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Biomedical subjects

P J Fitzpatrick

Publications and source records attributed to P J Fitzpatrick.

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

Ultrasound determination of the relationship of radioactive plaques to the base of choroidal melanomas.

There is an assumption that radioactive plaques placed at surgery are, and will remain, in proper relationship to the base of the tumor. The plaque dose is calculated based on this assumption. In fact, factors such as loose sutures, improper diameter estimations, pressure from adjacent rectus muscles, and intervening tissue (oblique muscles) can compromise this relationship. Ultrasound provides a practical method of imaging the tumor and plaque simultaneously. The authors have used postoperative ultrasound to monitor the accuracy of iodine-125 plaque placement in nine cases. Detection of eccentrically placed and malpositioned plaques provides valuable insight which can be used to refine surgical technique. Detection of plaque tilting by oblique muscles can serve as a basis for recalculating dosage. The relationship of plaque margins to vital ocular structures such as the optic nerve can also be determined by ultrasound.

Brachytherapy↗
PubMed1988

Malignant submandibular gland tumors. A review of 91 patients.

A retrospective review of 91 patients with submandibular gland carcinoma seen between 1958 and 1984, is reported. Among these were 37 (41%) adenoidcystic carcinomas, 14 (15%) adenocarcinomas, 14 (15%) mucoepidermoid carcinomas, and 10 (11%) malignant mixed tumors. The median patient age was 58 (26-93) [corrected] years and the male to female ratio was was 1.2:1. At diagnosis, 15 (16.5%) patients had regional metastases and six (7%) had distant metastases. The first planned treatment was surgery in 30 (33%) patients, radiotherapy in five (5%), and surgery and radiotherapy combined in 54 (59%) patients. The 5- and 10-year cause-specific survival rates were 60 and 48%, respectively, and the relapse-free rates 42 and 34%. The locoregional control at 5 years was 30% when surgery was the only treatment, and 69% when combined with radiation. These results suggest the advantages of combining surgery and radiotherapy as the first planned treatment for most tumors.

Adult↗
PubMed1987

Metastatic squamous cell carcinoma in linear porokeratosis of Mibelli.

We describe the clinical and pathologic observations of a 45-year-old woman with linear porokeratosis who developed squamous cell carcinoma in lesional sites. The squamous cell carcinoma metastasized to a regional lymph node. This is the second case of metastatic squamous cell carcinoma reported in porokeratosis and the first reported in the linear variety.

Carcinoma, Squamous Cell↗
PubMed1986

Cutaneous malignant lymphoma.

The skin as the first site of non-Hodgkin's lymphoma is uncommon. Between 1967-1982 only 61 evaluable patients were seen; lymphoma was confined to the skin in 43. Most histological subtypes of non-Hodgkin's lymphoma were represented with diffuse histiocytic tumors accounting for 28 (46%). Overall, there was a 5-year survival rate of 52% with a median of 75 months. For patients with disseminated lymphoma involving the skin, the median survival was 18 months and there were no 10 year survivors. Patients with disease confined to the skin had 5 and 10-year survival rates of 62 and 57%, and a median survival of 159 months. Significant prognostic indicators included the site and bulk of tumor, but not the histological subtype. For small bulk localized tumors radiotherapy achieved local control in all patients and an over 80% five-year relapse-free rate. We conclude that lymphomas confined to the skin can be adequately treated by radiotherapy, whereas disseminated tumors require systemic therapy in addition. The management of bulky cutaneous lymphoma remains controversial.

Adolescent↗
PubMed1986

Malignant salivary gland tumors.

A retrospective review of 403 patients with salivary gland tumors seen between 1958 and 1980 and a mean follow-up of 10 years is reported. The median age was 58 (7-94) years and the male to female ratio 1.3:1. There were 293 (72%) parotid, 83 (21%) submaxillary and 27 (7%) tumors developed at other sites. Among these were 84 (22%) mucoepidermoid (all degrees of differentiation), 87 (22%) adenocystic carcinomas, 70 (17%) adenocarcinomas, 25 (6%) acinic, 26 (6%) squamous cell, 44 (11%) undifferentiated, 52 (13%) mixed and 12 (3%) nonspecified carcinomas. A painless lump was the first symptom in 338 (84%) patients. The first planned treatment was surgery in 110 (27%), radiotherapy in 50 (12%), and surgery and radiotherapy combined in 239 (59%) patients. Following the first treatment, the primary parotid tumor was controlled by surgery in 17/70 (24%), by irradiation in 6/39 (15%) and surgery and radiation combined in 134/182 (74%) patients. Altogether, regional metastases developed in 36 (12%) and distant metastases in 36 (12%) of 293 patients with parotid tumors. For the submandibular tumors the primary tumor was controlled by surgery in 9/31 (29%), 0/4 (0%) by irradiation, and in 32/46 (70%) by surgery and irradiation. Here, regional and distant metastases developed in 16/84 (19%) and 19/84 (23%) patients. Among the other sites the primary tumor was controlled by surgery in 4/9 (44%), 0/7 (0%) by irradiation, and in 8/11 (73%) by surgery and radiotherapy combined. In this group 4/27 (15%) and 5/27 (18%) patients developed regional and distant metastases. The 5- and 10-year cause specific survival rates were 65 and 59% for the parotid tumors, 61 and 48% for the submaxillary tumors and 62 and 52% for the other sites. These results clearly demonstrate the advantages of combining surgery and radiotherapy as the first planned treatment for most tumors.

Adolescent↗
PubMed1986

Malignant parotid tumors. Prognostic factors and optimum treatment.

A retrospective study of 271 patients with parotid carcinoma seen between 1958 and 1980 is reported. Among these were 64 (24%) mucoepidermoid tumors (all degrees of differentiation), 50 (18%) adenocarcinomas, 40 (15%) malignant mixed tumors, 39 (14%) adenoid cystic carcinomas, 37 (14%) undifferentiated, 21 (8%) acinic, and 20 (7%) squamous cell carcinomas. The proportion of advanced (T3T4) to early (T1T2) tumors was 1.7:1. At diagnosis, 42 (15%) patients had regional metastases. An analysis for prognostic factors showed that the histology, tumor stage, regional metastases (No vs. N+), age, and damage to the facial nerve all influence cause-specific survival. After multivariate analysis the tumor size and the presence of regional metastases were the two most significant factors (p less than 0.0001 and 0.004). The prognostic characteristics were similar for the 67 (25%) patients treated by surgery and for the 169 (62%) patients treated with surgery and postoperative radiotherapy. Patients treated with combined therapy had a 10-year relapse-free rate of 62% compared to 22% for those treated by surgery alone (p = 0.0005).

Adolescent↗
PubMed1985

Role of radiation therapy in localized non-Hodgkin's lymphoma.

Relapse occurs in 50% of patients receiving radiation for clinical stage (C.S.) I and II nodal and extranodal non-Hodgkin's lymphoma (N.H.L.). Prior to the introduction of intensive chemotherapy those failing primary control with irradiation and most of those who relapsed died of their disease with a resultant overall mortality of 50%. An analysis of Princess Margaret Hospital results with radiation for C.S. I and II N.H.L. between January 1967 and December 1978 revealed that tumour bulk, age, stage and histology were of independent prognostic significance. It was possible to group patients using combinations of these attributes so that each group encompassed only patients with similar outcomes. Such prognostic groups were identified separately within the low grade and the intermediate plus high grade categories of the Working Formulation. Patients with a high probability of cure with radiation were so defined. Also those patients in whom chemotherapy would be optimal initial therapy were also defined. Such patients were in the intermediate plus high grade histology groups. Thirty percent of all patients with low grade histology lymphoma had an actuarial survival of 83%, and relapse-free rate of 63% at 10 years. By implication, approximately 20% of all patients with these histologies seen at the Princess Margaret Hospital for the same time period achieved prolonged relapse-free survival by localized therapy. This is at variance with the implications of staging from studies where laparotomy and multiple bone marrow biopsies have been used. Such aggressive staging procedures suggest truly localised disease in only 5-6% of patients with low grade lymphoma. A significant relationship between radiation dose and disease control was demonstrated only for patients with intermediate and high grade lymphoma of medium or large bulk. A minimum tumour dose of 30 Gy was required for optimal local control with radiation.

Adult↗
PubMed1985

Acute epithelioma--an aggressive squamous cell carcinoma of the skin.

This report describes an aggressive squamous cell carcinoma of the skin for which we suggest the name acute epithelioma. It is frequently larger than 2 cm and has a characteristic morphology with raised, rolled, vascular but not everted edges. Commonly there is a central crust covering a foul discharge on a papilliferous base. The biopsy is characteristically ambiguous but often that of a well differentiated squamous cell carcinoma. Irrespective of the history, which is usually short, all tumors have a period of rapid growth. Among 193 patients with squamous cell carcinomas of the eyelids or external ear, 24 (12%) of the tumors were designated as being acute epitheliomas. For the eyelids 15/125 (12%) patients were in this group; 10 (67%) had tumors larger than 2 cm, five (33%) developed regional metastases, and three (20%) had tumor related deaths. Irradiation controlled the primary tumor in 15 (100%) patients. Among the 68 ear tumors, nine (13%) were called acute epitheliomas. Eight (89%) were larger than 2 cm, three (33%) developed regional metastases, and two (22%) patients had tumor related deaths. Irradiation controlled the primary tumor in seven (78%) patients. It is postulated that these acute epitheliomas are virus induced tumors that develop in actinicly damaged and immunologically suppressed skin. Following treatment, careful follow-up is recommended because of their metastatic and lethal potential.

Adult↗
PubMed1985

Salivary gland tumors.

A retrospective review of 643 patients with salivary gland tumors seen between 1958-72 is reported. There were 328 malignant and 375 benign tumors. All patients with malignant tumors were assessed in a multidisciplinary head and neck clinic. The median age for developing malignant tumors was 58 and there was a male to female ratio of 1.2:1. For benign tumors the median age was 46 years and the male to female ratio 0.8:1. Overall the primary tumor was controlled by the first planned treatment in 145 (44%) malignant tumors and in 253 (80%) benign tumors. The five and 10 year actuarial survival for malignant tumors was 59.4% and 45.6% respectively.

Combined Modality Therapy↗
PubMed1984

Basal and squamous cell carcinoma of the eyelids and their treatment by radiotherapy.

We report 1,166 tumors of the eyelids that were treated by single or fractionated exposures to doses of 20-60 Gy. The five year tumor control rate was 95% for basal cell and 93.3% for squamous cell carcinoma. Irradiation was equally successful in primary cases and in those recurrent following surgery. Recurrence following irradiation was managed by surgery or further irradiation. The cosmetic and functional results were generally excellent and readily accepted by most patients. The overall complication rate was 9.6% with fewer than one-half rated as serious; these problems mainly occurred with large tumors that had destroyed normal tissues. In only 14 (1.2%) patients was death related to the tumor. Approximately one-half of the patients received a dose of 35 Gy in five daily fractions, one-quarter, 20 to 22.5 Gy in a single exposure and the others with larger tumors 42.5-60 Gy in 10 to 30 exposures in two to six weeks. Radiotherapy is a safe and cost effective treatment for eyelid tumors.

Adult↗
PubMed1984

Lymphoreticular tumors of the orbit.

Lymphoreticular tumors in the orbit are uncommon. Only 42 patients were identified from over 2000 patients with tumors of lymphoid tissue seen between 1958 and 1979. The patients were divided into 3 groups: primary malignant, secondary malignant, and benign lymphoma. In the primary malignant lymphoma groups, there were 24 patients with a median age of 64 (40 to 87) years and a 2.4:1 female to male ratio: 2 cases were bilateral. In 19 (79%) patients with the lymphoma limited to one orbit the tumor was controlled in every case with doses from 25 to 45 Gy. There were no serious complications. Subsequently lymphoma developed at other sites in 7 (37%) patients. The 5 and 10 year cause specific actuarial survival rates were 70 and 62%. In the 8 patients with secondary malignant lymphoma, the orbital disease was controlled by irradiation, although all patients required further treatment and died of their disease. Radiotherapy controlled all 7 patients with benign lymphoma without any complications.

Actuarial Analysis↗
PubMed1984

Multiple primary squamous cell carcinomas in the upper digestive tract.

Multiple squamous cell carcinomas are common and patients carry a constant and excessive risk of developing a new cancer at any time (13-21 X the normal). Among 6,203 cases of primary squamous carcinoma of the upper digestive tract, 648 patients (10.4%) developed two or more independent tumors. Altogether, 761 additional malignancies were observed, with up to five cancers being seen in individual patients. There were 279 patients with a prior or synchronous cancer and 409 patients who developed 462 metachronous tumors. There was a substantial risk for developing a second primary cancer in the upper aerodigestive tract. Overall the observed to expected ratio was 2.48, specifically 2.32 for males and 2.89 for females.

Carcinoma, Squamous Cell↗
PubMed1984

Radiotherapy for unusual tumors of the head and neck.

The role of radiotherapy is discussed relative to the management of juvenile nasopharyngeal angiofibroma, glomus tumors of the middle ear region, ameloblastoma, extramedullary plasmacytoma of the head and neck, and soft tissue and bone sarcoma. Moderate doses of carefully applied irradiation are effective and can be safely utilized for these conditions.

Adolescent↗
PubMed1984

Skin cancer of the head--treatment by radiotherapy.

A retrospective review of 498 patients with 584 skin cancers occurring on the head and seen between 1971 and 1976 is reported. All were treated by radiotherapy. There were 433 basal cell and 151 squamous cell carcinomas for a ratio of 2.9:1. The median age for developing skin cancer was 69 (22-92) years and there was a male to female advantage of approximately 1.5:1. Overall, the primary tumor was controlled at three years in 553 instances (94.7%). None of the basal cell carcinomas metastasized. Cervical node metastases developed in 12 patients (8%) with squamous cell carcinoma. Overall there were four (0.8%) tumor related deaths.

Adult↗
PubMed1984

Cancer of the lip.

A retrospective review of 361 patients with carcinoma of the lip seen between 1971 and 1976 was performed. There were 348 squamous cell and 13 basal cell carcinomas. The lower to upper lip ratio was 15:1 and the male to female ratio 12:1. The median ages for men and women were 64 and 71 years. The tumors were not staged but four had regional metastases when diagnosed. The primary tumor was controlled by surgery in 76/85 (89%) patients, by surgery and radiation combined in 65/70 (93%) patients, and by radiation alone in 193/206 (94%) patients. Altogether 24 (6.5%) patients developed cervical node metastases and these were controlled in 20 (83%). Tumor related deaths occurred in 11 (3%) patients and the five year cause specific survival rate was 97%.

Aged↗
PubMed1983

Ovarian irradiation and prednisone following surgery and radiotherapy for carcinoma of the breast.

Following mastectomy, patients with operable breast cancer underwent postoperative irradiation of the chest wall and regional lymph nodes. They were then assigned at random to receive no further therapy, ovarian irradiation (2000 rad in five days) or ovarian irradiation in the same dosage plus prednisone, 7.5 mg daily. A total of 705 patients received the randomly assigned treatment and were followed for up to 15 years. In premenopausal patients who received ovarian irradiation, the recurrence of breast cancer was delayed and survival prolonged, but not significantly. In premenopausal women aged 45 years or more, ovarian irradiation plus prednisone therapy significantly delayed the recurrence of breast cancer (p = 0.04) and prolonged survival (p = 0.02). No value was demonstrated for ovarian irradiation with or without prednisone therapy in postmenopausal patients.

Adult↗
PubMed1983

Dosimetry of radioactive gold grains for the treatment of choroidal melanoma.

The dosimetry of small permanent gold grain implants for treating choroidal melanoma has been studied. A means of planning the source configuration required to deliver a desired minimum dose to a tumour has been developed. The interaction of the variable parameters, source activity, number of sources used, geometrical arrangement, and implant diameter, within the physical limitations imposed by the eye and the practical limitations occurring in clinical practice, are discussed.

Brachytherapy↗