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Biomedical subjects

A R Makepeace

Publications and source records attributed to A R Makepeace.

11 recordsLinked to original sources
PubMed1991

Experience with CHART.

Continuous, hyperfractionated, accelerated radiotherapy (CHART) has been used at the Mount Vernon Cancer Treatment Center since January 1985. Patients with head and neck tumors and those with locally advanced non-oat cell carcinoma of the bronchus have formed the large majority of the 263 patients treated. Early reactions in the mucosae of the mouth and pharynx have been pronounced, but all have healed, while those in the skin have been less severe than with conventional radiotherapy. An unexpected late morbidity was radiation myelitis in four patients, but in other tissues including the skin, mucosae, the connective tissues, and the salivary glands, late changes appear reduced compared to those after conventional radiotherapy. In 92 patients with squamous cell carcinoma of the major sites in the head and neck region, of whom 71 were in Stages T3 and T4, a complete regression at the primary site and nodes was achieved in 90%. This can be compared with 62% in similar patients previously treated with curative intent at Mount Vernon between 1980 and 1985; the difference was maintained in follow-up (p = 0.003). Of 76 assessable patients with non-oat cell carcinoma of the bronchus, a complete radiological response has been achieved in 40%, compared to 12% in a retrospective group; again the difference has been maintained in follow up (p = 0.0001). A 1-year survival of 60% can be compared to 40% in the retrospective group and a 2-year survival of 29% compared to 12% (p = 0.01). With a reduction of permitted dose to the spinal cord, CHART gives promise for improvement in tumor control and a reduction in late morbidity. These promising results have led to multi-center randomized controlled clinical trials in carcinoma at the head and neck and in non-oat cell carcinoma of the bronchus. In these studies, CHART is being compared with conventional fractionated radiotherapy.

Aged↗
PubMed1990

A possible role for ultrasound of the axilla in staging primary breast cancer.

The axillae of 30 patients with primary breast cancer (Stage I and II) were prospectively examined in this pilot study using ultrasound. No patient had palpable axillary lymph nodes on clinical examination. Treatment had involved wide local excision, but no prior form of surgical dissection had been performed on the axilla. Using the contralateral axilla as an internal control, lymph nodes were observed in the ipsilateral axilla alone on ultrasound in 8/30 patients (27%). Following radical irradiation of the breast and local lymph drainage areas, 2/8 patients of the group with observed lymph nodes have relapsed, one with systemic disease and the other with local recurrence in the breast, after a minimum follow-up of 12 months. No patient without observed nodes has recurred. This difference does not reach statistical significance. This technique merits further investigation as an adjunct to current staging procedures for early breast cancer.

Adult↗
PubMed1989

Non-Hodgkin's lymphoma associated with the acquired immune deficiency syndrome: a report of five cases.

We report a series of five HIV positive patients with histologically proven non-Hodgkin's lymphoma. The paper illustrates the difficulties experienced in both the clinical diagnosis and its histological confirmation. In this series we have confirmed the predominance of aggressive histological variants and the high frequency of extra-nodal involvement. The prognosis despite treatment was poor; only one patient entered complete remission and the mean survival was only 4.3 months.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Non-Hodgkin's lymphoma of the nasopharynx, paranasal sinus and palate.

Twenty-two patients with non-Hodgkin's lymphoma of the nasopharynx, paranasal sinuses or palate were treated between 1952 and 1980. The histology was reviewed by one histopathologist and 77% of cases were classified as grade 2 non-Hodgkin's lymphoma. Forty-five per cent of patients relapsed after initial treatment and 41% of all patients died from lymphoma. The 5-year survival ranged from 22% for the nasopharynx to 80% for the palate.

Adolescent↗
PubMed1988

Primary non-Hodgkin's lymphoma of the orbit.

Between 1954 and 1980, 9 patients with non-Hodgkin's lymphoma of the orbit were treated at the Regional Radiotherapy Centre, Mount Vernon Hospital. Following radiotherapy complete local regression of the tumour was seen in every case. Three patients subsequently developed recurrent disease which proved fatal in two cases. The overall 5 year survival was 89%.

Adult↗
PubMed1988

Malignant fibrous histiocytoma: the most common soft-tissue sarcoma.

Although soft-tissue sarcomas account for less than 1% of all malignancies, over 55 different histological variants have been described. Consequently clinicians often find the classification both complex and confusing. A new variant, the malignant fibrous histiocytoma (MFH), is now the most common adult soft-tissue sarcoma, therefore a clear understanding of the diagnosis, its implications and the optimum treatment is desirable.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Non-Hodgkin's lymphoma of the thyroid.

Twenty-eight patients with non-Hodgkin's lymphoma of the thyroid were treated between 1954 and 1981. The duration of follow-up ranged from 39 to 176 months. The overall 5 year survival was 51%. Twenty deaths have been recorded of which 12 were attributed to non-Hodgkin's lymphoma. Eight patients relapsed following initial treatment. Of these, two patients are long term survivors and the remainder had a mean survival of 14.5 months. The histology was reviewed by one histopathologist, with 88% of the cases being classified as grade 2 non-Hodgkin's lymphoma. The presence of Hashimoto's thyroiditis was identified in 56% of the 25 assessable specimens.

Adult↗
PubMed1987

Gastrointestinal non-Hodgkin's lymphoma.

Seventy-two patients with gastrointestinal non-Hodgkin's lymphoma treated between 1952 and 1980 are reviewed. The small intestine was involved in 49% of cases and the stomach in 29%. Surgical resection of the tumour was performed whenever feasible. Radiotherapy was used either adjuvantly or for incompletely excised tumours and chemotherapy was more often reserved for advanced, unresected disease. The overall 5 year survival was 36% and the 5 year relapse free survival was 22%. Forty-one (57%) patients relapsed of whom 33 (80%) subsequently died of non-Hodgkin's lymphoma. The histology in each case was reviewed using the British National Lymphoma Investigation criteria and 94% of cases were reclassified as Grade 2 non-Hodgkin's lymphoma.

Adolescent↗
PubMed1987

Hodgkin's disease in childhood: the British National Lymphoma Investigation experience (BNLI Report No 27).

The experience of the British National Lymphoma Investigation in the treatment of 68 children with Hodgkin's disease is reported over a 14 year period from 1970. The presenting histology was reviewed by a single histopathologist; 87% of the cases were classified as nodular sclerosis (NS) and further subdivided into NSI (53%) and NSII (35%). Primary treatment consisted of local (involved field) or prophylactic (extended field) irradiation, combination chemotherapy alone or low dose irradiation and chemotherapy. An overall 5 year survival of 87% was achieved and a 5 year relapse-free survival of 64%. Eight deaths were reported during the study, all of which occurred in children who presented with NSII histology. Each child was in relapse and undergoing chemotherapy at the time of death. This histological subtype was also associated with both a lower complete remission rate and a reduced response to second line chemotherapy.

Adolescent↗
PubMed1987

Non-Hodgkin's lymphoma of the tonsil. Experience of treatment over a 27-year period.

Over the 27-year period from 1954-1981, 51 patients with non-Hodgkin's lymphoma arising in the tonsil were treated at the Regional Radiotherapy Centre, Mount Vernon Hospital. The original biopsy material was reviewed in each case and reclassified using the British National Lymphoma Investigation criteria. Grade 2 non-Hodgkin's lymphoma was reported in 80 per cent of cases. Ninety per cent of patients presented in stages IE or IIE and were treated with radical local radiotherapy. A 5-year survival of 51 per cent was achieved and a 5-year relapse-free survival of 35 per cent. Stage IE patients had a statistically significant survival advantage compared to stage IIE. Sixty-one per cent of patients relapsed, of whom 74 per cent died from active lymphoma. The abdomen was the most frequent site for relapse with involvement of both nodal and extranodal sites.

Adult↗