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Biomedical subjects

A W Silberman

Publications and source records attributed to A W Silberman.

At least 19 recordsLinked to original sources
PubMed2000

Adjuvant radiation trials for high-risk breast cancer patients: adequacy of lymphadenectomy.

BACKGROUND: The recently published, widely publicized adjuvant radiation trials from Denmark and Canada concluded that the addition of postoperative radiotherapy (XRT) to modified radical mastectomy (MRM) and adjuvant chemotherapy reduces locoregional recurrences and prolongs survival in high-risk premenopausal patients with breast cancer. Our thesis is that adequate lymphadenectomies were not performed in either study. Consequently, the conclusion to these studies is not applicable to those patients who have undergone adequate surgery. METHODS: To better assess adequate lymph node yield from an MRM, a retrospective review was performed on 215 consecutive patients treated surgically for invasive breast cancer. Data from this review were compared with the surgical data from the above-mentioned radiotherapy trials. RESULTS: In a group of 131 patients who had MRM, the average number of nodes removed was 26 (median, 25), and 75.5% of the specimens had 20 or more lymph nodes. In 73 patients who underwent segmental mastectomy with axillary lymph node dissection, both the average and the median number of lymph nodes removed were 24, and 68.9% had 20 or more nodes. These data compare to the Danish radiation trial in which a median of 7 lymph nodes were removed (with 76% of the patients having 9 or fewer lymph nodes in the specimen) and to the Canadian radiation trial in which a median of 11 lymph nodes were removed. In addition, in our breast cancer patients with positive nodes (84 of 204; 41.2%), 45.2.% (38 of 84) had more than three positive nodes compared with 29.8% in the Danish study and 35% in the Canadian study. CONCLUSIONS: Our surgical data are sufficiently different from those of the Danish and Canadian studies to indicate that, in those studies, incomplete lymph node dissections were performed and that residual disease was left behind in the axilla in some or all of the patients. The addition of XRT in the setting of residual axillary disease may compensate for an inadequate operation and yield an acceptable oncological result; however, these studies did not provide an adequate comparison with a well-performed MRM without XRT. In the absence of documented benefit, XRT should not be routinely added if a complete lymph node dissection has been performed.

Adult↗
PubMed1994

Granular cell tumor of the biliary system.

Granular cell tumors (GCT) are rare benign neoplasms of Schwann cell origin which have been found in virtually every location in the body. Their location in the biliary system is unusual, and typically occurs in black females during the fourth decade of life. Forty-eight cases have been reported since 1952. We present two patients treated for obstructive jaundice caused by GCT of the extrahepatic biliary tree. The literature on biliary GCT is reviewed and their management is outlined. Local excision with Roux-y-hepaticojejunostomy was performed in one patient with GCT obstructing the common bile duct at the level of the cystic duct. Pancreaticoduodenectomy was performed on one patient for GCT of the common bile duct involving the ampulla and adjacent pancreas. GCT of the extrahepatic biliary system are rare but should be considered in black females who present with obstructive jaundice in the fourth decade of life. Local excision with cholecystectomy and reconstruction of the biliary remnant is indicated. Primary biliary anastomosis is desired but choledochojejunostomy or hepaticojejunostomy may be necessary. Rarely, pancreaticoduodenectomy may be indicated in GCT of the distal common bile duct.

Adult↗
PubMed1993

Tumor aneuploidy in young patients with colorectal cancer.

BACKGROUND: Colorectal cancer in young patients (40 years of age or younger) often is considered to have a worse prognosis than in older patients. The authors studied tumor DNA status and stage of disease to determine whether tumors in younger patients behaved differently from tumors in older patients. METHODS: This retrospective study identified 33 young patients with colorectal cancer treated surgically between 1979 and 1989. The DNA content of the tumors was analyzed by DNA flow cytometry. Results were compared with 75 cases of colon cancer in patients older than 40 years of age. RESULTS: Six of the 33 young patients had inadequate tissue for study. Four patients with ulcerative colitis were excluded. Tumor aneuploidy was present in 14 of 23 young patients (61%; mean age, 35 years) and 46 of 75 older patients (61%; mean age, 71 years). When Dukes staging was performed for the young patients, one had Stage A (4%), nine had Stage B (39%), eight had Stage C (35%), and five had Stage D (22%) disease. The control group had similar staging. The distribution of aneuploid tumors within each Dukes stage was also similar. Twenty-one young patients were available for follow-up. Four (31%) of 13 patients with aneuploid tumors died, whereas none of 8 patients with diploid tumors died. This trend was not statistically significant (P < 0.10). CONCLUSIONS: The frequency of tumor aneuploidy, stage of disease at presentation, and distribution of tumor aneuploidy within each stage was similar when young and old patients with colorectal cancer were compared. There is a trend toward tumor aneuploidy being associated with a poorer prognosis in young patients.

Adult↗
PubMed1993

Thallium scintigraphy in the evaluation of mass abnormalities of the breast.

Palpable mass abnormalities of the breast are often difficult to evaluate mammographically, especially in patients with fibrocystic change and dense breasts. The current study evaluates 201TI scintigraphy as a potential test in detecting malignancy and in differentiating malignant from benign masses. Eighty-one female patients underwent thallium scintigraphy of the breast because of palpable breast masses. An additional 30 females with no palpable breast abnormalities were also studied using 201TI. Of 44 patients with palpable breast carcinomas, 42 carcinomas (96%) were detected using 201TI scintigraphy. Three of three patients had other primary breast malignancies that were also detected. In contrast, 19 patients with palpable breast abnormalities shown on biopsy to be benign fibrocystic disease processes were not detectable on thallium studies. Of two patients with fat necrosis, none were detectable. Three of 13 patients had adenomas of the breast (23%) that were detected. The three detectable adenomas were all highly cellular. The smallest detectable carcinoma was an adenocarcinoma measuring 1.3 x 1.1 x 0.9 cm. Thallium-201 scintigraphy of palpable breast lesions is an effective test for evaluation of palpable masses. Sensitivity for detection of malignant masses greater than 1.5 cm is high. Highly cellular adenomas, however, may demonstrate significant 201TI uptake. Benign fibrocystic disease is not detectable with thallium scintigraphy. Thallium scintigraphy of breast lesions is an effective means of differentiating benign from malignant lesions.

Adenocarcinoma↗
PubMed1990

Cystadenocarcinoma of the pancreas: neo-adjuvant therapy and CEA monitoring.

Cystadenocarcinoma of the pancreas is generally considered to be unresponsive to chemotherapy and radiation therapy. We present two cases of laparotomy-proven unresectable cystadenocarcinoma which responded to intravenous 5-fluorouracil (1,000 mg/m2/24 hr x 5 days x 2) and 4,000 rads of radiation therapy. Both patients had objective response with marked shrinkage of the tumor as determined by clinical examination and computed tomography. At reexploration both tumors had become completely resectable with histologically clear margins and negative lymph nodes. Carcinoembryonic antigen (CEA) levels were elevated in both patients at initial presentation (86 and 71 ng/ml). The CEA levels declined to 19.9 and 66.0 ng/ml, respectively, after neo-adjuvant therapy, and both fell to normal levels after resection. Although surgical resection has been considered the only curative therapy for patients with pancreatic cystadenocarcinoma, we suggest that preoperative irradiation and chemotherapy may reduce the size of seemingly unresectable tumors. We also recommend serial CEA determinations in patients with levels initially elevated as a marker of the response to neo-adjuvant and operative therapy.

Carcinoembryonic Antigen↗
PubMed1990

Cystic neoplasms of the pancreas.

Cystic neoplasms of the pancreas can be easily misdiagnosed and mistreated by the surgeon unfamiliar with the pathology, natural history, and operative strategy specific to these uncommon tumors. The authors have treated nine patients over a seven-year period involving four cystadenocarcinomas, two mucinous cystadenomas, two serous cystadenomas, and one solid and papillary epithelial tumor. Our experience illustrates the inaccuracies in both clinical and pathologic diagnosis. Suspected cystic neoplasms are optimally managed by resection. Their slow growth and late metastasis permits curative surgery after a previous drainage or bypass procedure. An aggressive surgical approach is therefore warranted, and multimodal treatment with radiation and chemotherapy may be clinically applicable to large, invasive cystadenocarcinomas.

Adult↗
PubMed1987

A complication of the Infusaid pump: duodenal atony reversed by urecholine.

The totally implantable infusion pump (Infusaid pump) for treating metastatic disease to the liver is a new treatment that is gaining widespread acceptance. However, as might be expected for any new major surgical procedure, there are increasing reports of complications. We report a complication in which duodenal atony was caused by the infusion of the chemotherapeutic agent (FUDR) into the stomach and duodenum. The atony was totally reversed by the subcutaneous administration of urecholine.

Bethanechol Compounds↗
PubMed1987

Retroperitoneal sarcomas: the role of diagnostic imaging and multimodal management.

Retroperitoneal sarcomas are a varied group of malignancies which have a high rate of recurrence following surgery alone. The majority of the initial recurrences are local in nature, and new therapeutic approaches are clearly needed. Diagnostic imaging and "interventional radiology" have important roles to play in the management of these malignancies, as well as in investigational approaches to therapy. Two cases are presented which illustrate some recent advances in diagnosis and staging of this group of tumors which can be attributed to new cross-sectional imaging techniques, when used in concert with "conventional" imaging methods. The latter include arteriography to guide the placement of intra-arterial catheters for local infusion chemotherapy. CT-guided needle biopsies can be performed to secure a preoperative diagnosis and also to obtain viable tissue for in vitro chemosensitivity assays. A judicious combination of local and systemic chemotherapy, radiation, and surgery may hold promise for better control of this malignancy, similar to the therapeutic advances which have already been obtained with limb sarcomas.

Adult↗
PubMed1987

Malignant melanoma. Practical considerations concerning prophylactic regional lymph node dissection.

Seventy-three patients had 77 prophylactic regional lymph node dissections (PRLND) in addition to wide excision of the primary lesion for clinical Stage I primary malignant melanoma. The preoperative evaluation, surgical procedure, and postoperative follow-up were performed by one surgical oncologist. Seven patients had micrometastatic disease in the regional nodes for a yield of 9.6%. Considering only patients with Clark IV and V melanomas, and Clark III melanomas greater than or equal to 2.00 mm, the yield was 15.6%. The most optimistic, published survival statistics demonstrate a 25% 5-year survival advantage for patients who have PRLND with an incidence of occult nodal disease of 14.3%; thus, even the most optimistic data would predict that only a modest number of patients would actually benefit from surgery. It is difficult to justify PRLND for its therapeutic benefit unless a higher yield of positive-node patients is obtained or the surgical indication is for staging or prognostic information.

Axilla↗
PubMed1986

Effect of localized magnetic-induction hyperthermia on the brain. Temperature versus intracranial pressure.

Normal brain and brain tumor temperatures were studied for their effects on intracranial pressure (ICP) in 13 patients who received 37 localized thermochemotherapy treatments for recurrent primary or metastatic brain tumors. Two transient neurologic complications occurred in patients with an elevated initial ICP value; thus, the authors concluded that an initial ICP value of 30 cm H2O or greater may contraindicate brain hyperthermia. It appears that noninvasive brain hyperthermia by magnetic-loop induction can cause an initial rise in ICP value, although a protective mechanism(s) that tends to lower ICP occurs over time, and also at a normal brain temperature of approximately 42.0 degrees C. Possible mechanisms of ICP reduction include direct heating of the hypothalamus with a reduction in pCO2 and the development of tachypnea and hyperpnea with a reduction in pCO2. Hyperthermia applied to the brain should be undertaken only with adequate monitoring of ICP; in addition, extreme caution should be taken in patients with an elevated initial ICP value and in those patients in whom adaptation to elevated pressure does not occur.

Adult↗
PubMed1985

Phase I trial of thermochemotherapy for brain malignancy.

High-grade primary and refractory brain tumors and metastases to the brain from other primary sites are associated with a grave prognosis. Treatment, usually palliative, consists of some combination of surgery, radiation, and chemotherapy. Recently, noninvasive hyperthermia by magnetic-loop induction has been safely used to treat patients with advanced cancer in extracranial sites. Both disease regression and disease stabilization have been observed. This technique was recently applied to brain tumors in an animal model, and its safety was again demonstrated. As a result, a Phase I trial of noninvasive localized hyperthermia in combination with intravenous chemotherapy has been carried out in ten patients whose primary or metastatic brain tumors failed to respond to standard therapy. Ten patients underwent 23 thermochemotherapy sessions using the magnetic-loop induction device. The median, maximum temperature of normal brain after 1 hour of hyperthermia was 41.1 degrees C (range, 38.6 degrees C-43.4 degrees C); the median, maximum temperature of brain tumor was 42.5 degrees C (range, 38.8 degrees C-46.3 degrees C) (P less than 0.01). The temperatures of both the normal brain and brain tumor were obtained during 18 treatments. The tumor temperature was greater than the normal brain temperature in 15 of 18 treatments. In 78% of the treatments, the measured tumor temperature reached at least 42 degrees C, whereas the normal brain reached 42 degrees C in only 13% of the treatments. These data demonstrate the "selective inability" of brain tumor tissue to dissipate heat. Vital signs, intracranial pressure, and neurologic status were monitored throughout the hyperthermia treatments. No mortality or increase in chemotherapeutic toxicity could be attributed to the thermochemotherapy. In addition, there were no local complications or permanent neurologic complications. Two patients with elevated intracranial pressure before therapy had transient neurologic deficits that may have been exacerbated by the hyperthermia. It is concluded that this new, noninvasive modality not only produced effective intracranial tumor heating, but could be performed safely with the proper precautions. Phase II trials are warranted.

Adult↗
PubMed1985

Variability of heating patterns in animals by magnetic induction hyperthermia.

In a test of electromagnetic induction hyperthermia to deep viscera of a live dog model, we found that heating was not uniform to any depth, but was quite variable. In general, there was a thermal gradient between peripheral and central portions of the transposed spleen of about 1 degree C. Though heat generation within the abdomen was not uniform, its temperature pattern in the alive animal resulted in significant heating of that part of the organ that had been surgically placed at the center of the animal. This heating could not be explained by perfusion with regionally heated core blood. Our results indicate that extensive investigations in living systems and complex dynamic phantoms will be necessary before individual patient response can be predicted.

Abdomen↗
PubMed1984

Clinical thermochemotherapy. A controlled trial in advanced cancer patients.

In vitro and in vivo animal studies and some clinical trials have shown apparent benefit from thermochemotherapy; however, this treatment modality has not been adequately tested in humans. This investigation evaluated response to and toxicity of secondary thermochemotherapy, using each patient as his own control. Patients with advanced cancer who had documented disease progression while receiving chemotherapy alone were subsequently treated with the same drug, by the same dose and route, combined with localized hyperthermia. Thirty-four patients whose diseases included metastatic colon carcinoma, melanoma, sarcoma and hepatoma in viscera (29) or surface tissues (5) were treated with combination thermochemotherapy for 1 hour daily for 5 days/month. Effective heating from 41 to 45 degrees C minimum tumor temperature was possible in 17/19 (89%) tumors in which temperatures could be measured safely. The authors observed 5 (15%) tumor regressions for 1 to 5 months (median, 2 months), and 19 (56%) tumor stabilizations (growth arrest of previously progressive disease) for 1 to 9 months (median, 4 months). Subjective improvement in activity and/or pain control occurred in 6 (18%) patients and 20 (59%) had no progression of symptoms during treatment. Moreover, there was no detectable morbidity from localized hyperthermia, and no evidence of increased chemotherapy toxicity. While the mechanism(s) of response is poorly understood, the documented disease regressions and stabilizations of previously progressive disease in 24 (71%) patients during secondary combination thermochemotherapy indicates that the addition of hyperthermia may have useful anticancer activity. Expanded trials are warranted.

Adult↗
PubMed1984

Combination radiofrequency hyperthermia and chemotherapy (BCNU) for brain malignancy. Animal experience and two case reports.

Patients with high-grade primary and metastatic brain malignancies have a median survival time of 3-8 months, regardless of therapy. Because MagnetrodeTM hyperthermia provides safe, deep internal heating without normal-tissue injury, we studied its effects first on the brain and surrounding tissues of rabbits. The normal rabbit brain (n = 26) could be heated to potentially tumoricidal temperatures (42-43 degrees C) without apparent histopathologic or clinical damage to the brain, skull, external eye, subcutaneous tissue or skin. Intracranial pressure did not rise significantly. Using transplanted VX-2 carcinoma, we showed both the safety and potential efficacy of thermochemotherapy (IV BCNU: 14 mg/kg) in the presence of a solid brain tumor. The average maximum brain temperature achieved was 43.06 degrees C. Mean survival from the time of tumor implantation in the treated group (n = 16) was 18.56 days, compared to 9.3 days for untreated controls (n = 30) (p less than .0001). Two patients have been treated with localized brain hyperthermia combined with intravenous BCNU (80 mg/m2) for a total of eight treatments. Maximum normal brain temperature achieved was 40.0 degrees C in Patient #1 and 41.5 degrees C in Patient #2. A tumor temperature of 42.9 degrees C was achieved in Patient #2. Intracranial pressure remained within the upper limits of normal. Swan-Ganz monitoring in Patient #1 revealed a stable cardiac index and mean pulmonary artery pressure with mild fluctuations in the CVP, PAD, and PCW. No increase in chemotherapy toxicity was observed and no normal tissue injury occurred in either patient. We conclude that non-invasive localized radiofrequency hyperthermia to the brain is feasible and can be performed safely in the presence of a solid brain tumor.

Animals↗
PubMed1983

Blood flow in human tumors during hyperthermia therapy: demonstration of vasoregulation and an applicable physiological model.

A quantitative assessment of the effect of localized magnetic-loop hyperthermia on blood flow was performed in 12 human tumors using the 133Xe clearance method. Because blood flow in these tumors changed in response to needle injection, a physiologically based, one-compartment model was developed that included both a hyperemic and a steady-state component. In six tumors, changes in blood flow induced by heat were also observed. The ability of tumor vessels to respond dynamically to stress and the degree of response may be predictive of tumor heating capacity and subsequent therapeutic response.

Abdominal Neoplasms↗
PubMed1983

The pharmacologic manipulation of blood flow in hyperthermia therapy.

Many human tumors treated by hyperthermia do not reach therapeutic temperatures (42 degrees C). The explanation for this difference may be that some tumors react to thermal stress in a manner similar to normal tissues; ie, they increase blood flow during hyperthermia in order to dissipate the heat. Higher temperatures might be achieved in these heat-resistant tumors by administering vasoconstrictive agents in an effort to reduce blood flow. In this preliminary study, we determined the extent to which pharmacologic inhibition of local blood flow might allow higher temperatures to develop in normal muscles exposed to localized radiofrequency hyperthermia. We found that the local muscle temperature rise could be increased by at least 90% in two dogs and six rabbits with the use of a local vasoconstrictive drug.

Animals↗