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Biomedical subjects

R Komaki

Publications and source records attributed to R Komaki.

At least 145 records · Page 8Linked to original sources
PubMed1983

Indolent diffuse histiocytic lymphoma with sclerosis and chylous effusions.

A case of diffuse histiocytic lymphoma with sclerosis and chylous pleural and peritoneal effusions spanning four years from onset to diagnosis is presented. Treatment with combination chemotherapy and consolidative radiotherapy resulted in clinical improvement and the patient remains free of disease 14 months after stopping treatment. The problems of chylous effusions and the subgroup of diffuse histiocytic lymphoma with sclerosis are discussed.

Chylous Ascites↗
PubMed1983

A high yield method for the preparative synthesis of coenzyme A by combination of chemical and enzymic reactions.

Dried cells of Brevibacterium ammoniagenes are a good enzyme source for the preparative synthesis of CoA from pantothenic acid, L-cysteine and ATP. A problem with this synthesis is that the CoA synthesis is repressed by negative feedback inhibition by CoA to pantothenate kinase, the first step enzyme for the biosynthesis of CoA, which catalyses phosphorylation of pantothenic acid or pantetheine. As the inhibition operates only at this step, a further increased yield is possible if the enzymic phosphorylation step is replaced with chemical synthesis. Yields from phosphorylated substrates are more than 10-times higher than those from pantothenic acid or pantetheine (33 g/l from phosphopantothenic acid with a molar yield of 86%; 115 g/l from phosphopantetheine with a molar yield of 100%).

Brevibacterium↗
PubMed1983

Frequency of brain metastasis in adenocarcinoma and large cell carcinoma of the lung: correlation with survival.

From January 1970 through December 1981, 469 patients with histologically or cytologically proven adenocarcinoma (AC) (349) and large cell carcinoma (LC) (120) of the lung were seen at the Department of Radiation Oncology, Medical College of Wisconsin Affiliated Hospitals. One quarter (126/469) of these patients had brain metastasis: 48 patients presented with brain metastasis (AC 35/349 = 10% and LC 13/120 = 11%) and 78 patients subsequently developed brain metastasis (AC 61/314 = 19%, LC 17/107 = 16%). Those patients who received prophylactic cranial irradiation were excluded from this study. Brain was the dominant site of metastasis in 82 patients who received only cranial + thoracic irradiation; 37 patients (17 simultaneous, 20 metachronous) also required irradiation of other sites of metastasis. All 17 patients with LC, and 47/61 (77%) with AC who developed metachronous brain metastasis did so within one year. The cumulative probability of brain metastasis increased with survival to the levels predicted by autopsy studies. Therapeutic brain irradiation may result in long-term survival in patients with single organ brain metastasis. Three of 119 patients who underwent whole brain irradiation for metastasis, are alive at 60 (LC), 48 (AC) and 48 months (AC) after treatment. Since patients with AC and LC so frequently develop brain metastasis and the brain may be the only site of metastasis, prophylactic cranial irradiation may significantly reduce morbidity and mortality from these diseases.

Adenocarcinoma↗
PubMed1983

Irradiation of para-aortic lymph node metastases from carcinoma of the cervix or endometrium. Preliminary results.

Twenty-two patients with biopsy-proved para-aortic lymph node metastases from carcinoma of the cervix (15 patients) or endometrium (7 patients) received a median dose of 5,000 rad/25 fractions. Para-aortic nodal metastases were controlled in 77% of cases. Control was significantly lower following radical retroperitoneal lymph node dissection than less extensive sampling procedures. Obstruction of the small bowel developed in 3 patients with tumor recurrence in the para-aortic region. Eight of the 10 patients who were disease-free at 2 years received greater than 5,000 rad. Three patients were still alive without disease at 129, 63, and 60 months, respectively. The 5-year disease-free survival rate was 40% for cervical cancer and 60% for endometrial cancer: in the former group, it was significantly different depending on whether the para-aortic nodes were irradiated (40%) or not (0%). The authors suggest that 5,000-5,500 rad in 5-5.5 weeks is well tolerated and can control aortic nodal metastases in cervical and possibly endometrial cancer.

Abdominal Neoplasms↗
PubMed1983

Internal mammary lymphoscintigraphy in patients with breast cancer. Correlation with computed tomography and impact on radiation therapy planning.

Twenty patients with Stage I or II breast cancer, all of whom had undergone radiation therapy planning, were examined with internal mammary lymphoscintigraphy (IMLS) and computed tomography (CT). Based on the results of IMLS, radiation fields were revised in 12 cases (60%). The mean number of nodes identified by IMLS in each patient was 7.8, which is in agreement with previously published autopsy and scintigraphic data. CT identified 243 possible nodes of normal size, but only 49 of them were within 10 mm of regions shown to be positive on the scintigram. The authors conclude that IMLS is the method of choice for defining parasternal lymphatic drainage and identifying those internal mammary nodes that are normal in both size and function.

Adult↗
PubMed1983

Is immediate chest radiotherapy obligatory for any or all patients with limited-stage non-small cell carcinoma of the lung? Yes.

External irradiation with the greatest technical sophistication available is indicated in all patients with inoperable non-small cell carcinoma of the lung confined to the primary site and to regional lymph nodes including the ipsilateral supraclavicular nodes. Irradiation with moderately high doses results in responses in 40%-65% of all patients. With irradiation to a level of at least 6000 rad in 30 fractions in 6 weeks, greater than 60% of patients never fail in the chest. Some of these patients become long-term, disease-free survivors. Until it is possible clearly to predict those patients who do not respond and thereby to justify an approach other than thoracic irradiation, it is necessary to offer radiation therapy to all of these patients. Since local control is far from satisfactory, one can certainly justify investigating new approaches, including further increases of the total dose, altered fractionation schemes, addition of radiosensitizers, and high linear energy transfer radiations. Since distant metastases frequently appear in spite of thorough pretreatment evaluations, one can also justify investigating the addition of systemic agents, both cytotoxic drugs and biologic response modifiers. Benefit from these systemic approaches may be completely masked, even in patients with disseminated disease, by failure to prevent complications and death due to the intrathoracic tumor.

Adenocarcinoma↗
PubMed1983

Changes in the relative risk and sites of central nervous system metastasis with effective combined chemotherapy and radiation therapy for small cell carcinoma of the lung.

Prolongation of survival of patients with small cell carcinoma of the lung with current effective systemic therapy has been accompanied by a marked increase in the frequency of relapse in the central nervous system (CNS). Prophylactic cranial irradiation (PCI) was shown to reduce the frequency of brain metastasis, but there was no increased short-term survival. Therefore, the necessity for PCI early in the course of treatment has been questioned, especially for patients with extensive disease. From January 1974 through March 1982, 205 patients with small cell carcinoma of the lung were treated at the Medical College of Wisconsin Affiliated Hospitals. None had clinical, radioisotopic, or computed tomographic evidence of brain metastasis. Eighty-two patients received radiotherapy and chemotherapy, but no PCI; 123 patients received combination chemotherapy and radiation therapy with PCI. The cumulative probability of brain metastasis without PCI was 36% at 12 months and 47% at 24 months; the probabilities were 6 and 10%, respectively with PCI. The 24-month probability of brain metastasis in patients with limited disease and no PCI was 45%; for those with extensive disease, it was 47%. No patient presented with extracranial central nervous system (ECNS) metastasis and no one without PCI developed it. Twelve patients who received PCI developed ECNS metastasis; the cumulative probabilities rose to 14% at 12 months and 22% at 24 months. The increased frequency of ECNS involvement has led to a phase I trial of PCI followed by six cycles of combination chemotherapy, without maintenance chemotherapy, followed by irradiation of the chest and spinal cord for patients with complete response.

Brain↗
PubMed1982

The role of thoracic and cranial irradiation for small cell carcinoma of the lung.

Since 1974, 120 previously untreated patients with small cell carcinoma of the lung seen in Therapeutic Radiology at The Medical College of Wisconsin have been entered into one of 4 successive studies. Study I used thoracic irradiation (TI) alone (4500-6000 rad in 3-6 weeks) with chemotherapy at progression. Study II randomized patients with limited disease to TI (3000 rad in 2 weeks) plus either cyclophosphamide, doxorubicin, vincristine (CAV) or total body irradiation (TBI); patients with extensive disease received TI + CAV. Study III employed prophylactic cranial irradiation (PCI) plus CAV and withheld TI unless there was incomplete response or recurrence. Of 93 evaluable patients from the first three studies, 55 had limited and 38 extensive disease. Study I (37 patients) showed a 62% complete response (CR) rate; 43% failed in the chest, 14% had brain metastases, and the median survival was only 22 weeks in spite of a preponderance of limited disease patients. Study II (27 patients) showed a CR of 59%; 30% had brain metastases and the median survival was 48 weeks. Study II patients (29) had a 69% rate; 72% failed in the chest, 4% with PCI developed brain metastases, and the median survival was 50 weeks. In March, 1979, Study IV was initiated; patients receive PCI (2500 rad in 2 weeks) plus high dose CAV, methotrexate and leucovorin. After 6 cycles, consolidation TI (3750 rad in 3 weeks) is given to patients with complete response. Preliminary results with 27 patients treated on this study show a 67% CR rate, a 41% chest failure rate (but only 11% for the patients who received thoracic irradiation) and no intracranial failures, but a 13% extracranial CNS failure rate. PCI, TI and spinal irradiation may be necessary to maximize the probability of long term disease free survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1981

Local control of intrathoracic disease with chemotherapy and role of prophylactic cranial irradiation in small-cell carcinoma of the lung.

Between 1978 and 1979, 39 consecutive patients at the Medical College of Wisconsin were seen with small-cell carcinoma of the lung; of these, 31 were treated with chemotherapy and prophylactic CNS irradiation (2500 rad/10 fractions) and were evaluable after 22 month median follow-up. The intrathoracic primary was not irradiated unless there was no response to chemotherapy or subsequent recurrence. Of the 31 patients, 12 had limited disease (LD) and 19 had extensive disease (ED). Twenty, including all the patients with LD, had a complete response, eight had a partial response, and three were nonresponders. Of 24 patients with complete response at the primary site, 20 subsequently displayed local failure of the intrathoracic primary tumor, most developing disseminated extrathoracic disease simultaneously with or shortly after primary failure. The median survival time (MST) of the evaluable group was ten months with an actuarial one-year survival of 39%. Patients with LD had a median remission duration of 13 months and a MST of 16 months. Three patients are still alive with no evidence of disease at 14, 20, and 27 months. Of 26 patients receiving prophylactic cranial irradiation, all are free of CNS relapse. Chemotherapy alone appears insufficient to permanently control the bulky intrathoracic tumor, leading to the use of "consolidation" irradiation of moderate dose (3750 rad/15 fractions) to follow chemotherapy. Prophylactic CNS irradiation should be used routinely.

Antineoplastic Agents↗
PubMed1981

Stage III nodular lymphoreticular tumors (non-Hodgkin's lymphoma): results of central lymphatic irradiation.

Since 1969, 29 previously untreated patients with Stage III nodular malignant lymphoreticular (MLT) have received total central lymphatic (TCL) irradiation. The volume irradiated included the entire abdomen, Waldeyer's ring, and preauricular nodes in addition to the usual regions encompassed by total nodal irradiation. Doses of 2000--3000 rads in three to six weeks were delivered to the nodal regions, liver, and spleen; fraction sizes ranged from 100 to 180 rads. Patients have been followed from one to ten years (median six years). The actuarial survival is 78% at five years, and the disease-free survival is 61%. There is no difference in disease-free survival of the patients with poorly differentiated lymphocytic vs. those with "histiocytic" or mixed cytology. Men and women had disease-free survivals of 82% and 43%, respectively. The long-term follow-up of these patients indicates that prolonged disease-free intervals are common after TCL irradiation, and some patients may be cured.

Abdominal Neoplasms↗
PubMed1981

Patterns of failure in treatment of stage I and II diffuse malignant lymphoid tumors.

Fifty-nine patients with Stage I and II diffuse malignant lymphoid tumors were irradiated between 1966 and 1979. Seventeen had primary lymph node disease and 42 had extranodal presentations. Local recurrence was noted in 1 of 14 evaluable lymph node presentations and 8 of 36 extranodal distributions. Failures occurred in unirradiated lymph nodes (contiguous or transdiaphragmatic) in 3 of 17 patients with lymph node disease and 6 of 42 with extranodal disease. Dissemination occurred in 4 of 17 lymph node presentations and 6 of 42 extranodal tumors. Local recurrence was low, particularly among lymphatic tumors. There was no identifiable dose effect for local control. Extension to contiguous or distant lymph nodes occurred in 15% of cases. The authors suggest that the transdiaphragmatic lymph nodes be included when treating patients with lymph node tumors. The role of adjuvant chemotherapy remains unproved.

Adolescent↗
PubMed1980

Locally advanced adenocarcinoma of the endometrium: results of irradiation with and without subsequent hysterectomy.

From 1965 through 1977, 54 patients with locally advanced adenocarcinoma of the endometrium were treated at the Medical College of Wisconsin Affiliated Hospitals. According to the FIGO-AJC staging system, 39 had Stage II and 15 Stage III disease. Stage II was subdivided into II A-microscopic (28 patients) and II B-clinical (11 patients) involvement of the cervix. Patterns of failure were evaluated, viz. central pelvic, lateral pelvic, and distant. The results confirm an association of increasing grade with increasing stage. Disease-free survival rates at five years are better for Stage II (78%) than Stage III (34%), but are no different for Stages II A (77%) and II B (81%). Pattern of failure and disease-free survival data support the combined irradiation-surgical approach over irradiation alone. Central pelvic failures are reduced by subsequent hysterectomy (6% vs. 20%). Lateral pelvic failures are less frequent when the dose of external pelvic irradiation is 5000+ rads/5-6 weeks compared to less than 5000 rads (4% vs. 20%). In Stage II (corpus et collum) the prognosis is better with preoperative irradiation and abdominal hysterectomy than with irradiation alone (89% vs. 63%). Whenever possible, patients with Stage III disease should be offered irradiation and hysterectomy.

Adenocarcinoma↗