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A T Turrisi

Publications and source records attributed to A T Turrisi.

At least 55 records · Page 3Linked to original sources
PubMed1993

Innovations in multimodality therapy for lung cancer. Combined modality management of limited small-cell lung cancer.

Recent approaches to the treatment of limited small-cell lung cancer have combined local radiotherapy and systemic chemotherapy in an attempt to improve local control and inhibit distant metastases. Local control is a key indicator of the efficacy of radiotherapy administration in combined-modality regimens. However, even in combined-modality trials using high total radiotherapy doses, local failure rates have ranged from 30 to 50 percent. The components of radiotherapy administration--including dose, volume, fractionation, integration with chemotherapy (concurrent, alternating, or sequential), and timing (early or late administration)--are also important considerations. Hyperfractionation, or the administration of small fractions of radiation more than once daily (usually twice), and accelerated hyperfactionation, or the administration of three fourths of the standard radiation dose two to three times daily, have emerged as important concepts in radiotherapy. Although the optimal chemotherapy regimen for combined-modality treatment has not yet been established, use of cisplatin and etoposide combinations, which do not promote pulmonary, cardiac, or esophageal toxicity, have been particularly appropriate in patients with small-cell lung cancer.

Antineoplastic Agents↗
PubMed1993

The evolving role of radiation therapy in the treatment of locally advanced lung cancer.

RT has been used routinely in the treatment of NSCLC and SCLC for the past several decades. Although largely considered a palliative treatment by most oncologists, there is increasing evidence that RT, when combined with cisplatin-based chemotherapy or given by altered fractionation, may improve the survival in NSCLC. Three large randomized trials have now shown that RT plus a cisplatin-based combination or cisplatin alone prolongs patient survival. Studies of hyperfractionation and accelerated hyperfractionation have also shown promise and are being tested in randomized trials worldwide. The results from these trials must be assessed against ongoing radiation dose escalation studies using new treatment planning technologies, albeit still in their infancy. These trials are discussed in this report. Systemic therapy is the cornerstone of treatment for SCLC. Although the value of RT was hotly debated during the 1970s and 1980s, it is now well established that RT improves survival when combined with chemotherapy in limited stage patients. Despite this advancement, other issues (such as timing or sequencing of modalities, radiation dose, fractionation, and treatment volume), remain unsettled. Randomized trials designed to address these important issues are in progress.

Antineoplastic Agents↗
PubMed1991

The integration of platinum and radiotherapy in the treatment of lung cancer.

Combined-modality therapy in lung cancer is a common practice throughout the world. The use of radiochemotherapy appears to be firmly established in the treatment of small cell lung cancer, but the role of prophylactic cranial irradiation remains undecided. Many recommend its use in the treatment of non-small cell lung cancer as well, but no facts exist to support this position. Because of poor long-term outcome and high frequency of systemic relapse, integration of chemotherapy for the treatment of non-small cell lung cancer is becoming more prevalent. This article discusses methods of integration, the problems of combined- modality toxicity, recent trials, and reports of multimodal therapy in lung cancer. The advantages of certain regimens of chemotherapy and new methods of radiotherapy are also discussed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Adjuvant radiotherapy for recurrent granular cell tumor.

Granular cell tumor (GCT) is a rare neoplasm traditionally treated with surgical excision alone. However, recurrences and metastases of GCT have been reported. The authors review the literature and report the case of a 33-year-old black woman with a large, recurrent GCT. The patient was treated with adjuvant radiation therapy and followed without evidence of recurrence. Adjuvant radiotherapy may have a role in the treatment of certain GCT thought, by clinical or pathologic criteria, to be at high risk for recurrence or metastasis, especially in those cases where extensive surgical excision would produce unacceptable morbidity.

Adult↗
PubMed1990

The influence of tumor size and pre-treatment staging on outcome following radiation therapy alone for stage I non-small cell lung cancer.

From 1970 through 1987, 77 patients with Stage I lung cancer were treated with definitive radiation therapy (RT) alone at the Fox Chase Cancer Center or the Hospital of The University of Pennsylvania. All patients had a pathologic diagnosis of non-small cell lung cancer and were not candidates for surgical resection because of premorbid medical problems or patient refusal. The median age was 72 years, although 10 patients were over 80. The histologic cell type was squamous in 44, adenocarcinoma in 15, large cell in 3, adenosquamous in 1, non-small cell in 11, and bronchioli-alveolar in 3. Tumor size was retrievable in 75 patients and 25 were less than or equal to 3 cm, 41 from 3-6 cm, and 9 greater than 6 cm. Diagnostic staging varied during the study period. Twelve patients, evaluated with a CT scan of the chest, including the liver, and a bone scan were classified as having "excellent" staging, 24 patients with conventional tomography, liver-spleen scan and a bone scan had "good" staging, and 41 patients were staged less rigorously. The RT was of megavoltage energy in all patients. The median dose was 60 Gy. The mediastinum was treated in all but eight patients who had poor pulmonary function. Survival was measured from the date of pathologic diagnosis. The actuarial 3-year survival rate of the entire group of patients is 17% with a median survival time of 20 months. Of the 61 deaths, 51 were due to disease and 10 were due to intercurrent disease without evidence of tumor recurrence. The actuarial 3-year disease-specific survival (DSS) was 22%. The 3-year disease-specific survival for patients with tumors less than 3 cm and from 3-6 cm was 30% and 17%, respectively. All nine patients with tumors greater than 6 cm were dead of disease. Local progression occurred in 33 patients, resulting in a 44%, 3-year actuarial freedom from local progression. The median time to local failure was 28 months and there were no local failures after 3 years in the 18 patients eligible for observation beyond this point. Of the patients with "excellent" staging, only 2 of 12 were dead of disease compared with 22 of 24 with "good" staging and 30 of 41 of the remainder. In this large group of Stage I non-small cell lung cancer, thorough pre-treatment staging and smaller tumor size are associated with a more favorable outcome.

Aged↗
PubMed1990

Thoracic radiotherapy variables: influence on local control in small cell lung cancer limited disease.

In limited small cell lung cancer (LSCLC), the high local failure rate of chemotherapy by itself (60-100%) and with the addition of external beam radiotherapy (approximately 30%) has led to investigation of methods to improve local control. To that end, we integrated Platinum 60 mg/m2, d. 1, 22 and Etoposide 120 mg/m2, d. 4, 6, & 8; 25, 27 & 29 with concurrent twice-daily 150 cGy (total dose: 4500 cGy). Of 32 consecutively referred patients, 4 with variant histology, 31 were evaluable for toxicity, response, and survival. Two of 4 variant histology patients responded, and 27 of 27 pure small cell responded, p = 0.005. CT scans were inaccurate at forecasting survival. Of 17/32 patients considered "positive," 59% of these were survivors; of those considered "negative," 47% were survivors, p = N.S. Radiation portals were volumetrically conservative; the supraclavicular fossa was included infrequently and the contralateral hilum not at all. Local failure occurred in only 1/27 patients (4%). All four variant patients failed locally, p = 0.001. With a median follow-up of 43 months, the actuarial disease-free survival remains nearly 50%. Variant histology is more predictive of local control than the physical factors of dose or volume.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Radiation and chemotherapy sensitizers and protectors.

Radiosensitizers and radioprotectors are part of the chemical modifier approach to cancer therapy whereby the state of the tumor cells and/or normal tissues are modified such that a therapeutic gain is achieved using conventional radiation or chemotherapy. Radiosensitization can be achieved by the use of oxygen-mimetic compounds, agents that alter DNA sensitivity to irradiation, maneuvers that alter DNA repair processes, and manipulation of tissue oxygenation. Standard chemotherapeutic agents such as cisplatin can be utilized in a manner that optimizes the radiosensitization properties. Protection and sensitization can occur by altering the thiol status of the cell. The chemical modifiers field is both developing novel approaches to cancer treatment and increasing the understanding of basic cancer biology.

Animals↗
PubMed1988

Palliative radiotherapy for metastatic malignant melanoma: brain metastases, bone metastases, and spinal cord compression.

The records of all patients receiving palliative radiotherapy for malignant melanoma metastatic to brain, to bone, or with spinal cord compression were reviewed. The median survival of 77 patients with brain metastases from the initiation of radiotherapy was 14 weeks. A statistically improved survival was observed only in the 10 patients who underwent subtotal to total resection of a solitary brain metastasis prior to radiotherapy (median = 36 weeks). No improved survival was observed in the 12 patients with a solitary brain metastasis treated by radiotherapy alone (median = 16 weeks). Multivariate analysis revealed that fraction size, total dose, patient age, sex, and duration of the interval between initial diagnosis and appearance of brain metastases did not significantly influence survival, but the use of chemotherapy was associated with a decreased survival. Twenty six patients with symptomatic and radiographic evidence of 39 bone metastases showed a palliative response rate of 85%. 18 of 20 bony lesions treated with high-dose-per-fraction (greater than or equal to 400 cGy) and 15 of 19 bony lesions treated with conventional fractionation (less than or equal to 300 cGy) were palliated. Total dose, patient age, sex, interval between initial diagnosis of malignant melanoma and the appearance of bone metastases, prior or concurrent chemotherapy, or lesion location did not significantly influence palliation. Seventeen patients were identified with symptomatic and myelographic evidence of spinal cord compression. Complete palliation was observed in 47% (8/17) and partial palliation was observed in 24% (4/17). The overall palliation response rate for neurologic symptoms due to spinal cord compression of 71% appeared to be independent of fraction size and total dose.

Bone Neoplasms↗
PubMed1988

Response to Seydel.

Explore the source record for details and available documents.

Combined Modality Therapy↗
PubMed1988

A preliminary report: concurrent twice-daily radiotherapy plus platinum-etoposide chemotherapy for limited small cell lung cancer.

From July 1984 through March 1987 23 patients with small cell lung cancer have entered a trial at the University of Pennsylvania. Concurrent Platinum (DDP) Etoposide (VP-16) chemotherapy and twice-daily, 150 cGy radiotherapy to a total dose of 4500 cGy in 3 weeks was used. Besides the twice-daily radiotherapy, multiple field arrangements attempted to minimize normal tissue exposure while concentrating on the target volume. Sophisticated CT-assisted treatment planning employing beams-eye-view technology was used. Esophagitis occurred in 73% (13% severe); hematologic toxicity occurred in 65% (17% WBC less than 1000). Response--100% in pure small cell carcinoma, 91% overall. Median follow-up is 22 months with an actuarial projection of 56% 2-year survival. Median survival is not yet reached. This is a highly effective therapy with substantive but tolerable toxicity. Accrual and follow-up continues. This is a preliminary report. We expect 30 patients before closing the study. A parallel study is underway in the Eastern Cooperative Oncology Group, with a randomized prospective trial in the design stage.

Aged↗
PubMed1988

Final report on phase I trial of WR-2721 before protracted fractionated radiation therapy.

This is the final report of the Phase I Protocol for the initial clinical study of Multiple Dose WR-2721 with radiotherapy (RTOG 80-02). The essential object of the study was to determine the highest dose of WR-2721 that could be given daily for the greatest number of weeks 15 to 30 minutes before conventional radiation treatment schedules. Eighty-four patients were entered into various dose levels. The major and dose-limiting toxicities were emesis, hypotension and malaise. The latter symptom was characterized by increasing weakness, fatigability, and ill-feeling. The maximum tolerated dose (MTD) established by this study is 340 mg/m2 given 4 days a week (excepting Wednesday) for 5 weeks. The drug is delivered intravenously in 7 minutes. There were no long-term blood chemistry changes. There were no deaths due to the administration of the radioprotector.

Adolescent↗
PubMed1988

Cortical versus medullary thymomas: a useful morphologic distinction?

We have tested the hypothesis that thymomas can be classified solely on the basis of epithelial cell morphology and that this distinction is prognostically useful. One hundred thymic epithelial tumors were classified according to the morphologic resemblance to cortical or medullary thymic epithelium and to the traditional classification (lymphocytic, epithelial, mixed, and spindled). Follow-up data was obtained on 78 patients. Fifty-eight percent of the tumors were invasive. Nineteen of the invasive tumors relapsed and none of the non-invasive tumors relapsed (P less than .0001). Four of nine tumors with microscopic invasion through the capsule recurred. Statistical analysis showed no significant differences in relapse-free survival for any of the histologic categories. Ninety-four percent of the tumors studied were keratin positive and all were chromogranin negative. Carcinoembryonic antigen was negative for all but one cytologically malignant tumor; of the tumors 75% were epithelial membrane antigen positive, 80% were Leu-7 positive, and 11% were neuron specific enolase positive. Seven of 12 tumors tested expressed HLA-DR. There was no correlation between immunoreactivity and classification. The morphologic cortical/medullary distinction is conceptually attractive but appears clinically to be no more advantageous than the traditional classification.

Adult↗
PubMed1988

Invasive thymoma: the role of mediastinal irradiation following complete or incomplete surgical resection.

To evaluate the role of mediastinal irradiation (RT) following surgery for invasive thymomas, a clinical and pathologic review of 117 patients with the diagnosis of thymoma was completed. Fourteen cases were excluded because of the lack of histologic criteria for a thymic tumor, and the remaining 103 were classified according to a staging system as follows: stage I, completely encapsulated (43); stage II, extension through the capsule or pericapsular fat invasion (21); stage III, invasion of adjacent structures (36); and stage IV, thoracic dissemination or metastases (3). The 5-year actuarial survival and relapse-free survival rates were 67% and 100% for stage I, 86% and 58% for stage II, and 69% and 53% for stage III. No recurrences occurred among stage I patients after total resection without RT. However, eight of 21 patients with invasive (stage II or III) thymomas had mediastinal recurrence as the first site of failure following total resection without RT. The 5-year actuarial mediastinal relapse rate of 53% in this group compares unfavorably with the mediastinal relapse rate seen among stage II or III cases following total resection with RT (0%) or following subtotal resection/biopsy with RT (21%). Despite attempted salvage therapy, five of eight patients with mediastinal relapse following total resection alone died of progressive disease. No significant difference was observed in the local relapse rate, overall relapse rate, or survival between those patients undergoing biopsy and RT v subtotal resection and RT for invasive thymomas (stages II and III). Total resection alone appears to be inadequate therapy resulting in an unacceptably high local failure rate with poor salvage therapy results.

Adult↗
PubMed1988

Limited small cell lung cancer--the role of radiotherapy.

At this time there is no standard therapy for limited small cell lung cancer. Chemotherapy regimens are usually cyclophosphamide-based, but vary in dose, intensity, and in other agents used. Radiotherapy varies in dose, duration, and course (split or continuous). Combinations of the two modalities include sequential therapy, concurrent therapy, and alternating therapy. What emerges from recent trials is the fact that radiotherapy is clearly active in small cell lung cancer and improves local control. What must still be determined are the optimal type of combined chemotherapy/radiotherapy and the best method of integration and timing.

Carcinoma, Small Cell↗