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Biomedical subjects

P Mauch

Publications and source records attributed to P Mauch.

At least 127 records · Page 7Linked to original sources
PubMed1982

Role of radiation therapy in the treatment of Hodgkin's disease.

We reviewed the results of 10 years of experience in treating 105 patients with stage IA-IIIB Hodgkin's disease at the Joint Center for Radiation Therapy. It appears that "total nodal irradiation" may largely be avoided. For supradiaphragmatic stage I and IIA disease, mantle and para-aortic irradiation result in excellent relapse-free survival except in patients with large mediastinal masses. Stage IIB patients can be treated similarly to those in stage IIA. Stage IIIA patients treated with total nodal irradiation alone fare less well. Combined modality treatment improves survival markedly but may cause excessive complications. For stage III1A, we currently recommend that patients be treated with mantle and para-aortic nodal irradiation, with chemotherapy used only in those who fail. We treat stage III2A and IIIB patients with both chemotherapy and radiation.

Hodgkin Disease↗
PubMed1980

Evidence for structured variation in self-renewal capacity within long-term bone marrow cultures.

Bone marrow pluripotent stem cells (CFUs) demonstrate capacity for both proliferation and differentiation. The proliferative capacity of CFUs has been measured by serial transplantability and by the Rs, a measurement of CFU production in a single 14-day transfer. In the present study, the self-renewal capacity fo both adherent and nonadherent CFUs from long-term bone marrow cultures was measured. Culture conditions were established such that nonadherent cells were derived from the adherent cell layer. Both adherent and non-adherent cells produced spleen colonies, demonstrating that significant proliferative potential was present in both locations; however, at all times in culture, the CFUs within the adherent stromal cell layer had a significantly greater self-renewal capacity than did the nonadherent CFUs. During the initial establishment of the cultures, the self-renewal capacity of the adherent CFUs decreased as the total number of CFUs per flask increased. After 3 weeks in culture, the self-renewal potential of the adherent CFUs stabilized and was maintained. These results suggest two different mechanisms of stem cell proliferation. In order to increase the most primitive stem cell pool size, there was initial proliferation of early stem cells with a concomitant decrease in self renewal capacity. Once this pool was established, the self-renewal capacity of the adherent CFUs maintained for 13 weeks in culture suggests that CFU production and cell maintenance were achieved by clonal succession.

Animals↗
PubMed1980

Anatomic substages of stage III-A Hodgkin's disease. A collaborative study.

The clinical significance of anatomic substage was assessed in 130 patients with Hodgkin's disease in pathologic stage III-A: stage III1-A includes involvement of spleen, or splenic, celiac, or portal nodes, or any combination of these; stage III2-A includes involvement of para-aortic, iliac, or mesenteric nodes, with or without upper abdominal involvement. Median follow-up was 58 months. Both 5-year disease-free survival, 74% versus 46%, and 5-year survival, 94% versus 65%, were better (P less than 0.001) in stage III1-A than in stage III2-A. In stage III1-A, 5-year disease-free survival was better in patients receiving radiotherapy and chemotherapy than in patients receiving radiotherapy alone as initial treatment, 96% versus 63%, P less than 0.003; however, 5-year survival rates in P = 0.22. For stage III2-A, both 5-year disease-free survival, 76% versus 32%, P less than 0.001, and 5-year survival, 84% versus 56%, P less than 0.03, were superior with radiotherapy-chemotherapy. Consideration of anatomic substage may aid therapeutic planning for stage III Hodgkin's disease.

Hodgkin Disease↗
PubMed1979

An evaluation of total nodal irradiation as treatment for stage III A Hodgkin's disease.

Between April 1969 and December 1974, 37 patients with surgically staged III A Hodgkin's disease were treated with total nodal irradiation (TNI). Their probability of relapse-free survival at 7 years is 51% and overall survival 82% with the majority of patients remaining disease free after retreatment with MOPP (10 of 16). In contrast, 21 stage III B patients treated with TNI and MOPP chemotherapy over the same time period have a relapse-free survival of 74% and overall survival of 91%. Because of superior results in treating stage III B patients with combined modality treatment, we fell that a relapse-free survival of 51% may not justify continuation of TNI as the only modality of treatment for patients with stage III A disease, and we have initiated a trial of combined radiation therapy and MOPP chemotherapy in these patients. The most effective treatment of stage III A Hodgkin's disease, however, remains uncertain and depends both on the ultimate risk of combined modality treatment and the success of retreatment following relapse after radiation.

Adolescent↗
PubMed1979

Radiographic features of recurrent intrathoracic Hodgkin's disease following radiation therapy.

Of 254 consecutive, surgically staged, IA-IIIB Hodgkin's disease patients treated at the Joint Center for Radiation Therapy between April 1969 and July 1976, 21 developed intrathoracic relapses. This study evaluated the radiographic features of relapse in these 21 patients. The superior mediastinum (nine patients) and the lung parenchyma (10) were the most frequent sites of involvement. In contrast to patients who initially had Hodgkin's disease, extranodal lung relapses were not associated with radiographically detectable relapses in the hilum or mediastinum. The appearance of the pulmonary relapses included both single and multiple nodules, with or without cavitation, and with both sharp and irregular margins. Due to this nonspecific appearance at relapse, tissue should be obtained in patients suspected of having recurrent Hodgkin's disease.

Adolescent↗
PubMed1979

Lung metastases in cervical and endometrial carcinoma.

Carcinoma of the cervix or endometrium was evaluated in 1,021 patients at the Joint Center for Radiation Therapy, Boston, between July 1968 and December 1977. The patients were retrospectively evaluated for the presence of lung metastases, appearing initially or during their disease course. On chest radiography, 42 patients were found to have metastases. Lung metastases were seen in 5.1% of patients with carcinoma of the cervix and in 3.6% of patients with carcinoma of the endometrium. Median time from initial disease staging to detection of lung metastases was 12 months. Once pulmonary spread was discovered, 80% of patients expired within 1 year. Lung nodules varied greatly in size. In 11 patients they were solitary; five patients had pleural effusions; three had mediastinal or hilar adenopathy; and none had excavation.

Adult↗
PubMed1978

The significance of mediastinal involvement in early stage Hodgkin's disease.

Between April 1969, and December 1974, 111 consecutive surgically staged I A and II A patients with supradiaphragmatic Hodgkin's disease were treated at the Joint Center for Radiation Therapy. Patients received 3600--4400 rad to mantle and para-aortic--splenic pedicle regions. Median follow-up was 56 months (30--96). Fourteen patients developed relapsing Hodgkin's disease and three patients died of possible treatment-related causes, two with acute myocardial infarctions and one with radiation pneumonitis. Patients with mediastinal enlargement greater than one third of the chest diameter have a significantly higher risk (p less than 0.01) of developing relapse (9 of 18) than patients with lesser or no mediastinal disease (5 of 93). Of the 18 patients with large mediastinal disease, six relapsed in the mediastinum and two in the lung. There continue to be no pelvic extensions in the entire group. There is a 92% relapse-free and 97% overall survival in the 93 patients without extensive mediastinal disease. We continue to recommend mantle and para-aortic--splenic pedicle irradiation for these patients. In view of the large number of relapses in patients with extensive mediastinal disease, we are now treating this subgroup of patients with MOPP chemotherapy in addition to mantle and para-aortic irradiation.

Adolescent↗
PubMed1977

Stages IIB and IIIB Hodgkin's disease. Results of combined modality treatment.

Between April 1969, and December 1974, 23 IIB and 26 IIIB surgically staged patients with Hodgkin's disease were treated at the Joint Center for Radiation Therapy. Stage IIB patients received either mantle and para-aortic-splenic pedicle, or total modal irradiation (TNI) alone or with the addition of combination chemotherapy. Relapse-free survival is 83% and overall survival 88%. Eleven patients received combination chemotherapy in addition to mantle and para-aortic irradiation, and both the relapse-free and overall survival are 100%. Of the stage IIIB patients, seven received TNI alone with four relapses, and 19 were treated with TNI and MOPP with two relapses. These relapse rates are significantly different (p less than 0.05). The relapse-free and overall survival for all stage IIIB patients is 66% and 84% respectively. These data imply that irradiation alone is not adequate treatment for stage IIIB Hodgkin's disease, and that with the addition of combination chemotherapy both the disease-free and overall survival is similar to that of early stage Hodgkin's disease without systemic symptoms. The ideal management of stage IIB Hodgkin's disease is less certain; it is our plan to study the efficacy of combined modality treatment.

Adolescent↗
PubMedDate not supplied

Prognostic factors in patients with subdiaphragmatic Hodgkin's disease.

Between April 1969 and December 1980, 329 patients with pathologically staged IA-IIB Hodgkin's disease were treated at the Joint Center for Radiation Therapy. Twenty-five (7.6 per cent) of these patients presented with inguinal-femoral or superficial iliac adenopathy and had disease limited to below the diaphragm. In addition 11 patients presented with intra-abdominal masses and Hodgkin's disease was diagnosed on laparotomy. The median age, histologic subtypes, and actuarial relapse free and overall survival of patients with peripheral adenopathy limited to below the diaphragm were similar to patients with supradiaphragmatic Hodgkin's disease. Patients with disease limited to the pelvic or inguinal-femoral nodes were treated with pelvic and para-aortic irradiation alone. Staging laparotomy identified those patients with para-aortic or splenic involvement and these patients were treated with total nodal irradiation or combined modality treatment. The small group of patients who presented with intra-abdominal disease without peripheral adenopathy was older, had a predominance of lymphocyte depleted histology, and had a worse prognosis than the other patients described.

Actuarial Analysis↗