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Biomedical subjects

A Ketcham

Publications and source records attributed to A Ketcham.

10 recordsLinked to original sources
PubMed1992

Postsurgical adjuvant chemotherapy with or without radiotherapy in women with breast cancer and positive axillary nodes: a South-Eastern Cancer Study Group (SEG) Trial.

In a prospective study of 622 women with breast cancer, those with one to three histologically positive axillary lymph nodes were randomised after mastectomy to receive cyclophosphamide 100 mg/m2 orally on days 1-14, methotrexate 40 mg/m2 intravenously on days 1 and 8, and fluorouracil 600 mg/m2 intravenously on days 1 and 8 every 28 days for six cycles (CMF x six), or for twelve cycles of the same chemotherapy (CMF x 12). Those with > or = four positive nodes were randomised to one of these two groups or to 5000 cGy of postmastectomy regional radiotherapy (RT) followed by six cycles of the same chemotherapy (RT + CMF x six). With about 10 years median follow-up, there was no significant difference in survival or disease-free survival among the three groups. There was evidence of decreased locoregional recurrence in patients with > or = four nodes who received RT + CMF x six (relative risk 0.53, P = 0.067). Multivariate analysis indicated that the presence of > or = four positive nodes (negatively) and the percentage of ideal (full) dose of CMF received (positively) were the strongest factors predictive of survival. This study shows no advantage for 12 over six cycles of CMF chemotherapy in women with breast cancer and positive axillary nodes. There was a suggestion of decreased locoregional recurrence but no improvement in survival with radiotherapy for women with > or = four positive nodes.

Adult↗
PubMed1984

Gestational macromastia.

Gestational macromastia is a rare entity. Causes are many and include excess hormonal production, hormonal imbalance, and decreased hormonal catabolism. Documentation of elevated serum prolactin levels and tissue hormonal receptor levels brings new light to this pathologic condition. Pharmacologic measures are not recommended because of lack of effectiveness and possible teratogenic side effects. Primary therapy should consist of local measures, such as breast support, bed rest, and analgesics. If this fails and progression is inevitable, we recommend total mastectomy with provision made for reconstruction and nipple banking. Skin flaps must be thin, and all breast tissue must be removed, otherwise the pathologic condition will continue during the ensuing months of the pregnancy and will recur with each successive pregnancy. Abortion is feasible, but this leaves the patient in need of a reduction or total mastectomy at a later date, and thus is not recommended as a primary line of therapy. If the patient progresses to delivery without complication, a reduction mammoplasty can be considered but only if no future pregnancies are planned.

Adolescent↗
PubMed1983

Postmastectomy adjuvant chemotherapy with or without radiation therapy in women with operable breast cancer and positive axillary lymph nodes: the Southeastern Cancer Study Group experience.

Between September 1976 and June 1982, 308 patients with operable breast cancer with 1-3 involved axillary nodes were stratified according to institution, type of mastectomy, and time from surgery to protocol entry, and then randomized to receive either six or 12 months of adjuvant chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF). With a median time of follow-up of 33 months, relapse rates among 181 reviewed and evaluable patients are 20/85 (23.5%) for pre- and 23/96 (24%) for postmenopausal patients. Results for premenopausal women, while better than historical controls at a similar time interval, appear inferior to other published adjuvant studies (e.g., NSABP and Milan). Although total relapse rates were 23/100 (23%) for six months and 20/81 (25%) for 12 months of therapy, suggestive differences were encountered by menopausal status with early trends favoring 12 months of treatment for premenopausal patients and six months of treatment for postmenopausal patients. During this same period, 283 patients with four or more involved axillary nodes were randomized to 1-3 treatment arms: six months of CMF, six months of CMF preceded by local-regional x-ray therapy (XRT), or 12 months of CMF. The latter arm was closed in February 1980 while the two six-month chemotherapy arms remain open as of January 1983. Relapse rates for 174 reviewed and evaluable patients on the three arms include: 27/76 (36%) for six months CMF, 15/54 (28%) for XRT and CMF, and 24/44 (45%) for 12 months CMF. Local-regional relapse rates were 12/120 (10%) for the combined two non-XRT arms and 3/54 (6%) for the XRT treatment arm (p = 0.34). Thus, at this early stage of follow-up there are still no statistically significant differences between six or 12 months of adjuvant CMF therapy and neither definite beneficial nor detrimental effects of prechemotherapy adjuvant radiation therapy. Longer follow-up will be needed to provide definitive conclusions.

Adenocarcinoma↗
PubMed1978

Inflammatory oncotaxis.

Tumor recurrence after a prolonged disease-free interval suggests that neoplastic cells may remain dormant within the host. Activation and growth of these metastatic focuses may occur secondary to inflammation at sites distant from the primary tumor. The concept of inflammatory oncotaxis is presented as a mechanism of cancer cell attraction and facilitation of transcapillary migration into tissue spaces. Physicians should focus astutely on internal and external sites of inflammation as possible focuses for tumor recurrence in the follow-up of the cancer patient.

Aged↗