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Biomedical subjects

S D Williams

Publications and source records attributed to S D Williams.

At least 145 records · Page 8Linked to original sources
PubMed1982

Vindesine: an effective agent in the treatment of non-small cell lung cancer.

A dose of 3-4 mg/m2 of vindesine (DVA) was given by iv push weekly to 33 patients with non-small cell lung cancer. Twenty-nine patients were evaluable for response. All evaluable patients had a performance status greater than 50% and measurable disease, and received at least two consecutive weekly doses of DVA. Standard response criteria were used. Among 15 patients with squamous cell carcinoma there were four partial responses and one complete response; three of eight patients with adenocarcinoma had partial responses. The overall response rate was 28% (eight responses among 29 patients). Myelosuppression was moderate, but two patients were hospitalized for granulocytopenic infections. The most common dose-limiting side effects were due to neurotoxicity. Four responding patients had treatment stopped because of neurotoxic reactions. DVA appears to be among the most active drugs in non-small cell lung cancer, but improved dose schedules that reduce neurotoxicity would be highly desirable.

Adenocarcinoma↗
PubMed1981

The role of maintenance therapy in disseminated testicular cancer.

We concluded a prospective study of the value of maintenance therapy in disseminated testicular cancer after chemotherapy-induced complete remission or chemotherapy cytoreduction followed by surgical resection of residual teratoma. A group of 171 patients were randomized to treatment consisting of cisplatin, vinblastine, and bleomycin, or these drugs plus doxorubicin. There was no apparent difference between these two induction regimens. Complete remission was achieved in 113 patients (66 per cent), and 19 (11 per cent) were free of disease by surgical resection of residual tumor. Of the 171 who started, 113 were eligible to receive either maintenance doses of vinblastine (58 patients) or no further therapy (55 patients) after remission-induction therapy. There was a 9 per cent relapse rate during maintenance with vinblastine and a 7 per cent relapse rate with no maintenance therapy; the overall relapse rate was 8 per cent (nine of 113). Our data indicate that maintenance therapy is unnecessary in disseminated testicular cancer.

Adolescent↗
PubMed1981

Surgical resection in disseminated testicular cancer following chemotherapeutic cytoreduction.

Platinum combination chemotherapy will regularly produce a 70% complete response rate in testicular cancer. Many patients failing to achieve complete remission can still be rendered disease-free with surgical resection of residual localized disease. Twenty-one patients underwent resection for residual pulmonary lesions and 41 underwent lymphadenectomy for persistent retroperitoneal disease. There were no characteristic radiographic findings for fibrous tissue versus mature teratoma versus carcinoma. Although elevated HCG or AFP levels indicated the presence of carcinoma, negative HCG and AFP did not rule out such a diagnosis as 12 of 22 resected carcinoma patients were seronegative. Of 35 patients, 31 (89%) with fibrous tissue or mature teratomas and all four patients with immature teratomas have been continuously free of disease with a minimal postoperative follow-up time of six months. However, only two of 22 patients with resected carcinomas have been continuously disease-free. Post-operative chemotherapy for mature teratoma or fibrous tissue is probably not necessary. However, we feel that further aggressive chemotherapy is needed in the resected carcinoma patient with at least two courses of platinum combination chemotherapy. Surgical resection of residual disease following chemotherapy-induced cytoreduction with platinum combination chemotherapy may be therapeutic in some cases and helps to define the optimal subsequent treatment strategy.

Antineoplastic Agents↗
PubMed1981

Disseminated seminoma: re-evaluation of treatment protocols.

Radiotherapy provides a high cure rate for patients with stages I and II seminoma but the results for those with stage III disease have been disappointing. We report on 19 patients with high stage seminoma who have been treated with platinum, vinblastine and bleomycin (14 patients) or platinum, vinblastine, bleomycin and doxorubicin hydrochloride (5 patients). Of the 19 patients 12 (63 per cent) had complete remission of the disease and the remaining 7 had partial remission. To date, 11 patients (58 per cent) remain free of disease. Of the 6 patients with no prior irradiation 5 achieved complete remission, while the 1 failure had massive hepatic metastases. The median followup was 19 months (range 12 to 37 months). These results parallel that achieved with the same chemotherapy regimen in patients with stage III nonseminomatous testicular cancer.

Adolescent↗
PubMed1980

VP-16-213 salvage therapy for refractory germinal neoplasms.

Thirty-three patients with advanced refractory germinal neoplasms were treated with VP-16-213 alone or in combination with cis-platinum, bleomycin, and frequently Adriamycin. All had prior chemotherapy, which in most was extensive. There were 14 complete and 15 partial remissions. Five of the patients with partial remission were rendered disease free by resection of residual tumor. Eleven remain disease free from 6+--23+ months. Toxicity was considerable. One-third were hospitalized for fever and granulocytopenia and four had life-threatening thrombocytopenia. There was one drug-related death. VP-16 is an active drug in germinal neoplasms. It appears to be an important component of "salvage" regimens for refractory patients, but severe toxicity may ensue.

Antineoplastic Agents↗
PubMed1980

Chemotherapy of disseminated testicular cancer. A random prospective study.

Seventy-eight patients with disseminated testicular cancer were entered on a random prospective study evaluating three separate remission induction arms. Therapy with cis-diamminedichloroplatinum (20 mg/M2 for five consecutive days every three weeks for 3-4 courses) and bleomycin (30 units intravenous push weekly for 12 consecutive weeks) was constant. Patients were allocated at random to one of the following induction regimens (in combination with platinum plus bleomycin): (1) vinblastine 0.4 mg/kg every three weeks for four courses; (2) vinblastine 0.3 mg/kg every three weeks for four courses; or (3) vinblastine 0.2 mg/kg plus Adriamycin 50 mg/M2 every three weeks for four courses. All patients received maintenance therapy with vinblastine 0.3 mg/kg once a month for 20 months (total therapy two years) unless progressive disease intervened. The incidence of granulocytopenic fever and sepsis was highest with regimen 1, as 9 patients (35%) developed granulocytopenic fever requiring hospitalization and antibiotics; only 4 (15%) patients on regimen 2 developed granulocytopenic fever. No patients on regimen 2 had documented sepsis. Fifty-three patients (68%) achieved complete remission and an additional 11 patients were rendered free of disease with surgical resection of residual localized disease. Fifty-three patients (68%) remain alive and continuously free of disease from 15+ to 39+ months. There was no difference in the complete remission rate or disease-free status with the higher dosage of vinblastine (regimen 1) during remission induction therapy compared to the less toxic lower dosage of vinblastine (regimen 2). This suggests that dosage reduction of vinblastine to 0.3 mg/kg can produce equivalent therapeutic results with diminished toxicity, and we no longer recommend the 0.4 mg/kg vinblastine dosage.

Adolescent↗
PubMed1980

Aggressive surgical management of testicular carcinoma metastatic to lungs and mediastinum.

During the past six years, more than 200 patients were treated with chemotherapy for disseminated testicular cancer with a 70% complete remission rate. In 22 patients who were 17 to 46 years old, there was persistent thoracic disease, which was treated surgically. Six required a median sternotomy for bilateral pulmonary involvement or mediastinal metastasis. In 8 patients, chemotherapy had altered the histological appearance of the metastases from that of an undifferentiated primary tumor to a mature cystic teratoma. Five patients had nodules in the lungs, which were necrotic and fibrosed with no evidence of tumor. Nine showed embryonal cell carcinoma metastases in the lungs. All who had cystic teratoma are alive and free from disease. Three of the 5 with nodules and 1 of the 9 with metastases are currently free from disease. Agressive surgical intervention is important in this unique group of patients in order to determine the precise pathological category of the lesions, to remove intrathoracic malignancy, and to assess the need for additional chemotherapy. An operative mortality of zero and a low morbidity justify this approach.

Adolescent↗
PubMed1980

Cytoreductive surgery for metastatic testis cancer: considerations of timing and extent.

We report on 26 patients who presented with widespread, massive metastatic disease from nonseminomatous germinal cell tumors of the testis. Of these 26 patients 22 (85 per cent) are well and 21 (80 per cent) are presumed to be cured after initial chemotherapy with platinum, vinblastine and bleomycin cytoreduction followed by secondary retroperitoneal lymph node dissection. The most critical prognostic determination was the nature of the tissue resected. Patients with only fibrous or cystic elements and those with mature teratoma fared well. All 22 patients are well from 1 to 5 years postoperatively. However, of 9 patients with persistent cancer in the resected tissue 4 are dead and 2 others were salvaged only after extensive further chemotherapy. Of the several options available pre-treatment with 4 courses of platinum, vinblastine and bleomycin before any surgical treatment in those with massive bulk metastatic disease seems to provide the most effective cytoreduction and best survival.

Bleomycin↗
PubMed1980

Chemotherapy of disseminated seminoma.

Nineteen patients with disseminated seminoma were treated with platinum + vinblastine + bleomycin +/- Adriamycin. All patients have been followed for at least 1 year. Nine patients had elevated HCG and two also had elevated AFP. Twelve of 19 patients (63%) achieved a complete remission, with a median duration of 18 months, and none of these patients have relapsed. Four of these patients have been in a continuous complete remission for over 2 years. The results of chemotherapy in metastatic seminoma are comparable to those achieved in nonseminomatous germ-cell tumors, and similar treatment strategies should be employed.

Adolescent↗
PubMed1979

Superiority of nabilone over prochlorperazine as an antiemetic in patients receiving cancer chemotherapy.

Two double-blind, crossover trials comparing the antiemetic effectiveness of nabilone, a new synthetic cannabinoid, with that of prochlorperazine were conducted in patients with severe nausea and vomiting associated with anticancer chemotherapy. Of 113 patients evaluated, 90 (80 per cent) responded to nabilone therapy, whereas only 36 (32 per cent) responded to prochlorperazine (P less than 0.001). Complete relief of symptoms was infrequent, occurring only in nine patients (8 per cent) given nabilone. When both drugs were compared, both nausea (P less than 0.01) and vomiting episodes (P less than 0.001) were significantly lower in patients given nabilone. Moreover, patients clearly favored nabilone for continued use (P less than 0.001). Predominant side effects noted by patients were similar for both agents and included somnolence, dry mouth and dizziness but were about twice as frequent and more often severe in patients receiving nabilone. In addition, four patients (3 per cent) taking nabilone had side effects (hallucinations in three, hypotension in one) that required medical attention. Euphoria associated with nabilone was infrequent (16 per cent) and mild.

Adolescent↗
PubMed1979

Brain metastases in disseminated germinal neoplasms: incidence and clinical course.

From July 1973, to March 1978, 139 patients with disseminated germinal neoplasms were treated with a variety of combination chemotherapy regimens. Twenty-one patients (15.1%) exhibited evidence of brain metastases at some time during their course. Central nervous system spread occurred somewhat more frequently in patients with choriocarcinoma and yolk sac histologies, although all types were at risk. This was a major cause of morbidity and mortality. However, central nervous system spread almost always occurred in patients with systemic relapse and thus did not affect overall survival. We have yet to identify a subgroup who potentially could benefit from prophylactic central nervous system therapy.

Antineoplastic Agents↗
PubMed1979

cis-Platinum combination chemotherapy of bladder cancer: an update.

The combination of cis-platinum (DDP), adriamycin, and 5-fluorouracil was evaluated in 44 patients with advanced urothelial cancer, 39 of whom were evaluable for response. There were 18 partial remissions (46.2%) and no complete responses. Remissions were clinically meaningful, but of short duration. Four patients had bulky pelvic disease that was made resectable by chemotherapy, but none of these patients remained disease-free. These results are not superior to that expected from DDP as a single agent. In addition, there appears to be little or no survival benefit associated with chemotherapy. DDP represents an advance in the treatment of bladder cancer, but additional active agents and innovative approaches are needed.

Adult↗
PubMed1979

Chemotherapy of disseminated testicular cancer.

Dramatic improvements have been made in recent years in treatment of disseminated testicular cancer. Germ-cell neoplasms, even when advanced, are potentially curable by modern chemotherapy. Although disseminated testicular cancer is a rare disease, it is highly treatable, and primary physicians, internists and urologists should have some knowledge of its management.

Bleomycin↗