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Biomedical subjects

P J Fitzpatrick

Publications and source records attributed to P J Fitzpatrick.

At least 55 records · Page 3Linked to original sources
PubMed1983

Extranodal malignant lymphomas of the head and neck.

The management of primary extranodal lymphomas of the head and neck at The Princess Margaret Hospital is reviewed. This manner of presentation is uncommon and particularly rare in Hodgkin's disease. As with lymphomas at any other site, detailed investigation is necessary to determine the stage of the disease before definitive treatment is attempted. Surgery is normally restricted to biopsy. Radiation therapy and chemotherapy, alone or combined are the principal treatment modalities. Early disease (stages IA and IIA) may be treated by radiation alone with a cause specific survival of approximately 70% at five years and 60% at 10 years. Survival is better for histiocytic, nodular, and less bulky disease. Primary thyroid disease is uncommon but highly curable with local radiation. Similarly, orbital disease is usually locally curable with negligible sequelae. The addition of combination chemotherapy has significantly improved the prognosis with more advanced and bulky disease.

Adolescent↗
PubMed1982

Gorlin's syndrome, or nevoid basal cell carcinoma syndrome.

Gorlin's syndrome is a condition inherited in an autosomal dominant fashion. It involves many organs, but principally affects the skin, skeleton, and endocrine and nervous systems. The most common features are multiple nervi and basal cell carcinomas of the skin, benign jaw cysts, dyskeratotic pits in the palms and soles, rib and vertebral abnormalities, brachymetacarpalism, and calcification of the falx cerebri. In 14 patients, 4 of whom belonged to one family, the age at the time of diagnosis ranged from 11 to 63 years. Ten patients are alive, but five are severely disfigured by carcinomas. Two patients died of complications resulting from uncontrolled tumours, and two died of other cancers. New skin tumours constantly develop; small ones can be excised, but large ones require extensive surgery with or without radiotherapy.

Adolescent↗
PubMed1982

Carcinoma of the floor of the mouth.

Treatment of 377 patients with squamous cell carcinoma of the floor of the mouth has been studied. Almost two-thirds (235) of the patients had T1 or T2 tumors and a similar number (242) were free of cervical metastases. The median age was 60 years and men predominated over women 4:1. Irradiation, the first treatment of 330 (87.5%) patients, produced a five-year actuarial survival rate of 40%. For stages T1-2 No and T3-4 No such survival rates were 57% and 31% respectively. Regional metastases were the most important prognostic factor and their development reduced survival: if controlled the five-year survival rate was 33% against 17.5% when they were not. Among 221 treated failures, 122 (54%) had persistent disease at three months, and recurrent disease was detected within two years in 93%. A second treatment was successful in 56 (49%) of 115 patients in whom disease recurred either at the primary or secondary sites but only in 13 (24%) of 54 with uncontrolled disease at both sites. Tragically 101 (27%) patients developed other cancers: 69 in the aerodigestive tract and 26 in the lung.

Adult↗
PubMed1981

Radiotherapy in nonlentiginous melanoma of the head and neck.

Thirty-seven patients with superficial spreading or nodular melanoma of the head and neck treated with irradiation are reviewed. Twenty-one patients were referred within three months of surgery. Six had an incisional biopsy followed by postoperative irradiation, 4 were locally controlled (1 dying of metastatic melanoma, 2 dying of intercurrent disease and 1 is alive and well), and 2 were not (both dead of melanoma). Fifteen patients had a local excisional biopsy (11 having tumor to the limits of the excision) followed by postoperative irradiation. Fourteen of the 15 had local control (3 had lymph node metastases and died, 3 died of distant metastases from melanoma, 7 are alive and well from 1-14 years following treatment, and one is dead of intercurrent disease), and 1 had a local recurrence and subsequently died of metastatic melanoma. Sixteen patients were irradiated for local and/or regionally recurrent disease following unsuccessful surgery, and only two were successfully controlled by irradiation and are alive and well at four and five years, respectively. Local control was 70% when a dose per fraction of greater than 400 rads was used, compared with 25% when a dose per fraction of less than 400 rads was used. It is concluded that nonlentiginous melanoma of the head and neck is not a radioresistant tumor and that local excision followed by high dose per fraction radiotherapy deserves further study in the management of melanomas of the head and neck.

Adult↗
PubMed1981

Second respiratory and upper digestive tract cancers after oral cancer.

Between 1958 and 1975, 377 patients with squamous cell carcinoma of the floor of the mouth were treated. 123 new cancers (not recurrences) developed in 101 (27%) of these patients after treatment. 82 (67%) were squamous cell carcinomas of the respiratory and upper digestive tracts, one-third of these being in the mouth. These tumors developed at a constant rate of 3.6% per year and led to excess mortality of 5.2% per year. Men with oral cancer have a relative risk of 13.4 for new tumours in the upper respiratory and upper digestive tracts compared with the general population; in females the relative risk for all sites is 82.6. All patients with mouth cancer should thus be examined regularly because of this high risk of new cancers.

Adult↗
PubMed1980

The radiotherapy of lentigo maligna and lentigo maligna melanoma of the head and neck.

Between 1958 and 1977, 8 cases of lentigo maligna (LM) and 15 cases of lentigo maligna melanoma (LMM) were treated with radiotherapy at the Princess Margaret Hospital. Only 1 of the 8 cases of LM recurred following irradiation and this recurrence was controlled with further radiotherapy. Of 15 cases of LMM, 14 were controlled by irradiation for periods ranging from two months to six years postradiotherapy; the 1 recurrence was salvaged with local excision. Conventional orthovoltage irradiation using doses of 4500--5000 rad in ten to 15 fractions has been found to be highly effective in controlling this disease. The lesion may take up to 24 months to completely regress following irradiation. The benefits of this modality of treatment for a disease process which predominantly occurs in the head and neck region of elderly people is discussed in detail. The results are compared with other methods of irradiation (Miescher's technique) and other modalities of treatment.

Aged↗
PubMed1980

The nasopharyngeal angiofibroma.

Between 1948 and 1975, we have seen 48 patients with nasopharyngeal angiofibroma. Radiotherapy is the treatment of choice for most patients. A dose of 3,000 rads in three weeks leads to thrombosis, fibrosis, and tumor regression, although a latent period up to two years may elapse before final disappearance. Coronal tomography demonstrated tumor extension into the accessory air sinuses in 26 of 29 patients examined. Radiation controlled the tumor both clinically and radiologically from two to 20 years in 28 (80%) of 35 patients treated for the first time. Ten patients, initially treated by surgery, underwent irradiation for recurrence, and in seven the tumor was controlled. Overall, ten (22%) of 45 tumors were not controlled by the first course of radiotherapy; seven of these were controlled by a second course and three were treated by surgery. Hormonal study results on 12 patients were normal.

Adolescent↗
PubMed1980

Adenoid cystic carcinoma of the salivary glands.

Among 334 malignant tumours of the salivary glands 62 (18.6%) were adenoid cystic carcinomas. Although this tumour grows slowly, local recurrence and metastatic spread, particularly to lung, are common. The recommended treatment is surgical excision followed by radiotherapy. Postoperative irradiation reduces the frequency of local recurrence caused by residual microscopic disease. The 5- to 10-year actuarial survival rates were 77% and 57%, respectively. Local and regional recurrence can be eradicated by aggressive treatment, either by radical operation or a combination of operation and irradiation.

Adult↗
PubMed1979

Ovarian irradiation and prednisone therapy 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 rads in 5 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 10 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 = 0.02) and prolonged survival (P = 0.02); the survival expectancy of these patients was similar to that of the general population of the same age from the third year after the cancer operation. No value was demonstrated for ovarian irradiation with or without prednisone therapy in postmenopausal patients.

Adult↗
PubMed1979

The acute radiation syndrome. A memorial to William Michael Court-Brown.

The pattern of symptoms in 189 patients irradiated with a large single dose to one half of the body are described. Radiation sickness developed in 83 and 39% of upper half-body irradiation and lower half-body irradiation treatments respectively and the incidence is not reduced by sedatives or anti-emetics. Following treatment there is a latent period up to 90 min before a phase of acute upset and nausea and vomiting starts. This phase persists for about 6h with an average of six bouts of vomiting and is then followed by recovery.

Antiemetics↗
PubMed1978

Nasopharyngeal angiofibroma: a twenty year study.

A control rate of approximately 80% has been obtained in 45 cases of juvenile nasopharyngeal angiofibroma treated by a single moderate dose of radiotherapy at the Princess Margaret Hospital, Toronto. The remaining patients ultimately achieved control generally after further irradiation. Immediate side-effects of the treatment have been minimal, and no late complications have been observed. In 2-20 years' follow-up, no irradiation-induced tumors have been found. Superiority of irradiation in these cases over surgery is emphasized, as well as the importance of using sophisticated techniques to limit the volume of tissues irradiated and protect vulnerable radiosenstitive structures. Because tumor regression can be expected to continue for many months after treatment has been completed, a policy of observation following radiotherapy is recommended.

Adolescent↗