Search PubMed⌕ Search

Biomedical subjects

R Birch

Publications and source records attributed to R Birch.

At least 163 records · Page 9Linked to original sources
PubMed1986

Chemotherapy for head and neck cancer. Comparison of cisplatin + vinblastine + bleomycin versus methotrexate.

One hundred ninety-one patients with recurrent or metastatic squamous cell carcinoma of head and neck origin were allocated at random to chemotherapy with conventional-dose weekly intravenous methotrexate or the combination of cisplatin, vinblastine, and bleomycin. Methotrexate induced responses in 16 of 98 patients (16%), whereas 22 of 92 (24%) responded to the combination regimen (P = not significant). Remission duration (20.2 weeks methotrexate; 15.1 weeks combination) was similar on both arms, as was survival (31.4 weeks methotrexate; 29.0 weeks combination). Therapy was relatively well-tolerated on both treatment arms, although methotrexate produced more mucositis and the combination more gastrointestinal and renal toxicity. Response to chemotherapy and disease confined to the locoregional area were associated with somewhat longer survival. Combination chemotherapy as given in this study did not improve any observed parameter, and the results of treatment were poor in both arms.

Adult↗
PubMed1986

Impact of tumor control on survival in carcinoma of the lung treated with irradiation.

The long-term results in tumor response, intrathoracic tumor control and survival are reported in patients with medically inoperable or unresectable non-oat cell and small cell carcinoma of the lung. In 376 patients with stages T1-3, NO-2 carcinoma of the lung tumors, accessioned to a Radiation Therapy Oncology Group (RTOG) randomized study to evaluate different doses of irradiation, a higher complete response rate (24%), intrathoracic tumor control (67%) and three year survival (15%) was observed with 6000 cGy, compared with lower doses of irradiation (4000 or 5000 cGy). Increased survival was noted in patients with complete tumor response. Three year survival in complete responders was 23%, in partial responders, 10%, and in patients with stable disease, 5%. Patients treated with 6000 cGy had an overall intrathoracic failure rate of 33% at 3 years, compared with 42% for those treated with 5000 cGy, 44% for patients receiving 4000 cGy with split course, and 52% for those treated with 4000 cGy continuous course (p = 0.02). Patients surviving 6 or 12 months exhibited a statistically significant increased survival when the intrathoracic tumor was controlled. Patients treated with 5000-6000 cGy, showing tumor control, had a three year survival of 22%, versus 10%, if they had intrathoracic failure (p = 0.05). In patients treated with 4000 cGy (split or continuous), the respective survival was 20% and 10%, if the intrathoracic tumor was controlled (p = 0.001). In patients surviving 12 months after treatment with 5000-6000 cGy, on whom the intrathoracic tumor was controlled, the median survival was 29 months, in contrast to 18 months, if they developed intrathoracic failure (p = 0.05). In patients treated with 4000 cGy, the median survival was 23 months with control and 18 months without control of the intrathoracic tumor [corrected] (p = 0.008). In another RTOG study for patients with more advanced tumors (T4 or N3), those with local tumor control at 12 months had a three year survival rate of 25%, compared with 5% for those with thoracic failures. These differences are statistically significant (p = 0.006). Higher doses of irradiation yield a greater proportion of complete response, higher intrathoracic tumor control and better survival in non-oat cell medically inoperable or unresectable carcinoma of the lung.(ABSTRACT TRUNCATED AT 400 WORDS)

Carcinoma, Bronchogenic↗
PubMed1986

Prognostic factors for favorable outcome in disseminated germ cell tumors.

Between 1978 and 1982, 180 patients from Indiana University (Indianapolis) were entered on the Southeastern Cancer Study Group (SECSG) protocol 78 GU 240, a randomized comparison of cisplatin, vinblastine, and bleomycin (PVB) v PVB plus doxorubicin induction chemotherapy regimens, with a second randomization to maintenance vinblastine v no further therapy. One hundred forty-eight of these patients obtained a favorable response to chemotherapy, defined as a complete response (CR) or a surgical resection of teratoma. The prognostic significance of various patient characteristics was investigated using the logistic regression model. Two classifications for the extent of disease were considered: the Indiana staging system and the M.D. Anderson (MDA) staging system. The Indiana staging system had the greater prognostic significance. This staging system allowed the population to be split into three groups (minimal, moderate, advanced disease) in which the observed proportions of favorable responders were 99%, 90%, and 58%, respectively. Within the advanced group, the number of elevated tumor markers subdivided these patients into three groups, with the observed proportions of favorable responders being 73%, 65%, and 45%. The Indiana and MDA staging systems were subsequently prospectively used in SECSG protocol GU 81 332, a study randomizing patients to remission induction therapy with PVB v cisplatin, VP-16, and bleomycin. The prognostic value of the Indiana staging system was prospectively validated in this study.

Adolescent↗
PubMed1986

Randomized dose-response evaluation of etoposide in small cell carcinoma of the lung: a Southeastern Cancer Study Group Trial.

To evaluate postulated dose-response relationships of etoposide (VP-16) for patients with recurrent small cell carcinoma of the lung, a prospectively randomized study was undertaken. VP-16 was administered iv at three dose levels: 300, 600, and 900 mg/m2. Based on historical information, a 20% response rate was anticipated in the standard-dose level and the study was designed to be able to detect a response rate of 40% in either of the high-dose levels. The planned number of patients required in each arm was 45, with an alpha-level of 0.1 and a beta-level of 0.2. The total number of patients actually entered was less than the planned number due to a low response rate. Seventy-seven of 79 treated patients were eligible, and 26, 27, and 26 patients were treated at each dose level, respectively. Toxicity was predominantly hematologic, with the higher dose levels substantially more toxic. Response to therapy was infrequent, with only four partial responses achieved and distributed between all dose levels. In this study, using previously treated patients, VP-16 at standard-dose or at moderate-dose increments had minimal activity.

Carcinoma, Small Cell↗
PubMed1986

Serum insulin and blood pressure in an obese population.

Serum insulin has been implicated as a determinant of blood pressure (BP) level in obese hypertensive individuals. We examined the relationships among fasting insulin, mean arterial pressure (MAP), body composition, and fat distribution in 204 subjects unselected for glucose tolerance. All met the criteria of taking no oral hypoglycemic agents, insulin or antihypertensive medications. 95 percent were considered obese and 78 percent were female. Mean age was 39 years (range 15-71), percent ideal body weight (IBW) 171 percent (109-332), BP 125/81 mmHg (80-181/50-110) and fasting insulin 44 microU/ml (4-196). Lean body mass (LBM) and body fat were measured by tritium dilution. The correlation coefficient between insulin and MAP was 0.32 (P less than 0.0001). Both insulin and MAP correlated highly with percentage IBW, percentage body fat, fat mass, LBM, body build and upper fat pattern. Controlling for these variables simultaneously eliminated the association between insulin and BP. By contrast, the correlations between MAP and measures of body composition and fat distribution retained significance after controlling for insulin level. These findings suggest that measures of body composition and fat distribution have a relationship with BP that is not entirely accounted for by serum insulin level, and the relationship between serum insulin and BP is indirect and largely accounted for by their mutual association with measures of body composition and fat distribution.

Adipose Tissue↗
PubMed1986

Phase II study of etoposide for carcinoma of the prostate.

The treatment of prostate carcinoma with the epipodophyllotoxin derivative etoposide was studied in a multi-institutional phase II trial. An iv dose schedule of 130 mg/m2 daily for 3 days every 3 weeks was utilized. A total of 36 patients were evaluable; the observed total response was 3%. Moderate toxicity (predominantly myelosuppression) was seen utilizing this treatment schedule. It is concluded that etoposide possesses little single-agent therapeutic activity for prostate carcinoma.

Blood Cell Count↗