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Biomedical subjects

W F Whitmore

Publications and source records attributed to W F Whitmore.

At least 163 records · Page 9Linked to original sources
PubMed1983

Planned preoperative cisplatin and radiation therapy for locally advanced bladder cancer.

Cisplatin (DDP) is an active agent in the treatment of disseminated bladder cancer. In addition to its direct tumor cytotoxicity, recent animal and clinical data suggest synergism with radiation therapy (RT). Since improved survival with preoperative RT is largely restricted to bladder cancer patients in whom radiation-induced downstaging (P less than T) may be recognized, the authors administered DDP + RT preoperatively to patients with locally advanced (T3, T4) bladder tumors selected for cystectomy. The aim was to evaluate the feasibility of such a combination in relation to surgical and hematologic complications, the immediate effect on tumor downstaging, disease progression, and survival. Two thousand rad (400 rad X 5 days) was delivered to the whole pelvis, followed by cystectomy in 2 days. DDP (70 mg/m2) was given intravenously on day 2 of the RT. Twenty-four patients received preoperative DDP + RT and underwent attempted cystectomy; however, six patients were nonresectable owing to extensive pelvic disease, and an additional five patients had resectable pelvic lymph node metastases. Pelvic complications developed in 3 of 24 (12%) patients, but none required reoperation. No patient had a wound dehiscence. Transient myelosuppression was similar to that induced by 2000 rad preoperative RT alone. Tumor downstaging (P less than T) was seen in 9 of 24 (38%) patients, and in 5 (21%) patients, no tumor was found in the surgical specimen (P0). Distant metastases alone have been detected in 4 of 18 (22%) patients who had a cystectomy (all 4 had nodal metastases). Disease-free survival at a median follow-up of 22 months (range, 12-34 months) is 60% (14/24) for all patients (89% for P less than T and 40% for P greater than or equal to T patients) and 78% (14/18) for the resected patients. Combined preoperative DDP + RT proved to be a safe and feasible regimen which resulted in a possibly greater recognition of radioresponsive bladder tumors, and after cystectomy, an encouraging early survival rate in patients with locally advanced disease.

Aged↗
PubMed1983

Experimental studies on the radiation-modifying effect of cis-diamminedichloroplatinum II (DDP) in human bladder transitional cell carcinomas grown in nude mice.

The effect of cis-diamminedichloroplatinum II (DDP) and ionizing radiation on human bladder transitional cell carcinoma (TCC) was evaluated in nude mouse-grown human tumors following administration of single-agent and combination treatment. Combination of DDP and radiation resulted in accelerated tumor regression and substantially delayed tumor regrowth. The potentiating effect of DDP on ionizing radiation was related to timing and sequence of treatments and was independent of tumor sensitivity to DDP. Best results, as judged by tumor growth curve characteristics, histopathologic changes, and absence of tumor metastases, were obtained when DDP was administered at an early stage following radiation treatment.

Aged↗
PubMed1983

Unresectable carcinoma of the bladder.

The clinical courses of 119 patients with unresectable bladder cancer were analyzed. All patients had a laparotomy with the intent of cystectomy. TN categorization postlaparotomy did not identify variables significantly influencing the natural history of the disease, although previous definitive irradiation or T4aNx-4 categories were associated with especially poor survival. T category correlated more closely with survival than did N category. Supravesical urinary diversion palliated patients with urinary symptoms and/or bilateral ureteral obstruction. Patients without compelling urinary symptoms at the time of laparotomy uncommonly needed diversion later. Pelvic irradiation and systemic chemotherapy available in the interval from 1961 to 1976 had minimal if any demonstrable effect on the time course of the disease.

Biopsy↗
PubMed1983

VAB-5 combination chemotherapy in prognostically poor risk patients with germ cell tumors.

Forty-four patients with nonseminomatous germ cell tumors with "poor prognostic features" were entered on the VAB-5 regimen and 38 are evaluable. VAB-5 represents an intensified version of the VAB-4 protocol. Poor prognostic features were considered to be bulky metastases ( greater than 5 cm in diameter), palpable retroperitoneal disease, liver metastases, brain metastases, involvement of two or more parenchymal organs, pure choriocarcinoma, alpha fetoprotein or human chorionic gonadotropin serum levels over 1000 ng/ml, lactic acid dehydrogenase serum levels over 400 mg/dl, and failure to prior chemotherapy. Eighteen of 38 evaluable patients became free of neoplasm, 11 with chemotherapy alone, and seven with combined chemotherapy and surgery. Fourteen of 18 complete responders remain alive and free of disease with a median follow-up of 50 months. Complete remission with testis tumor occurred in 13/15 without and 5/15 with prior chemotherapy and in none of eight patients with primary extragonadal germ cell tumors. Thirty-one patients received antibiotics when they developed fever during myelosuppression. Ten patients developed transient serum creatinine levels over 2 mg/dl after cis-platinum and one required hemodialysis with subsequent recovery. All patients had severe mucositis after induction. An apparent improvement of results over prior VAB protocols in patients with poor prognostic features was compromised by significant increases in toxicity and such patients require special study to improve cure rates.

Antineoplastic Agents↗
PubMed1983

VAB-6 combination chemotherapy without maintenance in treatment of disseminated cancer of the testis.

Thirty-six men with Stage III or bulky Stage II malignant germ cell tumors of the testis who received no prior chemotherapy were treated with the VAB-6 protocol without maintenance and 34 were evaluable. The VAB-6 regimen is a 3-4 month program beginning with successive inductions at 3-4 week intervals: day 1, cyclophosphamide 600 mg/m2 of body surface, bleomycin 30 mg, vinblastine 4 mg/m2 and dactinomycin 1 mg/m2 intravenously; days 1-3, bleomycin 20 mg/m2/day X 3 by continuous 24-hour intravenous infusion; and day 4, cis-platinum 120 mg/m2 intravenously. Complete responders receive a fourth induction and are followed thereafter without further chemotherapy. Incomplete responders have resection of residual disease one month after the third induction. If the resected specimen contains malignant tissue, an additional two inductions are given. Thirty-one of 34 (91%) evaluable patients achieved complete remission and 28 remain in complete remission with median follow up of 24+ months. Chemotherapy alone was most effective in patients with minimal metastatic disease, with no teratoma in primary tumor, and with pure seminoma. Patients with advanced metastatic deposits or with teratoma in the primary tumor frequently required combined chemotherapy and surgery to achieve disease free status. Myelosuppression was the principal potentially serious toxicity. With effective induction, maintenance chemotherapy is not necessary.

Adolescent↗
PubMed1983

VAB-6 combination chemotherapy in resected stage II-B testis cancer.

Twenty-four patients with resected Stage II-B nonseminomatous germ cell tumors of the testis received adjuvant chemotherapy with the modified VAB-6 regimen for one year. Eighteen patients had nodal category N2B and six nodal category N3 (extranodal extension of tumor). Adjuvant VAB-6 started with two four day inductions at approximately four week intervals. Induction was cyclophosphamide 600 mg/m2 IV, vinblastine 4 mg/m2 IV, dactinomycin 1 mg/m2 IV, bleomycin 30 mg IV on day 1, then bleomycin 20 mg/m2/day by continuous 24 hour infusion for three days, and cis-platinum 120 mg/m2 IV on day 4. Maintenance was vinblastine 6 mg/m2 IV and dactinomycin 1 mg/m2 IV every three weeks. Six patients received a third induction but without bleomycin. All 24 patients remain free of disease with a median follow up of 24 months. Myelosuppression was the major toxicity. Four patients received antibiotics for fever during myelosuppression. In one patient, serum creatinine temporarily rose over 2 mg/dl after cis-platinum. VAB-6 is effective in the prevention of recurrences in resected Stage II-B nonseminomatous germ cell tumors. However, the optimal regimen remains to be defined.

Adolescent↗
PubMed1983

Serum tumor markers in patients with metastatic germ cell tumors of the testis. A 10-year experience.

The serum values of alphafetoprotein, human chorionic gonadotropin, lactate dehydrogenase, and carcinoembryonic antigen in patients with metastatic testicular cancer were reviewed for the period 1972 to 1982. All values were obtained before chemotherapy was begun. Elevated values of alphafetoprotein were present in 47 percent of patients tested, of human chorionic gonadotropin in 60 percent, of lactate dehydrogenase in 64 percent, and of carcinoembryonic antigen in 11 percent. The frequency of elevated values of alphafetoprotein, human chorionic gonadotropin, and lactate dehydrogenase decreased during the study period. Inverse relations between elevated values of alphafetoprotein, human chorionic gonadotropin, and lactate dehydrogenase and both complete remission rate and survival rate were noted in some of the chemotherapy trials. Carcinoembryonic antigen was believed not to be useful as a marker in this disease. It is concluded that assays of alphafetoprotein, human chorionic gonadotropin, and lactate dehydrogenase are important both clinically and prognostically in patients with testicular cancer.

Carcinoembryonic Antigen↗
PubMed1983

Presumptive downstaging from preoperative irradiation for bladder cancer as determined by flow cytometry: preliminary report.

Presumptive tumor downstaging was evaluated in 28 patients with grade II or III, solid, muscle-infiltrating bladder cancer (clinical category T3) treated by integrated irradiation (2000 rad to the whole pelvis in 5 days) and cystectomy (1-14 days later) by comparing the results of flow cytometry (FCM) on barbotage specimens obtained before and after irradiation (at the time of cystectomy) and the results of pretreatment clinical stage (T category) and post cystectomy pathological stage (P category). The patients were divided into three groups: (1) P greater than T, (2) P = T, and (3) P less than T. All of the patients in this study had positive FCM specimens with an aneuploid stemline in the pre-irradiation specimen. A complete radiation response (CRR) was defined by FCM as disappearance of the aneuploid stem cell line. Of the 5 patients in the P less than T group, 4 showed a CRR; of 20 patients in the P = T group, 8 showed a CRR; of the 3 patients in the P greater than T group, none showed a CRR. The proportion of patients in the various T/P groups is consistent with that previously observed in patients receiving integrated irradiation (2000 rad in 5 days) and cystectomy (1-14 days later). The overall downstaging response of 43%, as determined by FCM, correlates well with the pathological downstaging rates of 40%-68% reported by others following high dose (4000-5000 rad) integrated irradiation cystectomy regimens; however, it is more than the 27% rate reported with the low dose short course (2000 rad in 5 days) regimen. The correlation of the FCM findings with clinico-pathological downstaging is consistent with the possibility that FCM may be useful in identifying a favorable radiation response.

Carcinoma, Squamous Cell↗
PubMed1983

Second primary germ cell tumors in patients with seminoma of the testis.

In a review of our experience with seminoma 9 cases of bilateral primary testis germ cell tumors were encountered, including 2 simultaneous and 7 successive. Of the 9 cases 6 were bilateral seminomas and 7 were stage I, contributing to the good survival experience. Treatment policy is specified and discussed.

Adult↗
PubMed1983

Recurrences in surgical stage I nonseminomatous germ cell tumors of the testis.

A retrospective analysis of patients with surgical stage I nonseminomatous germ cell tumors of the testis was done in an attempt to define the pathogenesis of treatment failure. Of 138 patients 126 (91 per cent) remain free of disease, with a median followup of 5 or more years, and 12 (9 per cent) suffered relapse an average of 9 months after orchiectomy and retroperitoneal lymph node dissection. The majority of recurrences were in the lungs. Of 12 patients who had recurrence 6 were salvaged and are alive without evidence of disease 3 or more years after the second complete remission. A history of scrotal surgery or scrotal violation, the extent of the primary tumor and the presence of sarcomatous elements in the primary were not statistically significant risk factors in this study. A higher recurrence rate with embryonal carcinoma than with teratocarcinoma was not statistically significant.

Adolescent↗
PubMed1983

Renal cell carcinoma extending into inferior vena cava.

Of 18 patients with renal cell carcinoma extending into the inferior vena cava 16 underwent radical nephrectomy with either venacavotomy and tumor thrombectomy or vena cava resection. Of 8 patients with no evidence of metastasis at the time of surgery 4 (50 per cent) are free of cancer for a mean duration of 93 months. Of 8 patients with known preoperative metastasis 7 died with cancer after a mean survival of 12 months. Operative mortality was 6.2 per cent and morbidity was minimal.

Adenocarcinoma↗
PubMed1983

Phase II trial of sequentially administered cisplatin, cyclophosphamide and doxorubicin for urothelial tract tumors.

A total of 32 patients with urothelial tract tumors, 31 of whom had bidimensionally measurable disease parameters, underwent sequential intravenous administration of 70 mg./m.2 cisplatin, 250 mg./m.2 cyclophosphamide and 45 mg./m.2 doxorubicin on days 1 to 3 every 3 to 4 weeks. Of these patients 28 (88 per cent) were treated adequately, including 13 (46 per cent, 95 per cent confidence limits of 28 to 64 per cent) who achieved a complete (2) or partial (11) remission. Almost all remissions occurred within 1 to 3 weeks and persisted for a median duration of 8 months (range 4 to 16 months), with 5 patients responding for 1 or more years. Responders lived significantly longer than nonresponders, with a median of 91 versus 38 weeks, respectively (p less than 0.001). The over-all response rate with this 3-drug combination was not statistically different from that which has been observed in previously untreated, selected patients given cisplatin only. When the results of the 3-drug combination (92 responses in 202 patients) are compared to those of cisplatin alone (85 responses in 255 patients) the 3-drug regimen is statistically superior (p less than 0.002).

Aged↗
PubMed1983

Selected experience with surgery and combination chemotherapy in the treatment of nonseminomatous testis tumors.

We treated 208 patients with newly diagnosed nonseminomatous germ cell tumors of the testis between January 1975 and March 1978. Patients with stages I and II disease underwent retroperitoneal lymph node dissection, and the majority of patients with stage II neoplasm received adjuvant chemotherapy afterwards. Patients with stage III and palpable stage II neoplasm had initial chemotherapy with or without subsequent surgery. The over-all cure rates were 96 per cent (76 of 79) for patients with stage A, 94 per cent (31 of 33) with stage IIA, 83 per cent (35 of 42) with stage IIB and 35 per cent (15 of 43) with stage III disease. The stage of disease at the time of diagnosis, local extent of the primary tumor, nodal category in stages I and II cancer, and chemotherapy were factors influencing relapse rate and over-all survival.

Adolescent↗
PubMed1983

Ureteroileal anastomotic leaks: percutaneous treatment.

Interventional techniques are increasingly important in patient care. We present new uses of these techniques in each of three patients who had rapidly deteriorating clinical status due to an anastomotic leak following the creation of a ureteroileal conduit. To divert urine flow and to promote healing, large bore nephrostomy tubes were placed percutaneously. Silastic ureteral stents were placed from above to help divert flow of urine, and to prevent the formation of strictures. The procedures, the nephrostomy tubes, and the stents were all well tolerated, and the clinical status of the patients improved rapidly. These three patients left the hospital with tubes and stents in place, and complete healing occurred without complications in one to three months. Following removal of the nephrostomy tubes and stents, all patients had good preservation of renal function and normal loopograms.

Aged↗