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Biomedical subjects

S D Williams

Publications and source records attributed to S D Williams.

At least 127 records · Page 7Linked to original sources
PubMed1984

Brain metastases and testicular tumors: need for aggressive therapy.

In late 1974, the combination of cisplatin, vinblastine, and bleomycin (PVB) became the standard chemotherapeutic regimen for treatment of disseminated nonseminomatous germ cell testicular tumors (NSGCT) at Indiana University Hospital. A retrospective analysis of the treatment records of all patients with brain metastases from NSGCTs treated at the Indiana University Radiation Oncology Department from 1975 through 1982 was undertaken. These 22 patients were divided into four groups. Group 1 (n = 5) consisted of those patients who presented initially with brain metastases and had no prior systemic treatment. Group 2 (n = 4) were referred to Indiana University after failing systemic therapy other than PVB chemotherapy. Group 3 (n = 5) consisted of those patients who after achieving a complete response with PVB developed a relapse confined to the brain. Group 4 (n = 8) consisted of those patients who were initially treated with PVB and eventually developed progressive disease and brain metastases. The survival by group is 80%, 0%, 60%, and 0%, respectively, with the overall survival for the entire group being 31.8%. All patients currently alive have a range of follow-up of 22 to 96 months from diagnosis and 12 to 83 months from whole brain irradiation (WBRT). Group 1 was treated with PVB +/- doxorubicin plus WBRT. Group 3 was treated with surgical excision, when feasible, followed by WBRT and platinum-containing chemotherapy. Group 2 and 4 were usually treated with palliative intent WBRT. The CNS is a site of sanctuary from PVB. Patients with brain metastases who may achieve a complete response should be treated with curative intent and receive aggressive WBRT (5,000 rad/25 fractions) with concomitant chemotherapy.

Adult↗
PubMed1984

Pathologic findings at orchiectomy following chemotherapy for disseminated testicular cancer.

Patients with testicular cancer who have disseminated disease at presentation do not always undergo orchiectomy for diagnosis of staging before initiation of chemotherapy. Between October 1978 and November 1982 orchiectomy was performed following cisplatin combination chemotherapy in 20 patients with disseminated germ cell tumors. There were three patients with residual carcinoma in the removed testis and six patients with teratoma. Therefore, in patients with evidence of a primary testicular neoplasm that was not resected initially, orchiectomy should be performed after chemotherapy. Furthermore, the testis may be a sanctuary site for germ cell malignancies during systemic treatment.

Adolescent↗
PubMed1984

Lymphomatoid granulomatosis. Successful treatment with CHOP combination chemotherapy.

A patient with lymphomatoid granulomatosis is reported. The patient was treated with a combination of cyclophosphamide, doxorubicin, vincristine, and prednisone as initial management immediately after diagnosis. She obtained a complete remission and remains free of disease 3 1/2 years from the time of diagnosis. The favorable outcome in this patient may be related to her initial limited disease or to the use of initial intensive chemotherapy; nonetheless, the generally unfavorable prognosis of this disease appears to mandate early trials of intensive therapy in most patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Relationship between type of surgical clerkship, order of completion, and achievement on patient management problems.

Complex cognitive skills, such as interpretation of information and problem solving, are essential for the practice of medicine. Patient management problems (PMPs) are used by both medical school faculty and certifying boards to measure higher-order cognitive skills. This study investigates two questions that relate to PMPs. Whether there is a difference among students in their achievement on PMPs that may be attributed to their clinical experience is examined. In addition, the effect of the order in which PMPs are taken is evaluated. For the purpose of this study, three PMPs were developed measuring three different areas of surgical problem solving. One hundred four third-year medical students who took their surgery clerkship during a 9-month period in 1982 were examined. Students were randomly assigned to one of three rotations for an 8-week period. At the end of the rotation, they each took three PMPs in random order. The multivariate analysis of variance procedure was used to examine the hypothesis of no relationship between clinical rotation and order of completion. The proficiency score for each PMP was considered the dependent variable. There was no difference in performance between groups rotating in different clinical surgical settings (multivariate F (6186) = 0.67; p = 0.67.) This suggests that generalization occurs with patient management and problem-solving skills. Statistically significant differences were found between groups on the basis of the order in which they took the PMPs (multivariate F (6186) = 4.07; p less than 0.001.) There are several plausible explanations for this finding. One explanation is that all three problems were difficult. As a result, students' perceptions about their performance on each problem may have influenced their performance on subsequent problems. Another explanation is that motivation to achieve may have diminished with time. These data suggest that there are basic management skills that may be taught in a variety of surgical experiences. Care must be taken in the use of the PMP as a tool for evaluation so that noneducational factors such as order do not play a role in the results.

Achievement↗
PubMed1983

Treatment of MOPP-refractory Hodgkin's disease with vinblastine, doxorubicin, bleomycin, CCNU, and dacarbazine.

Eighteen patients with advanced Hodgkin's disease, refractory to combination chemotherapy with nitrogen mustard, vincristine, prednisone, and procarbazine (MOPP), were treated with vinblastine, doxorubicin (Adriamycin), bleomycin, CCNU, and dacarbazine (DTIC) (VABCD). Fifteen patients had Stage IV disease and 11 had systemic symptoms. Although hematologic toxicity was considerable, there was no drug related mortality. Eight patients achieved a complete remission (CR), and five are currently in a continuous CR of five, 24, 30, 34, and 36 months duration, respectively. An additional patient had a 30-month CR and relapsed with localized lymphadenopathy and is currently disease-free following involved-field radiotherapy 46 months from initiation of VABCD. This study suggests that long-term disease-free survival and potential cure can be achieved with VABCD in MOPP-refractory Hodgkin's disease.

Adolescent↗
PubMed1983

The importance of one-stage median sternotomy and retroperitoneal node dissection in disseminated testicular cancer.

More than 350 patients with testicular germ cell cancer have been treated with cisplatin combination chemotherapy. Seventy-two with metastases to the thorax who had operation are discussed here. In a subgroup of 24 patients with additional retroperitoneal disease, a one-stage median sternotomy was performed in 18 patients, and a thoracotomy in 6, with retroperitoneal node dissection. Seventeen patients had similar pathological lesions in the thorax and retroperitoneum; in 7, the lesions differed. There was no operative mortality in the entire group. Overall, chemotherapy altered the metastases to mature teratoma in 28 patients, and 27 are long-term survivors. Among 22 patients with fibrotic, necrotic masses, 19 are long-term survivors; 6 of the 22 with persistent carcinoma had chemotherapy postoperatively and are long-term survivors. The overall cure rate for patients with disseminated testicular cancer is approximately 80%. Among those who had a one-stage thoracoretroperitoneal procedure, long-term survival is 83%; for the entire thoracic surgical group, it is 74%.

Adolescent↗
PubMed1983

Review of delayed orchiectomy in patients with disseminated testis tumors.

Of 8 patients who underwent delayed orchiectomy after adequate chemotherapy for metastatic testicular cancer 7 had no evidence of disease at the time of orchiectomy but 3 had residual cancer in the testis removed. The testis may be a privileged sanctuary for malignancy even during treatment with appropriate chemotherapy. Therefore, the primary tumor should be removed in patients presenting initially with metastatic disease, even if the metastases clear with treatment.

Adolescent↗
PubMed1983

Fertility after chemotherapy for testicular cancer.

Sixty-nine patients with disseminated testicular cancer and no prior retroperitoneal lymphadenectomy treated with cisplatin, vinblastine, and bleomycin with or without doxorubicin were evaluated for semen analysis, serum gonadotropins, and testosterone. Since 1979, 41 men have been prospectively studied. Before treatment 77% were oligospermic, 17% were azoospermic, and only 6.6% could meet requirements for sperm banking. After 2 mo of therapy, 96% were azoospermic. A group of 28 patients treated between 1975 and 1979 were retrospectively evaluated. Normal sperm counts were found in 46% of those studied. Only 17% were azoospermic. Thirty-two percent have impregnated their wives, resulting in 5 healthy babies, 1 spontaneous abortion, and 3 ongoing pregnancies. These results show that (1) significant impairment of spermatogenesis exists before therapy, precluding the possibility of sperm banking in most patients, (2) combination chemotherapy in testicular cancer has substantial effects on gonadal function, rendering almost all patients azoospermic, and (3) a high degree of recovery of spermatogenesis occurs sometime after 2-3 yr from the initiation of treatment.

Adolescent↗
PubMed1982

Advanced extragonadal germ-cell tumors. Successful treatment with combination chemotherapy.

Thirty-two patients with primary extragonadal germ-cell tumors were treated at Vanderbilt and Indiana University Hospitals during the period from 1967 to 1981. Thirty-one patients had far-advanced disease when treatment was begun. All patients received intensive cisplatin-containing combination chemotherapy regimens. Tumors remaining after chemotherapy were surgically removed when feasible. Of the 31 evaluable patients, 18 have been continuously disease-free after therapy, 21 patients had a complete remission; the remaining 10 had partial response. Eighty-nine percent of patients with complete remission remain free of disease after median follow-up of 30 months. No relapses occurred after 12 months of complete remission. Patients with partial response had a median survival of 9 months with no long-term survivors. Response rates and survival are similar to patients with advanced-stage testicular germ-cell tumors. Extragonadal germ-cell tumors are as curable as testicular germ-cell tumors when treated with intensive cisplatin-containing combination chemotherapy regimens, and surgical resection when necessary.

Adolescent↗
PubMed1982

Random prospective study cyclophosphamide, doxorubicin, and methotrexate (CAM) combination chemotherapy versus single-agent sequential chemotherapy in non small cell lung cancer.

A group of 104 patients with unresectable non-small cell lung cancer were randomized to receive combination chemotherapy with cyclophosphamide, doxorubicin, and methotrexate (CAM) or single-agent sequential chemotherapy with the same three agents. CAM combination chemotherapy produced a 22% objective response rate, including two complete remissions, compared to a 9% response rate, including one complete remission, produced by single-agent therapy (P = 0.16). The median survival time was 32 weeks (range, 3-116) for CAM, compared to 25 weeks (range, 4-179 +) for sequential single agents (P = 0.24). Overall survival was 31% (1-year), (16%) (1 1/2-year), and 5% (2-year), with no difference between the study arms. Although there was no statistically significant survival advantage for the CAM arm, both arms had survival superior to that in historical controls, presumably because of better patient selection. This study indicates that cyclophosphamide, doxorubicin, and methotrexate are, at best, marginally active as single agents, and new drugs with more efficacy are needed before combination chemotherapy can be expected to result in any meaningful prolongation of survival in non-small cell lung cancer.

Adenocarcinoma↗