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Biomedical subjects

A D Steinfeld

Publications and source records attributed to A D Steinfeld.

At least 19 recordsLinked to original sources
PubMed1999

Effect of combined adoptive immunotherapy and radiotherapy on tumor growth.

Advanced squamous cell carcinomas of the head and neck are difficult to control despite optimal surgery, radiotherapy and/or chemotherapy, and the tumors are usually not immunogenic. Because of the anatomic accessibility of the tumors, local adoptive immunotherapy of these tumors is feasible and may interact with radiotherapy to retard tumor growth. It is hypothesized that antigens released from tumor cells injured by radiation may stimulate, in the presence of interleukin-2, an enhanced immunocytodestruction of live tumor cells by adoptively transferred lymphokine activated killer cells and recruited tumor cytotoxic cells. DBA/2 mice were injected subcutaneously with 5 x 10(5) syngeneic squamous cell carcinoma cells in the thigh and the resulting tumors were treated for two weeks with daily peritumoral injections of interleukin-2 (1,000 International Units) or saline, four radiation treatments of 625 cGy each, and four peritumoral injections of 10(7) lymphokine activated killer cells. The results suggested that radiotherapy combined with peritumoral injection of lymphokine activated killer cells and interleukin-2 resulted in a significant reduction (P < 0.01) of tumor size whereas radiation alone, at the same dose, failed to produce a significant effect. Such results may have direct clinical application in enhancing the response of tumors to radiotherapy and in reducing the incidence of tumor recurrence.

Animals↗
PubMed1999

Radiotherapy for the treatment of giant cell tumor of the spine: a report of six cases and review of the literature.

Optimal treatment for giant cell tumors in the axial skeleton (GCTS) remains challenging. Surgical excision remains the treatment of choice, but the potential spinal cord injury may limit the extent of resection. We report the long-term results of treatment of six patients diagnosed with giant cell tumor of the spine treated with radiotherapy and review the literature regarding therapy. Between 1971 and 1995, six patients with GCTS were treated with conservative surgery and radiotherapy. The surgery consisted of either biopsy or subtotal resection of tumor. The involved vertebrae were then irradiated with doses ranging from 3000 to 5400 cGy. The mean follow-up was 13 years, and three of six patients had follow-up of 17 or more years. Five of six patients are alive with no evidence of disease. One is alive with disease, although it is not clinically apparent. No patient was lost to follow-up. We conclude that radiotherapy is useful in the management of GCTS and that conservative surgery with local radiotherapy is a reasonable treatment alternative for tumors that cannot be completely excised or in which surgery would result in significant functional morbidity. Although there is no clear dose response, review of the literature suggests that doses ranging from 3500 to 4500 cGy are safe and effective in controlling giant cell tumor.

Adolescent↗
PubMed1996

Delay in the diagnosis of glioblastoma multiforme: is age a factor?

Discrimination in the delivery of health care, based on the age of the patient, is attracting increased attention. We investigated this problem by studying possible age-related delay in diagnosis in patients treated for glioblastoma multiforme (GBM). A total of 213 charts of patients with GBM seen from 1972 to 1992 were evaluated for type and duration of symptom, with 204 charts having sufficient data to be analyzed. The mean and median duration of symptoms for the entire group was 48.9 and 28 days, respectively. No age-related difference in duration of symptoms was noted. In light of the increasing incidence of GBM in patients above 60 years of age, further investigation of other possible areas of age discrimination in patients with GBM is warranted.

Adult↗
PubMed1994

Late effect of multiple daily fraction palliation schedule for advanced pelvic malignancies (RTOG 8502).

PURPOSE: Determine late complication incidence for pelvic palliation using accelerated multiple daily fraction radiation [Radiation Therapy Oncology Group (RTOG) 8502]. METHODS AND MATERIALS: Prospective evaluation of a palliative radiation schedule for advanced pelvic malignancies was conducted from 1985 to 1989 by RTOG 8502. The dose was 44.40 Gy in 12 fractions (3.7 Gy BID) with a rest after 14.80 Gy and 29.60 Gy. The pilot part of the study allowed for a variable rest interval of 3-6 weeks. The rest interval was then randomized between 2 and 4 weeks to determine effect on tumor control. No difference in tumor control was identified (p = 0.59). The pilot segment accrued 151 patients and the randomized segment accrued 144 patients. A total of 290 cases were analyzable (four ineligible or canceled) for late effects. To minimize actuarial bias, only patients surviving 90 days (193) were analyzed for late effect risk. The primary site consisted of gynecologic (40%), colorectal (28%), genitourinary (25%), and miscellaneous (7%). The extent of tumor consisted of pelvis only (62%) and additional tumor outside the pelvis (38%). Most of the patients were elderly (76% > 60 years, 47% > 70 years). Karnofsky performance status (KPS) was > or = 80 in 60% of patients and < 80 in 40%. RESULTS: None of the patients with < 30 Gy (less than three courses) developed late toxicity. A total of 11/193 (6%) developed Grade 3+ late toxicity (nine Grade 3, one Grade 4, one Grade 5). Actuarial analysis of complication rate by survival time for Grades 3, 4, and 5 shows a cumulative incidence for complications after 6 months that plateaus at 6.9% by 18 months. The cumulative incidence for Grades 4 and 5 is 2.0% by 12 months. The difference in late effect for the 2-week rest vs. 4-week rest was not statistically different (p = .47). Patient factors evaluated for increased risk of late complications included prior surgeries, age, sex, KPS and primary. None were found to have significant statistical correlations with late effects. CONCLUSION: The crude late complications rate is 6%. Actuarial analysis using cumulative incidence shows 6.9% by 18 months. This represents a significant decrease in late complications from 49% seen with higher dose per fraction (10 Gy x 3) piloted by Radiation Therapy Oncology Group (7905) for a similar group of patients. Long-term analysis of late complication indicates this schedule can be used in the pelvis with relatively low incidence of complication. This schedule has significant logistic benefits and has been shown to produce good tumor regression and excellent palliation of symptoms.

Adolescent↗
PubMed1993

Effect of rest interval on tumor and normal tissue response--a report of phase III study of accelerated split course palliative radiation for advanced pelvic malignancies (RTOG-8502)

From August 1985 through September 1989, 284 patients with advanced pelvic malignancies were entered into a trial (RTOG 8502) of palliative split course radiation (4440 cGy in three courses of 1480 cGy/2 days/4 fractions with a rest of 2-4 weeks between courses). The initial 148 patients were part of a Phase II acceptable response rate and minimal acute or late toxicity (IJRBP 17:659-662, 1989). The present analysis is a report of the subsequent 136 patients randomized between rest intervals of 2 weeks versus 4 weeks to determine if length of rest would influence tumor response or patient toxicity. The patients were stratified for performance status (Karnofsky Performance Status) and histology. The patients were evenly matched for age and sex. There was a trend toward increased acute toxicity incidence in patients with shorter rest interval (5/68 versus 0/68; p = .07). Late toxicity was not significantly different between the two groups. Decreasing the interval between courses did not result in a significant improvement in tumor response (CR+PR = 34% vs. 26%, p = n.s.). More patients in the 2 week groups completed all three courses (72% vs. 63%). Not surprisingly, patients completing cell three courses had a significantly higher overall response rate than for patients completing less than three courses (42% vs. 5%) and higher complete response rate (17% vs. 1%). A multivariate analysis indicated performance status as the significant predictor for number of courses completed. For Karnofsky Performance Status greater than or equal to 80, the survival at 12 months was 40% for the 2 week interval and 25% for the 4 week interval. Performance status and histology were the only significant variables in a multivariate analysis of survival.

Adolescent↗
PubMed1993

Synchronous carcinoma and soft-tissue sarcoma. The importance of searching for incidental radiation exposure.

A 68-year-old woman was found to have synchronous soft-tissue sarcoma of the anterior chest wall and adenocarcinoma of the breast. During her initial interview, she denied prior radiation therapy. On further questioning, it was learned that the patient had been treated for tuberculosis, as a young woman, by the induction of a pneumothorax that was monitored by repeated chest fluoroscopies. Biologically important doses of ionizing radiation can be given as an incidental part of a variety of medical treatments. The importance of searching for atypical radiation exposures, particularly in patients with unusual tumor presentations, is stressed.

Adenocarcinoma↗
PubMed1991

Pulmonary embolization of iodine-125 seeds following prostate implantation.

The optimal treatment of prostatic carcinoma limited to the gland remains controversial. Treatment has included implantation of Iodine-125 seeds via both a suprapubic approach and, more recently, a transperineal technique utilizing ultrasound guidance. We recently have noted a heretofore unreported complication with this latter technique, namely, embolization of seeds to the lungs. Review of the chest x-ray films of 31 patients who underwent suprapubic implants showed no evidence of this phenomenon. One of 5 patients undergoing transperineal implant was found to have seeds lodged in the lung. Complications surrounding the various treatments of localized prostate carcinoma are reviewed.

Brachytherapy↗
PubMed1991

Intentions and outcomes in the radiotherapeutic management of epidemic Kaposi's sarcoma.

The indications for and outcome of radiotherapy for 226 epidemic Kaposi's sarcomas are reported. The overall likelihood of obtaining complete regression of tumor masses was 68%, although residual purple pigmentation remained in 20%. Local recurrence developed in 9%. The indications for treatment were not equally represented. Palliation of pain or improvement of the patient's appearance were the most common indications for treatment. Kaposi's sarcoma lesions do not all behave in a like manner. Best fit log-linear models of associations among the variables were derived. They demonstrated that the combination of treatment intention, anatomic site, and Karnofsky score predicted the short-term and long-term tumor response. The intention of treatment was closely linked to the anatomic site of treatment and in concert directly influenced outcome. The host's Karnofsky score was an independent predictive factor, but had less impact on outcome than did site or intention. Our data demonstrate that case selection can markedly alter the observed response rate of epidemic Kaposi's sarcoma to radiotherapy. This finding should be considered in future analyses of trials that test the efficacy of treatment for this disease.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The relationship between facility structure and outcome in cancer of the prostate and uterine cervix.

Since 1972, the Patterns of Care Study (PCS) has investigated the quality and demographics of clinical radiation therapy in the United States. Using outcome results from a study of patients treated for carcinoma of the cervix or adenocarcinoma of the prostate in 1978, an evaluation of the relationship of outcome to facility structure was undertaken. Binary logistic regression of outcome on stage and structure showed consistent but modest contributions of structure, even after the effects of stage were considered. Implications of these findings are discussed.

Adenocarcinoma↗
PubMed1990

Radiologic staging of chest in testicular seminoma.

We investigated the usefulness of chest x-ray (CXR), conventional planar tomography (TOM), and computerized axial tomography (CAT) in evaluating patients with Stages I and II testicular seminoma. All patients had a CXR, and 22 patients had either TOM or CAT as part of initial staging. No occult pulmonary or mediastinal nodal disease was found during initial staging, and none of the patients manifested recurrence of tumor in these sites as a first event. Review of the literature corroborates our finding of a very small thoracic failure rate in early stage seminoma. Routine use of CAT or TOM is not indicated in staging these patients.

Dysgerminoma↗
PubMed1990

Stage II testicular seminoma: evolution of radiotherapeutic practice in the United States.

We studied the evolution of treatment philosophy for testicular seminoma, by means of a questionnaire mailed to radiation oncologists practising in the United States. Of the 600 respondents 65% indicated a change in treatment policy since 1982. In patients with stage IIA disease the mediastinum is no longer treated by 62% of physicians, whereas 38% omit such treatment in Stage IIB patients. A trend towards the use of lower doses of radiation in areas treated was also noted. Omission of mediastinal irradiation in some stage II patients may be associated with an increased risk of failure in this site. Patients who do not receive treatment to the mediastinum must be carefully followed for recurrent tumour.

Dysgerminoma↗
PubMed1990

Second malignancies following radiotherapy for testicular seminoma.

Traditional treatment for testicular seminoma produces excellent survival. We report five, second non-testicular malignancies which occurred in a group of seminoma patients. A total of 79 men with primary testicular seminoma were available for analysis. All underwent a radical inguinal orchiectomy. Those with Stage I disease received adjuvant radiation therapy to the para-aortic and ipsilateral iliac nodes. The usual dose was 2500 cGy in 15 treatments. Stage II patients also received prophylactic mediastinal radiation therapy to a dose of 2500 cGy. None of the 51 Stage II patients died of tumour, whereas four of the 28 Stage II patients died of their disease. The median follow-up was ten years (range 4-25 years). The second malignancies seen were melanoma (2), myeloma, caecal adenocarcinoma, and retroperitoneal fibrosarcoma. All but one tumour developed within the radiation fields. Based on US SEER data for white males, only 1.5 cancers were expected, giving significantly greater (P = 0.04) relative risk. This observation lends support to observation, rather than elective treatment, in patients with Stage I testicular cancer.

Dysgerminoma↗
PubMed1990

Cerebral metastases: value of reirradiation in selected patients.

Fifty-two adult patients were selected to receive a second course of cranial radiation therapy to relieve symptoms caused by recurrent cerebral metastases. To be selected, patients had to (a) have remained in relatively good general condition for at least 4 months after their initial course of radiation therapy and (b) experience renewed deterioration of their neurologic condition. Initial treatment typically consisted of 3,000 cGy administered in 10 fractions over 2 weeks to the whole brain. Reirradiation most commonly consisted of 2,500 cGy in 10 fractions. Twenty-two patients (42%) responded to reirradiation and improved by at least one level in their neurologic function status. Survival after second therapy averaged 5 months. The authors conclude that reirradiation of cerebral metastases should be considered for patients who remain in good general condition but who experience neurologic deterioration 4 or more months after satisfactory response to initial palliative cerebral radiation therapy.

Brain Neoplasms↗