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Biomedical subjects

R H Sagerman

Publications and source records attributed to R H Sagerman.

At least 37 records · Page 2Linked to original sources
PubMed1989

Radiation therapy technology: manpower survey 1987.

A chronic shortage of radiation therapy technologists exists in the United States. This report presents the data obtained in a 1987 survey of all radiation oncology facilities identified by the Patterns of Care master list. Of the 1,142 questionnaires mailed, 52% were returned. The survey identified 2,328 credentialed (ARRT) and 554 non-credentialed technologists employed in radiation therapy. Of this total of 2,882, 2,141 were identified as staff technologists. A total of 1,186 megavoltage units were identified, giving a ratio of 1.8 technologist/megavoltage unit. Two hundred sixty open funded positions and 230 unfunded positions for radiation therapy technologists were identified. The report compares the results of this 1987 Radiation Therapy Technology Manpower Survey with the results of the three previous surveys conducted in 1975, 1977, and 1981. Whereas this comparison demonstrates that progress has been made, current trends in allied health education are expected to have a negative impact on recruitment into radiation therapy technology. Program directors report that the number and quality of applicants to all allied health education programs is declining, and this trend in radiation therapy technology is substantiated by a drop in the number of students enrolled in programs, from 970 in 1986-87 to 777 in 1987-88. Our discussion addresses the areas of new program development, recruitment, retention, innovative programs, and overseas recruitment.

Allied Health Personnel↗
PubMed1989

Stage II seminoma: results of postorchiectomy irradiation.

One hundred forty patients with testicular seminoma were treated at the State University of New York Health Science Center at Syracuse between 1966 and 1985. Disease was classified as stage II in 32 patients (23%): stage IIA in 21 patients and stage IIB in 11 patients. All patients underwent irradiation below the diaphragm after a radical orchiectomy, and 28 underwent planned mediastinal and supraclavicular irradiation. The median follow-up was 8 1/2 years; 24 of 32 patients have been followed up for more than 5 years. Twenty-eight patients remain alive and well; four patients died of intercurrent disease. Two patients developed a recurrent seminoma in the mediastinum; a variant lymphangiographic pattern was shown in these patients, and they were cured. A third patient developed a non-seminomatous "recurrence" in the ipsilateral, unirradiated, inguinal nodes and is well after chemotherapy.

Adult↗
PubMed1988

Stage III thymoma: results of postoperative radiation therapy.

The results of postoperative radiation therapy in 12 patients with stage III thymoma treated during 1966-1986 were reviewed. Surgical therapy consisted of total resection in one, subtotal resection in seven, and biopsy only in four. Megavoltage irradiation in the dose range of 3,000-5,600 cGy was employed, with nine patients receiving a dose of at least 5,000 cGy. The local control rate was 67%. The actuarial observed and adjusted 5-year survival rates were 57% and 75%, respectively. These results indicate that postoperative radiation therapy is an effective therapeutic modality in the control of stage III thymoma.

Actuarial Analysis↗
PubMed1987

Controversy in the management of optic nerve glioma.

The records of 16 patients with optic nerve glioma treated between 1961 and 1984 were reviewed. All patients except two had extension of tumor beyond the chiasm to the hypothalamus, adjacent brain and/or along the posterior optic tract. Eleven of 16 cases were biopsy-proven, two patients had craniotomy and visual inspection but no biopsy was performed, and in two cases the biopsy was not diagnostic. Fourteen patients received radiation therapy, usually consisting of 50 Gy in 5 weeks (range 40-56 Gy), one patient was treated surgically and one with chemotherapy. With a follow-up of 1 to 20 years, 7 of the 14 patients irradiated are alive, three patients are dead of disease at 3, 6 and 9 years post-treatment, three were lost to follow-up at 1, 8, and 8 years, and one is dead of intercurrent disease at 5.5 years. Overall vision was improved in five patients and stable in seven following treatment. In two patients, vision could not be evaluated because of young age at presentation. Four patients had recurrences. One was retreated with 30 Gy in 3 weeks and shows no evidence of disease at 20 years. The three other patients died of their disease. There is controversy over the best treatment for these patients. Based on these results and a review of the literature, the authors recommendation is to irradiate tumors with extension beyond the chiasm at the time of presentation rather than waiting for increasing symptoms because function that is lost may not always be recovered. Chemotherapy needs to be further investigated but holds promise, especially for the younger children.

Adolescent↗
PubMed1987

Atypical distribution of Pneumocystis carinii infiltrates during radiation therapy.

Bilateral peripheral pulmonary infiltrates caused by Pneumocystis carinii developed in a patient undergoing mediastinal irradiation after chemotherapy for Hodgkin disease. The paramediastinal part of the lung included within the treatment port remained clear during the 2 1/2 weeks of radiation therapy. The distribution of the pneumocystis infiltrates was altered by the radiation, producing a pattern that is the "radiographic negative" of typical post-radiation therapy paramediastinal fibrosis.

Adult↗
PubMed1986

Treatment of plasma cell granuloma of the lung with radiation therapy. A report of two cases and a review of the literature.

Plasma cell granuloma is a rare, benign tumor that affects people at all ages and most frequently involves the lung, gastrointestinal tract, and salivary gland. They are the most common, isolated, primary lesion of the lung in children less than 16 years of age, and usually present as circumscribed, peripheral, parenchymal tumors, which may be static or increase slowly in size without causing symptoms. Whereas surgical excision is the treatment of choice, there are situations in which the lesion cannot be resected without significant morbidity because of direct extension into the mediastinum or lymph nodes. In these circumstances, radiation therapy may be a better therapeutic option. Two cases of plasma cell granuloma that could not be completely resected are described. The patients were treated with radiation therapy consisting of 4320 rad in 4.5 weeks and 4500 rads in 4.5 weeks, respectively, and both have been cured. Although surgery as the primary treatment for most patients is still recommended, especially in the young so the potential side effects of radiation therapy can be avoided, the authors believe that in rare cases where the lesion is locally aggressive and surgically unresectable or resectable only with major morbidity, radiation therapy can be an effective alternative. Currently, the recommended treatment is 4000 to 4500 rad given in 180 to 200 rad fractions, with the fields being carefully tailored to tumor volume in order to minimize the dose to the surrounding normal tissue.

Child, Preschool↗
PubMed1985

Bladder carcinoma. Experience with radical and preoperative radiotherapy in 421 patients.

Four hundred twenty-one patients with bladder carcinoma were treated with radical intent between 1968 and 1981: 356 were treated with irradiation alone with megavoltage tumor doses of 60-66 Gy delivered over a period of 6 to 7 weeks. Actuarial 5- and 10-year survival was 66% and 58% for Stage A (58 patients), 42% and 35% for Stage B1 (62 patients), 35% and 28% for Stage B2 (120 patients), and 23% and 19% for Stage C (75 patients), respectively. Five-year survival after salvage cystectomy (47 patients) was 51% from the time of surgery, with 4 operative mortalities and a major complication rate of 30%. Sixty-five patients were entered into an integrated preradical cystectomy irradiation program. Fifty-three patients in stages B2-C-D1 received high-dose preoperative radiotherapy (40-50 Gy) before a planned, delayed radical cystectomy. The actuarial 5-year survival was 66% for 65 patients, and 64% for the 53 patients in the high-dose precystectomy program; major complications were encountered in 34% and there were 2 mortalities. Five-year actuarial survival for Stage B2-C was 30% but fell to 24% when patients with salvage cystectomy were excluded. Distant metastasis was found in 30% of patients in Stage B2-C-D1, and also in the high-dose precystectomy program patients. Two-thirds of patients with distant metastasis in the radiation alone group were never considered for salvage cystectomy as they had distant metastasis alone, persistent disease with metastasis within 6 months after initiation of irradiation, or local recurrence and distant metastasis simultaneously. Early local recurrence may be salvaged in 50% to 60% of patients without a significant increase in mortality or major complications. Accordingly, a program of radical irradiation with salvage cystectomy may avoid loss of the bladder in 45% of patients in Stage B2-C-D1 without compromising overall survival.

Adult↗
PubMed1984

Local excision and radiotherapy for cancer of the oral tongue. A preliminary report.

A group of 18 patients with squamous cell carcinoma of the mid one-third of the tongue was treated by local resection and planned postoperative radiotherapy between 1976 and 1980. Tumors 0.5 cm or greater in thickness were included; no patients had cervical adenopathy. Six were categorized as T1, 10 as T2 and two as T3. In eight patients, histologic review showed tumor extension at or near the resection margin, despite a tumor-free margin at frozen section, while in 10 patients the margins were clear. Local tumor control was achieved in 16 patients (89%). Two failures were evident within 3 months after completion of treatment. The relatively short follow-up of such a small series limits the conclusions from this preliminary study, but the excellent results thus far merit further study.

Adult↗
PubMed1984

Dose enhancement in bone in electron beam therapy.

This study investigated dose to bone tissue in electron beam therapy. Measurements were made using films and thermoluminescent dosimeters in a polystyrene phantom containing bone inhomogeneity for 15-MeV, 12-MeV, and 9-MeV electron beams. An increase in dose of approximately 18%, 12%, and 11%, for the three electron energies respectively, relative to the dose in polystyrene, was found for bone material having an electron density (relative to water) of 1.73. Measurements were also made using films for 15- and 9-MeV electrons in a phantom with a mandibular bone and teeth. A dose enhancement in bone of approximately 10% and 7%, respectively, for the two energies was found in the phantom where the electron density of bone was about 1.60. These results suggest that injury to bone is possible in those clinical situations where high doses of electrons are used for therapy.

Bone and Bones↗
PubMed1984

External-beam irradiation of carcinoma of the penis.

Twenty-four patients with biopsy-proved squamous-cell carcinoma of the penis underwent external-beam radiation therapy between 1966 and 1980. Fifteen were treated for the primary tumor and 9 for metastatic inguinal lymphadenopathy; no patient received prophylactic nodal irradiation. Doses ranged from 4,500 rad (45 Gy)/15 fractions/3 wk. to 6,400 rad (64 Gy)/32 fractions/6 1/2 wk. Seven out of 9 tumors in stage I, 2/3 in stage II, and 1/3 in stage IV were controlled for three years. Control of fixed, inoperable groin nodes was poor, and none of these patients survived beyond 1 1/2 years.

Adult↗
PubMed1983

Radiation therapy of microgliomas.

Microglioma (reticulum-cell sarcoma) of the central nervous system is uncommon. The authors reviewed 12 biopsy-proved cases with clinical and radiographic evidence of involvement limited to the central nervous system which were seen between 1966 and 1980. The age range was 15-81 and there were 8 females and 4 males. No patient had clinical evidence of seeding in the spinal canal. All patients were treated with 3,000-5,000 rad (30-50 Gy). Eleven patients died of tumor; the only survivor has remained continuously free of recurrence for 79 months. The poor survival suggests that a higher dose and adjuvant chemotherapy should be considered in the initial management of microglioma.

Adolescent↗
PubMed1983

Influence of heat on the intracellular uptake and radiosensitization of 2-nitroimidazole hypoxic cell sensitizers in vitro.

The effect of elevated temperature (44 degrees) on the intracellular uptake of the 2-nitroimidazole hypoxic cell radiosensitizer, misonidazole (MIS), and analogues more hydrophilic than MIS was studied in Chinese hamster ovary cells. It was found that the intracellular uptake of these compounds which enter cells by restricted passive diffusion can be enhanced approximately 4-fold when incubated at 44 degrees compared to the uptake at 37 degrees. Peak intracellular uptake (expressed as the ratio of intracellular concentration to extracellular concentration) following incubation of cells in 2 mM MIS was 100% at 44 degrees but only 25% at 37 degrees. Furthermore, a short-term nonlethal heat pulse (44 degrees for 15 min) with MIS present caused a 2-fold enhancement in uptake which was sustained for an additional 45 min at 37 degrees. This same nonlethal heat pulse was found to induce a similar enhancement in uptake even when MIS was added at subsequent time intervals at 37 degrees. The heat pulse induced a time-related enhancement of uptake at 37 degrees which increased for 1 hr and persisted for at least 6 hr. Finally, in vitro radiosensitization studies of hypoxic Chinese hamster ovary cells showed that the nonlethal heat pulse of 44 degrees for 15 min could greatly enhance the sensitization by low concentrations (0.5 mM) of MIS added after heating due to increased intracellular concentrations of the drug. MIS (0.5 mM) alone achieved a radiosensitization enhancement ratio of 1.29 (compared to irradiated hypoxic cells alone), while the addition of the short-term heat pulse, which had only a minor effect itself, achieved an enhancement ratio of 1.78.

Animals↗
PubMed1982

The changing role of external-beam irradiation in the management of malignant tumors of the major salivary glands.

Postoperative irradiation reduces the local recurrence rate for malignant salivary gland tumors. Less extensive surgery followed by immediate radiotherapy is possible without decreasing local control; moreover, cosmetic appearance and physiological function are preserved. Local tumor control was achieved in 16 out of 17 patients without gross tumor using a dose of 6,000 rad/6 wk. Combined photon and electron beams give better cosmetic and functional results than either modality alone. Irradiation with greater than or equal to 7,000 rad should be employed in unresectable cases and may effect tumor control.

Adult↗
PubMed1982

Treatment results of combined high-dose preoperative radiotherapy and surgery for oropharyngeal cancer.

Fifty eight patients receiving planned high-dose preoperative radiotherapy followed by en bloc oro-mandibular-cervical resection for oropharyngeal cancer were reviewed. These patients received continued close observation and care from both the Otolaryngology and Radiotherapy services. In light of the ongoing controversy of preoperative vs. postoperative radiotherapy, we present our data demonstrating the value of preoperative radiation. An overall tumor control rate of 66% was achieved, with an adjusted survival rate of 62%. This was not only for early lesions, but also in patients having advanced (T3, T4) tumor and/or nodal disease (N1-4). These figures are somewhat higher than expected from the literature. A review and discussion of the surgical complications are also presented.

Aged↗
PubMed1981

Irradiation decreases vascular prostacyclin formation with no concomitant effect on platelet thromboxane production.

Effects of irradiation on vascular tissue include endothelial cell degeneration, vasoconstriction, and thrombus formation. The effect of irradiation on the in-vitro production of prostacyclin (PGI2) was evaluated, since it is a potent antithrombotic metabolite and vasodilator. After a single dose of 200 rad, umbilical artery PGI2 levels were much decreased when estimated both be bioassay and by evaluation of the stable end-product of PGI2, 6-keto-prostaglandin in Fl alpha. The mean PGI2 production in control tissue was 0.94 +/- 0.14 (1SEM) ng/mg vascular tissue compared with 0.18 +/- 0.07 ng/mg in paired irradiated vessels (p less than 0.001). However, irradiation had no effect on platelet thromboxane formation in a dose rage of 200-2000 rad. Since radiotherapy is routinely administered for the whole period of therapy in daily dose fractions similar to the in-vitro experimental dose used in this study, recovery of vascular PGI2 production may be inhibited for the total period of radiotherapy.

Blood Platelets↗
PubMed1981

Computed tomography in the management of head and neck cancer.

Computed tomography is indispensable in determining the deeper extensions of tumors and proper treatment planning as well as in documentation of tumor resolution for lesions arising in the nasal cavity, paranasal sinuses, orbit, and salivary glands. In the hypopharynx and larynx, computed tomography provides information of differing degrees of value according to the clinical stage, site of origin, and usual therapeutic approach for each tissue. Detection of subclinical cervical adenopathy needs further investigation. Computed tomography has not been of particular value for lesions arising in the oral cavity and oropharynx.

Adult↗
PubMed1980

Prophylactic neck irradiation.

Treatment of subclinical cervical metastases from advanced squamous carcinomas of the nasopharynx, oropharynx, oral cavity, hypopharynx, and larynx remains contentious. Watchful waiting, elective neck surgery, and, more recently neck irradiation all have their advocates. The possibility of "sterilization" of the neck showing no clinical signs of metastasis has been especially appealing in concept. Wth this in mind, and by use of an external high-dose megavoltage technique, radiation therapy was used in 152 patients with clinically negative necks at the Upstate Medical Center from 1968 to 1977. Lymph node failures were extremely low (4%) when wide-field radiation ports were used and the primary lesion controlled.

Carcinoma, Squamous Cell↗