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Biomedical subjects

T R Baker

Publications and source records attributed to T R Baker.

At least 37 records · Page 2Linked to original sources
PubMed1993

Survival in patients with paraaortic lymph node metastases from endometrial adenocarcinoma clinically limited to the uterus.

PURPOSE: The purpose of this study was (a) to evaluate the incidence of paraaortic lymph node metastasis from adenocarcinoma of the endometrium clinically limited to the uterus (1971 FIGO Stages I and II) and (b) to report the 5 year disease-free survival of patients with histologically documented paraaortic lymph node metastasis from endometrial adenocarcinoma clinically limited to the uterus treated on two separate protocols. METHODS AND MATERIALS: From June 1979 to June 1990, 109 patients underwent staging paraaortic lymphadenectomy or paraaortic lymph node biopsy at the time of total abdominal hysterectomy and bilateral salpingo-oophorectomy for adenocarcinoma of the endometrium clinically limited to the uterus. Patients with histologically documented paraaortic lymph node metastasis were treated on two protocols: (a) pelvic radiation (5,040 cGy) plus progestins or (b) pelvic radiation therapy (5,040 cGy) plus paraaortic radiation (4,500 cGy). RESULTS: Paraaortic lymph node metastases was primarily associated with grade 3 tumors (34.4%) and deep myometrial invasion (42%) and was present in 17.4% (19) of 109 patients. None of the women treated with pelvic radiation therapy and progestins survived five years disease-free. In contrast, the 5 year disease-free survival was 27% for patients treated by pelvic and paraaortic radiation. CONCLUSIONS: Since all patients with macroscopic metastases to the paraaortic lymph nodes developed recurrent cancer and only a small percentage of those with microscopic metastases to the paraaortic lymph nodes survived disease-free at 5 years, improved survival for patients with paraaortic lymph node metastases will necessitate the addition of effective cytotoxic chemotherapy to pelvic and paraaortic radiation.

Adenocarcinoma↗
PubMed1993

A phase II study of weekly cisplatin followed by cisplatin and ifosfamide in advanced or recurrent cervical carcinoma.

BACKGROUND: Ifosfamide is an active agent in cisplatin-resistant cervical cancer. To determine the response rate of the combination of cisplatin and ifosfamide, a Phase II study was conducted of the administration of the combination after weekly cisplatin induction therapy. METHODS: Forty-seven patients with advanced or recurrent cervical carcinoma were treated with 1 mg/kg of cisplatin weekly for six courses, followed by 20 mg/m2 of cisplatin and 1.2 g/m2 of ifosfamide daily for 3 days every 28 days. RESULTS: Objective responses were seen in 11 of 40 (27.5%) assessable patients (complete response, 20%; partial response, 7.5%). The duration of response ranged from 3 months to 26+ months (median, 9+ months). All of the patients who responded to the cisplatin-ifosfamide combination initially responded to weekly cisplatin induction therapy. None of the four patients who had previously received chemotherapy responded. Grade 3 or 4 hematologic toxic effects occurred in 17 of 43 patients (39%). Neurologic and urologic toxic effects were infrequent. The current response rates are not better than the prior experience of the authors with other cisplatin combinations. CONCLUSIONS: These results do not confirm the favorable reports of other authors with cisplatin-ifosfamide regimens in cervical carcinoma. The results of ongoing Phase III studies comparing cisplatin-ifosfamide with cisplatin alone in cervical carcinoma are awaited.

Adult↗
PubMed1993

Familial ovarian cancer. A report of 658 families from the Gilda Radner Familial Ovarian Cancer Registry 1981-1991.

BACKGROUND: Because of the small number of cases (five) reported between 1929 and 1969 and a significant increase reported in the decade of the 1970s, the Familial Ovarian Cancer Registry was established in 1981 to study the occurrence of familial ovarian cancer in the United States. METHODS: Any woman (with or without ovarian cancer herself) who contacted the Registry and demonstrated a familial history of ovarian cancer was added to the Registry as an index case. RESULTS: From 1981 through May 31, 1991, 658 families for a total of 1568 cases of familial ovarian cancer were accessioned into the Registry. Of the 219 mothers and 251 daughters with familial ovarian cancer, the mean (58.5 years) and median (57.0 years) age at diagnosis of the mothers was significantly older than the mean (49.8 years) and median (49.0 years) ages of their daughters with ovarian cancer. Significantly more index cases without ovarian cancer had used oral contraceptives as compared to index cases with ovarian cancer (P < 0.001). Significantly more index cases with ovarian cancer used other estrogens as compared to index cases without ovarian cancer (P < 0.001). The Registry cases exhibited a higher proportion of serous adenocarcinoma, poorly differentiated adenocarcinoma, borderline carcinoma, and gonadoblastoma as compared to the 1978 SEER data. Mother and a minimum of one daughter was the most common relationship and was represented in 49.5% of the families with familial ovarian cancer. Sister-sister relationships were the second most frequent and accounted for 38.5% of the 658 families. CONCLUSIONS: Familial ovarian cancer occurs most frequently in mother-daughter relationships followed by sister-sister and appears to be an autosomal dominant inheritance with variable penetrance.

Adult↗
PubMed1993

Predictive value of serum CA125 following optimal cytoreductive surgery during weekly cisplatin induction therapy for advanced ovarian cancer.

One hundred seventy-one patients with epithelial ovarian cancer were treated on a prospective protocol of weekly cisplatin induction (1 mg/kg weekly for four courses) followed by monthly cisplatin (50 mg/m2), Adriamycin (50 mg/m2), and cyclophosphamide (750 mg/m2). Seventy-five patients with FIGO stage III or IV disease who underwent optimal cytoreductive surgery (<2 cm residual disease) were treated on this protocol and had weekly as well as monthly serum CA125 levels measured. A retrospective analysis was performed in order to determine if a > or = 50% fall in elevated serum CA125 levels during weekly cisplatin induction therapy would be predictive of findings at second look operation, normalization of serum CA125 levels (< 35 u/ml) immediately prior to the third course of multiagent chemotherapy, and to determine the impact of such a decline on median progression-free interval. Positive predictive values for this parameter with respect to findings at second look operation ranged between 38% and 50% (P > 0.05). Positive predictive values for this parameter with respect to normalization of serum CA125 levels immediately prior to the third course of multiagent chemotherapy ranged between 64.2% and 89.6% (P > 0.05). Logistic regression analysis demonstrated that a > or = 50% fall observed in CA125 levels during four weekly courses of chemotherapy served as an independent predictor of normalization of serum CA125 levels (<35 u/ml) following two courses of multiagent chemotherapy (P = 0.009) and improved median progression-free interval (P = 0.04). Eighteen patients demonstrated a rise in serum CA125 levels during weekly induction cisplatin chemotherapy. Only one of these patients (5.5%) demonstrated a surgical complete response at the end of standard therapy.

Adult↗
PubMed1993

Antisense DNA oligonucleotides. I: The use of ionspray tandem mass spectrometry for the sequence verification of methylphosphonate oligodeoxyribonucleotides.

The sequences of synthetically prepared methylphosphonate oligodeoxyribonucleotides have been verified using ionspray tandem mass spectrometry with sample introduction via flow injection. The technique involves the use of product-ion scans from multiply protonated (4+ and 5+) precursors. Among the ions detected are several series of fragments of different charge states that indicate the base sequence of the intact molecule. Oligomers as large as 18 bases have been successfully characterized.

Base Sequence↗
PubMed1993

Antisense DNA oligonucleotides. II: The use of matrix-assisted laser desorption/ionization mass spectrometry for the sequence verification of methylphosphonate oligodeoxyribonucleotides.

Matrix-assisted laser desorption/ionization (MALDI) mass spectrometry has been used to measure accurately the molecular masses of synthetic methylphosphonate oligodeoxyribonucleotides, up to 18 nucleotides in length. A simple method has been developed for the complete sequence verification of these compounds, which are intractable by classical means. Sequencing from the 5' end of the molecule is possible because of inefficiencies in the synthetic procedure. Complementary information from the 3' end can be obtained by partial hydrolysis of the methylphosphonate backbone.

Base Sequence↗
PubMed1993

Response to Taxol chemotherapy in resistant ovarian carcinoma.

Taxol was administered to 25 patients with progressive ovarian cancer who had failed three or more lines of chemotherapy. A response rate of 27% was noted in 22 evaluable patients (5 partial responders; 1 complete responder). Median duration of response was only eight weeks. The impact of Taxol's use in this disease awaits the result of trials in which it is administered as first line therapy.

Adult↗
PubMed1993

The addition of etoposide and ifosfamide to cisplatin as second line therapy in ovarian carcinoma.

Forty-five patients with progressive or recurrent ovarian carcinoma received cisplatin, etoposide, and ifosfamide as salvage chemotherapy. The primary purpose of this trial was to evaluate if etoposide and ifosfamide added to cisplatin was effective second line therapy in the 20 patients with progressive or recurrent ovarian cancer after first line cisplatin-based chemotherapy. The overall response in the 20 patients was 20%, all of which were complete responses. However, responses were seen only in patients who had previously responded to first line cisplatin-based chemotherapy and then developed recurrent cancer, whereas none of the patients whose cancer progressed during first line cisplatin-based chemotherapy responded. The addition of etoposide and ifosfamide to cisplatin as second line therapy does not potentiate cisplatin in patients demonstrating first line cisplatin resistance and most likely does not contribute to the second line responses in those patients who demonstrated first line cisplatin sensitivity. This combination is also ineffective as third, forth, fifth or sixth line salvage chemotherapy with a response rate of only 8%.

Adult↗
PubMed1992

A prospective trial of progesterone therapy for malignant peritoneal cytology in patients with endometrial carcinoma.

From February 1982 to February 1991, 45 patients with endometrial carcinoma confined to the uterus except for malignant peritoneal cytology were treated with 1 year of progesterone therapy. Thirty-six patients have undergone planned second-look laparoscopy with repeat peritoneal washings and the remaining 9 patients either refused second-look laparoscopy or the procedure was medically contraindicated. Of the 36 who underwent second-look laparoscopy, 34 (94.5%) were NED (no evidence of disease) and had negative repeat peritoneal cytology and 2 (5.5%) had persistent malignant cytology. The latter two patients, after an additional year of progesterone therapy, were found to be NED and had negative peritoneal cytology at third-look laparoscopy. Of the 45 women enrolled in this protocol, no patient has developed recurrent endometrial cancer, and the expected 5-year disease-free survival was 88.6%.

Adenocarcinoma↗
PubMed1991

Phase II trial of cisplatin, adriamycin, and etoposide for metastatic endometrial adenocarcinoma.

Twenty patients with metastatic or recurrent endometrial adenocarcinoma not amenable to surgery or radiation were treated with monthly cisplatin (20 mg/m2 x 3), etoposide (75 mg/m2 x 3), Adriamycin (40 mg/m2) (PAV) and Megace. Patient characteristics were as follows: grade 3 differentiation, 55%; papillary subtype, 15%; prior radiotherapy, 70%; prior chemotherapy, 10%; and prior hormonal therapy, 20%. Hematologic toxicity was significant but acceptable: WBC nadirs, 50%; platelet nadirs, 40%. There was no hematologic mortality. There was a 75% objective response rate and a 55% complete response rate with PAV. The median survival was 15+ months, the 2-year survival was 42%, and the 2-year progression-free survival was 20%. PAV appears to be an active combination with acceptable toxicity in the treatment of metastatic or recurrent endometrial cancer, and we believe that phase III evaluation is indicated.

Adenocarcinoma↗
PubMed1991

Prospective trial of cisplatin, adriamycin, and dacarbazine in metastatic mixed mesodermal sarcomas of the uterus and ovary.

Twenty-four patients with advanced or recurrent uterine (13) and ovarian (11) mixed mesodermal sarcomas received a combination of cisplatin. Adriamycin and dacarbazine (PAD) as initial therapy after surgical debulking. Of the 13 patients with metastatic uterine sarcoma, six (46.1%) remained without evidence of disease (NED) from 8 to 36 months from the start of PAD. The estimated 1-, 2-, and 3-year survivals for these patients were 68%, 68%, and 51%, respectively. Of the 11 ovarian sarcoma patients, five (45.4%) were NED at 5, 7, 32, 56, and 59 months from the start of PAD. The estimated 1-, 2-, and 3-year survivals for these patients were 70%, 35%, and 35%, respectively. The PAD regimen is an active regimen in patients with metastatic uterine and ovarian mixed mesodermal sarcomas and progression-free survival may be improved by maximum debulking surgery prior to the initiation of PAD chemotherapy.

Aged↗
PubMed1990

Mass spectrometric assay for determination of pancuronium and vecuronium in biological fluids utilizing the moving belt introduction system.

An assay for the determination of the neuromuscular blocking agents pancuronium bromide and vecuronium bromide in plasma or urine has been developed. This method is based on syringe application of sample extracts to the moving belt surface and single metastable transition monitoring of the elimination of acetic acid from the ion of m/z 543 during chemical ionization. The analysis shows good linearity over three orders of magnitude and is capable of analyzing for the compounds below the 5 ng ml-1 level. The assay has been used in preliminary pharmacokinetic studies of the biological fluids of surgical patients. The utility of the method for simultaneous determination of the deacetylated metabolites of these two drugs has also been investigated.

Chromatography, Liquid↗
PubMed1990

Cisplatin-based chemotherapy for stage II ovarian adenocarcinoma: a preliminary report.

We have performed three sequential trials in patients with FIGO stage II ovarian cancer in an attempt to improve long-term survival. The first trial utilized whole-abdomen radiation and a pelvic boost and the second study utilized pelvic radiation plus melphalan chemotherapy. These trials resulted in estimated 5-year survivals of 40 and 50%, respectively (Gynecol. Oncol. 23, 168-175, 1986). In the current study, 20 patients were treated with 6 months of adjuvant cisplatin-based chemotherapy. The estimated progression-free survival was only 45%. However, by tailoring salvage therapy to the findings at second-look laparotomy, the estimated 5-year survival was 77%. Notwithstanding the latter result of 77%, improved therapy is still required for the relatively rare patient who has stage II ovarian cancer.

Adenocarcinoma↗