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At least 19 recordsLinked to original sources
PubMed1988

Combined modality treatment for resected advanced non-small cell lung cancer: local control and local recurrence.

The purpose of this study was to compare the effect of post-operative thoracic radiation with or without systemic chemotherapy on survival and recurrence patterns in patients subjected to thoracotomy with curative intent, but subsequently found to have residual tumor in the resected margin or metastasis in the highest paratracheal lymph node. All patients were treated with postoperative mediastinal irradiation and randomized to receive or not receive combination chemotherapy (cytoxan, adriamycin, and platinum) for 6 months beginning concurrently with radiation. Of the 172 patients randomized, 164 were eligible for analysis. The mean time since randomization for the eligible patients is 4.2 years. Radiation therapy was administered to all patients by split course regimen [20 Gy in 5 fractions over 5 days]. Two such courses were given with a 3-week interval. The initial recurrence rates for both in-field recurrence and distant relapse were reduced in the combined postoperative radiation therapy and chemotherapy group, although only the latter difference achieved statistical significance (p = 0.01). Also, local recurrence overall (not restricted to initial recurrences) is examined as a function of histology, extent of residual disease after resection, and T and N status. The treatment effect achieves statistical significance only for patients with macroscopic residual (p = .023) or T3 tumor (p = .010). The combined therapy group of patients have a significantly longer recurrence-free survival [p = 0.006 by the two-sided Mantel-Haenszel logrank test] which fails, however, to translate to a significant difference in overall survival (p = 0.146). Median survival of the entire group is 14.5 months with 34% alive 2 years after resection. Most of the initial recurrences (82%) have been systemic, with brain being the most common site. Distant failure, therefore, remains an important problem even in the favorable prognosis subset of patients with advanced NSCLC, but combined modality approaches can produce improved recurrence-free survival.

Adenocarcinoma↗
PubMed1986

Local control and survival in locally advanced gastrointestinal cancer.

When conventional modalities (external beam irradiation and chemotherapy +/- resection) are used in the treatment of locally advanced gastrointestinal malignancies, although useful palliation can be achieved in many patients, local control and long-term survival are infrequent. In recent trials, investigators have used fractionated external beam doses of 4500-5000 rad in 180 rad fractions in combination with irradiation boost techniques of intraoperative electrons, or intraoperative or transcatheter brachytherapy (+/- chemotherapy and resection). With colorectal and biliary cancer, both local control and long-term survival appear to be improved, compared to results achieved with conventional treatment. With pancreatic cancer, an apparent improvement has been noted with local control and median survival, but long-term survival has not been altered. For partially resected gastric cancer, the use of intraoperative irradiation has yielded five year survival rates of approximately 20%. With unresectable or residual gastric cancer, accelerated fractionation alone or in combination with chemotherapy has yielded excellent local control, but patients have died as a result of abdominal failure or lung metastases. Prevention of abdominal failures will be necessary to improve long-term survival with pancreatic and gastric cancer. Randomized trials by site are needed to determine if the observed differences seen in prospective nonrandomized trials are real or due to differences in case selection.

Bile Duct Neoplasms↗
PubMed1987

[Possibility of using high-frequency electromagnetic fields for modeling local controlled hyperthermia].

The possibility to use high-frequency electromagnetic fields (13.56 MHz) as a means of controlled local heating of deep and massive tissue areas was shown in 196 experiments on tissue equivalent phantoms and 20 healthy dogs. The advantages of each type of high-frequency emitters were determined. The thermometric evaluation of heat distribution in local high-frequency heating used in complex treatment of 12 patients with sarcomas of the locomotor system confirmed the experimental results.

Animals↗
PubMed1987

Local retinal regions control local eye growth and myopia.

In chicks, visual deprivation leads to myopia and enlargement of the vitreous chamber of the eye. When chicks were raised with white translucent occluders over their eyes so that either the nasal half, the temporal half, or all of the retina was visually deprived, the resulting myopia (median = -15 diopters) was limited to the deprived part of the retina, regardless of which half of the retina was visually deprived; the nondeprived part remained nearly emmetropic. Correspondingly, the vitreous chamber was elongated only in the region of the visual deprivation, resulting in eyes with different asymmetric shapes depending on which retinal region was deprived. These results argue for a local regulation of ocular growth that is dependent on vision and suggest a hypothesis to explain the epidemiological association of myopia in humans with large amounts of reading. Because most nonfoveal retinal neurons have large receptive fields, they cannot resolve the individual letters on the printed page; this may lead to their activity being less during reading than during most other forms of visual stimulation. Thus, the impoverished stimulus situation of reading may lead to myopia, as do other types of visual form deprivation.

Animals↗
PubMedDate not supplied

A multiple regression analysis for predicting local control of esophageal carcinoma treated by intracavitary irradiation.

A multiple regression analysis for predicting local control of esophageal carcinoma treated by intracavitary irradiation is reported. In phase I, the value of predicting local control (VPLC) was determined by five parameters: VPLC = 1.38950 - 0.01571 X (age) + 0.04517 X (tumor length) + 0.62167 X (stenosis) + 0.94811 X (deep ulcer) - 0.02969 X (Total dose of intracavitary irradiation). From correlations between VPLC and the local control observed in 19 phase I patients, it was determined that a VPLC value of 0.5 or more predicted local failure and a VPLC of less than 0.5 signified successful local control. In phase II, prediction of local failure or local control was made for another 24 patients by calculating VPLC, and 22 of the 24 cases (91.7%) were correctly predicted. These results indicate that VPLC is a useful index for predicting of local control after intracavitary irradiation in cases with esophageal carcinoma.

Brachytherapy↗
PubMed1986

Impact of improved local control on survival.

Estimates of the gain in survival, if all local failures were eliminated, indicate that many more patients could be cured provided the efficacy of treatment of the primary and regional disease were substantially improved. The expected gain in survival is assumed to be the gain in local control, less the loss due to distant metastases and intercurrent disease among the new local control subjects. The observed incidence of DM among local failure patients may be higher than among local control patients; this excess in incidence of DM is assumed to result from metastases established secondary to the persistent or recurring tumor. A powerful argument that higher local control rates would result in more cured patients is the high incidence of long-term survivors after salvage surgery for local failures. Examples of higher survival associated with more effective local therapy are presented from the literature for medulloblastoma, ependymoma, carcinoma of the oral cavity-oropharynx, carcinoma of the urinary bladder, carcinoma of the prostate and carcinoma of the rectum. For Stage I-II cancer of the breast, the reduction of an already low local failure rate by combining surgery and radiation has a very small impact. For tumors, such as, early stage breast cancer, where the possible decrease in local failure is small and the loss due to DM is high, a demonstrable gain in survival is not likely. The potential increase in number of survivors among the U.S. cancer population, if the primary-regional disease were regularly treated successfully, indicates large gains for patients with cancer of the uterine cervix, oral cavity-oropharynx, ovary, colo-rectum, non-oat cell cancer of lung, prostate cancer, and bladder cancer. These provide powerful bases for aggressive investigation of new approaches to improvement of local-regional therapies.

Breast Neoplasms↗
PubMed1991

The influence of some factors on local control of early glottic cancer.

A total of 135 patients with T1N0M0 and T2N0M0 carcinoma of the vocal cord were treated during a 20-year period at St Mary's Hospital in Portsmouth by local radiotherapy. A total of 122 patients were available for local control analysis. The local control of T1 tumours was 80.5%, and for T2, 51.1%, total T1 + T2 local control was 69.7% (P less than 0.001). The only other factor in univariate analysis, which influenced the results was the overall treatment time. In the group of patients treated by an overall time of 45 days or less, the local control was 83.7%. For longer time it was 62% (P less than 0.02). Multivariate analysis confirmed these findings but brought out the importance of vocal cord mobility as the best discriminating factor between local control and failure, followed by overall treatment time.

Adult↗
PubMed1986

The effect of combined modality therapy on local control and survival.

The systemic component of combined modality therapeutic programs has influenced both the selection of the approach to local control and survival in a number of tumor types. The more effective systemic therapy is against metastatic cancer by itself, the greater the impact on local control and survival. This observation is consistent with the invariable inverse relationship between curability and tumor cell number. For some common cancers, local control is good, but survival remains poor because of the inability to deal effectively with micrometastases. Improved systemic treatment is likely to have an impact on survival may shift local control measures, in some cases, to radiation therapy or lesser surgery without radiation therapy. There remains a substantial number of tumor types where both local control and survival is poor. In these tumors, improvement in local control by itself is not likely to improve survival because of the presence of micrometastases, but such improvements must occur before we can have a true evaluation of the systemic treatment of micrometastases in these tumors. The recent understanding that the metastatic process is under genetic control and the cloning of metastases genes offers a substantial opportunity to control this process and influence both local control and survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1976

Local control of breast cancer with tumorectomy plus radiotherapy or radiotherapy alone.

58 cases of breast cancer treated primarily by radiotherapy were evaluated to determine the optimum dose for local control. Of 36 patients with T1 + T2 lesions who had tumorectomy prior to radiotherapy, incomplete excision of tumor was demonstrated on microscopic examination in 18. The minimum tumor dose to the breast was 4,500 rads in 5 weeks. Treatment failed to control local tumor in only 2 (5%) and metastases in 1.26 (72%) remained disease-free for 2 to 9 years. Of the 22 patients with T3 + T4 lesions, treatment failed to control both local tumor and metastases in 12 (54%); in those who received 6,000 rads or less in 6 weeks, treatment failed to control any of these lesions. 4,500-5,500 rads controlled the tumor in 95% of those with NO + N1 disease, compared to only half of those with N2 + N3 tumors.

Adult↗
PubMed1985

Relationship between the radiologic features of esophageal cancer and the local control by radiation therapy.

In order to predict the possibility of local control of esophageal cancer by radiation therapy, the relationship between the x-ray findings before and after irradiation and the histologic radiation effect obtained from the surgically resected esophagus was analyzed in 130 cases irradiated preoperatively during the period 1971 through 1980. In the superficial or proliferative type in x-ray image before treatment, the local control was obtained in 46.5% of the cases with the dose of 40 Gy, whereas in the ulcerative or infiltrative type, in 21.8%. The barium examination performed after irradiation was more useful to evaluate the radiation effect than that before treatment. In cases with a marked radiation effect after irradiation, the frequency of local control reached 76.9%. On the other hand, the local control remained 11.9% in cases with no or poor radiation effect. The results obtained by the preoperatively irradiated cases were applied to the analysis of 119 cases irradiated radically during the period 1965 to 1980. Almost the same results were also acquired in radically irradiated cases. The degree of radiologic and histologic radiation effect on the primary tumor was closely related to the long-term survival rate of the patient.

Adult↗
PubMed1990

The effect of overall treatment time on local control in patients with adenocarcinoma of the prostate treated with radiation therapy.

Studies of patients treated with radiation therapy for squamous cell carcinoma of the head and neck have demonstrated that when all other variables are constant, protraction of the overall treatment time leads to a decreased probability of local control. Few data exist on the effect of overall treatment time on local control following irradiation of tumors that are generally thought to be slowly proliferating, such as adenocarcinoma of the prostate. This analysis was undertaken to determine the time-dose relationships for local control of prostatic adenocarcinoma at the University of Florida. All patients were treated at least 5 years prior to the date of analysis. For patients with Stage A2 disease, a tumor dose of 6500 cGy in 7 to 7.5 weeks to 7000 cGy in 8 weeks resulted in local control in 17/17 patients (100%). For patients with Stage B1 disease, the local control rate was 14/16 (88%) with an overall treatment time of less than or equal to 8 weeks versus 1/3 in patients who received split-course treatment in greater than 8 weeks (p = .097). For patients with Stage B2, C1, and C2 disease who received greater than or equal to 6500 cGy, the 5-year rate of local control was lower when overall treatment time was protracted beyond 8 weeks. Results were as follows: B2 (62 patients), less than or equal to 8 weeks, 88%, versus greater than 8 weeks, 55%, p = .002; C1 (87 patients), less than or equal to 8 weeks, 88%, versus greater than 8 weeks, 73%, p = .052; Cs (33 patients), less than or equal to 8 weeks, 81%, versus greater than 8 weeks, 65%, p = .056. Stratification by tumor grade of patients with Stage B1, B2, C1, and C2 disease who received greater than or equal to 6500 cGy demonstrated significantly lower local control rates for all grade categories when the overall treatment time was protracted beyond 8 weeks. Five-year local control rates (life-table method) for overall treatment time less than or equal to 8 weeks versus greater than 8 weeks were as follows: well differentiated, 93% versus 73% (p = .003); moderately differentiated, 86% versus 69% (p = .017); and poorly differentiated, 75% versus 59% (p = .046). These data suggest that tumor repopulation during excessively protracted treatment may be a clinically significant factor in patients with adenocarcinoma of the prostate.

Adenocarcinoma↗
PubMed1990

Local control of operable breast cancer after radiotherapy alone.

221 patients with operable breast carcinoma stage Tis, T1, T2, T3, N0N1 were treated with radiotherapy alone without tumorectomy. The mean follow-up time was 15.5 years (range 5-22). The annual risk for local recurrence was 3% during the first 5 years and 1% during the following 10 years, resulting in an actuarial local control rate of 75.4% after 15 years. The risk for local recurrence was assessed in multivariate analysis and was significantly related to the size of the tumour measured on mammography (P = 0.0002), the radiation dose administered (P = 0.0018), the length of the split-course intervals being longer than 75 days (P = 0.001) and age (P = 0.019). Dose was related to response over a wide range as a function of tumour volume. All 18 patients with minimal tumour load (T0 and Paget's disease) treated with doses above 55 Gy in 6 weeks achieved local control. 5-year local control rates ranged from 40 to 100% for T1 carcinomas treated with 45-110 Gy, and from 0 to 95.3% for T2 carcinomas at the same dose. For T3 carcinomas local control varied between 50 and 83% at 60-110 Gy. The risk for local failure increased by 8% per cm tumour diameter. With exclusive radiotherapy, the doses needed to provide local control rates similar to those obtained after tumorectomy and irradiation are 10 Gy higher for T1 (95% 5 year control) and 35 Gy higher for T2 (90% 5 year control).

Adult↗
PubMed1990

Histological and immunohistochemical prediction for local control of cervical squamous cell carcinoma treated with radiotherapy alone.

Predictability of local control following radiotherapy was evaluated with morphological methods such as histology and immunohistochemistry for 36 cervical squamous cell carcinomas. All these patients showed viable cancer cell predominance on the specimens excised with drill biopsy after radiation therapy. These specimens were stained with routine haematoxylin and eosin staining as well as with antibodies against epithelial membrane antigen (EMA), carcinoembryonic antigen, and S-100 protein. Five histological features, the number of the cancer nests per 22.5mm2 section, stromal reaction, space formation in the cancer nests, foamy cell or foreign body giant cell (FBG) clusters, and epithelial membrane antigen reactivity on the specimens excised after radiation therapy, were significantly related to the local control probability. Namel, less than 20 cancer nests, granulomatous stroma, presence of the space formation, absence of the foamy cell or foreign body giant cell clusters, and epithelial membrane antigen negativity were favorable for local control of the cervical cancer with radiation therapy. These data suggested that radiation sensitivity of cancer and stromal reaction for drainage of the degenerated cancer debris were important for local control of the tumors.

Adult↗
PubMed1987

Tumor excision and radiotherapy as primary treatment of breast cancer. Analysis of patient and treatment parameters and local control.

From 1966 to 1979, 235 patients with operable breast cancer were treated by tumor excision and radiotherapy. The actuarial survival at 10 years was 94.8% for stage I and 58% for stage II tumors. Local recurrent cancer was seen in 23/235 patients and was related to T stage, N stage, width of surgical excision, radiation dose to the tumor bed and anatomopathological differentiation. Recurrences were seen in 1/7 of T0, 3/57 (5.2%) of T1, 11/102 (10.8%) of T2 and 2/6 of T3 tumors. Local control in the breast decreased significantly in N1b cases (p = 0.005) or when 3 or more axillary lymph nodes were positive (p = 0.0074). Local control after segmentectomy or tumorectomy was identical. However, a poorer local control was found in 20 cases treated with subtotal resection (p less than 0.05). A clear dose-local control relationship was found in this material, with a 100% local control in all T0, T1 tumors which received more than 1800 ret and all T2 tumors which received more than 2000 ret. As 19 of 23 breast recurrences were seen at the primary site in the breast we believe that booster doses should be given in order to maximise local control.

Adult↗
PubMed1991

Local control in T3 laryngeal cancer treated with radical radiotherapy, time dose relationship: the concept of nominal standard dose and linear quadratic model.

In a retrospective study of the Dutch cooperative head and neck group 104 evaluable patients with T3NxMO squamous cell carcinoma of the larynx were treated primarily with a full course of radiotherapy. The results of treatment are presented in terms of locoregional control. The actuarial 3-year local control rate was 53%. Regional control was 77% for node positive patients and 96% for N0 patients (p = 0.01). Surgical salvage was successful in 53% of cases with a local recurrence and in 3/8 regional recurrences, resulting in an ultimate locoregional control rate of 83% for N0 patients and 68% for N+ patients. A uni- and multivariate analysis of local control rate versus total dose, nominal standard dose, and extrapolated response dose has been done. To calculate extrapolated response dose the linear quadratic equation was used, assuming an a/b of 10 and a potential doubling time of clonogenic cells of 3, 5, and 7 days. In multivariate analysis the extrapolated response dose with a potential doubling time of 5 days was the only independent prognostic factor for local control (p = 0.069) and ultimate locoregional control (p = 0.0015). Nominal standard dose showed no dose-response relationship. Based on the S-shaped dose response curve, using the LQ model, several therapeutical options are discussed.

Aged↗
PubMed1987

Local control of Ewing's sarcoma: an analysis of 67 patients.

Local control of Ewing's sarcoma was analysed in a series of 67 patients treated by surgery and/or radiotherapy as well as combination chemotherapy. Radiotherapy was employed with or without surgery in 60 patients and produced an overall local control rate of 55%; complete excision of the primary lesion seemed to be beneficial. There was a marked variation in control rates depending on the site of the primary lesion: limb 85%, rib 53%, pelvis 31% and other sites 33%. Primary tumours greater than 10 cm in diameter were significantly less likely to be controlled. Using daily fractions of approximately 180 cGy, total doses in excess of 6000 cGy seem more likely to produce serious late morbidity and may not increase the local control rate. No cases of second malignancy arising in irradiated tissue have been observed to date, but one patient developed acute lymphoblastic leukaemia.

Adolescent↗
PubMed1990

Placebo-controlled clinical trial of meglumine antimonate (glucantime) vs. localized controlled heat in the treatment of cutaneous leishmaniasis in Guatemala.

Sixty-six Guatemalans with parasitologically proven cutaneous leishmaniasis were randomly and equally divided into 3 treatment groups: those receiving meglumine antimonate (Glucantime), 850 mg antimony/day im for 15 days; those receiving localized controlled heat from a radio-frequency generator, 50 degrees C for 30 sec, 3 treatments at 7 day intervals; and those receiving treatment with a placebo. Of 53 isolates identified, 40 were Leishmania braziliensis braziliensis and 13 were L. mexicana mexicana. Thirteen weeks after beginning treatment, the number of patients from each group with completely healed and parasitologically negative lesions were as follows: meglumine antimonate, 16 (73%); localized heat, 16 (73%); and placebo, 6 (27%). The cure rate for those with infections due to L. b. braziliensis in each group was as follows: meglumine antimonate, 11 out of 14 (79%); controlled heat, 9 out of 14 (64%); and placebo, 0 out of 11.

Adult↗