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Biomedical subjects

R Feld

Publications and source records attributed to R Feld.

At least 145 records · Page 8Linked to original sources
PubMed1984

VP-16 alone and in combination with cisplatin in previously treated patients with small cell lung cancer.

Fifty-four patients with small cell cancer of the lung (SCCL) who failed to respond to induction chemotherapy or relapsed within 3 months of its completion were treated either with VP-16 alone or VP-16 and cisplatin. Fifty-two patients were initially treated with cyclophosphamide, doxorubicin (Adriamycin) and vincristine (CAV), and two were treated with cyclophosphamide, methotrexate, and vincristine. Nine patients also received other drug combinations either as maintenance therapy or as treatment for relapse. Fourteen of 18 patients treated with VP-16 alone were evaluable for response, and there was only one partial remission. On the other hand, 15 of the 34 evaluable patients (44%) treated with VP-16 and cisplatin had a partial response, and an additional 11 patients (32%) showed substantial tumor regression and were classified as improved. Two patients had stable disease, and six (18%) progressed. Five of the nine (55.6%) limited-disease patients achieved a partial response compared with 10 of 25 (40%) with extensive disease. The median survival time from the date of first treatment with the combination was 17 weeks (29 weeks for patients achieving a partial response; 19 weeks for those showing improvement; 11 weeks for those with stable disease; and 13 weeks for patients with disease progression). Gastrointestinal toxicity was mild relative to that of CAV-induction therapy but myelosuppression, particularly thrombocytopenia, was common. Mild nephrotoxicity occurred in four patients, but no other important toxicities were identified.

Adult↗
PubMed1984

Serum folate and vitamin B12 levels in patients with small cell lung cancer.

Serum folate and vitamin B12 levels were evaluated in 80 patients with small cell lung cancer at diagnosis and during therapy over a 30-week period. Approximately one half of the patients were randomized to receive hyperalimentation. Folate and vitamin B12 intake was adequate without parenteral nutrition in these cancer patients. Serum folate and Vitamin B12 levels did not correlate with disease extent. At the initiation of therapy, serum folate declined with increasing weight loss. During therapy, the intake of folate was adequate to maintain a normal serum folate despite marked weight loss.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Systemic infection by Rhodotorula spp. in the immunocompromised host.

Invasive fungal disease continues to be a significant problem among immunocompromised patients. We report a case of systemic Rhodotorula infection in a patient with acute myelogenous leukaemia. Rhodotorula was isolated from bone marrow on two separate occasions despite initial treatment with amphotericin B. Liver computerised tomographic scan suggested liver abscesses, and yeasts were seen on biopsy. The patient survived after aggressive antifungal and antileukaemia treatment. Rhodotorula fungaemia has been occasionally associated with shock. As our case illustrates, Rhodoturola may be a cause of invasive fungal disease in the immunocompromised host but can be eradicated if treated aggressively.

Adult↗
PubMed1984

Sites of recurrence in resected stage I non-small-cell lung cancer: a guide for future studies.

The Lung Cancer Study Group recently completed a double-blind adjuvant immunotherapy study, in which 473 patients with resected stage I non-small-cell lung cancer were randomized to either intrapleural BCG or placebo. The study showed no significant difference in time to first recurrence for the two treatment arms. The present report analyzes the distribution of the anatomic site of first relapse and relates this to TN staging, histology, and other appropriate risk factors. The overall rate of recurrence is significantly higher for increasing TN status and for nonsquamous as compared to squamous-cell type. However, the distribution of site of recurrence does not, in general, change with increasing TN status or with histology. Approximately 65% to 75% of the first recurrences involve distant sites, with the brain being by far the most common, regardless of TN staging or histology. The implications of this for planning future studies is discussed.

Adenocarcinoma↗
PubMed1984

Combined modality induction therapy without maintenance chemotherapy for small cell carcinoma of the lung.

One hundred fifty-three patients with limited and 167 with extensive small cell carcinoma of the lung (SCCL) were evaluable for response to treatment with six courses of chemotherapy (cyclophosphamide, doxorubicin, and vincristine), irradiation to intrathoracic disease, and prophylactic cranial irradiation (PCI). No maintenance chemotherapy was given. Fifty-two percent of patients with limited disease (LD) and 10% of extensive disease patients (ED) achieved a complete response. The median survival times for LD and ED patients were 49 and 34 weeks, respectively. These results were compared to a previous experience with 147 patients who were treated with three courses of similar induction chemotherapy and thoracic irradiation, as well as one year of maintenance chemotherapy (CCNU, procarbazine, and methotrexate) but without PCI. Although the use of PCI was found to reduce the frequency of brain metastases as the site of first relapse, detailed comparisons of response rates and survival showed no significant differences between the two study populations. Prolonged maintenance chemotherapy of the type used in the first study does not favorably influence outcome after intensive induction therapy for SCCL.

Adult↗
PubMed1984

Changes in body composition in patients with small-cell lung cancer. The effect of total parenteral nutrition as an adjunct to chemotherapy.

y composition was studied in 31 patients receiving chemotherapy for small-cell lung cancer. Patients were randomly assigned to receive either 4 weeks of total parenteral nutrition (study group) or to continue a self-regulated oral diet (control group). The relationship between height and total body nitrogen was altered initially for patients who had lost more than 5% of body weight. During the 4 weeks of parenteral nutrition, body weight, total body fat, and total body potassium, but not total body nitrogen, increased significantly in the study group (p less than 0.001). However, after parenteral nutrition was stopped, body weight and potassium levels in the study group fell significantly and to the same extent as in the control group. Nitrogen levels showed an overall fall in the 32 weeks of observation for both groups. After the period of parenteral nutrition, the decrease in body fat was significantly greater in the control group than in the study group (p less than 0.05). Thus, parenteral nutrition increased body fat and total body potassium, but not total body nitrogen.

Adipose Tissue↗
PubMed1984

Effects of total parenteral nutrition and chemotherapy on the metabolic derangements in small cell lung cancer.

Changes in energy metabolism, substrate use, and hormone profiles were prospectively studied in 31 patients with small cell lung cancer receiving chemotherapy. Patients were randomized to receive either 4 weeks of total parenteral nutrition (n = 15) or to continue self-regulated p.o. diet (control group; n = 16). The initial actual resting energy expenditure measured by indirect calorimetry was 31% higher than the predicted resting energy expenditure determined by the Harris-Benedict formula. The p.o. calorie intake was inappropriately low for these hypermetabolic patients. Total parenteral nutrition resulted in a significant positive net energy balance, but in follow-up was associated with prolonged anorexia and a negative energy balance. Complete response to therapy reduced resting energy expenditure and increased calorie intake, whereas the contrary was true in nonresponders. Elevated plasma-free fatty acids (800 +/- 62 microM; S.E.) and a low respiratory quotient (0.74 +/- 0.02) indicate that the dominant energy source in patients with small cell lung cancer is fat, and that increased fat oxidation continues despite tumor response. Elevated fasting plasma catecholamines and insulin resistance may contribute to continued fat mobilization. Initially, there was a significant increase in blood lactate (1118 +/- 95 microM) suggesting either increased tumor or tumor-mediated glycolytic activity. Response to therapy was associated with a fall in blood lactate levels. The most effective way of improving the metabolic derangements in patients with small cell lung cancer was to achieve tumor response to therapy.

Adult↗
PubMed1984

Empiric therapy for infections in patients with granulocytopenia. Continuous v interrupted infusion of tobramycin plus cefamandole.

A combination of tobramycin sulfate and cefamandole nafate was used as initial empiric therapy for the treatment of 71 evaluable febrile (temperature greater than 38.5 degrees C) episodes in 64 (neutrophils, less than 1,000/microL) adult patients with cancer and granulocytopenia. Carbenicillin sodium or ticarcillin disodium was substituted for cefamandole in patients with Pseudomonas infections and in patients in whom the initial regimen was unsuccessful. Twenty-nine episodes were randomized to receive tobramycin by continuous infusion, while 42 were randomized to receive tobramycin by interrupted infusion. Twenty-seven (79%) of the 34 documented infections responded to the initial empiric antibiotic combination, ten (83%) of 12 being given continuous infusion and 17 (77%) of 22 being given interrupted infusion of tobramycin. Nephrotoxic reaction occurred in 7% of patients treated with continuous infusion and 15% treated with interrupted infusion, mostly patients older than 60 years. Tobramycin, by either continuous or interrupted infusion, plus cefamandole is safe and efficacious empiric therapy for infections in patients with cancer and granulocytopenia.

Adult↗
PubMed1983

Upper half body irradiation (UHBI) for extensive small cell carcinoma of the lung.

Upper half body irradiation (UHBI) was given to 41 of 121 patients with extensive small cell carcinoma of the lung. All patients were treated with 6 courses of cyclophosphamide, doxorubicin, and vincristine (CAV). Responding patients also received prophylactic cranial irradiation and local irradiation to prechemotherapy intrathoracic disease. Among the 70% (85/121) of patients who responded to chemotherapy, 41 have received UHBI, given one to two months later. The single fraction midline dose given has been increased in successive patients from 300 to 720 cGy (uncorrected for inhomogeneities). Actual lung doses were higher by 9-22%, (determined in 31 patients by CT scanning and lung density measurements). Adverse effects seen were vomiting, fever, drowsiness, myelosuppression, liver dysfunction and dry mouth. All were transient, and no pneumonitis or treatment deaths occurred. Adverse effect rates were similar at all dose levels. UHBI is well tolerated in patients who have received chemotherapy and merits further study.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

A multicentre prospective randomized trial comparing ceftazidime with cefazolin/tobramycin in the treatment of hospitalized patients with non-pneumococcal pneumonia.

A multicentre prospective randomized control trial was done to compare the efficacy and toxicity of ceftazidime with that of cefazolin/tobramycin in the treatment of hospitalized patients with non-pneumococcal pneumonia. The results for 50 patients are reported in this paper; 24 in the ceftazidime group and 26 in the cefazolin/tobramycin group. Measurements of clinical response show no differences between the two groups: the same is true for bacteriological response. Minimal toxicity was seen with both treatment groups. The results support the use of ceftazidime as single-drug treatment of hospitalized patients with pneumonia.

Adult↗
PubMed1983

Intramedullary spinal cord metastases from small cell carcinoma of the lung.

Four patients with intramedullary spinal cord metastases from small cell carcinoma of the lung (SCCL) are described, with emphasis on clinical presentation and treatment. All patients developed the Brown-Séquard syndrome due to intramedullary tumor in the cervical spinal cord, three within 2 mo after combined modality treatment using chemotherapy and radiotherapy. One patient presented with a Brown-Séquard syndrome and an extradural spinal cord compression from tumor. The radiological and cerebrospinal fluid findings are presented and discussed. Radiation treatment was administered to the involved segments of spinal cord in each patient. All patients responded; two for 3 and 7 mo, two for 3 and 4 wk, respectively. There was significant improvement in the quality of life for three of the four patients.

Carcinoma, Small Cell↗
PubMed1983

Symposium on the diagnosis and treatment of common cancers. 1. Lung cancer--1983.

The frequency of lung cancer, common in both men and women, seems to be increasing rapidly, particularly in women. The main causative factor appears to be cigarette smoking. Diagnosis and staging have not changed notably in the last few years, although the advent of computerized tomography and gallium scanning have been of some help in identifying mediastinal tumours, which are unresectable. Further refinements in these techniques may allow us to avoid mediastinoscopy but, at present, this is still usually necessary before operation for lung cancer. Operation is the major form of therapy for non-small cell cancer when this is medically and technically possible. Adjuvant therapy in the treatment of this type of lung cancer has so far been of little help. Radiotherapy as primary treatment, although occasionally curative, should be used only if patients refuse operation or clearly have medical contraindications for thoracotomy. Radiotherapy is very useful for palliation. Chemotherapy is of little value in treating advanced, non-small cell lung cancer, although responses can be seen in up to 40% of patients. This does not translate into important, long-term survival, but responders do survive longer than non-responders. Patients with small cell lung cancer should be treated with combination chemotherapy, with or without thoracic irradiation and with or without cranial irradiation. The latter two modalities have not yet been proved to prolong survival, but may reduce the morbidity. Immunotherapy has not been shown to benefit those with non-small cell lung cancer. Thymosin was beneficial in one controlled trial in patients with small cell lung cancer, but this must be confirmed. In the future, many new approaches will be necessary to control or eradicate this steadily increasing cause of cancer death.

Antineoplastic Agents↗
PubMed1983

Reduction in local recurrence and improved survival in surgically treated patients with small cell lung cancer.

To assess the role of operation in the treatment and prevention of local recurrence in limited small cell lung cancer, we analyzed retrospectively 35 patients undergoing surgical resection for small cell lung cancer between 1976 and 1982. Twenty-eight patients underwent resection for presumed non-small cell histology. Seven later patients had planned combined modality therapy consisting of chemotherapy and prophylactic cranial irradiation followed by surgical resection and irradiation to the primary site. Twenty-four patients received adjuvant postoperative chemotherapy and/or radiotherapy. All patients have been treated and followed up for a minimum of 1 year. There were 19 patients in Stage I and 16 in Stages II and III. In 15 patients, relapse has occurred. The commonest site of first relapse was brain (7/15). Five of these patients had received prophylactic cranial irradiation. In only two patients was there a relapse locally in the hemithorax and/or mediastinum--one with NO disease and one with N1 disease. No local recurrence was noted in six patients with N2 disease. Only two relapses have occurred beyond 1 year--both in brain. In those patients surviving more than 2 years, no relapses have occurred. The median survival time for patients with Stage I disease is 158 weeks and for those with Stages II and III, 92.4 weeks. The median survival time for the whole group is 92.4 weeks with a projected 5 year survival rate of 24%. It appears that surgical resection may help to prevent local recurrence in small cell lung cancer, even in N1 and N2 disease. In our series, projected 5 year survival rates are similar to those seen in the surgical treatment of patients with non-small cell lung cancer. The eventual role of operation in the prevention of local recurrence and improvement in overall survival of limited small cell lung cancer awaits prospective randomized trials.

Adult↗
PubMed1983

Prophylactic metronidazole in appendectomy: a double-blind controlled trial.

Ninety-eight patients with suspected nonperforated acute appendicitis have to date been entered into a continuing, prospective, blinded randomized trial to determine the role of prophylactic metronidazole in postoperative wound infection. Twenty-six patients were excluded for the following reasons: diagnosis other than acute appendicitis (16), perforation of the appendix (8), administration of other antibiotics (1), and refusal to enter study (1). Seventy-two patients, 47 men and 25 women, with a mean age of 27.5 years (range 15 to 60 years), underwent appendectomy and were studied. Thirty patients received 1 gm intravenous metronidazole preoperatively and five intravenous doses of 500 mg metronidazole postoperatively. Forty-two patients received placebo only. Cultures of the appendiceal stump grew aerobic cultures in 45 (62%) and anaerobic organisms in 29 (40%): Escherichia coli and Bacteroides fragilis, respectively. Six of the 72 patients (8.2%) developed postoperative wound infections: four of 42 (9.5%) who received placebo and two of 30 (6.6%) who received metronidazole (P = 0.54 by Fisher exact test). No toxicity from metronidazole was observed. The postoperative wound infection rate is insufficient to demonstrate the efficacy of metronidazole for prophylaxis in nonperforated acute appendicitis, although there appears to be a tendency of to assume its efficacy in this regard.

Adolescent↗
PubMed1982

Herpes zoster in patients with carcinoma of the lung.

Herpes zoster was observed in only four of 250 (1.6 percent) patients with small cell carcinoma of the lung, who were treated in a prospective, combined modality therapy trial. Induction chemotherapy in this study consisted of six courses of cyclophosphamide, doxorubicin, and vincristine (CAV), followed by intrathoracic and cranial irradiation. Those with extensive disease also received single doses of upper half-body irradiation. Patients did not receive maintenance chemotherapy (CAV2 protocol). This contrasted with our previous study (CAV1 protocol), which consisted of three courses of the same induction chemotherapy, the same intrathoracic irradiation, but with one year of oral maintenance chemotherapy. During the CAV1 regimen, we observed that herpes zoster developed in 13 of 161 (8.1 percent) patients in association with their therapy. A retrospective analysis of 6,576 patients with lung cancer revealed that herpes zoster developed in 58 (0.9 percent). This complication developed in 10 of 622 (1.6 percent) patients with small cell carcinoma of the lung, as compared to 48 of 5,954 (0.8 percent) patients with non-small cell carcinoma of the lung. The risk of development of herpes zoster in the CAV1 group was significantly greater than the historical group (p = 0.007) and was also greater than the CAV2 group (p = 0.031). However, there was no significant difference between the historical group and the CAV2 group. Attempts to explain the differences in the rate of herpes zoster in our three studies and those in the literature suggest that the duration of therapy, the type of chemotherapy used, and the improving survival rate may be important contributing factors to this complication in patients aggressively treated for small cell carcinoma of the lung. The literature and our own studies suggest that procarbazine is the most likely chemotherapeutic agent predisposing to this complication.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1982

Computed tomography of the brain, liver, and upper abdomen in the staging of small cell carcinoma of the lung.

Computed tomography (CT) examinations of the brain, liver, and upper abdomen were obtained in 60 previously untreated patients with histologically proven small cell carcinoma of the lung (SCCL). These results, together with clinical findings and laboratory investigations including radionuclide scans, determined the final staging of the patients. Computed tomography changed the stage from limited to extensive disease in three patients and from extensive to limited disease in seven patients. Overall, 10 of 60 patients (16%) had their final stage altered by CT. This study indicates that CT examinations may yield valuable information in some cases of small cell lung cancer but that it is of limited value in the routine staging of these patients.

Abdominal Neoplasms↗