) partial responders. The median duration of complete remission was 14+ months with six of nine patients remaining in remission to a maximum of 21 months. The median survival of the nonresponders was 3 months. B-DOPA is an effective combination chemotherapy regimen for advanced Hodgkin's disease in patients who have previously received MOPP treatment, including patients who are refractory to MOPP therapy. The B-DOPA program or modifications thereof, may be integrated into primary treatment programs for advanced Hodgkin's disease.

Adult↗
PubMed1976

Leukemic ophthalmopathy in children.

Abnormalities of the eye were detected in 52 of 657 children (9%) suffering from acute leukemia. The treatment for leukemia was single agent chemotherapy administered sequentially. "Prophylactic" treatment of the central nervous system was not administered. Major manifestations of leukemic ophthalmopathy comprised retinal hemorrhage (in 19) and infiltration of the optic nerve, retina, iris or orbit (29). The ophthalmopathy was treated by topical dexamethasone and radiation therapy. Concurrent bone marrow relapse occurred in most patients. Twenty-seven of 29 patients whose cerebrospinal fluid was examined before or at the time of the onset of leukemic ophthalmopathy demonstrated meningeal leukemia. In contrast, this complication has not been observed in recent patients who received "prophylactic" treatment for meningeal leukemia. Leukemic invasion of the eye should receive appropriate recognition; the posterior pole should be included in the treatment of the central nervous system as a pharmacologic sanctuary.

Child↗
PubMed1976

Improved outlook for Ewing's sarcoma with combination chemotherapy (vincristine, actinomycin D and cyclophosphamide) and radiation therapy.

Vincristine, actinomycin D, and cyclophosphamide (VAC) were administered to 14 patients with Ewing's sarcoma. The primary tumors were treated with radiation therapy and concurrent chemotherapy. Nine patients had no visible metastases at diagnosis: two died following the development of pulmonary metastases and the rest have been free of disease for periods varying from 4 months to 4 1/2 years following completion of treatment. This contrasts with a 27% survival in patients previously treated at this center with single agent chemotherapy. Five other patients had demonstrable metastases at diagnosis: VAC chemotherapy achieved complete regression of pulmonary metastases in three for 9, 9+ and 24+ months, respectively. Following disappearance of tumor in the latter two, pulmonary irradiation was administered in an attempt to consolidate the response, but tumor recurred 6 months later. These patients eventually died of widespread disease although survival appeared prolonged in comparison to that seen in past experience. Chemotherapy was well tolerated, although three patients developed hemorrhagic cystitis, necessitating discontinuation of cyclophosphamide. The data suggest the potential for prolonged control and an increase in the cure rate with this therapeutic approach.

Adolescent↗
PubMed1976

Development of an effective treatment program for childhood acute lymphocytic leukemia: a preliminary report.

The development of an effective therapeutic regimen for acute lymphocytic leukemia (ALL) of childhood is described. By careful surveillance of toxicity and efficacy, positive modifications of treatment strategy were achieved without resorting to classically randomized trails. Teh resultant protocol utilizes vincristine-prednisone induction followed by asparaginase consolidation, intensive intermittent combination maintenance chemotherapy with adriamycin as a major component, and cranial radiotherapy plus intrathecal methotrexate for central nervous system prophylaxis. Preliminary analysis suggests that this regimen may result in prolonged continuous complete remission in at least 80% of children with ALL.

Adolescent↗
PubMed1976

Recrudescence of neuroblastoma after apparent cure.

Many years after apparent cure recrudescence of neuroblastoma was reported in 2 patients. In 1 patient, two recurrences occurred 5 and 10 years after apparent disappearance of tumor. Factors contributing to the extraordinary clinical course are unknown. Speculation rests on tumor characteristics, environmental influences, immunity, or the development of a second primary tumor.

Child↗
PubMed1976

Herpes zoster in children with stage I-III Hodgkin's disease.

Herpes zoster infection developed in 12 (52%) of 23 children with Stage I-III Hodgkin's disease but had no prognostic significance. Of these 23 patients, 22 are presently alive without evidence of active Hodgkin's disease. The authors conclude that a combination of factors is important in the high incidence of herpes zoster, including more aggressive staging as well as more aggressive irradiation and chemotherapy, and that the results in their series would seem to justify continuation of this approach to staging and treatment in such cases.

Adolescent↗
PubMed1976

Osteogenic sarcoma: state of the art with high-dose methotrexate treatment.

The development and application of the VCR-MTX-CF regimens for the treatment of osteogenic sarcoma have changed the biological behavior of the tumor. Recent results strongly project major advances for the future. Although the major effect of chemotherapy resides in the eradication of micrometastases, its application for treatment of the primary tumor may also be considered. However, careful experimental design and follow-up periods for several years will be required to determine the optimum approaches. For example, it is possible that the interaction between weekly VCR-MTX-CF and radiation therapy may assume increasing importance. Thus, with the effective application of VRC-MTX-CF, the management of osteogenic sarcoma has evolved into a multidisciplinary approach and future advances will be based on the collective judgement of specialists from many fields.

Bone Neoplasms↗
PubMed1976

Skeletal alterations following irradiation for Wilms' tumor: with particular reference to scoliosis and kyphosis.

The roentgenographic changes in the axial skeleton after irradiation for Wilms' tumor were studied in eighty-one patients. In addition to the initial alterations found in the individual vertebrae within the field of irradiation, spinal deformity subsequently developed in fifty-nine patients (pure scoliosis in thirty-eight, kyphoscoliosis in nineteen, and pure kyphosis in two). Unitl the adolescent growth spurt these deformities tended to remain slight, but some progression did occur. In seven patients the scoliosis became severe enough to require spine fusion. A Milwaukee brace used in three patients failed to correct the curve. The trapezoidal shape of the vertebrae and scarring of the soft tissues within the concavity made correction difficult. Recognizable roentgenographic alterations failed to develop in twenty-two patients who, in general, were older and had received less irradiation. There appeared to be a correlation between the amount of irradiation and the severity of the spinal deformity (p is less than 0.05) and between the age of irradiation and the amount of deformity (p is less than 0.02).

Adolescent↗
PubMed1975

Hemodialysis for acute anuric uric acid nephropathy.

A patient with acute oliguric uric acid nephropathy was treated with hemodialysis. Recovery in this disorder is based on treatment of both the uremic state and the intrarenal crystal obstruction. Hemodialysis with high uric acid clearance is much more efficient than other forms of therapy in this disorder.

Abdominal Neoplasms↗
PubMed1975

Prophylaxis of varicella in children with neoplastic disease: comparative results with zoster immune plasma and gamma globulin.

The incidence and severity of varicella following a close family contact were evaluated in children with neoplastic diseases who received prophylaxis either with commerical gamma globulin or with zoster immune plasma, as compared to patients who did not receive any prophylaxis. In the untreated group, all 14 patients developed varicella, complicated by 1 case of encephalitis and 2 cases of fatal pneumonia. In the group of 17 patients who received 0.6-1.2 ml/kg body weight of gamma globulin, 16 developed varicella, complicated by pneumonia in 2 cases, with 1 death. In the third group of 27 patients who received 10 ml/kg body weight of zoster immune plasma (ZIP), obtained from healthy adults convalescing from herpes zoster, there were only 8 cases of varicella, all very mild. Thus, prophylaxis with ZIP significantly reduced the incidence of clinical varicella (p less than 0.01) and attenuated the severity of its course.

Antineoplastic Agents↗