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Biomedical subjects

S Kramer

Publications and source records attributed to S Kramer.

At least 127 records · Page 7Linked to original sources
PubMed1983

Patterns of care outcome studies. Results of the national practice in Hodgkin's disease.

The outcome of treatment for Hodgkin's disease has been determined for 407 patients treated in 1973. A two-level random sampling assures that these results are representative of the national practice. Actuarial analysis of recurrence-free survival at four years is: Stage IA, 80%; Stage IIA, 75%; Stage IIIA, 60%; combined Stages IB, IIB, and IIIB, 50%. Factors significantly associated with recurrence include stage, histology, age, chemotherapy, new patient load, part-time practice, treatment technique, treatment machine, treatment simulation, work up score, treatment score, and facility of treatment. Major treatment complications by stage ranged from 4-12%; complications are significantly associated with disease location, patient age, and the presence of coexisting disease.

Actuarial Analysis↗
PubMed1983

Childhood craniopharyngioma: survival, local control, endocrine and neurologic function following radiotherapy.

Between 1961 and 1978, 19 patients with a diagnosis of childhood or teenage craniopharyngioma received supervoltage radiotherapy. All patients had previously undergone either partial surgical resection (10 patients), total gross resection (3 patients), or aspiration and biopsy (6 patients). Fourteen patients were treated primarily and five were treated for recurrence. The five-year survival was 73% with a 10-year survival of 64%. Sixteen percent developed a recurrence following radiotherapy. Long term effects were assessed in terms of neurologic, intellectual, psychological and endocrine function. Seventy-nine percent had none or minimal neurologic disability. The mean full scale IQ for the group was 90. There were no additional endocrine deficiencies that could be directly attributed to radiation. Behavioral disorders occurred in 50%. These results are at least comparable, if not superior, to those of surgery.

Adolescent↗
PubMed1983

Radiation therapy technology manpower needs 1982.

A shortage of radiation therapy technologists has existed in the United States for many years. This report analyzes the data from the third manpower survey of ACR/ASTR carried out in 1981 to 1982, using the Patterns of Care master facility list. Of 1106 questionnaires mailed, 77% were returned. The survey identified 3757 technologists performing radiation therapy technology duties. Of these, 2537 of these were Registered Technologists (Therapy) American Registry of Radiologic Technologists RTT (ARRT), 1220 were not. There has been a good growth in the total number of RTT (ARRT) members as indicated by the 1982 ARRT Annual Report (1148 in May, 1977, 2878 in May, 1982). Using the "Blue Book" Criteria of 1981 of 2 RTT/megavoltage unit or 2 RTT/300 new patients, the technology need (2900) would appear filled. However, 860 of the RTT were performing supervisory or dosimetry duties and 42% of the 2897 staff technologists were non RTT personnel. At the time of the survey, 597 funded vacancies existed (241 in 1977). A trend toward a changing standard of 3 RTT/megavoltage unit, reflecting the increased complexity of modern radiation therapy techniques, especially in Patterns of Care Strata A1, A2, C1 institutions was identified. While great progress has been made, there is a continuing need for recruitment into the 113 existing educational programs to try to stabilize the supply of technologists. Attention should also be given to measures for upgrading the skills and knowledge of the non RTT personnel in the field and retention of the RTT personnel.

Health Facilities↗
PubMed1983

Tumor regression and other prognosticators in advanced head and neck cancers: a sequel to the RTOG methotrexate study.

The randomized Radiation Therapy Oncology Group (RTOG) Methotrexate trial in advanced squamous cancers of the head and neck has reported no control or survival benefits when the chemotherapy adjuvant was administered to patients just prior to definitive irradiation. The required data collection and outcome reporting among 146 patients bearing oral cavity primaries and 354 patients with oropharyngeal cancers has allowed a multi-variate approach seeking answers to many unresolved questions. As anticipated, the ability to control these squamous cancers is largely a function of size (T & N stage) with a superior clearance among T3-4 primaries of the oropharynx (66%) contrasted to identically staged oral cavity tumors (48%). Adjusted median survival is more than doubled to 26.6 months or 19.8 months among oral cavity and oropharynx patients respectively, when compared to the 8 month median survival when neither primary nor cervical nodes are controlled. Lymph node deposits also impact upon survival, especially among oropharynx patients where the 17.6 month adjusted median survival among N0 patients declines to 11.0 months when the primaries are associated with N3 nodes. Surprisingly, the ability to control nodel deposits of all sizes (N1, N2, or N3) is superior among oropharynx patients when compared with identical oral cavity metastases (e.g. 71.4% adjusted clearance in N3 oropharyngeal deposits versus 46.1% in N3 nodes secondary to oral cavity primaries). Adjustments for maldistribution of advanced N-stages in association with T-4 primary stage eliminated an apparent T-stage effect upon nodal clearance within both anatomic regions. Finally, the association of T and N-stage upon distant metastases was investigated, with the surprising conclusion that neither initial T nor N-stage exerts any apparent influence on the observed 10-12% occurrence. The interrelationship of these various prognostic variables is explored using the Cox and logistic models.

Carcinoma, Squamous Cell↗
PubMed1983

The dissemination of cancer by transurethral resection of locally advanced prostate cancer.

In 1973 a study was done on 443 patients treated with radiation therapy for cancer of the prostate. An actuarial analysis was done on survival comparing patients whose cancer was diagnosed by transurethral resection of the prostate to those diagnosed by needle biopsy. This analysis indicated a doubling of recurrence and of deaths of patients diagnosed by transurethral resection of the prostate. This effect of transurethral resection of the prostate was observed in patients with T3 and T4 cancer of intermediate, poor or unstated differentiation. It was not observed in those with well differentiated cancer. The effect was not caused by a difference in the extent of cancer or a distribution of histologic subtypes between the 2 diagnostic groups. Therefore, it appears that transurethral resection of the prostate causes dissemination on locally advanced prostatic cancer and clinical studies are suggested to avoid or minimize this effect.

Biopsy↗
PubMed1983

Assessment of the quality of life in long-term survivors after definitive radiotherapy.

An interview questionnaire was developed to assess quality of life both in objective and subjective terms in cancer patients. Standardized measures were employed and allowed for comparison with a national baseline. Three hundred thirty-nine patients who were alive without evidence of disease 3 or more years following initial treatment were interviewed. There was no difference in terms of educational level, marital status, or satisfaction with local government, family, job, friends, community, health, recreation, or activities when compared to the age-adjusted national baseline. The patients were more satisfied with region, self, and life as a whole. There was no evidence of a diminished quality of life in these patients.

Adolescent↗
PubMed1983

Protoporphyrinogen oxidase and ferrochelatase in porphyria variegata.

Protoporphyrinogen oxidase activity and ferrochelatase activity were measured in leucocytes from patients with porphyria variegata. The mean activity of protoporphyrinogen oxidase (PPO) in porphyria variegata (PV) was about 50% of normal (P less than 0.05). The mean activity of ferrochelatase with 59Fe2+ sulphate and protoporphyrin as substrates (in the presence of ascorbic acid) was reduced by 40% (P less than 0.009). The mean activity of ferrochelatase with 59Fe3+ chloride and protoporphyrin as substrates (in the presence of reduced glutathione) was increased by 65% (P less than 0.005). Both are statistically highly significant. The findings are interpreted as follows: (a) The occurrence of a low level of protoporphyrinogen oxidase in PV is confirmed. (b) The findings indicate a concurrent structural change in ferrochelatase (this may be structurally related to (a) but no evidence of this is at present available).

Adult↗
PubMed1983

Locally recurrent breast carcinoma: the effect of adjuvant chemotherapy on prognosis.

A group of 72 patients who had received radiotherapy between 1972 and 1980 for isolated local-regional recurrence of breast cancer was studied; 38 had received adjuvant chemotherapy and 34 had not. The two groups were comparable except for the initial nodal status and median time from mastectomy to recurrence. Outcome was not significantly different for the two groups in terms of response to radiotherapy, incidence of re-recurrence, distant metastases, and three-year survival. The length of the disease-free interval and the response to radiotherapy were the only factors studied that were significantly related to survival.

Antineoplastic Agents↗
PubMed1983

An evaluation of a cancer control outreach program in radiation therapy.

Using the methodology of retrospective chart review, this study in radiation therapy compared workup and treatment scores for two groups of community hospitals. The group that participated in clinical trials with a radiation therapy cooperative consortium was superior in several respects to a matched comparison set of hospitals. However, the superiority appears to have been in evidence before the program began. There are presumed to be selection mechanisms that operate to bring certain facilities into the clinical research effort, while excluding others.

Analysis of Variance↗
PubMed1983

Survival in childhood acute lymphocytic leukemia: effect of protocol and place of treatment.

The objective of this study was to determine the effect of place and type of initial treatment on survival from acute lymphocytic leukemia (ALL). Every one of the 327 children under 15 years of age diagnosed with ALL from 1970 to 1975 in a 31-county area designated the Greater Delaware Valley, were studied. Treatment according to protocol was associated with improved survival, yielding a 4 year survival of 60% vs 19% for nonprotocol treated patients (p less than 0.001). There was also a significantly improved survival rate among patients treated in a cancer center, especially for those with a low white blood count (WBC) at diagnosis. The prognostic importance of WBC, age, and sex was confirmed.

Adolescent↗
PubMed1983

Incidence of childhood cancer: experience of a decade in a population-based registry.

Incidence rates of cancer among children aged 0-14 for the period 1970-79 have been generated with the use of data from the Greater Delaware Valley (GDV) Pediatric Tumor Registry. This population-based registry covers a 31-county area and has a pediatric base population of 2 million. During the period, approximately 2,300 cases of childhood cancer were diagnosed in the region. Incidence rates for all histologic types combined are similar to rates from other large surveys conducted in the United States and Western Europe. However, certain histology-specific rates in the GDV vary by race. In the GDV nonwhites relative to whites have higher rates of Wilms' tumor, soft tissue sarcomas other than rhabdomyosarcoma, and retinoblastoma. These contrasts are supported by surveys in African populations showing relatively higher rates of these tumors among African black children. GDV whites exceed nonwhites in incidence of acute leukemia, neuroblastoma, and Ewing's sarcoma. African black children also experience low rates of these tumors. The frequency of central nervous system tumors is similar for GDV whites and nonwhites, despite reports of a rarity of these neoplasms in African blacks. Variations in incidence rates reveal population subgroups with particular tumor susceptibilities and may provide clues as to the relative influence of heredity and environment on patterns observed.

Adolescent↗
PubMed1982

Pancreatic tumours in patients with previous malignancy.

One hundred and ten patients were seen in the Department of Radiation Therapy at Thomas Jefferson University Hospital for pancreatic tumours between January 1975 and June 1980. Twelve patients had previously been treated for a non-pancreatic malignancy. Pancreatic biopsies were performed in nine patients and were interpreted as pancreatic carcinoma. When the previous pathological material was compared to the pancreatic biopsy, the diagnosis was changed in five of the 12 patients to recurrent non-pancreatic malignancy. We emphasise the importance of the distinction between primary pancreatic malignancy and metastatic disease in the pancreas.

Adenocarcinoma↗
PubMed1982

Assessment of the long-term effects of primary radiation therapy for brain tumors in children.

One-hundred-twelve children with primary brain tumors received definitive radiotherapy between the years 1958--1979. Sixty-nine patients were alive at intervals of 1--21 years. Thirty-eight patients underwent neurologic and endocrine evaluation, psychologic and intelligence testing, and assessement for second malignancy post-treatment. A second intracranial malignancy developed in one child, for an incidence of 1.6%. Performance status was good to excellent in 89% of the patients studied. Seventeen percent of the group were mentally retarded. Behavioral disorders were identified in 39% of the patients, 59% of the mothers, and 43% of the fathers. Of the 23 patients with nonparasellar tumors, six were found to have growth hormone deficiency, including two patients with panhypopituitarism. Disability was related to age under 3 years at the time of treatment and tumor extension to the hypothalamus.

Adolescent↗
PubMed1982

Does preoperative irradiation increase the rate of surgical complications in carcinoma of the head and neck? A Radiation Therapy Oncology Group Report.

This is a comparison of the rate of surgical complications in a group of patients with advanced but operable carcinoma of the head and neck who underwent surgery after preoperative radiotherapy (5000 rad in five weeks, 200 rad fractions, directed to the primary tumor area and neck) versus another group operated without prior irradiation. Both groups of patients formed part of a randomized prospective multiinstitutional trial of the Radiation Therapy Oncology Group (73-03). Of 229 patients who had planned operations, 88 (38%) developed some degree of surgical complications, and in 28 (12%) the complications were rated as severe. The most frequently reported complications were delayed healing and fistula formation each occurring in approximately one-fourth of each of the two treatment groups. Carotid blow-out occurred in 5% or less of the cases. No significant statistical difference between treatment groups was noted for the overall complication rate or specific type of surgical complications. A trend was noted towards more complications in the preoperative group for patients with lesions in the oropharynx and supraglottic larynx. However, an opposite trend towards more complications in the no prior irradiation group was observed among patients with lesions in the oral cavity and hypopharynx. Surgical mortality and postoperative hospital stay were not significantly different between treatment groups. We conclude that preoperative irradiation for carcinoma of the head and neck, with the stated dose, followed by surgery in 4-6 weeks, does not substantially increase the rate of overall or specific type of surgical complications, surgical mortality or hospital stay versus those patients operated without prior irradiation.

Aged↗