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P Warde

Publications and source records attributed to P Warde.

71 records · Page 4Linked to original sources
PubMed1992

The role of radiation therapy in the management of transitional cell carcinoma of the bladder.

The advantage of radical radiation therapy is that a proportion of patients will be cured while preserving normal bladder and sexual function. In most solid tumors, radiation therapy results in a local control rate inferior to that obtained by surgery, and this is also true in bladder cancer. Thus, efforts to preserve bladder function are likely to result in a lower local control rate than that achieved by cystectomy, and even if XRT achieved a 100% response rate, it cannot be expected to eliminate the risk of new tumor formation. Because cystectomy results in the loss of normal urinary bladder function and has only limited ability to cure, radiation remains an important therapeutic option in patients with bladder cancer. However, the question of whether radiation with an option of cystectomy for salvage would yield results comparable to those obtained by cystectomy has not been adequately answered. Most radiation oncologists agree that the use of radical radiation in patients with little or no chance of local control is inappropriate. Therefore, attempts at selection of responders, based on either clinical or biologic pretreatment parameters, are being investigated. Radical radiation therapy currently achieves a 50% complete response rate; thus, a large number of patients are potentially subjected to the morbidity of both modalities. Patients who have a small chance of achieving local control with XRT or who are known to be at risk for the rapid development of further bladder tumors (therefore unlikely to preserve their bladder for a significant time) are better served by primary cystectomy. Some patients prefer surgical treatment because it is decisive and quick; any attempts at bladder preservation potentially result in a lengthy treatment. Ideally, bladder sparing with XRT should be reserved for patients who are motivated to preserve normal bladder function and, therefore, patients should be involved in the decision regarding the choice of primary management. Although most patients embrace the opportunity for bladder preservation, they are frequently dissuaded from radiotherapy by the poor prospect of achieving local control and the risks of late complications.(ABSTRACT TRUNCATED AT 400 WORDS)

Brachytherapy↗
PubMed1991

A management approach to incompletely excised basal cell carcinomas of skin.

There were 187 incompletely resected basal cell carcinomas (BCC) of skin referred to the Princess Margaret Hospital between 1970 and 1985. Median age at presentation was 62 years. The commonest location of these lesions was in the head and neck region (93%). One hundred twenty lesions were immediately treated: 119 were irradiated and 1 was excised. The remaining 67 lesions were managed expectantly. Follow-up time for the entire population ranged from 1 month to 17 years, with a median time of 2.7 years. The 5-year probability of remaining relapse-free in the group immediately treated was 91% versus 61% if managed expectantly (p = 0.0001). If only lateral margins were positive, the crude probability of local failure was 3/18 (17%), versus 9/27 (33%) if the deep margins were involved (p = 0.2). Once relapse occurred in the group of lesions treated expectantly, 17/20 (85%) of these relapses were salvaged by either radiation or surgery. The 10-year actuarial probability of local control for the lesions immediately treated and observed were similar: 92% and 90%, respectively (p = 0.5). An economic analysis revealed that immediate radiation treatment saved the health system only $223.00 per patient. Since there is no difference in the ultimate local control between these two approaches, and these elderly patients may be spared the morbidity of unnecessary treatments, it is suggested that a policy of observation may be adopted for basal cell carcinomas of skin which have been incompletely excised.

Actuarial Analysis↗
PubMed1991

Bladder cancer: long-term follow-up results of patients treated with radical radiation.

Carcinoma of the bladder is commonly treated for cure with external beam radiation. Whilst short-term results are associated with a good chance of disease control there is little information about the long-term results of such therapy. We present a retrospective review of the Princess Margaret Hospital experience in treating transitional cell carcinoma of the bladder and emphasis on the long-term follow-up of patients treated with radiotherapy (XRT). Between 1972 and 1980, 355 patients were treated with a radical course of external beam radiation. The overall survival was 20% at 10 years and the cause-specific survival was 32%. Radiation treatment resulted in a long-term bladder preservation in at least 25% of patients. The majority of long-term survivors without evidence of relapse were patients with T1 (solitary tumours), T2 and T3a tumours. This subgroup represents patients with disease favourable for treatment with radiation. Factors affecting response to the XRT and survival included T stage and tumour bulk. Radiation complications were frequent and were usually associated with local disease recurrence.

Adult↗
PubMed1990

RECPAM analysis of prognostic factors in patients with stage III breast cancer.

A retrospective chart review was conducted of women with stage III breast cancer seen at the Princess Margaret Hospital between January 1977 and December 1980. Three hundred and sixty-nine patients were available for analysis. These cases were evaluated to determine the prognostic factors of patients presenting with this stage of the disease using a recursive partitioning technique, RECPAM, and a Cox regression model. A non-mathematical description of RECPAM is presented and the advantages of RECPAM over Cox analysis are discussed. The results identify primary tumour size, axillary node involvement, internal mammary node involvement, and estrogen receptor status as the most important prognostic variables. RECPAM identified 3 prognostic groups and simultaneously provided rules based on the prognostic variables to assign patients to poor, intermediate, or good prognosis categories. Patients with estrogen receptor negative tumours, or those with axillary node involvement, primary tumours greater than 5 cm, and serum alkaline phosphatase greater than 60 IU/L, or those with internal mammary node involvement, no skin changes, and serum alkaline phosphatase greater than 60 IU/L, define a group with a poor prognosis. Patients with estrogen receptor positive tumours, no axillary node involvements, and primary tumours greater than 5 cm, or estrogen receptor positive tumours, axillary node involvement, primary tumours greater than 5 cm, but serum alkaline phosphatase less than or equal to 60 U/L, have an intermediate prognosis. The good prognosis group consists of those patients with estrogen receptor positive tumours who have either skin changes or primary tumours less than or equal to 5 cm. The effect of loco-regional and systemic therapy was assessed and there was no association between treatment assignment and prognostic group. On the basis of this RECPAM analysis, we have defined important prognostic variables to be used in the design of clinical trials, and three major patient subgroups which can be used in routine oncologic practice as a guide to patient management.

Biomarkers, Tumor↗
PubMed1990

Counting the costs of chemotherapy in a National Cancer Institute of Canada randomized trial in nonsmall-cell lung cancer.

An economic evaluation was undertaken of a previously reported National Cancer Institute of Canada (NCIC) trial of chemotherapy in advanced nonsmall-cell lung cancer (NSCLC). That trial had demonstrated a survival benefit associated with the use of either vindesine and cisplatin (VP) or cyclosphosphamide, doxorubicin, and cisplatin (CAP) in relation to best supportive care (BSC). The economic technique used in this evaluation was cost-effectiveness analysis (CEA). All costs were determined from the viewpoint of two provincial health care plans. When compared with BSC, the survival benefit of 8 weeks in favor of patients receiving CAP chemotherapy was associated with an economic saving of $949.49 (in 1984 Canadian dollars). This translated into a savings of $6,171.69 per year of life gained. The mean survival benefit of 12.8 weeks that was obtained with VP chemotherapy compared with BSC was associated with an increased cost of $3,637.60 per patient, or $14,777.75 per year of life gained. The economic evaluation demonstrated that the majority of costs on each of the three treatment arms was related to hospitalization and not to the use of chemotherapy agents. These results compare favorably with estimates of cost-effectiveness (CE) of commonly used treatments for other diseases and demonstrate that a policy of supportive care is associated with costs that may exceed those of active treatment. It is concluded that economic factors should not adversely affect decisions regarding the use of chemotherapy in advanced NSCLC.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Carcinoma of the subglottis. Results of initial radical radiation.

During the 12-year period 1971 to 1982, 23 patients with primary squamous cell carcinoma of the subglottis were treated with initial radical radiation therapy. There were 19 men and four women, with a mean age of 64 years. Five patients had T1 tumors, four had T2, three had T3, and 11 had T4. The actuarial overall and cause-specific survival rates were 26% and 61%, respectively. Local control was achieved with initial radiation therapy in 16 patients (70%). Subsequent local control was achieved in one other patient following surgery for recurrence, giving an ultimate local control figure of 74% (17 of 23 patients). All patients with T1, T2, and T3 disease achieved local control with initial treatment; however, seven of the 11 patients with T4 disease either had residual disease following radiation therapy or developed local recurrence on follow-up.

Aged↗
PubMed1987

Eliciting preferences for alternative drug therapies in oncology: influence of treatment outcome description, elicitation technique and treatment experience on preferences.

Several methodologic issues arise in eliciting preferences for therapy. Examples are the selection of appropriate descriptions of treatment outcomes and of elicitation techniques. Of particular importance is the correspondence of patients' anticipated preferences for treatment to actual preferences once they have experienced treatment. Treatment outcome descriptions and elicitation techniques were compared for a hypothetical drug decision problem involving trade-offs between quality and quantity of life. Preferences of 54 cancer patients were elicited before, and 6 weeks following initiation of chemotherapy treatment. Patients' preferences were not influenced by the way information about side effects was presented, nor the stated probability of survival at high and moderate levels. A riskless rating technique produced different preferences from those of a risky treatment choice method. Although patients experienced significant toxicity following initiation of treatment, their preferences remained stable on retest. The results raise questions about the extent to which patients are willing, at the time of decision making, to trade off survival rate for improved quality of life.

Antineoplastic Agents↗
PubMed1987

Computed tomography in advanced ovarian cancer: an evaluation of diagnostic accuracy.

The authors have investigated the diagnostic accuracy of computed tomography (CT) of the abdomen and pelvis in the assessment of patients prior to second-look laparotomy for advanced ovarian cancer. CT studies (read independently by three radiologists) and laparotomy findings were analyzed in 50 patients. Sensitivity varied from 0.30 to 0.65 among the radiologists, specificity from 0.44 to 0.89, positive predictive value from 0.50 to 0.73, and negative predictive value from 0.60 to 0.70. Receiver operator curve analysis of the data indicated poor performance of CT as a diagnostic test. The authors also examined some problems in interpreting their data and that of others in the literature, in particular, the influence of potential sources of bias.

Evaluation Studies as Topic↗
PubMed1986

Computed tomography in advanced ovarian cancer. Inter- and intraobserver reliability.

We have examined the reliability of computed tomography (CT) in the assessment of patients with advanced ovarian cancer. Three radiologists independently read the same set of 140 CT scans. Fifty percent of the films were reread by the same radiologist to assess intraobserver agreement. In addition we assessed variability among radiologists in reporting signs of disease such as a mass and ascites and the variability in reporting a change in signs in response to therapy. Intraobserver agreement on the identification of signs such as a mass and ascites and on overall response to therapy was moderate to excellent (Kappa 0.52-0.84). Agreement among observers on the same signs was not as good (Kappa 0.36-0.79).

Adult↗
PubMed1985

Renal glomerulopathies associated with Hodgkin's disease.

From a series of 138 patients with Hodgkin's disease seen over a 17-year period, 2 developed the nephrotic syndrome. One patient developed hematuria unrelated to cytotoxic chemotherapy or thrombocytopenia. All three patients had evidence of glomerulopathy on histologic examination of renal tissue, but none had the more usually associated minimal-change glomerular histologic features. The patients with nephrotic syndrome had effective clinical regression with systemic chemotherapy. The significance of renal glomerular disease in association with Hodgkin's disease is discussed.

Adult↗
PubMedDate not supplied

Benign parotid adenomas: a review of the Princess Margaret Hospital experience.

BACKGROUND: The morbidity of treating benign parotid tumors is an important issue because the majority of patients are young. We therefore undertook this study to evaluate the outcome for these patients treated at the Princess Margaret Hospital. METHODS: A retrospective review was conducted on all patients registered with benign parotid tumors between 1970 and 1987. RESULTS: Seventy-six patients were included in this review; postoperative radiotherapy (XRT) was administered to 55 patients. Median follow-up time was 12.5 years. Postoperative XRT was particularly important for patients with recurrent disease. The risk of both temporary and permanent facial nerve paralyses increased with each operation. No patients in this study developed a malignancy. CONCLUSIONS: We recommend that all patients with benign parotid tumors be treated with a complete parotidectomy with preservation of the facial nerve. Consideration to postoperative XRT should be given to patients in whom there was tumor spillage, residual disease, or recurrences.

Adenoma↗
PubMedDate not supplied

Role of Epstein-Barr virus in fine-needle aspirates of metastatic neck nodes in the diagnosis of nasopharyngeal carcinoma.

BACKGROUND: The patient with nasopharyngeal carcinoma (NPC) frequently is initially seen with regional node dissemination. Preliminary investigations suggest that the presence of Epstein-Barr virus (EBV) genomes in neck metastases from an occult primary may be diagnostic and predictive of NPC. The goal of this study was to test this proposition. METHODS: The polymerase chain reaction (PCR) was used to detect the presence of EBV DNA in fine-needle aspirate (FNA) samples obtained from malignant neck nodes. Control samples were obtained from other locations in the head and neck. PATIENTS: The patients in this study were evaluated at the Toronto Princess Margaret Hospital, a province-wide tertiary-care cancer treatment center. Of the 23 patients evaluated with malignant neck masses, 6 had NPC, 5 patients had metastatic squamous cell carcinoma of an unknown primary, and 12 patients served as controls with other known head and neck carcinomas. One of the patients initially diagnosed as an unknown primary later demonstrated NPC. FNA specimens were also obtained from 24 normal parotid, submandibular, or thyroid glands for comparison. RESULTS: In the samples with sufficient DNA for analysis, EBV was detected in 5 of 5 neck nodes from patients with known NPC. EBV was also detected in the neck node of a patient who went on to develop NPC and in a cervical node from 1 of 2 patients in whom the primary tumor remained unknown. None of the evaluable control neck nodes of FNA controls from other sites demonstrated EBV. CONCLUSIONS: These results demonstrate the utility of NPC-diagnostic EBV gene amplification in FNA samples of neck metastases and suggest that the presence of the EBV genome in FNA samples of neck nodes is predictive of the presence of NPC.

Adolescent↗
PubMedDate not supplied

Volvulus of the sigmoid colon in Brazil: a report of 230 cases.

Etiologic and physiopathologic aspects of volvulus of the sigmoid colon in Brazil are presented. It is believed that sigmoidal volvulus in Brazil is a frequent complication of megacolon caused by Chagas' disease, differing in some characteristics from volvulus found in other countries. A review of 230 cases treated between 1938 and 1974 in the Surgical Department of Hospital das Clinicas, University of Sao Paulo School of Medicine, is presented. The successive variations used to treat this disease occurred parallel to those introduced in the surgical treatment of uncomplicated megacolon. From the results, the following treatment is recommended: endoscopic emptying in cases without clinical, roentgenographic or endoscopic signs of intestinal ischemia. Laparotomy should be performed when a complicated volvulus is suspected or when it is not possible to empty the loop. When a simple volvulus is found, the loop should be untwisted and the gaseous contents siphoned off by menas of a rectal catheter. When there is necrosis of the colon, the Hartmann operation is recommended. It is important to submit patients to a definitive treatment of the megacolon soon after endoscopic emptying or surgical detorsion of the volvulus, since recurrences following these measures are frequent.

Adult↗