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Biomedical subjects

A O Langlands

Publications and source records attributed to A O Langlands.

At least 19 recordsLinked to original sources
PubMed1992

The cost of treating small cell lung cancer.

OBJECTIVE: To determine the cost of treating small cell lung cancer (SCLC) and to assess quality-adjusted survival in these patients. DESIGN: Retrospective analysis. SETTING: Westmead Hospital, a tertiary referral institution. PATIENTS: Consecutive sample of 31 patients with histologically proved SCLC, treated between January 1987 and December 1987. MAIN OUTCOME MEASURES: The cost of investigation, hospitalisation, chemotherapy, radiotherapy and follow-up of patients overall and for those with limited and extensive disease respectively. Quality-adjusted survival was based on a Q-TWiST analysis. RESULTS: The median overall cost per patient was $14,413 (range, $1188-$39,598) for all patients and for limited disease and extensive disease was $18,234 (range, $1914-$39,598) and $13,177 (range, $1188-$32,798) respectively. The two major costs were hospitalisation (42%) and chemotherapy (18%). Radiotherapy accounted for 11% of all costs. The Q-TWiST analysis suggests that for patients with limited disease, quality-adjusted survival is similar to absolute survival. CONCLUSIONS: The treatment of SCLC at our institution was expensive but the cost may be reduced by reduction in the duration of hospitalisation, the use of less expensive combination drug regimens, or the use of "true" outpatient chemotherapy. Despite intensive therapy, patients with limited disease maintained a reasonable quality of life.

Aged↗
PubMed1992

Delayed radiation necrosis of the central nervous system in patients irradiated for pituitary tumours.

Four cases of delayed radiation necrosis involving the CNS were found in a group of 46 patients irradiated for pituitary tumours over a six year period. This occurred in three of 11 patients with Cushing's disease representing an incidence of 27% in this group. There were no cases among 11 patients with acromegaly or among seven with prolactinomas. One case (6%) was found in the 17 patients with chromophobe adenomas. Standard doses of radiation were delivered to these patients and the findings support suggestions that the metabolic disturbances of Cushing's disease may reduce tolerance to radiation. Our results and a literature review indicate that if radiotherapy is used to treat Cushing's disease, the total dose should be less than 50 Gy at 2 Gy per day fractionation.

Adenoma↗
PubMed1979

Long-term survival of patients with breast cancer: a study of the curability of the disease.

A retrospective analysis was made of 3878 cases of breast carcinoma first seen in Edinburgh from 1954 to 1964. During this time there was a policy to treat breast cancer by simple mastectomy and x-ray therapy, and over 90% of cases classified as international stages I and II were so treated. The mortality in these women was compared with that in an equivalent normal population using Scottish national age-specific death rates. For every year of follow-up within 20 years of initial treatment there was an excess mortality from all causes. There was an overall excess mortality of 58% among patients with breast cancer 15-20 years after initial treatment, and 20 times more deaths occurred in this period from breast cancer than in a normal population. For patients disease-free after 15 years there was still a 28% excess mortality from all causes. Factors known to be of major prognostic significance for five-year survivorship had less influence than might have been expected when the ratio of observed to expected deaths was considered for longer periods of follow-up. The effect of clinical staging (I, II, or III), though initially marked, largely disappeared by the 10th year of follow-up, and after allowing for age there was no evidence beyond 10 years of an effect on survival of the original stage of the disease. Similarly, the effect of tumour size on survival disappeared after 10 years. Women who were premenopausal at presentation still had a significant excess of deaths in the fourth quinquennium of follow-up. In the menopausal and postmenopausal groups combined there was still a small non-significant excess of deaths from all causes after 15 years but this almost disappeared when patients who had already relapsed were excluded. In terms of overall mortality only patients who have undergone the menopause before presentation and who are disease-free 15 years after primary treatment may prove to be cured by conventional techniques such as simple mastectomy and postoperative radiotherapy.

Adult↗
PubMed1978

Fluorouracil cardiotoxicity.

Our of 140 patients treated with intravenous 5-fluorouracil, four developed ischaemic chest pain within 18 hours of either the second or third dose. In three of these patients the pain recurred after subsequent doses. Predose electrocardiograms in two cases were normal. None of the four patients had a history of ischaemic heart disease, although all had received left ventricular irradiation. Although cardiotoxicity is a rare complication of fluorouracil treatment, it merits wider recognition.

Adult↗
PubMed1978

Cell receptor studies on six anaplastic tumours of the thyroid.

Cell suspensions from six anaplastic thyroid tumours were studied for expression of lymphocyte and macrophage surface markers, and results were correlated with electron microscopy, clinical extent of disease, and response to radiotherapy. The clinical presentation of the disease was similar in all six patients. In five cases, many of the cells showed surface immunoglobulin. Electron microscopy was available on three of these and showed appearances in keeping with malignant lymphoma. The single case whose cells did not show surface immunoglobulin had an entirely different ultrastructure and was probably a carcinoma. This case was the only one that did not achieve complete remission with radiotherapy and the patient died from extensive local recurrence. It is concluded that receptor techniques are of value in distinguishing between malignant lymphoma and other anaplastic tumours of the thyroid, particularly when the results are correlated with histology.

Aged↗
PubMed1977

Radiation osteitis following irradiation for breast cancer.

Radiographs of the shoulder girdle were examined in 180 women who attended the breast follow-up clinic at the Department of Radiotherapy, Edinburgh. These comprised 52 controls who had been treated by radical mastectomy alone and 128 patients who had received post-operative X-ray therapy. The significance of osteoporosis as a sequel to irradiation is doubtful as it occurred in a substantial proportion of the control cases. Osteitis of severe degree occurred in 13.3% of patients who had been irradiated and was present in a mild form in a further 8.6%. The development of severe osteitis requires an NSD of 1650 rets or more. Estimates of the frequency of radiation osteitis are of no value unless detailed information is also provided about the techniques and quality of radiation.

Aged↗
PubMed1976

Lymphoma of the thyroid. An unusual clinical course in a patient possessing a 14/21 translocation.

The unusual course of a lymphoma in a woman with a chromosome abnormality is reported. When aged 30 years, the right lobe of her thyroid gland was found to be infiltrated by a follicular lymphoma. Two years later, poorly differentiated diffuse lymphoctic lymphoma recurred locally, grew rapidly, and infiltrated the adjoining muscles. It was treated by widefield irradiation of the upper trunk and neck, and disappeared completely. The patient remained sympton-free for 22 years. Unequivocal Hodgkin's disease then developed in a left cervical lymph node; the patient received radiotherapy. Eighteen months later the right inguinal nodes were infiltrated by similar tumor and further treatment was given. Massive abdominal involvement followed and the patient died 28 years after developing the thyroid lymphoma. The tumor at necropsy was pleomorphic and contained Reed-Sternberg cells. The significance of the constitutional chromosome abnormality, a Robertsonian translocation of the No. 14 chromosome, is discussed.

Adult↗
PubMed1976

On the staging of breast carcinoma.

The implications of the new staging system for breast carcinoma proposed in 1973 by the International Union Against Cancer (UICC) in conjunction with the American Joint Committee on Cancer Staging and End Results (AJC) has been examined both in terms of staging distribution and the presentation of survival results as compared with the currently used International staging classification in a large consecutive series of patients referred for treatment between 1960-62. The new UICC/AJC system, if accepted, will require some 23% of cases at present Stage II (International) to be allocated to Stage I depending on a clinical assessment as to whether the nodes are involved or not. It will result in the reporting of increased survival rates for Stage I and Stage II disease, and this change is sufficiently large to be of statistical significance in Stage I disease at five and ten years.

Breast Neoplasms↗
PubMed1976

Carcinoma of the male breast: report of a series of 88 cases.

A series of 88 cases of male breast cancer was compared with 241 cases of female breast cancer randomly selected from Departmental records. Cases of male breast cancer differed significantly from control female cases with regard to stage of the disease, age of onset and liability to the development of a second carcinoma. In 11 of the 88 cases (12.5%) of male breast cancer another primary malignant tumour developed. In seven instances the large bowel or rectum was the site of the other carcinoma. When correction was made for age and for the stage of the disease the prognosis of breast cancer in men and women was found to be similar. Only minor histological differences were found between male and female cases. Two of 54 cases examined for X-chromatin proved to be Barr-positive.

Adult↗