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Biomedical subjects

A Cangir

Publications and source records attributed to A Cangir.

At least 37 records · Page 2Linked to original sources
PubMed1990

Multimodal therapy for the management of primary, nonmetastatic Ewing's sarcoma of bone: a long-term follow-up of the First Intergroup study.

A total of 342 previously untreated eligible children were entered into the first Intergroup Ewing's Sarcoma Study (IESS) between May 1973 and November 1978. In group I institutions, patients were randomized between treatment 1 (radiotherapy to primary lesion plus cyclophosphamide, vincristine, dactinomycin, and Adriamycin [doxorubicin; Adria Laboratories, Columbus, OH] [VAC plus ADR]) or treatment 2 (same as treatment 1 without ADR), and group II institutions randomized patients between treatment 2 or treatment 3 (same as treatment 2 plus bilateral pulmonary radiotherapy [VAC plus BPR]). The percentages of patients relapse-free and surviving (RFS) at 5 years for treatments 1, 2, and 3 were 60%, 24%, and 44%, respectively. There was strong statistical evidence of a significant advantage in RFS for treatment 1 (VAC plus ADR) versus 2 (VAC alone) (P less than .001) and 3 (P less than .05) and also of treatment 3 versus 2 (P less than .001). Similar significant results were observed with respect to overall survival. Patients with disease at pelvic sites have significantly poorer survival at 5 years than those with disease at nonpelvic sites (34% v 57%; P less than .001). Among pelvic cases, there was no evidence of differing survival by treatment (P = .81), but among nonpelvic cases, there was strong evidence of differing survival by treatment (P less than .001). The overall percentage of patients developing metastatic disease was 44%; the percentages by treatments 1, 2, and 3 were 30%, 72%, and 42%, respectively. The overall incidence of local recurrence was 15%, and there was no evidence that local recurrence rate differed by treatment. Patient characteristics related to prognosis, both with respect to RFS and overall survival experience, were primary site (nonpelvic patients were most favorable) and patient age (younger patients were more favorable).

Adolescent↗
PubMed1990

Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin.

Since 1984, we have treated 26 patients with malignant ovarian germ cell tumors with a combination of bleomycin, etoposide (VP-16), and cisplatin (BEP) at The University of Texas MD Anderson Cancer Center (UTMDACC). The median age of the patients was 19 years (range, 8 to 32). All patients underwent initial surgery (unilateral salpingo-oophorectomy in 14, unilateral salpingo-oophorectomy plus abdominal hysterectomy in one, and bilateral salpingo-oophorectomy with or without hysterectomy in 11 patients). Twenty patients had no residual disease, three had less than or equal to 2 cm (one each, dysgerminoma, mixed, and immature teratoma), and three had more than 2 cm lesions (two dysgerminomas, one endodermal sinus tumor). Fourteen patients had pure dysgerminoma (five, stage I; one, stage II; six, stage III; and two, recurrent), and 12 had nondysgerminomatous tumors (five, stage I; two, stage II; three, stage III; and two, recurrent). All four patients with clinically measurable disease had a complete response. All four patients who underwent second-look laparotomy had negative findings. Twenty-five patients (96%) remain in sustained remission 10.4 to 54.4 months from the start of chemotherapy. One patient died of progressive disease 14 months after beginning chemotherapy. We conclude that the BEP regimen has excellent activity and acceptable toxicity in patients with malignant ovarian germ cell tumors.

Adolescent↗
PubMed1990

Multimodal therapy for the management of nonpelvic, localized Ewing's sarcoma of bone: intergroup study IESS-II.

Two hundred fourteen eligible patients with previously untreated, localized Ewing's sarcoma of bone were randomized on IESS-II to receive Adriamycin (ADR; doxorubicin; Adria Laboratories, Columbus, OH), cyclophosphamide, vincristine, and dactinomycin by either a high-dose intermittent method (treatment [trt] 1) or a moderate-dose continuous method (trt 2) similar to the four-drug arm of IESS-I. Patient characteristics (sex, primary site, type of surgery) were stratified at the time of registration; these and other patient characteristics (age, time from symptoms to diagnosis, race) were distributed similarly between treatments. Surgical resection was encouraged, but not mandatory. Local radiation therapy was the same as for IESS-I. The median follow-up time is 5.6 years. The overall outcome was significantly better on trt 1 than on trt 2. At 5 years, the estimated percentages of patients who were disease-free, relapse-free, and surviving were 68%, 73%, and 77% for trt 1 and 48%, 56%, and 63% for trt 2 (P = .02, .03, and .05, respectively). The major reason for treatment failure for both treatment groups was the development of metastatic disease. The lung was the most common site of metastases followed by bone sites. The combined incidence of severe or worse toxicity (67%) was comparable between the treatments; however, severe or worse cardiovascular toxicity was significantly greater on trt 1. Tne only treatment-associated deaths (N = 3) were on trt 1 and were cardiac-related.

Adolescent↗
PubMed1988

Computed tomography in histiocytosis X of the temporal bone.

Involvement of the temporal bone in histiocytosis X is seen in about one-third of the cases at onset, is bilateral in 31% of cases, and is often clinically silent. We report two cases of histiocytosis X with temporal bone involvement and emphasize the usefulness of computed tomography in detecting such a lesion, noting its extraskeletal extension, and following the course of the disease.

Acute Disease↗
PubMed1988

Salvage chemotherapy for recurrent primary brain tumors in children.

Sixty consecutive evaluable children with recurrent primary tumors of the central nervous system were treated with a regimen of vincristine, nitrogen mustard, procarbazine, and prednisone over a 12-year period. Tumor types included medulloblastoma (19), brain-stem glioma (16), astrocytoma (13), and a miscellaneous glioma (12). Responses and sustained survivals were achieved. Responses were highly dependent on tumor type. Disease progression was halted in 73% of the children with medulloblastoma, and three have survived in complete remission for more than 10 years from the start of therapy with vincristine, nitrogen mustard, procarbazine, and prednisone. Two of four patients with anaplastic glioma, are long-term survivors. In contrast, less than one third of children with brain-stem gliomas responded. Toxicity consisted mainly of neutropenia, thrombocytopenia, infections, and rarely a procarbazine rash.

Adolescent↗
PubMed1988

Neuropsychological effects of childhood cancer treatment.

The potential neuropsychological effects of treatment were investigated in 124 childhood cancer patients. Children were classified into groups on the basis of treatment modality and treatment status. All patients received systemic chemotherapy. Other treatment modalities included intrathecal chemotherapy and intrathecal chemotherapy plus central nervous system radiation therapy. Treatment status was determined by whether children were newly diagnosed patients in active treatment or long-term survivors of cancer. This classification resulted in five groups; group 1 (n = 29)--children with newly diagnosed disease who were receiving intrathecal chemotherapy; group 2 (n = 21)--children with newly diagnosed disease who were receiving systemic chemotherapy without central nervous system treatment; group 3 (n = 24)--long-term survivors who had received intrathecal chemotherapy; group 4 (n = 25)--long-term survivors who had received intrathecal chemotherapy plus cranial radiotherapy; and group 5 (n = 25)--long-term survivors who had received systemic chemotherapy only (no specific central nervous system treatment). Groups were compared by using multivariate analysis of variance on sets of neuropsychological test variables that represent major cognitive domains. Results of comparisons indicated significant group differences for most dependent-variable sets. Follow-up pairwise comparisons showed that the group of long-term survivors who had received intrathecal chemotherapy plus cranial radiotherapy consistently obtained lower test scores than the other four groups. These findings are consistent with results of previous studies, thus indicating that intrathecal chemotherapy plus cranial radiotherapy is associated with significant effects on neuropsychological performance. Comparisons among newly diagnosed and long-term groups of patients who did not receive cranial radiotherapy yielded null results on measures of higher-order cognitive functions. However, significant group differences were observed on measures of fine-motor and visual-motor skills; newly diagnosed groups obtained lower scores than the nonirradiated long-term survivor groups. Findings were attributed to chemotherapy-induced peripheral neuropathy that differentially affected the newly diagnosed groups.

Adolescent↗
PubMed1987

Adjuvant and neoadjuvant chemotherapy with dacarbazine in high-risk childhood melanoma.

Four of four children with clinical Stage II-IIIB childhood melanoma treated at The University of Texas System Cancer Center M.D. Anderson Hospital with surgical excision of gross disease and adjuvant or neoadjuvant chemotherapy with dimethyl triazeno-imidazole carboxamide (dacarbazine) were alive without evidence of disease at 2, 6, 9.5, and 10.5 years after treatment. In one of the four patients suspected pulmonary nodules developed shortly after the start of chemotherapy, but regressed completely with continued treatment. In another patient with a primary left wrist melanoma and palpable epitrochlear and axillary nodes, there was dramatic shrinkage of nodal disease during chemotherapy and subsequent biopsies were cytologically negative. The expected survival of children with this rare condition when diagnosed at a comparably advanced stage and treated primarily by surgery is 32% compared with the 100% survival in these four cases. Although dacarbazine has not been notably successful as adjuvant therapy in high-risk adult melanoma, data from this small series is suggestive of an adjuvant effect in high-risk childhood melanoma and merits further study although the rarity of this condition may make a controlled trial difficult.

Child↗
PubMed1987

Survival and neurologic outcome of infants with medulloblastoma treated with surgery and MOPP chemotherapy. A preliminary report.

The results of treatment of infants with medulloblastoma using surgery and chemotherapy, without the use of radiation therapy, are reported. Both survival and outcome, in terms of growth, neurologic deficit, and intelligence are compared with the same parameters in children treated conventionally. Although preliminary, our results suggest that chemotherapy combined with surgery is a valid option for the treatment of infants with this type of neoplasm.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Renal toxicity with cumulative doses of cis-diamminedichloroplatinum-II in pediatric patients with osteosarcoma. Effect on creatinine clearance and methotrexate excretion.

Sequential corrected creatinine clearance (CCC) evaluations were obtained in 30 patients treated with intra-arterial and/or intravenous cis-diamminedichloroplatinum-II (CDP). The dose was 150 mg/M2 administered with mannitol diuresis at 2 to 3 weekly intervals. Four hundred fifty-three courses were administered (range, 6-18) over 18 months. Patients also were treated with 283 courses of high-dose methotrexate (MTX) and citrovorum factor "rescue" which were interposed between treatments. Deleterious effects of cumulative courses of CDP manifested as progressive reductions in CCC and delayed excretion of serum MTX. Severe MTX toxicity was aborted by augmenting the fluid intake and prolonging citrovorum factor rescue when elevated levels of serum MTX were detected. The first indication of renal induced CDP toxicity occurred with a cumulative dose of 450 mg/M2. At the termination of treatment (cumulative CDP dose over 1050 mg/M2) renal impairment still was present.

Child↗
PubMed1987

Pathologic fracture in osteosarcoma. Impact of chemotherapy on primary tumor and survival.

Twenty patients with osteosarcoma and pathologic fractures were treated with a chemotherapeutic regimen consisting of cis-diamminedichloroplatinum-II (CDP), Adriamycin (ADR) (doxorubicin) and high-dose methotrexate with citrovorum factor "rescue" (MTX-CF). Before the introduction of the regimen, the primary tumor in two patients was treated by immediate amputation and in 13 with preoperative intra-arterial CDP. Among these 13 patients, responses (healing) were observed in 11 (one required the addition of radiation therapy). In three patients, the responses were so dramatic that, at their request, surgery was deferred and treatment exclusively with chemotherapy was instituted. Based on this experience, treatment exclusively with chemotherapy was also administered to an additional five patients who were admitted without pathologic fractures. In the course of such treatment, pathologic fractures also developed; notwithstanding, chemotherapy was maintained and healing also occurred. One of the 20 patients had pulmonary metastases at diagnosis; these were resected after treatment and pathologic examination revealed no evidence of viable tumor. The remaining 19 patients were free of pulmonary metastases but these later developed in seven patients. These data were compared to a historical control series in which 16 of 21 patients with pathologic fractures developed pulmonary metastases. Three of the chemotherapy treated patients died of nonosteosarcoma related causes (leukemia, generalized varicella, and a metabolic complication). Overall, survival was improved in the chemotherapy treated patients as compared to the historical control series: 10 of 20 versus 6 of 21, respectively. Pathologic fractures in osteosarcoma may heal under treatment with chemotherapy, which also has a favorable impact on the eradication of pulmonary metastases and survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Phase I trial of procarbazine as a 5-day continuous infusion in children with central nervous system tumors.

Seven children with previously treated brain tumors were enrolled in a phase I trial of 5-day continuous-infusion procarbazine at 360, 480, and 638 mg/m2/day. Vitamin B6 levels were monitored. Myelosuppression was moderate though occasionally delayed, and nausea and vomiting were mild. At the highest dose level, a patient experienced severe psychosis that persisted for several weeks. From that dose-limiting toxicity and the degree of myelosuppression, the recommended dose for phase II trials in children is the same as for adults, 450 mg/m2/day.

Brain Neoplasms↗
PubMed1987

Coronary artery embolism following cancer chemotherapy.

A 16-year-old patient underwent partial gastrectomy for leiomyosarcoma of the stomach. Following resection, he received combination chemotherapy that included Adriamycin and dimethyltriazenoimidazole carboxamide (DTIC), with the cumulative Adriamycin dose being 405 mg/m2. The patient was subsequently treated with vincristine, actinomycin D, and cyclophosphamide. Six hours after receiving his fourth dose of cyclophosphamide, the patient developed signs and symptoms of acute anterior wall myocardial infarction. Although he recovered from this initial cardiac event, he subsequently experienced several additional episodes of vascular occlusion involving the cerebral, femoral, coronary, and pulmonary arteries. Cardiac catheterization demonstrated all coronary arteries to be normal. Both ventricles were hypokinetic, and bilateral mural thrombi were demonstrated; these were the presumed source of the embolic phenomena. To our knowledge, this is the first description of repeated coronary artery embolization following cancer chemotherapy in a patient without evidence of preexisting cardiac abnormalities.

Adolescent↗
PubMed1987

Endocrine complications after radiotherapy for tumors of the head and neck.

One hundred sixty-six patients 6 to 80 years of age with nasopharyngeal cancer and paranasal sinus tumors who were free of the primary disease were studied from 1 to 26 years after radiotherapy. Studies in 65 of these patients were performed prospectively. Both the hypothalamus and the anterior pituitary gland were in the field of irradiation. The median radiation dose was estimated to be 5700 rad to the anterior pituitary gland and 5000 rad to the hypothalamus. We found evidence of endocrine deficiencies in 134 of the 166 patients observed. One hundred eleven patients showed evidence suggestive of hypothalamic lesions and 67 patients showed evidence of primary pituitary deficiency. Forty-eight of the 110 patients who received radiotherapy to the neck for treatment or prevention of lymph node metastasis showed evidence of primary hypothyroidism. The median dose to the thyroid area was 5000 rad. Adolescents younger than 15 years of age had a higher incidence of growth hormone deficiency soon after radiotherapy, but the older group showed adrenocortical and luteinizing hormone deficiency. These results indicate that endocrine deficiencies after radiotherapy for tumors of the head and neck are common. The highest incidence of complications occurred 1 to 5 years after radiotherapy, but long-term follow-up is indicated because complications may appear years after radiotherapy.

Adolescent↗
PubMed1986

Treatment of malignant nondysgerminomatous germ cell tumors of the ovary with vinblastine, bleomycin, and cisplatin.

Fifteen patients with malignant nondysgerminomatous germ cell tumors of the ovary seen at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston, were treated with a combination of vinblastine, bleomycin, and cisplatin (VBP). All patients underwent initial surgery: biopsy alone in one patient, unilateral salpingo-oophorectomy in ten patients, and bilateral salpingo-oophorectomy with or without hysterectomy in four patients. Seven patients received VBP as primary postoperative therapy. One patient died of progressive disease at 15 months following diagnosis. The other six patients are alive without evidence of disease 9 to 47 months from the time of diagnosis. Eight patients received VBP as second-line treatment; three patients had a complete response to therapy and are surviving disease-free 41 to 71 months from the time of diagnosis. Four patients treated secondarily had a partial response; three of these patients subsequently developed progressive disease and died, while one patient survived after undergoing salvage therapy with an etoposide-containing regimen. One patient had no discernible response to VBP therapy and died. The VBP regimen represents an aggressive, moderately toxic, short-term combination regimen that has promising activity against malignant germ cell tumors of the ovary.

Adolescent↗
PubMed1986

Desmoid fibromatosis: a clinicopathologic study of 25 children.

We studied 25 patients under 15 years of age with desmoid fibromatosis (DF). There were 15 boys and 10 girls; 13 were under seven years of age and 12 were above. Histologically, DF was identical to DF in adult patients, except for a higher mitotic rate in children's tumors. The tumors were located on the head and neck (8), upper (7) or lower (6) extremities, or the trunk (4). Patients with head and neck DF received preoperative adriamycin and 5-(dimethyltriazeno) imidazole-4-carboxamide or a combination of vincristine, actinomycin D, and cyclophosphamide. In seven patients, tumor reduction began to occur during chemotherapy, while in one patient, there was no response at all. Five patients underwent conservative resections of their residual tumors, and in two patients, all tumor disappeared necessitating no additional surgery. Follow-up in these patients indicates that 6 have no evidence of disease, 1 is alive with recurrent disease, and 1 is lost to follow-up. Surgery was the primary modality of treatment for the trunk and extremity lesions. Twelve patients had no evidence of disease from 2 months to 25 years and 5 months, two died from complications of chemotherapy, and three were lost to follow-up. Our experience agrees with that of other investigators that DF is best managed surgically. However, preoperative chemotherapy should be strongly considered for patients with tumors occurring in the head and neck areas.

Adolescent↗