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PubMedDate not supplied

Performance status and age as independent predictors of survival among AIDS patients with primary CNS lymphoma: a multivariate analysis of a multi-institutional experience.

PURPOSE: There is limited information about the outcome of AIDS patients with primary central nervous system lymphoma treated with definitive irradiation. The purpose of this study was to determine factors associated with increased survival in such patients. METHODS: An analysis was performed of 163 patients with AIDS who were evaluated at nine urban hospitals. These patients were treated for primary central nervous system lymphoma after the establishment of a tissue diagnosis or on a presumptive basis after failing empiric treatment for toxoplasmosis. All patients were treated between 1983 and 1995 with radiotherapy (median dose-fractionation scheme = 3 Gy x 10) and steroids (> 90% dexamethasone). Because multiple fractionation schemes were used, prescriptions were converted to biologically effective dose according to the formula Gy10 = Total Dose x (1 + fractional dose/alpha-beta), using an alpha-beta of 10. RESULTS: Longer median survival times were associated with high Karnofsky performance status (KPS > or = 70 vs < or = 60: 181 vs 77 days), young age (< 35 vs > 35: 162 vs 61 days), and high total definitive irradiation doses (> 39 Gy10 vs < 39 Gy10: 162 vs 40 days). Tissue diagnosis, gender, race, number of lesions (solitary vs multiple), and the presence of other cancers did not influence outcome. In multivariate analysis, young age, high Karnofsky performance status, and the delivery of higher biologically effective doses of irradiation retained independent significance relative to the endpoint of survival. CONCLUSIONS: Even at urban tertiary medical centers, few AIDS patients with intracranial lesions undergo biopsies to establish a precise tissue diagnosis. Survival following definitive irradiation is strongly related to two pretreatment factors (young age, high performance status) and one treatment factor (total biologically effective dose of cranial radiotherapy). These variables should be considered in selecting patients for definitive irradiation and in designing future studies.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Long-term follow-up after high-activity 125I brachytherapy for pediatric brain tumors.

A retrospective review including long-term follow-up (4.6-12.0 years) was performed of all 28 pediatric patients who underwent high-activity 125I brachytherapy at the University of California, San Francisco, for primary or recurrent brain tumors from 1980 until 1991. There were 4 glioblastomas, 11 high-grade nonglioblastoma multiforme (NGM) malignant gliomas, 10 contrast-enhancing low-grade NGM, 2 choroid plexus carcinomas, and 1 rhabdomyosarcoma. The 13 survivors included 7 of 8 patients with primary high-grade NGM, 2 of 3 patients with primary low-grade NGM, and 3 of 7 patients with recurrent low-grade NGM. Necrosis (with or without tumor) was identified in 17 of 22 reoperated patients. The mean Karnofsky performance status was 88 +/- 9 at the time of brachytherapy, 87 +/- 7 at 3 years, and 87 +/- 9 in 11 patients alive at 6-12 years. Brachytherapy is a useful modality for treating selected pediatric brain tumors, and although focal necrosis is a common sequela, it does not tend to have a major impact on the Karnofsky performance status, if the implant site is amenable to reoperation.

Adolescent↗
PubMed1998

Anemia is associated with decreased survival and increased locoregional failure in patients with locally advanced head and neck carcinoma: a secondary analysis of RTOG 85-27.

PURPOSE: The purpose of the present study is to investigate the strength of association between anemia and overall survival, locoregional failure, and late radiation therapy (RT) complications in a large prospective study of patients with advanced head and neck cancer treated with conventional radiotherapy with or without a hypoxic cell sensitizer. METHODS AND MATERIALS: Between March 1988 and September 1991, 521 patients with Stage III or IV squamous cell carcinoma of the head and neck were entered into a randomized trial examining the addition of etanidazole (SR 2508) to conventional radiation therapy (RT) (66-74 Gy in 33-37 fractions, 5 days a week). Patients with hemoglobin (Hgb) levels measured and recorded prior to the second week of RT were included in this secondary analysis. Hemoglobin levels were stratified as normal (> or = 14.5 gm% for men, > or = 13 gm% for women) or anemic (< 14.5 gm% for men, < 13 gm% for women). Locoregional failure rates were calculated using the cumulative incidence approach. Overall survival was estimated according to the Kaplan-Meier method. Late RT toxicity was scored according to the RTOG morbidity scale. Differences in rates of overall survival, locoregional failure, and late complications were tested by the Cox proportional hazard model. RESULTS: Of 504 eligible patients, 451 had a Hgb level measured and recorded prior to the second week of RT. One hundred sixty-two patients (35.9%) were considered to have a normal Hgb level and 289 patients (64.1%) were considered to be anemic. The estimated survival rate is 35.7% at 5 years in patients with a normal Hgb, versus 21.7% in anemic patients (p = 0.0016). The estimated locoregional failure rate is 51.6% at 5 years in patients with a normal Hgb, versus 67.8% in anemic patients (p = 0.00028). The estimated rate of grade 3 or greater toxicity is 19.8% at 5 years in patients with a normal Hgb, versus 12.7% in anemic patients (p = 0.063). On multivariate analysis, several variables were found to be independent predictors of survival including: T stage, Karnofsky performance status, N stage, age, total radiation dose to the primary, and Hgb level. Independent predictors of locoregional control included T stage, Karnofsky performance status, N stage, radiation dose, and Hgb level. The only variables which predicted for the development of late RT complications were gender (p = 0.0109) and age (p = 0.0167). These findings were consistent regardless of whether Hgb level was considered a dichotomous or continuous variable. CONCLUSION: Low Hgb levels are associated with a statistically significant reduction in survival and an increase in locoregional failure in this large prospective study of patients with advanced head and neck cancer. Hgb level should be considered as a stratification variable in subsequent studies of head and neck cancer. Strategies to increase Hgb prior to RT in patients with head and neck cancer may lead to improved survival and loco-regional control.

Analysis of Variance↗
PubMed1996

[Supratentorial gliomas: neuropsychological study of long-term survivors].

A battery of psychologic tests was administered to 32 patients, aged from 26 to 61 years, who had survived 2 years or more after treatment with surgery and radiotherapy for supratentorial gliomas (18 low grade and 14 high grade) without evidence of recurrent tumor on MRI. Two groups were identified. A first group of 17 patients had neuropsychologic scores similar to estimated premorbid level (group I). A second group of 15 patients had abnormal neuropsychologic scores, lower that their estimated premorbid level (group II). In comparison with "normal" patients, those with abnormal neuropsychologic scores were older at the time of treatment, had a lower post-operative Karnofski Performance Status, a longer delay between surgery and the date of the tests and more often had left sided lesions. Comparison of Karnofski Performance Status between the post-operative time point and the date of neuropsychological evaluation did not show a significant change over time in groups I and II except in 3 patients who experienced progressive deterioration. Vigorous treatment of gliomas with surgery, radiotherapy and sometimes chemotherapy does not induce a substantial cognitive dysfunction in about half of the long term survivors (53%). Cognitive dysfunction is identified in the other half that could be related to post-operative sequelae (due to the tumor itself or to surgery) and/or to radiotherapy- and chemotherapy-induced delayed toxicity.

Adult↗
PubMed1998

Outcomes analysis in 100 liver transplantation patients.

BACKGROUND: There is an increasing demand for outcomes analysis, including quality of life and financial analysis, following medical interventions and surgical procedures. We analyzed outcomes for 100 consecutive patients undergoing liver transplantation during a period of case management revision. METHODS: Patient survival was calculated by Kaplan-Meier actuarial methods. The Karnofsky performance status was objectively assessed for surviving patients up to 6 years after transplantation and was evaluated by repeated measures analysis of variance and covariance. Subjective evaluation of quality of life over time was obtained using the Psychosocial Adjustment to Illness Scale. The correlations between time and scale were calculated. Financial data were accumulated from billing records. RESULTS: Six-month, 1-year, 2-year, and 3- through 5-year survival was 86%, 84%, 83%, and 78%, respectively. Karnofsky performance status confirmed poor functional status preoperatively with a mean of 53 +/- 2, but significantly improving to 72 +/- 2 at 3 months, 80 +/- 2 at 6 months, 90 +/- 1 at 1 year, 92 +/- 1 at 2 years, 94 +/- 1 at 3 years, 96 +/- 1 at 4 years, and 97 +/- 1 at 5 years (P <0.001). Psychosocial Adjustment to Illness Scale scores demonstrated significant improvement following transplantation overall (r = -0.33), improving most in sexual relationships (r = -0.41), and domestic environment (r = -0.35; P <0.001). Median length of stay for the first half of the patients was 19 days declining to 11 days for the second half. Median hospital charges declined from $105,000 to $90,000. CONCLUSIONS: Quality of life parameters assessed both by care givers (Karnofsky) and by patients (Psychosocial Adjustment to Illness Scale) improved dramatically following transplantation and over time, demonstrating that liver transplantation effectively restores a good quality of life. Outcomes can be improved while reducing length of stay and charges through modifications in case management.

Adaptation, Psychological↗
PubMed1997

Prolonged survival of 2 years or longer for patients with disseminated melanoma. An analysis of related prognostic factors.

BACKGROUND: Once melanoma has metastasized to distant sites, the prognosis is usually poor, showing an overall median survival of 6-8 months. Long term survival is extremely rare, and there is still controversy concerning the prognostic significance of therapeutic modalities. The aim of the current study was to identify important prognostic factors associated with Stage IV melanoma. METHODS: The current study was based on data for 3258 melanoma patients, for whom clinical, pathologic, and long term follow-up information was recorded during the period 1976-1996 at the Eberhard-Karls-University in Tuebingen. Germany. The attainment of 2 years' or longer survival time by patients with disseminated melanoma was addressed, and a multivariate analysis of related prognostic factors was performed by logistic regression. RESULTS: Four hundred forty-two patients (13.6%) developed distant metastasis. The median survival time was 7 months, and the 2-year, 5-year, and 10-year survival rates were 11.9%, 6.7%, and 4.7%, respectively. Forty-five patients had prolonged survival of 2 years or longer. Significantly more females belonged to the group of long term survivors (P = 0.0186). Of the modalities of therapy given, only surgery was associated with prolonged survival (P < 0.0001). Primary metastasis to the skin (P = 0.006), the brain (P = 0.015), more than a single metastatic site (P = 0.002), and Karnofsky performance status of less than 80 (P = 0.0035) were significantly related to short term survival. In addition, subsequent development of two or more new metastatic sites was also associated with short term survival (P = 0.0025). CONCLUSIONS: In the current analysis, prolonged survival of 2 years or longer for patients with disseminated melanoma was shown to depend on gender, site of primary metastasis, number of metastatic sites, and Karnofsky performance status. Of the modalities of therapy given, only surgery significantly influenced survival. However, in a small percentage of patients, long term complete remission was achieved with chemotherapy alone or in combination with surgery, suggesting that such regimens might be curative in selected cases.

Adult↗
PubMed1999

Postoperative radiotherapy for supratentorial malignant gliomas.

From January 1988 to December 1996, sixty-five patients with histologically confirmed supratentorial malignant gliomas were treated with postoperative radiation therapy in our department. They were subjected to this analysis according to different clinical and pathologic parameters. The overall 1-year, 2-year survival rate was 57% and 23%, respectively. With univariate analysis, age, postoperative Karnofsky performance status, duration of symptoms, multiplicity of lesions and the extent of surgery were identified as significant prognostic factors. With multivariate analysis, postoperative Karnofsky performance status and the extent of surgery continued to show independent prognostic significance on overall survival.

Combined Modality Therapy↗
PubMed1997

Hyperfractionated radiotherapy alone for clinical stage I nonsmall cell lung cancer.

PURPOSE: Among patients with Stage I nonsmall cell lung cancer (NSCLC), those treated with conventional radiotherapy show poorer prognosis than those treated by surgery. To improve the prognosis of such patients, we have used hyperfractionated radiation therapy. METHODS AND MATERIALS: Between 1988 and 1993, 49 patients were treated with hyperfractionated radiotherapy with 1.2 Gy twice daily to a total dose of 69.6 Gy. All patients were technically operable, but 29 had medical problems and 20 refused surgery. The median age and Karnofsky Performance Status was 63 years and 90, respectively. No patient received chemotherapy or immunotherapy. Prophylactic mediastinal irradiation was not given. RESULTS: The median survival time was 33 months, and the 5-year survival rate was 30%. The rate at 5 years for freedom from each of relapse, local recurrence, mediastinal lymphnode metastasis, and distant metastasis was 41%, 55%, 89%, and 75%, respectively. Univariate analysis revealed that higher Karnofsky Performance Status score, absence of weight loss before treatment, and T1 stage were associated with better survival, although the T stage became insignificant on multivariate analysis. There were two Grade 3 acute toxicities and three Grade 3 late toxicities, but there was no Grade 4-5 toxicity. CONCLUSION: The results of this study compare favorably with those of most previous studies employing conventional fractionation. Further studies on hyperfractionation seem to be warranted for Stage I NSCLC.

Aged↗
PubMed1995

Radiation Therapy Oncology Group (RTOG) 88-08 and Eastern Cooperative Oncology Group (ECOG) 4588: preliminary results of a phase III trial in regionally advanced, unresectable non-small-cell lung cancer.

BACKGROUND: Regionally advanced, surgically unresectable non-small-cell lung cancer represents a disease with an extremely poor prognosis. External-beam irradiation to the primary tumor and regional lymphatics is generally accepted as standard therapy. The use of more aggressive radiation regimens and the addition of cytotoxic chemotherapy to radiotherapy have yielded conflicting results. Recently, however, results from clinical trials using innovative irradiation delivery techniques or chemotherapy before irradiation have indicated that patients treated with protocols that incorporate these modifications may have higher survival rates than patients receiving standard radiation therapy. PURPOSE: On the basis of these results, the Radiation Therapy Oncology Group (RTOG)-Eastern Cooperative Oncology Group (ECOG) elected to conduct a phase III trial comparing the following regimens: 1) standard radiation therapy, 2) induction chemotherapy followed by standard radiation therapy, and 3) twice-daily radiation therapy. METHODS: Patients with surgically unresectable stage II, IIIA, or IIIB non-small-cell lung cancer were potential candidates. Staging was nonsurgical. Patients were required to have a Karnofsky performance status of 70 or more and weight loss less than 5% for 3 months prior to entry into the trial, to be older than 18 years of age, and to have no metastatic disease. Of the 490 patients registered in the trial, 452 were eligible. The disease in 95% of the patients was stage IIIA or IIIB. More than two thirds of the patients had a Karnofsky performance status of more than 80. Patients were randomly assigned to receive either 60 Gy of radiation therapy delivered at 2 Gy per fraction, 5 days a week, over a 6-week period (standard radiation therapy); induction chemotherapy consisting of cisplatin (100 mg/m2) on days 1 and 29 and 5 mg/m2 vinblastine per week for 5 consecutive weeks beginning on day 1 with cisplatin, followed by standard radiation therapy starting on day 50; or 69.6 Gy delivered at 1.2 Gy per fraction twice daily (hyperfractionated radiation therapy). RESULTS: Toxicity was acceptable, with four treatment-related deaths. Three patients subsequently died of chronic pulmonary complications. Compliance with protocol treatment was acceptable. One-year survival (%) and median survival (months) were as follows: standard radiation therapy--46%, 11.4 months; chemotherapy plus radiotherapy--60%, 13.8 months; and hyperfractionated radiation therapy--51%, 12.3 months. The chemotherapy plus radiotherapy arm was statistically superior to the other two treatment arms (logrank P = .03). CONCLUSIONS: In "good-risk" patients with surgically unresectable non-small-cell lung cancer, induction chemotherapy followed by irradiation was superior to hyperfractionated radiation therapy or standard radiation therapy alone, yielding a statistically significant short-term survival advantage.

Adult↗
PubMed2003

P105 as a prognostic indicator in patients irradiated for locally advanced head-and-neck cancer: a clinical/laboratory correlative analysis of RTOG-9003.

PURPOSE: In a previous retrospective study, p105 AD, a proliferation-associated nuclear antigen density (AD), was found to be an independent prognostic factor for patients irradiated for locally advanced head-and-neck cancer. We sought to confirm this finding by analyzing patients entered on RTOG 9003, a Phase III randomized trial of altered fractionation radiotherapy. METHODS AND MATERIALS: Paraffin blocks of pretreatment biopsies of the primary tumor of patients with Stage III or IV squamous cell carcinoma of the oral cavity, oropharynx, or supraglottic larynx, or Stage II squamous cell carcinoma of the hypopharynx or base of tongue entered on RTOG 9003 were prospectively collected at patient entry. From these paraffin blocks, areas of tumor were selected based on histologic examinations and sectioned. Nuclear suspensions were then prepared and processed for p105 antibody and DNA staining. Flow cytometric quantification of p105 labeling indices and DNA content were then performed for correlation with local-regional control and survival. RESULTS: Paraffin blocks of tumor biopsies from 457 of 1073 patients entered were available for p105 determination. There was no significant difference in pretreatment characteristics between patients who had paraffin blocks available or not available. The median (range) of p105 labeling index (LI-C), p105 labeling index of cells in S phase (p105 LI-S), and p105 AD were 56 (range: 6-99), 8.255 (range: 0.913-23), and 67 (range: 5-364), respectively. Multivariate analysis of prognostic factors showed that T stage, N stage, Karnofsky performance status, and fractionation schedule were significant for local-regional control (p < 0.0001, 0.0011, <0.0001, and 0.007, respectively) and T stage, N stage, Karnofsky performance status, and tumor grade were significant for survival (p = 0.018, 0.002, <0.0001, and 0.0058, respectively). Neither p105 LI-C nor p105 LI-S nor p105 AD nor DNA ploidy was significant for local-regional control or survival. CONCLUSION: p105 labeling indices, antigen density, and DNA ploidy do not predict the outcome of patients irradiated for advanced squamous cell carcinomas of the head and neck.

Antigens, Neoplasm↗
PubMed2006

Measuring subjective side effects and symptoms in palliative photodynamic therapy.

PURPOSE/OBJECTIVES: To evaluate the reliability and validity of the Photodynamic Therapy Side Effects and Symptoms Scale (PSES) and to begin to describe patient-reported outcomes of photodynamic therapy (PDT). DESIGN: Repeated-measures instrument validation. The PSES uses a 10-point numeric scale to evaluate side effects or symptom trouble or burden on 13 items. SETTING: A Pacific Northwest community hospital. SAMPLE: 14 patients with end-stage lung or esophageal cancer undergoing palliative PDT. METHODS: Participants completed five PSES surveys (i.e., at baseline and once a week for four weeks after PDT). Weekly phone calls were made to assess functional status, operationalized as Karnofsky Performance Status. MAIN RESEARCH VARIABLES: Symptoms and functional status. FINDINGS: The PSES possessed acceptable internal consistency reliability and concurrent validity. Functional status declined in the first week after PDT, concurrent with an increase in side-effect and symptom burden. Photosensitivity became more burdensome over time but was never extremely burdensome. CONCLUSIONS: The feasibility of measuring a diverse set of side effects and symptoms in end-stage cancer with a single-page, large-type instrument essentially was supported. The study provided preliminary information about side effects and symptoms in patients undergoing palliative PDT. IMPLICATIONS FOR NURSING: Nurses often are called on to provide information to patients considering various treatment options. This study offers the first data on patient-reported outcomes of palliative PDT that clinicians can use to help in answering inquiries. The design of the PSES may be replicated by researchers working with other populations with end-stage disease to reduce respondent burden and decrease attrition.

Aged↗
PubMed1986

Study of cardiovascular autonomic insufficiency in advanced cancer patients.

To determine the incidence of cardiovascular autonomic insufficiency (CAI), 43 patients with advanced breast cancer and 20 normal controls were evaluated using electrocardiographic tests (heart rate variation during deep breathing and Valsalva maneuver and upon standing) and clinical tests (blood pressure variation during hand grip tests and upon standing). Nutritional status, tumor mass, Karnofsky performance status (PS) score (0-100), and peripheral reflexes were also determined. Tests for CAI were abnormal in 43 patients (52%), versus seven of 100 in 20 controls (7%, P less than 0.001). In cancer patients, tests for CAI were more frequently abnormal in patients with PS less than 60 (P less than 0.01), basal heart rate greater than 100 (P = 0.05), and malnutrition (P less than 0.01). We conclude that CAI is a frequent finding in patients with advanced breast cancer and should be suspected mainly in patients with a low PS, tachycardia, or malnutrition. It is probably a multifactorial syndrome, and malnutrition, drugs, decreased activity, or paraneoplastic syndromes are all possible causes for CAI.

Autonomic Nervous System↗
PubMed1994

[Prosthetic replacement for pathological fractures of the proximal end of the femur: total prosthesis or bipolar arthroplasty?].

INTRODUCTION: The purpose of this prospective study was to present our experience with bipolar or total hip arthroplasty in 28 consecutive cases of metastasis of the intertrochanteric and subtrochanteric area. MATERIALS AND METHODS: Twenty-eight patients with metastatic involvement of the proximal femur underwent either bipolar or total hip arthroplasty. Proximal femoral resection and prosthetic replacement with a massive component was routinely performed. RESULTS: The postoperative morbidity rates for dislocation and pressure sores were significantly lower (p < 0.05) in the bipolar arthroplasty group. Postoperative pain relief according to Habermann was excellent in 81.5 per cent and good in 14.8 per cent of the patients. The functional results according to the hip rating scale of Merle d'Aubigné were rated as excellent in 19 per cent, very good in 22 per cent and good in 22 per cent of the hips. The prognosis for survival was superior in patients with a preoperative Karnofsky performance status index of more than 60 points (p < 0.01) and in patients without postoperative pulmonary complications (p < 0.01). New bone formation around the femoral prosthetic component occurred in 11 (61 per cent) of the 18 patients surviving three months or longer. This bone formation did not affect the clinical results. In the current series pain relief as well as postoperative walking ability were comparable in both groups but the dislocation rate was significantly lower (p < 0.05) with bipolar arthroplasty. CONCLUSION: We recommend bipolar arthroplasty rather than total hip arthroplasty in patients with a preoperative Karnofsky performance status index of more than 60 points if bone disease of the acetabulum is not evident on standard radiographs and if during operation the acetabular cartilage appears normal.

Adult↗
PubMed1981

Physical function assessment in patients with advanced cancer.

Accepted physical therapy assessment techniques were compared with the Karnofsky Performance Status scores in a group of patients with advanced cancer. Assessment of patients' physical functioning by physical therapy evaluation techniques was highly correlated with the Karnofsky Performance Status score. The KPS has been demonstrated to be a reliable assessment tool and is a good indicator of those patients most likely to maintain independent physical function. Extensive physical therapy measures in this patient population appear to offer no advantage over the KPS as an evaluation tool for studies.

Activities of Daily Living↗
PubMed1994

Vascular disease outcome and thrombocytosis in diabetic and nondiabetic end-stage renal disease patients on peritoneal dialysis.

STUDY OBJECTIVE: to evaluate vascular disease and its outcome in association with thrombocytosis in chronic peritoneal dialysis (PD) patients. DESIGN: the study was designed to investigate possible correlations between severity of vascular disease and thrombocytosis in PD patients. SETTING: tertiary-referral university hospital. PATIENTS AND METHODS: serial blood platelet levels were measured in 53 stable PD patients (32 male, 21 female; mean age 55 years; mean duration of PD 19 months) between January 1991 and July 1992. Twenty-four patients were diabetic and 29 were nondiabetic. Mean duration of PD was 23 and 36 months in diabetic and nondiabetic patients, respectively. Severity of coronary arterial disease (CAD), carotid arterial disease (CNS), and peripheral arterial disease (PAD) was assessed using the Craven et al. (1991) ESRD Severity Index, a measure of organ dysfunction. Functional status was assessed using the Karnofsky Performance Status Index (KPSI). RESULTS: eighteen out of 53 PD patients (34%) had platelet counts exceeding 300,000/mm3 for six months or longer. Thirteen of 24 diabetic PD patients (54%) had thrombocytosis. Blood platelets were significantly (p < 0.01) higher in diabetic (324,000 +/- 27,000/mm3) than in nondiabetic PD (236,000 +/- 11,000/mm3) patients. In the PD group as a whole, a positive correlation was observed between blood platelet and serum cholesterol (r = 0.5, p < 0.001), blood platelet and PAD (r = 0.5, p < 0.001), and blood platelet and CAD (r = 0.35, p < 0.05). No correlation was found with age or duration of PD. In diabetic PD patients, blood platelet counts correlated significantly with PAD (r = +0.5, p < 0.01) and CAD (r = +0.4, p < 0.05) indexes. No correlation was observed between blood platelet and CNS or KPS indexes. In nondiabetics, no correlation was observed between blood platelet and CAD, PAD, CNS, or KPS indexes. CAD, PAD, and KPS indexes were significantly higher in diabetics compared to nondiabetics. CONCLUSIONS: thrombocytosis, particularly in diabetic PD patients, appears to be associated with the severity of PAD and CAD.

Cholesterol↗
PubMed2004

Radiotherapy for spinal cord compression in patients with soft-tissue sarcoma.

PURPOSE: Spinal metastases of soft-tissue sarcoma (STS) occur rarely and pose a therapeutic problem. Although wide resection is warranted for best local control, it is rarely feasible. A radiotherapy (RT) dose of 70 Gy is usually needed to treat limb STS, but only 45 Gy can be given to the spine. In the present series, we report our experience using RT to treat spinal cord compression (SpCC) associated with STS. METHODS AND MATERIALS: The medical files of 19 adult patients with STS and SpCC were reviewed. RT was considered in all the cases, together with steroids and analgesics. The prescribed dose was 30 Gy in 10 fractions within 12 days. The effect of treatment was evaluated on a clinical basis. RESULTS: Twenty-three events of SpCC were found. The prevailing symptom was pain. The Karnofsky performance status was 40-70% at presentation. RT was given in all but 1 patient and surgical decompression in 3. Small, but important, improvements in signs and Karnofsky performance status were noted in 14 of 23 cases of SpCC, expressed mainly by pain alleviation and restoration of independence. The median survival after the diagnosis of SpCC was 5 months. CONCLUSION: Radiotherapy is an important tool in palliating SpCC in patients with STS.

Adult↗
PubMed2004

Long-term results of radiotherapy for intracranial germinoma: a multi-institutional retrospective review of 126 patients.

PURPOSE: Optimal management of radiotherapy (RT) for intracranial germinoma remains controversial. This study was conducted to evaluate the long-term results of RT in patients with these tumors. METHODS AND MATERIALS: The study group consisted of 126 patients with intracranial germinoma (50 patients with pathologically verified germinoma and 76 clinically diagnosed with germinoma by clinical and neuroradiologic signs) who were treated by RT alone between 1980 and 2001. The median age at diagnosis was 17 years (range, 2-47), and various radiation doses and treatment fields were used. Serum human chorionic gonadotropin (hCG) levels were elevated in 18 patients. The median follow-up of the 114 surviving patients was 122 months (range, 13-263). RESULTS: The 10-year actuarial overall survival and cause-specific survival rate for all patients was 90% and 95%, respectively. The 10-year actuarial cause-specific survival rate for patients with and without elevated hCG levels was 94%. Relapses were noted in 10 patients, 7 of whom died of the disease. No in-field relapses at primary sites were observed in 72 patients treated with total doses of 40-50 Gy. The incidence of spinal relapses was 4% (2 of 56) for patients treated with spinal irradiation and 3% (2 of 70) for those without spinal irradiation. After a median 10-year follow-up, 54 (92%) of 59 patients with tumors not involving the neurohypophyseal region and 42 (76%) of 55 patients with tumors involving the neurohypophyseal region had Karnofsky performance status scores of 90-100%. With regard to school education and occupation, 54 (92%) of 59 patients with tumors not involving the neurohypophyseal region and 39 (71%) of 55 patients with tumors involving the neurohypophyseal region were attending school or undertaking occupations. Hormonal replacement therapy was required in 50 (44%) of 114 surviving patients before RT; only 4 patients (4%), all with neurohypophyseal tumors, required hormonal replacement therapy after RT. Clinically evident severe neurocognitive dysfunctions were documented in 10 patients before RT, and no patients treated with total doses of <55 Gy developed apparent neurocognitive dysfunctions or other complications after RT. CONCLUSION: RT was a curative treatment for intracranial germinoma, and elevated serum hCG levels did not affect the prognosis of patients treated by RT alone. A total dose of 40-50 Gy to adequate treatment fields was effective in preventing intracranial relapse, and the incidence of spinal relapses was too low to warrant routine spinal irradiation. Karnofsky performance status scores, educational achievement, and the ability to work were generally good, particularly in patients with tumors that did not involve the neurohypophyseal region. Because most complications, such as hormonal deficiency and neurocognitive dysfunction, were documented before RT and newly diagnosed complications after RT were infrequent, the treatment toxicity faced by germinoma patients appears to be less than anticipated.

Adolescent↗
PubMed1987

Treatment of astrocytoma with a 5-day cisplatin infusion.

Although cisplatin may have intrinsic activity against astrocytoma, limited penetration into the central nervous system may severely curtail delivery of adequate amounts of drug to the tumor. In an attempt to increase the dose of delivered drug without markedly increasing toxicity, cisplatin was administered by 5-day continuous intravenous infusion at a dose of 28 mg/m2/day (total dose 140 mg/m2) to 15 evaluable patients (5 with astrocytoma Grade III and 10 with astrocytoma Grade IV). Median age was 39 years, median Karnofsky Performance Status was 80%, and all patients had been previously treated with other modalities. One patient (7%) achieved Partial Response as demonstrated by increased strength of paretic extremities, increased Karnofsky Performance Status, and decrease of enhancing tumor mass on CT scan. Although nephrotoxicity was minimal, nausea and vomiting (usually mild) was seen in 14 patients. Myelosuppression was also common (anemia in 7 patients, leukopenia in 4 patients and thrombocytopenia in 3 patients). Ototoxicity was seen in 5 patients and may represent a combined modality toxicity with prior cranial radiotherapy. Routes and schedules which allow a higher peak serum concentration of cisplatin (such as subselective intracerebral artery infusion) may be necessary to achieve greater central nervous system drug penetration and to maximally exploit cisplatin in the treatment of astrocytoma.

Adult↗