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Biomedical subjects

A B Karim

Publications and source records attributed to A B Karim.

At least 19 recordsLinked to original sources
PubMed1999

Carcinoma of the ethmoid: results of treatment with conventional surgery and post-operative radiotherapy.

AIMS: A retrospective study was carried out of 50 patients with carcinoma of the ethmoid, treated over a period of 20 years. METHODS: The treatment used was surgery, followed by post-operative external beam radiotherapy and when possible supplemented by brachytherapy. RESULTS: Although the nature of surgery in the majority of cases was conventional, the 63% 5-year overall survival, except in adenocarcinomas, was slightly better than that achieved by more aggressive surgery. There was no mortality and morbidity was minimal. CONCLUSIONS: Conventional surgery in combination with radiotherapy and brachytherapy gives satisfactory and comparable results.

Adenocarcinoma↗
PubMed1998

Quality of life after radiation therapy of cerebral low-grade gliomas of the adult: results of a randomised phase III trial on dose response (EORTC trial 22844). EORTC Radiotherapy Co-operative Group.

In 1985, the EORTC Radiotherapy Co-operative Group launched a randomised phase III study comparing high-dose (59.4 Gy in 6.5 weeks) versus low-dose (45 Gy in 5 weeks) radiotherapy with conventional techniques in patients diagnosed with low-grade cerebral glioma. The primary endpoint of the study was survival. No difference in survival was observed between the two treatment strategies. A quality of life (QoL) questionnaire consisting of 47 items assessing a range of physical, psychological, social, and symptom domains was included in the trial to measure the impact of treatment over time. Patients who received high-dose radiotherapy tended to report lower levels of functioning and more symptom burden following completion of radiotherapy. These group differences were statistically significant for fatigue/malaise and insomnia immediately after radiotherapy and in leisure time and emotional functioning at 7-15 months after randomisation. These findings suggest that for conventional radiotherapy for low-grade cerebral glioma, a schedule of 45 Gy in 5 weeks not only saves valuable resources, but also spares patients a prolonged treatment at no loss of clinical efficacy.

Adult↗
PubMed1997

Treatment of cervical lymph node metastasis from an unknown primary tumor, with a review of the literature.

BACKGROUND: The results of treatment at the Free University Hospital of 44 patients with cervical lymph node metastasis of an unknown primary tumor were reviewed in order to establish an optimal treatment policy and to look for prognostic parameters. These results were compared with results of other treatment policies known from the literature. PATIENTS AND METHOD: Thirty-three out of the 44 patients received a treatment with curative intent; 22 cases received a unilateral neck dissection and postoperative radiotherapy, 7 were irradiated after an excisional biopsy and 4 received radical radiotherapy alone. RESULTS: For the whole group 5- and 10-year overall survival was 50% and 44%, respectively, and for the group treated with curative intent 68% and 56%, respectively. Disease-free survival at 5 and 10 years after treatment for the whole group was 48% and 32%, respectively, and for the group treated with curative intent 63% and 37%, respectively. CONCLUSIONS: Multivariate analysis showed only treatment with intent and histology as significant independent prognostic factors for the whole group. For the patients treated with curative intent no significant influences of variables were found.

Adenocarcinoma↗
PubMed1997

Quantitative computer-assisted analysis vs. visual estimation of MR imaging response of brain metastases to radiotherapy.

Using both quantitative computer-assisted analysis and visual estimation the MR imaging response of brain metastases to whole-brain radiotherapy (WBRT) was prospectively studied in 49 patients. Compared to the computer-assisted analysis, the precision of the visual estimation (by two readers in conference) of tumor response was determined. Also the radiological response was related to the clinical response. Six weeks after WBRT follow-up MR was performed in 27 of 49 patients. Of the remaining 22 patients without follow-up MR, 9 had died or deteriorated due to neurologic decline. In four patients (15%) tumor increase was demonstrated by computer-assisted analysis; in the other 23 patients tumor remained stable (15%) or decreased (70%). In 11 of the 27 patients, a second follow-up MR was obtained 26 wk after WBRT demonstrating tumor increase in seven patients (64%). Complete discordance between both assessment methods was noticed in only 4 of 38 MR scans (27 scans 6 wk after WBRT and 11 scans 26 wk after WBRT) with small quantitative changes in tumor volume. In 26 of 38 (68%) observations 6 and 26 wk after WBRT, there was a positive correlation between change in tumor volume and change in the Neurologic Status. Visual estimation analysis seems an appropriate method of routine therapy monitoring in individual patients with brain metastases. The computer-assisted analysis should be considered if precise response monitoring becomes critical.

Adult↗
PubMed1996

A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844.

PURPOSE: Cerebral low-grade gliomas (LGG) in adults are mostly composed of astrocytomas, oligodendrogliomas, and mixed oligoastrocytomas. There is at present no consensus in the policy of treatment of these tumors. We sought to determine the efficacy of radiotherapy and the presence of a dose-response relationship for these tumors in two multicentric randomized trials conducted by the European Organization for Research and Treatment of Cancer (EORTC). The dose-response study is the subject of this article. METHODS AND MATERIALS: For the dose-response trial, 379 adult patients with cerebral LGGs were randomized centrally at the EORTC Data Center to receive irradiation postoperatively (or postbiopsy) with either 45 Gy in 5 weeks or 59.4 Gy in 6.6 weeks with quality-controlled radiation therapy. All known parameters with possible influences on prognosis were prospectively recorded. Conventional treatment techniques were recommended. RESULTS: With 343 (91%) eligible and evaluable patients followed up for at least 50 months with a median of 74 months, there is no significant difference in terms of survival (58% for the low-dose arm and 59% for the high-dose arm) or the progression free survival (47% and 50%) between the two arms of the trial. However, this prospective trial has revealed some important facets about the prognostic parameters: The T of the TNM classifications as proposed in the protocol appears to be one of the most important prognostic factors (p < 0.0001) on multivariate analysis. Other prognostic factors, most of which are known, have now been quantified and confirmed in this prospective study. CONCLUSION: The EORTC trial 22844 has not revealed the presence of radiotherapeutic dose-response for patients with LGG for the two dose levels investigated with this conventional setup, but objective prognostic parameters are recognized. The tumor size or T parameter as used in this study appears to be a very important factor.

Adolescent↗
PubMed1996

Hypofractionated radiation therapy in patients with glioblastoma multiforme: results of treatment and impact of prognostic factors.

PURPOSE: Median survival of patients with glioblastoma multiforme (GBM) is only about 4 months with surgery and about 9 months for surgery followed by radiotherapy. Prolonged treatment is futile for many patients and the time of treatment and hospitalization should be minimized. METHODS AND MATERIALS: This was a prospective, nonrandomized study of 30 patients treated with a hypofractionated radiation scheme (42 Gy in 14 fractions). RESULTS: Median survival was 36 weeks. Age, Karnofsky performance status (KPS) and extent of surgery were strongly interrelated and all correlated with survival (p < 0.05). Three prognostic groups were identified. Patients with three favorable prognostic factors (age <50, KPS 80-100, and > or = 75% of the tumor removed) had the best prognosis (median survival 50 weeks). Patients with no favorable prognostic factors (age > or = 50, KPS < or = 70, and < 75% of the tumor removed) had the worst prognosis (median survival 25 weeks). Median survival of the intermediate group (with one or two favorable prognostic factors) was 38 weeks. No severe acute or late toxicity was observed. CONCLUSION: The treatment results are comparable to those achieved with conventional radiotherapy schemes. Based on the number of favorable prognostic factors (age < 50, KPS 80-100 and > or = 75% of tumor resected) the radiation schedule should be selected.

Adult↗
PubMed1995

[Radiotherapy following breast-conserving surgery: more local recurrences after longer delay].

OBJECTIVE: Evaluation of results of breast conserving therapy in early stage breast cancer and of importance of time interval between surgery and radiotherapy. DESIGN: Descriptive study. LOCATION: Free University Hospital, Amsterdam. METHOD: In the period 1980-1989, 554 patients with 560 invasive breast cancers were referred for radiotherapy after wide local excision of the tumour with axillary lymph node dissection. The dose to the breast was 50 Gy + 15 Gy boost dose. In case of positive margins, a higher boost dose (20-25 Gy) was given. Node-positive patients received adjuvant chemotherapy (premenopausal patients) or hormonal therapy (postmenopausal patients). RESULTS: The median follow-up period was 82 months (range 52-160 months). The 5 and 10-year survival rates were 86.7% and 72.6%, respectively. Local (breast) relapse occurred in 22 patients (3.9%). The breast recurrence rate was 8/329 (2.4%) for patients who started radiotherapy within 7 weeks after surgery, as against 14/231 (6.1%) for patients with a longer interval (p < 0.05). In Cox's proportional hazards analysis, age (negative relation), T-stage and interval between surgery and radiotherapy were identified as independent factors predictive of breast recurrence (p < 0.05). CONCLUSION: A delay of radiotherapy after breast conserving surgery of more than 7 weeks can adversely affect the local tumour control rate.

Adult↗
PubMed1995

Results of radiotherapy and vitamin E in the treatment of Peyronie's disease.

PURPOSE: A retrospective analysis of 38 patients with Peyronie's disease treated with primary radiotherapy in the period of 1975-1993. METHODS AND MATERIALS: Important complaints were curvature of the penis during erection for 92% of the patients, painful erection for 68%, and problems with sexual intercourse for 37.5%. Average size of all indurated plaques was 2.5 cm. The average pretreatment duration of symptoms was 9.5 months. All 38 patients were irradiated with orthovoltage radiotherapy (200 and 250 kV photons) with a total dose of 9 Gy in 5 alternating days (regimen A). Because of minimal response, 16 patients were irradiated again with another 9 Gy in 5 days and finally received 18 Gy (regimen B). RESULTS: With regimen A, a satisfying improvement was achieved for the majority of the patients: 65% experienced less penile pain during erection, 40% reported less curvature of the penis, and 47% experienced an improvement of their sex life. With the higher dose of regimen B there was an additional improvement for a minority of the patients: 25% reported less pain during erection, 21% had less curvature, and 29% experienced an improved sex life. With regimen A, pain improvement was statistically significantly superior when compared to regimen B. For all other improvements (curvature, sexual intercourse, and induration) no dose-response relation could be demonstrated between regimen A and the higher dose regimen B. No patient experienced any radiation-induced morbidity. After evaluating regimen A and regimen B, the overall result was that 76% experienced less pain, 60% reported an improved sex life, and 48% had a diminished curvature during erection. CONCLUSION: From this analysis it can be concluded that the distressing symptoms of Peyronie's disease can be treated successfully with radiotherapy. Radiotherapy proves to be a safe, noninvasive treatment method without causing morbidity. Low-dose radiotherapy with only a few fractions is recommended for an effective treatment result.

Adult↗
PubMed1995

Endocrine functions in long-term survivors of low-grade supratentorial glioma treated with radiation therapy.

Endocrine functions were studied in long-term survivors of low-grade glioma treated with radiotherapy. Hypothalamic-pituitary dysfunction has recently been reported to occur more frequently than generally considered. Because endocrine dysfunction is a treatable condition, careful testing and, if necessary, supplementary treatment may enhance quality of life. Thirteen adult patients treated with radiotherapy because of supratentorial low-grade glioma at least one year before (range 1-11.5 years) were tested. Focal brain radiotherapy (45-61.2 Gy), with calculated dose to the hypothalamic-pituitary area ranging from 0 to 50 Gy (mean 36.1) had been applied to all patients. Serum levels of pituitary hormones, cortisol and thyroid hormone were determined before and after stimulation with hypothalamic hormones. In 10 out of 13 patients one or more hormonal values were out of the normal range. Most disturbances were demonstrated in the pituitary-adrenal axis (8 patients) and the GH-axis (4 patients). None of the patients had clinical symptomatology of adrenal, thyroid or gonadal dysfunction. Careful endocrine testing after cranial radiotherapy may reveal (subclinical) hypothalamic-pituitary dysfunction in long-term survivors. Follow-up testing in these patients seems warranted.

Adrenal Glands↗
PubMed1994

Curative radiotherapy for technically operable stage I nonsmall cell lung cancer.

PURPOSE: Retrospective study of patients with Stage I nonsmall cell lung cancer (NSCLC) unable to undergo surgery or refusing surgery. METHODS AND MATERIALS: Between 1984 and 1990, 47 patients with technically operable Stage I NSCLC received hypofractionated radiotherapy. The total dose varied from 32 Gy in six fractions (two fractions/week) or 40 Gy split course in ten fractions (low-dose schedules) to 48 Gy in 12 fractions or 56 Gy in 20 fractions (high-dose schedules). The mean age of the patients was 75 years. Three patients refused surgery and 44 patients were inoperable due to their medical condition. Severe associated disease was present in 34 patients (72.3%). RESULTS: The intrathoracic recurrence rate was 25.5%. In a multivariate analysis, tumor size was identified as the only significant factor predictive for intrathoracic failure (p < 0.001). Disease-specific survival was 90, 53, and 32% at 1, 3, and 5 years, respectively. In Cox's proportional hazards analysis, only tumor size was predictive for disease-specific survival. Overall survival (all causes) was 70, 33, and 15% at 1, 3, and 5 years, respectively. In Cox's proportional hazards analysis, only the presence of severe associated disease was predictive for overall survival (p < 0.01), while tumor size did not attain statistical significance (p = 0.08). There were no severe acute or late side-effects. CONCLUSION: Radiotherapy can effectively control small nonsmall cell tumors. The reported results are comparable to those achieved with more fractionated radiation schedules. In patients of age or in poor medical condition, hypofractionated radiotherapy can be given with curative intent, with minimal burden to the patient.

Carcinoma, Non-Small-Cell Lung↗
PubMed1994

Primary malignant melanoma of the oral cavity: a review of eight cases.

A review of oral malignant melanoma and data of eight patients are presented. The dismal prognosis of the condition is probably mainly due to its long, 'silent' course. In one-third of cases melanosis precedes the tumour--it is this condition that should alert clinicians. Therefore, pigmented oral lesions should be viewed with suspicion and biopsy is mandatory when the clinical diagnosis is uncertain. Early detection is essential to successful treatment. In spite of aggressive treatment modalities, survival in patients with advanced stage disease remains poor.

Adult↗
PubMed1994

Cognitive functions and quality of life in patients with low-grade gliomas: the impact of radiotherapy.

The role of early radiotherapy in the treatment of low-grade gliomas is controversial. For this reason the impact of radiotherapy on quality of life was studied in long-term survivors of biopsy-proved low-grade gliomas without signs of tumor recurrence. Twenty patients (age range, 18-66 years) had been treated with early radiotherapy; the other 21 patients (age range, 19-65 years) had undergone surgery or biopsy only. The interval from diagnosis to testing ranged from 1 to 12 years (mean, 3.5 years). Nineteen patients with low-grade hematological malignancies, surviving 1 to 15 years without central nervous system involvement, served as control subjects. Apart from the neurological and functional status, the patients' cognitive, affective, and psychological status was determined. None of the survivors had significant neurological impairment and the Karnofsky index for them was at least 70. However, more specific examinations of cognitive functions and the affective status (Profile of Mood States) indicated that, compared to the control subjects, the patients with low-grade gliomas had significantly more cognitive disturbances and suffered more frequently from fatigue and depressed moods. The two groups with low-grade gliomas, on the other hand, did not differ significantly on any of these measures. It is concluded that radiotherapy did not cause these disturbances and had no negative impact on quality of life in these patients.

Adolescent↗
PubMed1994

Importance of timing of radiotherapy in breast conserving treatment for early stage breast cancer.

This study reports on the treatment results in 508 patients with 514 AJCC stage I-II invasive breast carcinomas treated between July 1980 and July 1989. All patients underwent a lumpectomy with axillary lymph node dissection with postoperative irradiation. Adjuvant chemotherapy was given to premenopausal node-positive patients. Postmenopausal node-positive patients received adjuvant hormonal treatment. The median follow-up period was 68 months (range, 40-152 months). The 5-year survival rates were 92.6%, 81.4% and 65.5% for stage I, stage IIA and stage IIB, respectively. Distant metastases were the main cause of death. Locoregional failures occurred in 4.9%. Breast recurrences were detected in 17 patients (3.3%). In a Cox proportional hazards analysis, T-stage, pathological margins and interval between surgery and radiotherapy were identified as independent factors predictive of breast recurrence (p < 0.05). The results suggest that radiotherapy should be initiated early after surgery to maintain the breast recurrence rate as low as possible.

Adult↗