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Biomedical subjects

W F Whitmore

Publications and source records attributed to W F Whitmore.

At least 217 records · Page 12Linked to original sources
PubMed1982

Surgical treatment of clinical stage I nonseminomatous germ gell tumors of the testis.

The rationale for further treatment after orchiectomy and the logical basis of the principle therapeutic alternatives in the management of clinical state I nonseminomatous germ cell tumors of the testis have been reviewed. Retroperitoneal lymph node dissection provides the epitome of staging accuracy and a high degree of therapeutic effectiveness in clinical stage I nonseminomatous germ cell tumors of the testis and is associated with minimal early and late morbidity and a low mortality. However, all methods of further active therapy after radical orchiectomy are under legitimate scrutiny in view of the burden of unnecessary therapy, the accuracy of clinical staging, the ability to recognize failures early, and the high probability of successful treatment of such failures.

Dysgerminoma↗
PubMed1981

VAB-3 combination chemotherapy of metastatic testicular cancer.

The initial response and long-term follow-up of 74 evaluable patients who received combination chemotherapy for metastatic nonseminomatous testicular cancer are reported. Patients were treated with a protocol (VAB-3) including vinblastine, actinomycin-D, bleomycin, and cis-dichlorodiammine platinum (DDP). VAB-3 alone caused complete remission (CR) in 54% (40/74) and partial remission (PR) in 26% (1974). Five patients with less than CR to chemotherapy achieved CR following surgical excision of residual mature teratoma after starting VAB-3 protocol, resulting in an overall CR rate of 61% (45/74). With a minimum follow-up of 24+ months, and a median follow-up of 35+ months for those still living, 45% (33/74) of the patients are living free of evidence of disease, 4% (3/74) are living with disease, and 51% (38/74) are dead. Response to VAB-3 protocol was examined with respect to performance status, histology, prior therapy, extent of disease, tumor markers, and duration of disease from diagnosis. No one died because of toxicity of VAB-3, and life-threatening toxicity was uncommon. Long survival is significantly associated (P less than 0.001) with achievement of CR. The treatment goal for metastatic testicular cancer is cure. The achievement of CR, using aggressive combination chemotherapy and surgery, is essential in reaching this goal.

Adolescent↗
PubMed1981

The incidence and extent of pelvic lymph node metastases in apparently localized prostatic cancer.

Pelvic lymphadenectomy was performed in 300 patients with apparently localized adenocarcinoma of the prostate. Pelvic lymph node metastases were identified in 119 patients (40%) and in 35 of these cases (29%) the metastases involved a solitary lymph node. The incidences of metastases for clinical stage B1, B2 and C tumors were 7, 43, and 60%, respectively. The extent of the metastases in terms of the number and distribution of the involved nodes correlated directly with the clinical stage of the primary tumor. The incidences of metastases associated with well-differentiated, moderately differentiated and poorly differentiated tumors were 27, 45, and 70%, respectively. The degree of tumor differentiation, however, had no apparent impact on the incidence of metastases among patients with clinical stage B1 and C neoplasms. Since tumor stage, tumor grade, and pelvic lymph node metastases have each been demonstrated to be of prognostic significance in prostatic cancer, the status of the pelvic lymph nodes should not be considered an isolated prognostic parameter in patients with otherwise localized prostatic cancer.

Adenocarcinoma↗
PubMed1981

Combined chemotherapy and surgery in treatment of advanced germ-cell tumors.

Forty-eight selected patients with GCT who were suspected of having residual disease after two or three chemotherapy inductions underwent an attempt at resection of this residual tumor. In 37 patients all gross disease was resected: 11 had malignant tissue, eight adult teratoma, and 18 no residual neoplasm, and 9, 7 and 17, respectively, remain free of disease. Patients in whom complete resection was not possible generally did poorly. Elevated serum tumor markers following the completion of preoperative chemotherapy indicated residual malignant disease and poor probability for complete resection. Twenty-nine percent of patients with negative preoperative markers had malignancy at the time of surgery, but disease was resectable in most of these patients. The key for success is, first, the response to chemotherapy and, second, complete resection of residual disease. It is recommended that patients with initially bulky metastases (diameter greater than 5 cm) be first managed by chemotherapy, employing successive close inductions, and subsequently explored with intent to resect residual disease. When the resected specimen shows malignant elements, the patients should receive additional inductions, otherwise, maintenance chemotherapy is employed.

Antineoplastic Agents↗
PubMed1981

Methotrexate: an active drug in bladder cancer.

Forty-nine patients with transitional urothelial tract tumors received methotrexate: 0.5-1.0 mg/kg I.V. Q W (40 patients) or 250 mg/M2 in a 2-hour infusion with citrovorum factor rescue 24 hours later (nine patients). Eleven (26%, 95% confidence limits 13-39%) of 42 patients with bidimensionally measurable metastases achieved partial remission. Most responses occurred within 2-3 weeks and persisted for a median duration of six months (range, 2-20). Response rates were increased to 38% (6/16 patients, 95% confidence limits 18-65%) in patients who had no prior chemotherapy, and a 90-100% performance status (50, 5/10 patients, 95% confidence limits 22-78%) compared with 19% (5/26, 95% confidence limits 8-37%) in patients who had prior chemotherapy and a less than or equal to 80% performance status (19%, 6/32 cases, 95% confidence limits 9-32%). Toxicity included mucositis and myelosuppression. A review of the literature coupled with the present data suggest that methotrexate is as active as cisplatin in the treatment of patients with advanced urinary bladder cancer.

Adult↗
PubMed1981

VAB-4 combination chemotherapy in the treatment of metastatic testis tumors.

Forty-two patients with advanced testis carcinoma without previous chemotherapy were treated with VAB-4, and 41 were evaluable. The program consisted of three in-hospital inductions 16 weeks apart, and outpatient treatments every three weeks. Of the patients, 80% achieved complete remissions (CR). Chemotherapy alone induced CR in 61%, partial remissions (PR), in 24% and minor response (MR), in 15%. An additional 20% of patients (six PRs and 2 MRs) achieved CR following resection of residual tumor deposits. With a median follow-up of 27 months, the median duration of CR has not been reached. Of those achieving CR to chemotherapy alone, 12% had relapses. Bulk and extent of metastatic disease, histology of primary tumor, and tumor markers at the beginning of therapy influenced the frequency of CR. Of those with minimal disease, 90% achieved CR. The CR rate was 67% for those with advanced thoracic disease and 29% for those with advanced abdominal disease. Patients who had embryonal carcinoma and those who had no elevation of alpha-fetoprotein had a higher frequency of CRs. Myelosuppression with a leukocyte count drop less than 1000/mm3 occurred in three patients, and no patient had chronic renal failure or pulmonary fibrosis. One patient died from sepsis while in complete remission.

Adolescent↗
PubMed1981

Adjuvant chemotherapy combination of vinblastine, actinomycin D, Bleomycin, and Chlorambucil following retroperitoneal lymph node dissection for stage II testis tumor.

In an attempt to reduce recurrence of nonseminomatous germ cell tumors of testis stage II, 62 patients were treated with vinblastine, actinomycin D, bleomycin, and chlorambucil after retroperitoneal lymph node dissection. Of the patients, 84% have remained in complete remission with median follow-up of three years: 33/33 stage II-A (N-1,N-2A) and 19/29 (66%) stage II-B (N-2B,N3). The relapse rate in patients who had histologic evidence of extranodal extension of the tumor (N-3) was 54% (7/13). This program did not cause any serious toxicity. Adjuvant chemotherapy is effective in reducing relapses. More recently, with the current availability of chemotherapy with a high efficacy for control of disseminated disease, patients with resected stage II-A (N-1,N2A) have been followed closely and treated only if they developed evidence of recurrence. Patients with resected stage II-B (N-2B,N-3) have been placed on a more aggressive adjuvant program.

Adult↗
PubMed1981

Synthesis and body distribution of alpha-aminoisobutyric acid-L-11C in normal and prostate cancer-bearing rat after chemotherapy.

This paper describes the synthesis of alpha-aminoisobutyric acid-11C (11C-AIB) and studies its body distribution in healthy and tumor-bearing animals. High tissue levels of 11C-AIB were found in organs with high metabolic activity (pancreas, liver, kidney). The prostate tumor 11C-AIB concentrations are significantly lower than that of pancreas, liver, and kidney, but increased when compared with normal prostate levels. Effective chemotherapy, which reduces tumor growth of two different prostate adenocarcinoma cell lines (R-3327-H, R-3327-G) also decreases 11C-AIB levels and the 11C-AIB prostate to tumor ratio.

Adenocarcinoma↗
PubMed1981

Androgen stimulated chemotherapy in the Dunning R-3327 prostatic adenocarcinoma.

This study was undertaken to determine whether hormonal stimulation followed by chemotherapy with a cell-cycle specific agent would improve the effectiveness of the chemotherapy in a prostatic adenocarcinoma model. One hundred Copenhagen rats were randomised into 5 equal groups and injected subcutaneously with 2 x 10(7) cells of Dunning G strain prostatic adenocarcinoma. The groups were treated in the following fashion: 1. sham operated controls, 2. castration, 3. castration and methotrexate, 4. castration, testosterone and methotrexate and 5. castration and testosterone. When the tumours became palpable, all animals received the surgery to which they were randomised. Subsequent hormonal and chemotherapy was started 1 week thereafter. Therapy was given for 5 consecutive days followed by a 16-day recovery period and then continued in a cyclical fashion. Serial measurements of animal weights and tumour size were obtained. Analysis of tumour growth was restricted to the first 29 days of therapy because of a rapid decline in animal survival beyond that point. The group treated with castration, testosterone, and methotrexate inhibited tumour growth more than any other group and was the only group that was significantly different from control (P less than 0.05).

Adenocarcinoma↗
PubMed1981

Lymphocele after pelvic lymphadenectomy for urologic cancer.

Pelvic lymphadenectomy is used widely for staging prostatic or bladder carcinoma. In 9 of 187 patients (4.7 per cent) who underwent bilateral pelvic lymphadenectomy for urologic cancer pelvic lymphocele diveloped. The management of these patients is presented along with review of causes, clinical features, diagnosis, and treatment. Pelvic CT scan is a noninvasive modality which aids in the diagnosis of this complication. Minidose heparin used for prophylaxis of thromboembolic complications may increase lymphocele formation.

Adenocarcinoma↗
PubMed1981

Automated flow cytometry to monitor intravesical BCG therapy of superficial bladder cancer.

The automated flow cytometry system (FCM) at Memorial Sloan-Kettering Cancer Center has been used to monitor the effect of intravesical BCG in the therapy of superficial bladder cancer. Analysis of saline bladder washings prior to therapy, weekly during the six weeks of therapy, and at follow-up examination in 2 patients, 1 responder and 1 nonresponder, provides the basis for some projections regarding the potential value of this technique.

Adult↗
PubMed1981

Bladder papilloma: therapeutic and cost effect of outpatient department management.

Management of patients with benign papilloma of the bladder was reviewed for the calendar year 1979. Thirty-six patients (average age sixty-six years) were cystoscoped 113 times with 77 fulgurations. Over-all follow-up of these 36 patients averaged 8.2 years with a range of one to thirty-five years. In 5 patients (13.4 per cent) progressive disease developed: 1 invasive tumor requiring cystectomy, 2 Stage A lesions treated by transurethral resection, and 2 bilateral ureteral and renal pelvic papillomatosis with local bladder control. The average outpatient department (OPD) cost per patient in 1979 for management was $322.80 and for inpatient management $1,785.25. The over-all cost savings for 1979 was $112,608.65 among the patients treated for recurrence on an OPD basis. Outpatient management of benign bladder papilloma is a well-tolerated, therapeutically cost effective measure and is recommended.

Aged↗
PubMed1981

Bladder cancer in men and women treated by radiation therapy and/or radical cystectomy.

Four-hundred fifty-one patients with bladder cancer, 348 men and 103 women, were treated by radiation therapy and/or radical cystectomy during the last two decades at Memorial Sloan-Kettering Cancer Center. Radical cystectomy alone was the treatment in 98 men and 39 women. Radical radiation therapy to an average tumor dose of 6,000 rad in six weeks was given to 79 men and 30 women +/- one year before salvage cystectomy was done for recurrent or persistent tumors. Planned preoperative irradiation was delivered to the true pelvis either 4,000 rad in four weeks in 95 men and 24 women or 2,000 rad in one week in 76 men and 10 women +/- six weeks and two days, respectively, before radical cystectomy. Over-all survival and recurrence results in both sexes were similar, 40 per cent of men and 36 per cent of women were alive at five years without recurrence, 45 per cent of men and 48 per cent of women died in five or more years with local and/or distant recurrences, and 21 per cent of men and 15 per cent of women died before five years from causes other than cancer recurrence. Higher five-year survival for high clinical stage B2 to D1 tumors was noted similarly in the irradiated men (30 per cent) and women (37 per cent) than in the cystectomy alone patients (19 per cent in men and 4 per cent in women). Similar survival rates (52 to 57 per cent) were observed in men and women with low clinical stage O to B1 tumors treated with or without irradiation.

Adult↗
PubMed1981

Adjuvant chemotherapy in non-seminomatous testis cancer: "mini-VAB" regimen: long-term followup.

Since 40 to 50 per cent (range 20 to 80 per cent) of patients with stage II non-seminomatous germ cell tumors of the testis suffer relapse after orchiectomy and retroperitoneal lymph node dissection, relatively non-toxic adjuvant chemotherapy (consisting of vinblastine, actinomycin D, bleomycin and chlorambucil) was given to 62 patients after lymphadenectomy. Of these patients 82 per cent remained free of disease with a 4-year median followup and 18 per cent had relapse. Retrospective analysis reveals that no patient (0 of 33) with stage IIA and 38 per cent (11 of 29) with stage IIB disease had relapse. Patients with histologic evidence of extranodal extension of disease (N3 category) had the highest relapse rate (62 per cent). Based on our experience we recommend that patients with resected stage IIB disease, particularly those with extranodal extension of tumor, receive aggressive adjuvant chemotherapy.

Antineoplastic Agents↗