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Biomedical subjects

W P Greening

Publications and source records attributed to W P Greening.

At least 19 recordsLinked to original sources
PubMed1988

Quadrantic excision and axillary node dissection without radiation therapy: the long-term results of a selective policy in the treatment of stage I breast cancer.

The results of a selective policy of conservative surgery without radiation over a 14-year period with a minimum 5 year follow-up indicates that routine postoperative radiotherapy can be safely omitted in certain cases. Eighty-one patients were studied, the overall survival at 5 years and 10 years was 88% and 73% respectively. The risk of local recurrence within the treated breast or axilla was 10% at 5 years and 11% within the total follow-up period. Most (91%) local recurrences were noted within 5 years. The rate of dying from breast cancer did not change over 10 years of follow up. The risk of recurrence was significantly higher in younger (less than 46 years) patients (P less than 0.05) and premenopausal patients (P less than 0.005) compared with older, post menopausal patients. The risk of dying from breast cancer was also significantly greater in the younger premenopausal women. At 10 years the rate of dying from breast cancer was unchanged from that seen soon after diagnosis. In postmenopausal patients with tumours less than 2 cm and uninvolved axillary nodes after pathological assessment, radiotherapy can be safely omitted. In these patients there is a low risk of local recurrence (10%), similar to that reported following segmental mastectomy and radiation.

Adult↗
PubMed1985

Granular cell tumour of the breast.

Four cases of granular cell tumour of the breast reflecting the lifetime experience of one surgeon are presented. Recent advances in the pathology of this condition suggest that the customary term 'myoblastoma' is inappropriate, and that 'granular cell tumour' is preferable. The clinical and pathological features are reviewed and the differential diagnoses discussed, with emphasis on the distinction from carcinoma which may be mimicked both clinically and on frozen examination. The diagnosis may be made by pre-operative aspiration cytology, and a conservative surgical approach is recommended.

Adult↗
PubMed1984

Ectopic production of human chorionic gonadotrophin-like material by breast cancer.

Human chorionic gonadotrophin (hCG) is a placental protein whose ectopic secretion by nontrophoblast tumors has been claimed to be of clinical relevance. Serum levels of hCG were measured in 570 patients with breast disease. A double-antibody radioimmunoassay (RIA) using antisera to hCG-beta was employed. Approximately 14% of patients with breast cancer were found to have elevated serum hCG levels. Such raised titers were not stage- or tumor-type-related, but occurred only in postmenopausal subjects. Further study showed that those patients with elevated hCG levels also had raised levels of human luteinizing hormone (hLH). Assay cross-reactivity was shown to account for the "spurious" hCG elevations. An immunocytochemical study also failed to find hCG an ectopic breast tumor constituent and/or product. It is concluded that hCG is not produced by breast tumors and has no clinical utility.

Adult↗
PubMed1984

Breast conservation in the treatment of early breast cancer. A 20-year follow-up.

Two hundred sixty-three patients with unilateral primary breast cancer, treated by local excision of the primary tumor and radical radiation therapy between 1954 and 1969, were followed up for a minimum of 10 years and a maximum of 20 years. The treatment plan delivered 4500 rad in fractions of orthovoltage irradiation to five fields: tangential breast fields, axilla with posterior axillary field, parasternal and supraclavicular, with a subsequent boost of 1000 rad to the primary tumor site, axilla, and supraclavicular fossa. Patients were clinically staged using the TNM (UICC) system; 115 patients had tumors less than 2 cm in diameter and a clinically negative axilla (T1N0N1a), 96 had tumors 2 to 5 cm in diameter with a clinically negative axilla (T2N0N1a), and 52 had tumors less than 5 cm in diameter and clinical axillary lymph node metastases (T1T2N1b). The actuarial relapse-free survival of patients with T1N0N1a tumors was 72% at 5 years, 59% at 10 years, and 47% at both 15 and 20 years. The relapse-free survival of patients with T2N0N1a tumors was not statistically different (P greater than 0.05). A significantly worse survival was observed in patients with clinical axillary lymph node metastases (T1T2N1b), with a survival of 37% at 5 years, 29% at 10 years, 23% at 15 years, and 22% at 20 years, when compared with patients with clinically negative lymph nodes (P less than 0.01). Locoregional relapse occurred in 22%, at 10 years, of those patients with T1 or T2N0N1a tumors and 52% of the patients with T1T2N1b tumors. The pattern of locoregional relapses indicated that approximately 50% occur at least 5 years after treatment; this contrasts with the pattern of early locoregional relapse after mastectomy. The commonest sites of relapse were in the breast in 19% and axilla in 6% of patients with T1 or T2N0N1a tumors. There was no attenuation of the radiation dose administered at the site of a subsequent relapse. Surgery for radiation failure produced a 42% crude relapse-free survival at 5 years after salvage mastectomy in those patients originally treated for T1 or T1N0N1a tumors. The results of this study suggest that a significant proportion of patients relapse locally over a prolonged period after breast conservation. The evolution of new radiation techniques may provide better locoregional control and early salvage surgery may result in improved long-term survival.

Adult↗
PubMed1984

Radioiodine treatment of metastatic thyroid carcinoma: the Royal Marsden Hospital experience.

The case records of 235 patients who were treated for differentiated thyroid cancer between 1949 and 1981 were reviewed. Forty-two (18%) had distant metastatic spread outside the neck and received radioiodine (131I) therapy. In cases where the distant spread was confined to the lungs, 54% of patients were alive, free of disease, 10 years after 131I treatment was started. By contrast, no patient with skeletal involvement has survived for 10 years and only one for five years after treatment. A variety of cytotoxic drugs has been tried on an ad hoc basis with no notable success. One patient developed preleukaemia three months after completion of 131I treatment, but no other serious side effects were observed. Factors that influence the behaviour of metastatic thyroid carcinoma are discussed and a possible revised approach to 131I therapy is suggested in the light of these findings.

Adenocarcinoma↗
PubMed1980

Adjuvant chemotherapy for breast cancer: side effects and quality of life.

In a trial of postoperative adjuvant chemotherapy women with primary breast cancer and spread to one or more axillary nodes were randomised to receive a six-month course of either the single agent chlorambucil or the five-drug combination of chlorambucil, methotrexate, fluorouracil, vincristine, and adriamycin. On completing the treatment 47 patients were asked to fill in questionnaires at home on the side effects of treatment and its influence on the quality of their life. Side effects including nausea, vomiting, malaise, and alopecia had been severe enough to interfere with their lifestyle in 9 (42%) of the patients who had received the single agent and 19 (79%) of those who had received multiple-drug treatment. Various other side effects were reported by a few patients. Seven (29%) of the patients who had received the multiple-drug schedule voluntarily added that the treatment had been "unbearable" or "could never be gone though again." The proportion of patients who had experienced severe side effects while receiving the treatment was considerable; hence such adjuvant chemotherapy is justifiable only if it will substantially improve a patient's prognosis.

Alopecia↗
PubMed1980

Hemiagenesis of the thyroid gland.

Three cases of hemiagenesis of the thyroid gland are reported and the literature reviewed. It is emphasized that this rare congenital anomaly is seldom diagnosed except by thyroid scanning or at surgery. If the clinician is aware of it, the diagnosis presents little difficulty and an unnecessary operation may be avoided. All our cases were discovered as a result of an associated thyroid disorder. In 2 cases there was an adenoma and in 1 a papillary adenocarcinoma.

Adenocarcinoma, Papillary↗
PubMed1978

Clinical study of recurrence rate and survival time of patients with carcinoma of the breast treated by biopsy excision without any other therapy.

We report the recurrence rate and survival time in 31 patients with carcinoma of the breast who were treated by limited excision of the primary tumour and no other therapy. At three years the overall recurrence rate in the breast was 28%. One patient was found to have systemic disease and two died of other causes. The overall recurrence rate in the breast at five years was 33%. One patient died of disseminated disease at 6 years 4 months.

Adult↗