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Biomedical subjects

W Lawrence

Publications and source records attributed to W Lawrence.

At least 109 records · Page 6Linked to original sources
PubMed1983

The prognostic significance of tumor location and bowel obstruction in Dukes B and C colorectal cancer. Findings from the NSABP clinical trials.

The present study examines the prognostic significance of tumor location and bowel obstruction in Dukes B and C colorectal cancer. Data were obtained from 1021 patients entered into two randomized prospective clinical trials of the NSABP. Tumor location proved to be a strong prognostic discriminant. Lesions located in the left colon demonstrated the most favorable prognosis. Tumors of the rectosigmoid and rectum had the worst prognosis with the relative risk of treatment failure for the latter being over three fold that of the left colon. When the relative risks associated with tumor location were adjusted for nodal imbalances, the left colon continued to demonstrate the most favorable prognosis. The presence of bowel obstruction also strongly influenced the prognostic outcome. Examination of the data without considering tumor location disclosed that patients with bowel obstruction were at greater risk for treatment failure than those without obstruction. The effect of bowel obstruction was influenced by the location of the tumor. The occurrence of bowel obstruction in the right colon was associated with a significantly diminished disease-free survival, whereas obstruction in the left colon demonstrated no such effect. This phenomenon was independent of nodal status and tumor encirclement, the latter two factors proving to be of prognostic significance independent of tumor obstruction. A multivariate analysis in which the covariate effects of sex, age, nodal status, tumor obstruction, encirclement, and tumor location were adjusted underscored the role of tumor location and obstruction as prognostic discriminants. The results indicate that the definition of prognostic factors can identify patient subsets with unique characteristics.

Carcinoma↗
PubMed1982

Bladder and prostatic tumors in the intergroup Rhabdomyosarcoma study (IRS-I): results of therapy.

Sixty-four children with primary rhabdomyosarcoma of the bladder or prostate were enrolled in the IRS during the initial five years (October 1972-November 1977). Observation of these patients for from 2 1/2-8 years forms the basis of this report. The chemotherapy-radiotherapy regimens employed (IRS) for each Clinical Group were: (1) Group I (completely excised tumor), sequential actinomycin-D (ACD), vincristine (VCN), and cyclophosphamide (CYP), i.e., standard (VAC), with or without radiotherapy (RT); (2) Group II (resected local disease with node involvement, "microscopic" residual, or local extension), RT plus sequential ACD and VCN, or RT plus standard VAC; (3) Group III, (gross residual disease); and (4) Group IV (dissemination), RT and either pulse VAC or pulse VAC plus Adriamycin (ADR). Pulse VAC consisted of VCN (day 1), plus daily intravenous ACD and CYP (days 1-5). Relapse rates were: Group I, 0/8; Group II, 6/23; and the mortality in Group III, 6/23; and in Group IV, 7/10. Among patients with bladder tumors, the rate of relapse was 2/11 following pelvic exenteration (anterior, 10; total 1); 5/12 following partial cystectomy or gross tumor excision; and 3/5 following a primary chemotherapy-radiotherapy (PCR) regimen. In patients with prostatic tumors (Groups I-III), relapse occurred in 0/14 patients treated initially by pelvic exenteration (anterior, 12; total, 2); and in 2/11 patients treated by a PCR regimen.

Adolescent↗
PubMed1982

Medical adrenalectomy in patients with advanced breast cancer.

Medical adrenalectomy, consisting of aminoglutethimide plus either dexamethasone or hydrocortisone, was administered to 53 women with advanced breast cancer. Sixteen (30%) patients had an objective response, five patients had stabilization of disease, 26 patients demonstrated progression of disease, two patients did not adhere to protocol, and four patients had severe toxicity necessitating discontinuation of the drugs. Medical adrenalectomy accurately predicted response to subsequent surgical adrenalectomy in 23 patients. Estrogen receptor (ER) data accurately predicted response (eight of nine (89%) ER-positive patients responded) or failure (only two of 14 (14%) ER-negative patients responded) to medical adrenalectomy. Thirty (of 51 women adhering to protocol) had no toxicity. Therefore, it appears that medical adrenalectomy is safe, usually well tolerated, and can accurately predict response to surgical adrenalectomy. Its use should be limited to ER-positive patients, and it may totally supplant surgical adrenalectomy in the management of advanced breast cancer.

Adrenal Glands↗
PubMed1982

Extremity lesions in the Intergroup Rhabdomyosarcoma Study (IRS-I): a preliminary report.

The sites in which rhabdomyosarcoma occurs most frequently in children and young adults are the head and neck, genitourinary tract, and the extremities. Among these three sites, tumors of the extremities have been associated with the highest relapse rate and lowest survival rate in patients treated by protocols of the Intergroup Rhabdomyosarcoma Study (IRS). In five of six patients treated by primary extremity amputation, tumor recurred. Seven of 21 patients in Clinical Group I (completely resected tumors), and 9 of 27 patients in Clinical Group II (patients with gross tumor excision but positive lymph nodes, "microscopic residual" disease, or extension beyond the muscle of origin) had relapse. Thirteen of 18 patients (72%) in Clinical Group III (gross residual disease) responded to a chemotherapy-radiotherapy regimen, but ten have subsequently had relapses; and 13 of 18 are dead. Of 30 patients in Clinical Group IV (disseminated disease on entry), 15 initially responded to chemotherapy, but 25 of 30 are dead. The period of surveillance is 2 1/2 to 7 1/2 years, with a mean of 46.3 months at least examination. Increased rates of relapse were seen in patients with extremity tumors, as opposed to tumors in other sites, irrespective of the specific IRS chemotherapy-radiotherapy regimen employed. In Clinical Group I (nonamputation), relapse rates by histologic subtype of rhabdomyosarcoma were alveolar subtype, 5/8; embryonal, 1/7; and all other subtypes, 1/6. Clinical Group II, relapse rates were alveolar, 6/12; embryonal, 5/11; all other subtypes, 3/10.

Amputation, Surgical↗
PubMed1982

Estrogen receptors in primary breast cancer.

Estrogen receptor (ER) activity was assayed in 132 patients undergoing mastectomy for primary breast cancer and in 75 patients whose initial treatment for metastatic cancer was endocrine manipulation. Estrogen receptor status correlated with response to endocrine therapy. Among patients whose ER activity was assayed in the primary tumor, ER-positive patients had an improved disease-free survival (independent of stage or nodal or menopausal status) after mastectomy when compared with ER-negative patients (P less than .05). The ER-positive and ER-negative patients receiving adjuvant chemotherapy had similar disease-free survivals. These data confirm that patients with ER-positive primary tumors have a better prognosis than patients with ER-negative primary tumors. Although adjuvant chemotherapy improves the prognosis in patients with histologically positive lymph nodes in both ER-positive and ER-negative patients, the disease-free survivals in ER-negative patients may improve to a greater extent than in ER-positive patients.

Aged↗
PubMed1982

Pancreatic and periampullary carcinoma. Experience with 200 patients over a 12 year period.

The operative management of 200 patients with pancreatic and periampullary cancer was reviewed. Patients with metastatic disease and biliary obstruction are best treated by the nonoperative techniques of biopsy and internal biliary drainage if technically feasible. For patients who undergo exploration and are found to be candidates for a bypass procedure, both biliary and gastroduodenal bypass should be performed. Lymph node involvement and age of the patient were found to be significant variables in determining the candidates suitable for curative resection. A definite incidence of multicentricity was found in patients undergoing total pancreatectomy for ductal carcinoma of the pancreas; however, significant problems with diabetic management arose from this procedure. The primary site of the lesion as well as the intelligence and socioeconomic background of the patient should dictate the type of resection employed. Pancreatoduodenectomy (Whipple procedure) is recommended for periampullary cancers other than pancreatic carcinoma, while total pancreatectomy may be appropriate in selected patients. However, there has been no evidence thus far in this early trial with total pancreatectomy that more complete resection of the pancreas leads to longer survival.

Ampulla of Vater↗
PubMed1982

Primary chemotherapy in the treatment of children with bladder--prostate tumors in the Intergroup Rhabdomyosarcoma Study (IRS-II).

Twenty-nine children (24, male; 5, female) with non-disseminated rhabdomyosarcomas of the bladder or prostate were treated (1978-1980) by a primary chemotherapy regimen consisting of vincristine, actinomycin D, and cyclophosphamide ("Pulse" VAC), with or without local radiotherapy. During the initial 20 wk of chemotherapy, nine children achieved a Clinical Complete Response (CCR). Three of these are without evidence of disease (NED) and have functional bladders, two following partial cystectomy. Four who achieved a CCR subsequently relapsed or remained biopsy positive, but are at present NED following radiotherapy and anterior exenteration. Two patients who achieved CCR status relapsed and have died of disease. Twelve patients had a Clinical Partial Response (CPR) in less than 20 wk and two others in less than 40 wk. Seven of these are NED with intact bladders following chemotherapy-radiotherapy; and an additional patient is NED following partial cystectomy. Four patients in the CPR group have been treated by exenteration following failure to achieve complete response, and are NED. One patient has died, and one has progressive disease. Six patients had an inadequate response to chemotherapy (NR). Anterior exenteration was carried out in three, and two of these have survived. The overall results in these 29 patients are: (A) alive and disease-free with functional bladders, 11; (B) alive and disease-free following anterior exenteration, 10; and (C) dead or death from tumor anticipated, 8. The function of retained bladders (11) has been satisfactory.

Adolescent↗
PubMed1982

The scope of surgical oncology.

Surgical oncology, as a subspecialty within general surgery, has slowly evolved as our knowledge of cancer and its treatment had advanced. Determining the proper number and roles of surgical oncologists in cancer management, and defining the preparation of the surgical oncologist for these roles are incomplete projects at present. The heritage of surgical oncology, its current status, and perceived future needs for optimal development are described.

Forecasting↗
PubMed1982

Computed tomography in the management of soft tissue tumors.

Forty-six patients with primary soft tissue sarcomas underwent computed tomographic evaluation. Among 21 patients with retroperitoneal sarcomas, computed tomography was misleading in three patients and accurate and helpful in 18 patients. It was also useful in detecting recurrence by follow-up scanning and determining response to chemotherapy. Among 16 patients with tumors of the extremity, computed tomography demonstrated clinically helpful findings in only two patients and was misleading in two others. Computed tomographic scans were helpful and accurate in evaluating six sarcomas involving the trunk and abdominal wall. Computed tomographic scans were more accurate than ultrasonography or xeroradiography when patients had both imaging modalities. Computed tomographic scans should not supplant clinical examination for tumors of the extremity but are valuable in the preoperative evaluation of sarcomas arising at other sites. They are also valuable in the postoperative follow-up study of patients and may detect a recurrence prior to clinical examination.

Adult↗
PubMed1982

Continuing care.

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Family Practice↗
PubMed1981

Penetrating, obstructing, and perforating carcinomas of the colon and rectum.

One third of 735 patients with colorectal cancer operated on at the Medical College of Virginia Hospitals, Richmond, between 1957 and 1972 were initially seen with a major complication of their disease (involvement of adjacent organs or structures, obstruction, or perforation). Lesions penetrating to involve adjacent organs made up 9% of the group studied; the operative mortality (9%) and five-year survival figures (41%) for those with this finding were nearly identical to those of the overall series when only resections with curative intent were examined. The operative mortalities from obstructing and perforating lesions were, respectively, two and four times the overall mortality; and crude five-year survival figures were one half and one fourth the overall survival data for the series. This poor prognosis appeared to be largely a function of the more advanced stage of disease in these groups and of sequelae from the complicated manifestations that significantly increased operative mortality. Considering only patients surviving "curative" resections, the penetrating and obstructing lesions were associated with a five-year survival that was the same as that for the curative resection group as a whole (40%), while those patients with perforating lesions had roughly half this life expectancy. Therefore, patients with these major complications of colorectal carcinoma must be treated by an aggressive surgical approach if there is no evidence of metastatic disease.

Colonic Neoplasms↗
PubMed1981

Malignant neoplasms of the major salivary glands.

Between January 1, 1968 and December 31, 1978, 42 patients with malignant lesions involving the major salivary glands were seen at the Medical College of Virginia. A 60% 2-year survival and a 42% 5-year survival were noted. Histologic type was the major determinant of survival. Symptoms other than a painless mass, a largest dimension greater than 4 cm, older age, and clinical spread outside the gland were all suggestive of both a more malignant histologic type and a worse prognosis. Based on these observations, a plan is proposed for the diagnostic approach and treatment of salivary gland masses that is based on the mode of presentation and histologic findings.

Adenocarcinoma↗
PubMed1981

Rhabdomyosarcoma of the female urogenital tract.

During the initial 6 yr (1972-1978) of the Intergroup Rhabdomyosarcoma Study (IRS), 27 patients with rhabdomyosarcoma of the female urogenital tract were treated, and the results of therapy were evaluated on the basis of 3-7 yr of observation. By primary site these tumors were: bladder, 14; vagina, 9; vulva, 2; and cervix uterus, 2. Twenty-three presented with localized tumors; the four remaining patients (1 bladder, 1 vagina, and 2 cervix) had distant metastases at diagnosis. Two patients with bladder tumors underwent pelvic exenteration, local irradiation, and chemotherapy (2 yr), and were without relapse. Ten patients were treated by partial cystectomy and postoperative chemotherapy (with or without local irradiation) and fatal recurrence occurred in three. The remaining seven patients are disease-free for 36-74 mo (mean, 51.8 mo). Six of the eight patients with nondisseminated vaginal tumors were treated by initial pelvic exenteration (2), hysterectomy-vaginectomy (2), or hemivaginectomy (2). All received postoperative chemotherapy and three received local irradiation. Delayed hysterectomy-vaginectomy after primary chemotherapy was performed in the two additional patients with vaginal tumors. Relapse has occurred in one of these eight patients with localized vaginal disease. The remaining seven have been observed for 3-5.5 yr (mean, less than 4 yr). Two patients with vulval lesions treated by a combined therapy regimen are without recurrence. Our conclusion is that chemotherapy has significantly increased survival in females with urogenital tract rhabdomyosarcomas.

Adolescent↗