Biomedical subjects
Publications and source records attributed to R H Phillips.
By use of an extended maxillotomy approach, greater surgical access is provided to the midline skull base in comparison with lateral approaches. We describe this technique used to debulk a tumor extending from the sphenoid sinus across the craniocervical junction to the second cervical vertebrae.
Metastatic prostate cancer is well known to respond to hormonal manipulations, but once progression occurs new treatment modalities are required. Specific and systemic antitumour therapy is preferable to local treatments such as radiotherapy in such patients. The finding that somatostatin analogue, BIM 23014, inhibits prostatic tumour growth in animal models is of great interest. We treated 25 poor risk patients with progressive metastatic prostate cancer. Sixteen had also failed to respond to 'total androgen blockade'. Two patients have achieved a partial remission, one of which is maintained at over 30 months, and three had stable disease for over 6 months. Side effects have consisted of mild diarrhoea and abdominal cramp in the first few days of treatment in a minority of the patients. These results are encouraging and further randomized studies are in progress.
Twenty-five patients with liver metastases, chiefly due to colorectal cancer, were given a loading dose of razoxane for 3 days before 5 consecutive days of radiotherapy to the whole liver. Patients also took razoxane during the radiotherapy and then for one month afterwards. Liver tumour volume was measured on CT scans using the ELSCINT 3D soft tissue imaging programme just before and 4 weeks after the end of radiotherapy treatment. Twelve of the 25 patients had tumour volume reductions of more than 50%. The overall major response rate therefore is 12/25 (48%). In two of the major responders the liver metastases were due to recurrent stomach cancer. In addition to the 12 responders, four patients had a reduction of more than 20% but less than 50%, thus giving an overall response rate of 16/25 (64%). These results can form the basis of a formal, randomized, controlled clinical trial of radiotherapy alone (or any other treatment) compared with radiotherapy and razoxane in the difficult and life threatening condition presented by liver metastases.
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Fasting blood samples were collected from 83 patients with histologically proven breast cancer and analysed for plasma glucagon, serum immunoreactive tumour necrosis factor (TNF alpha), insulin, glucose, growth hormone, cortisol and TSH. Samples from patients with known diabetes mellitus or thyroid disease, and those on parenteral nutrition or with evidence of infection were excluded as were patients who had a history of weight loss through dieting or who were anorexic. Fasting plasma glucagon, serum cortisol and immunoreactive TNF alpha concentrations in patients with stage IV breast cancer who had developed weight loss were significantly higher than those in patients with stage IV disease who had not developed weight loss. There were no significant differences in the fasting serum concentrations of insulin, glucose, growth hormone and TSH between the two patient groups. The association between weight loss in stage IV breast cancer and increased concentrations of plasma glucagon, serum cortisol and TNF alpha suggests a possible role for these hormonal factors in the development of cancer cachexia.
The indications, technique and complications of salvage mastectomy in 25 patients with local recurrence after breast-conserving therapy for carcinoma of the breast have been reviewed. Two patients required myocutaneous flaps to repair the defect, and six patients (24%) suffered wound infection or breakdown. Subsequent local relapse occurred in a total of five patients, two of whom died with uncontrolled chest wall skin nodules.
AIDS-related Kaposi's sarcoma is often treated by local therapy for physically or cosmetically disabling symptoms. We present the first case of a bulbar conjunctival Kaposi's sarcoma lesion to be treated with a strontium-90 ophthalmic applicator. The treatment is simple, effective and well tolerated and we recommend that it should be considered for the management of superficial Kaposi's sarcoma lesions of the conjunctiva.
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Three hundred fifty-six patients with early (Stage I and II) breast cancer and 55 with advanced (Stage III and IV) breast cancer were treated between 1979 and 1985 with a consistent policy of breast conservation irrespective of tumor site, size, or histologic features. Only three patients underwent primary mastectomy (Stage III), and the remainder were treated either by wide local excision and postoperative radiotherapy (357 cases) or by needle biopsy and primary irradiation (51 cases). A total of seven of 356 (2%) Stage I and II patients have developed uncontrolled local or nodal recurrence at a median follow-up of 5 years, and nine of 55 (16%) of Stage III and IV patients. Of the 62 Stage I and II patients who have died, seven (11%) have died with uncontrolled locoregional disease. Of the 22 Stage III and IV patients who have died, eight (36%) have died with uncontrolled locoregional disease. Although the majority of local recurrences within the conserved breast could be salvaged by secondary surgery (37/38 Stage I and II patients), the development of chest wall or nodal recurrence was usually associated with the appearance of distant metastases and a poor prognosis. Data on uncontrolled local recurrence should be given in all studies of breast cancer treatment, since it represents an important end-point of therapy and a difficult clinical problem.
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Patients with epidemic Kaposi's sarcoma, who are often taking zidovudine, may be treated with cytotoxic chemotherapeutic agents. Both cytotoxic chemotherapy and zidovudine are myelotoxic and we have treated 16 patients with this combination. We report an acceptable rate of anaemia, leucopaenia, thrombocytopaenia and non-haematological side effects. This combination can be safely administered to this group of patients, although much of our experience is with the relatively non-myelotoxic chemotherapeutic agents, bleomycin and vincristine.
A consecutive series of 411 patients with primary breast cancer treated by a consistent policy of breast conservation, regardless of tumour size, location, clinical stage or histological subtype, is reported. Actuarial 5-year survival was 84% for UICC Stage I, 73% for Stage II and 47% for Stage III/IV. The incidence of local recurrence at 5 years was 13% for Stage I, 12% for Stage II, and 26% for Stage III/IV. The probability of salvage mastectomy at 5 years was 5% for Stage I, 8% for Stage II, and 15% for Stage III/IV. Of local recurrences, 40% were managed with further breast conservation. Primary treatment with breast conservation results in satisfactory local control rates, 5-year survival and cosmesis, but the prevention, diagnosis and treatment of local recurrence within the conserved breast requires further evaluation.
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Detection of mild hypertension by a small number of casual blood pressures may be inaccurate for the determination of average blood pressure. Nonetheless, casual pressures remain the basis for the diagnosis and treatment of hypertensive patients. We compared casual and noninvasive ambulatory blood pressure monitoring in a consecutive series of 60 subjects evaluated for possible mild hypertension on the basis of casual pressures. Ambulatory blood pressure monitoring was performed on days of usual activity. Correlations between casual systolic and average ambulatory systolic pressures or casual diastolic and average ambulatory diastolic pressures were not significant. Nearly half of the subjects had average ambulatory systolic pressures less than 130 mm Hg. Sixty percent had average ambulatory diastolic pressures less than 85 mm Hg. Nearly 40% had both systolic and diastolic pressures less than those limits. A preliminary analysis of the effects of these results on the short-term cost of antihypertensive treatment was made, assuming that treatment could be withheld from those with average ambulatory pressures less than 130/85 mm Hg. This approach suggests that ambulatory blood pressure monitoring need not increase overall cost, if the results of this evaluation are used in the decision to treat.
Fifty-four patients with musculo-aponeurotic fibromatosis treated with surgery, surgery and planned post-operative radiotherapy, or radiotherapy alone between 1936 and 1982 have been retrospectively reviewed. Twenty-seven patients had a previous excision before definitive treatment. All patients in whom surgery was known to be incomplete and who had no further treatment relapsed. Nine patients had a complete surgical excision alone and 1 relapsed. Twenty-nine patients were treated with surgery and post-operative radiotherapy and 7 relapsed. Relapse was associated with small field size, orthovoltage irradiation, and doses less than 50 Gy. Radiotherapy was effective in preventing relapse in 6 of 8 cases incompletely excised and in all of these cases the total dose was more than 50 Gy. In 13 assessable patients with clinically evident disease, 14 fields were treated with radiotherapy. Complete response was achieved in 9 fields (although one subsequently relapsed and 2 had a marginal relapse), partial response in 4, and disease stasis in one. Complete resolution took up to 21 months and total doses ranged from 35.2 Gy to 64 Gy. Radiotherapy is indicated in cases of incomplete excision and inoperable disease. Doses should be radical and fields should be sufficiently generous to encompass the anatomical limits of the infiltrated tissues.
One hundred thirteen patients were randomized for the study. There was no significant difference between the groups for response or survival. The incidence of side effects related to the reduction of testosterone was similar in both groups. Disease "flare" was seen in three patients treated with long-acting D-Trp-6 LH-RH. All symptoms resolved by the end of 8 weeks. There was less psychological morbidity in the D-Trp-6 LH-RH group but the difference did not reach statistical significance. Our results indicate that long-acting D-Trp-6 LH-RH offers a safe and effective alternative to surgical orchidectomy.
Forty-one patients with advanced ovarian cancer (FIGO stage III or IV) who had relapsed following conventional treatment were treated with long acting depot preparation of D-Trp-6-LH-RH once a month. There were no exclusion criteria and patients of any age or performance status were eligible. Thirty patients continued to progress following therapy. Twenty-six patients died within the first 16 weeks from onset of therapy. Five patients remained stable (SD) on D-Trp-6-LH-RH with no change in tumor size. Six patients had evidence of clinical and/or radiological partial remission (PR) where the tumor size decreased by more than 50%. The remissions in the responding patients were maintained for a mean duration of 10 months (range 6-18 months). Thus 11 patients (6 PR + 5 SD) have had remission or stabilization of disease which has been clinically worthwhile. Clinical benefit of therapy with microcapsules of slow-release D-Trp-6-LH-RH in about 26% of patients is highly encouraging. Treatment with D-Trp-6-LH-RH offers an important non-toxic alternative in patients who do not tolerate chemotherapy or who have progressive disease following chemotherapy.