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Biomedical subjects

B E Greer

Publications and source records attributed to B E Greer.

At least 55 records · Page 3Linked to original sources
PubMed1989

Stage IB adenocarcinoma of the cervix treated by radical hysterectomy and pelvic lymph node dissection.

Fifty-five patients with Stage IB adenocarcinoma of the cervix were treated by radical hysterectomy and pelvic lymphadenectomy from 1965 through 1985. Bleeding was the presenting symptom in 56% of the patients. Twenty patients underwent cone biopsy for diagnostic purposes and 70% had residual carcinoma at the time of definitive surgery. A single postoperative death occurred as the result of pulmonary embolism. Tumor size, depth of invasion, and nodal metastases proved to be important prognostic factors. Tumor grade and histologic type were not related to tumor recurrence, although adenosquamous carcinoma was more frequently associated with a greater depth of invasion. Nine patients had nodal metastases, and 78% of patients with spread to the regional nodes developed recurrent carcinoma. Microscopic invasion beyond the cervix or metastases to lymph nodes was present in all but two of the 12 patients with recurrence after surgery. The overall recurrence rate was 22%, with 10 of 12 patients dead of disease, one patient alive with disease, and one patient without evidence of disease. Peritoneal cytologic studies were performed on 22 patients and all had negative cytologic findings. None of the patients with recurrent disease had evidence of intraperitoneal spread. Ninety-one percent of the patients had ovarian preservation, and there is no evidence that this contributed to tumor recurrence.

Adenocarcinoma↗
PubMed1989

Postoperative pain management in gynecology oncology patients utilizing epidural opiate analgesia and patient-controlled analgesia.

Intraoperative analgesia is the purview of anesthesiologists whereas postoperative pain is traditionally managed by surgeons. This series reports 19 months experience of anesthesiologists using epidural opiate analgesia (EOA) or patient-controlled analgesia (PCA) to treat postoperative pain in 302 patients following surgery for pelvic malignancy. For the 244 (81%) patients who received EOA, a lumbar epidural catheter was placed just prior to surgery, injected with local anesthetic for intraoperative analgesia, and injected with preservative-free morphine at appropriate intervals postoperatively to relieve pain. Fifty-eight patients (19%) used PCA which consisted of small self-administered boluses of intravenous narcotics. All patients were seen daily to ensure adequate analgesia and to treat side effects. Utilizing a 0-10 verbal rating scale (0 = no pain; 10 = worst pain imaginable), mean pain with EOA was 0.75 at rest and 2.6 with coughing. Mean pain ratings with PCA were 2.8 at rest and 5.0 during coughing. Side effects with EOA included nausea or vomiting (28%) and pruritus (20%). The only side effect of significance with PCA was nausea or vomiting (21%). All patients improved with treatment of side effects. Acceptance of these techniques is indicated by a steady increase in the number of gynecologic oncology surgical patients utilizing these modalities (50% at the outset to 87% currently).

Analgesia↗
PubMed1989

Fetal and maternal considerations in the management of stage I-B cervical cancer during pregnancy.

The timing of treatment for stage I-B cervical carcinoma diagnosed during pregnancy is complicated by conflicting concerns for fetal survival and control of malignancy. There were 11 pregnant women with stage I-B cervical carcinoma diagnosed prior to fetal viability since 1969. Six patients were managed with termination of pregnancy and radical hysterectomy with pelvic lymphadenectomy. In 5 patients, treatment was delayed for 6 to 17 weeks and then delivery was accomplished by cesarean section followed directly by radical hysterectomy and pelvic lymphadenectomy. Two of the infants experienced complicated neonatal courses and would have benefited from additional delay. Benefits that could be achieved by delaying delivery for the fetus were calculated from a review of 600 inborn infants without congenital anomalies admitted to the neonatal intensive care (NICU) during 1984 and 1985. Neonatal mortality decreased from 32.8% at 26-27 weeks to 2.7% at 34-35 weeks gestation. Similar improvements in neonatal morbidity were demonstrated. Although adverse maternal outcomes were not associated with delay, an evaluation of risk cannot be derived from this series. Significant fetal benefit can accrue from relatively short delays in planned delivery dates. When stage I-B cervical carcinoma is diagnosed during pregnancy and when fetal survival is desired, delivery should be delayed to achieve fetal maturity, rather than only potential viability.

Adult↗
PubMed1989

The morbidity and benefits of concurrent gracilis myocutaneous graft with pelvic exenteration.

This study was undertaken to evaluate the morbidity and potential benefits of concurrent gracilis myocutaneous graft with exenteration. All patients undergoing exenteration from 1962-1986 were reviewed, of whom 24 had concurrent grafts. The mean operative time, blood loss, and hospital stay were not different in patients with versus without grafts. The rate of fistula formation in the hospital was less in the graft group (P = .004) but was not different when compared with contemporary patients only. The total infection rate (wound and pelvic) was decreased in the graft group (P = .04) when graft infections were excluded. The major problem with the graft was significant necrosis of the flap(s) in nine of the 24 patients. There were no life-threatening complications attributed to concurrent placement of gracilis myocutaneous flaps. Experience with the technique is improving the cosmetic and functional outcome of the neovagina formed with the graft. Patients most likely to benefit from this procedure include those requiring immediate reconstruction or those with potentially poor healing due to high-dose pelvic radiation, including intraoperative radiation.

Female↗
PubMed1988

Whole abdomen radiation for minimal residual epithelial ovarian carcinoma after surgical resection and maximal first-line chemotherapy.

Ten patients with Stage III epithelial ovarian received whole abdomen radiation therapy after extensive courses of chemotherapy and second or third laparotomies. All patients had less than 2-mm diameter residual disease. The major side effect was bone marrow suppression which led to decreased dose or field size in four patients. Five patients have recurred and three of these have died. Further treatment after recurrence was compromised by bone marrow suppression. While 40-50% of selected patients may respond to this approach, numerous alternatives are being explored that would not handicap further treatment to the same degree and may have equal response rates.

Abdomen↗
PubMed1988

Glassy cell carcinoma of the cervix redefined.

Glassy cell carcinoma of the cervix has been classically regarded as a poorly differentiated adenosquamous carcinoma, infrequently diagnosed and associated with a poor outcome regardless of the modality of therapy. The histologic characteristics associated with this lesion are also frequently encountered among undifferentiated large-cell, nonkeratinizing cervical carcinomas. In a review of all undifferentiated large-cell carcinomas of the cervix encountered at the University Hospital in Seattle, Washington, over an eight-year period, 29 cases appeared to display the characteristic histologic criteria described as typical for glassy cell carcinoma. All cases were stage Ib lesions, and 28 were treated by radical hysterectomy. The mean age was ten years younger than that of the usual patient treated at this institution with stage I carcinoma. Fourteen of these patients (45%) have developed recurrent carcinoma, and in all but one, the interval to recurrence was less than eight months. Only two have survived after second-line salvage therapy. The current survival rate among the 29 women is 55%. These observations suggest that the poor prognosis ascribed to the classically defined glassy cell carcinoma also holds true for this extended group of large-cell, undifferentiated cervical cancers that display similar histologic features and pursue a similarly aggressive clinical course.

Adenocarcinoma↗
PubMed1987

Adjunctive hysterectomy following radiation therapy for bulky carcinoma of the uterine cervix: prognostic implications of tumor persistence.

Twenty-five patients underwent adjunctive extrafascial hysterectomy 14-60 days following completion of external and intracavitary irradiation for bulky carcinoma of the uterine cervix. Review of the operative histopathology and correlation with subsequent patient outcomes suggests that morphologically persistent cancer is prognostically ominous and that cancer near the surgical margin is viable in the majority of instances.

Adenocarcinoma↗
PubMed1987

Radical reirradiation for recurrent or second primary carcinoma of the female reproductive tract.

Twenty-five women have been treated with a second course of irradiation for recurrent cancer or a second primary carcinoma arising within a previously irradiated pelvic volume. Fourteen patients have been rendered cancer-free (56%) with follow-up ranging from 10 to 61 months. Three of these patients have died of intercurrent disease. Seven of these patients have experienced major complications (50%), necessitating surgical intervention in three cases. The rationale for reirradiation and techniques of retreatment are discussed. Prognostic factors are analyzed and criteria for patient selection are identified.

Adult↗
PubMed1987

High dose para-aortic lymph node irradiation for gynecologic cancer: technique, toxicity, and results.

A technique for high dose (5600-6100 cGy) extended field irradiation to the para-aortic lymph nodes is described. Fourteen patients have been treated with this technique, of whom 10 have had histologic confirmation of para-aortic node metastases. With follow-up ranging from 11 to 78 months, 7 of 14 patients are alive and clinically cancer-free. Acute effects of extended field treatment on patient weight and circulating blood counts are analyzed, and late treatment morbidity assessed. The findings suggest that such treatment, executed with modern equipment and appropriate technique, is not significantly more hazardous than pelvic irradiation, and can result in a substantial probability of disease-free survival.

Adult↗
PubMed1985

Lymphatic spread in carcinoma of the vulva.

A study of 153 patients with squamous cell carcinoma of the vulva is reviewed. Regional node metastases were present in 20%, and lymphatic spread proved the single most significant prognostic factor in this disease. Recurrent carcinoma developed in 47% of cases with nodal metastases. Lymph node metastases were directly related to stage of disease, tumor differentiation, lesion size, and depth of invasion. Sixty percent of nodal disease was not suspected by clinical examination. No patient developing recurrent disease after identification of positive nodes survived the disease. Surgical staging based only upon size of lesion and presence of nodal metastases appears to offer a clearer prognostic profile than conventional clinical staging. The pattern and frequency of nodal spread suggest that in selected instances modifications of the standard surgical treatment of vulvar cancer may be appropriate.

Adult↗
PubMed1984

Adjuvant postoperative pelvic radiation for carcinoma of the uterine cervix: pattern of cancer recurrence in patients undergoing elective radiation following radical hysterectomy and pelvic lymphadenectomy.

Thirty-seven patients with invasive cervical cancer have been referred to the Department of Radiation Oncology at the University of Washington following radical hysterectomy and pelvic lymphadenectomy. Patients at high-risk for tumor recurrence were selected for adjuvant pelvic irradiation because of adverse risk factors identified on pathological study of the hysterectomy specimen. All patients were treated because of possible residual, microscopic carcinoma. Fourteen patients (38%) developed recurrent cancer, of whom 10 (27%) manifested initial failure within the irradiated volume. Possible explanations for this observation are discussed.

Brachytherapy↗
PubMed1983

Treatment variables in the management of endometrial cancer.

A review was made of 240 women with endometrial carcinoma who were treated at the University Hospital in Seattle, Washington, between 1961 and 1979. The most common predisposing factor was a history of exogenous hormones, elicited in 46.7%. As predicted, such patients exhibited a more favorable outcome. Twelve percent of patients developed recurrent disease, and the vagina was the most common site of recurrence. However, 85% of patients with vaginal recurrence had received preoperative radiation therapy. Nodal sampling was a phase of the primary surgical treatment of the disease in 41 of the 240 patients. An effort to focus on this issue was made by including in a separate review 26 additional patients similarly managed in 1980 and 1981, thereby raising to 67 the total number of patients with nodal sampling. Fifty-nine of these patients had Stage I endometrial cancer. In these patients, histologic grade of tumor and depth of invasion determined at the time of operation appear to serve as reasonable predictors of nodal involvement.

Adult↗
PubMed1983

Treatment of intraperitoneal metastatic adenocarcinoma of the endometrium by the whole-abdomen moving-strip technique and pelvic boost irradiation.

Between October 1961, and November 1978, 31 patients with intraperitoneal metastatic adenocarcinoma of the endometrium were treated by whole-abdomen moving-strip technique and pelvic boost irradiation. In 27 patients, with residual disease less than or equal to 2 cm, the corrected 5-year survival rate was 80%. The absolute 5-year survival rate was 63%. Within this group of 27 patients, the favorable prognostic trends were Stage III, incidental findings, and age less than 50 years. Tumor-reductive surgery to 2 cm or less residual disease was beneficial. Only one patient required operative correction for a complication of radiotherapy. The four patients who had residual disease greater than 2-cm disease died from tumor.

Adenocarcinoma↗
PubMed1982

Acute nonlymphocytic leukemia after therapy with alkylating agents for ovarian cancer: a study of five randomized clinical trials.

We evaluated the occurrence of acute nonlymphocytic leukemia (ANL) among 1399 women with ovarian cancer who were treated in five randomized clinical trials. Of the 1399 women, 998 had been treated with alkylating agents, and among these, 12 cases of ANL were observed; the expected number was 0.11. Ten patients with ANL had received melphalan, and two chlorambucil. ANL was not observed in 401 women who had been treated with surgery or radiation or both, without alkylating agents. The excess risk of ANL that was associated with alkylating-agent therapy was 5.8 cases per 1000 women per year, and the cumulative seven-year risk of ANL among patients who were treated with chemotherapy alone was indistinguishable from that observed in patients receiving both radiation and chemotherapy. A positive correlation between initial drug dose and the risk of ANL was suggested. These data underscore the need to assess other cytotoxic agents and regimens of drug administration to identify those that do not have harmful late effects.

Acute Disease↗
PubMed1978

Cryocoagulation of the endometrium at the uterine cornua.

A cryoprobe that will produce coagulation necrosis and subsequent scar formation of the cornual areas of the uterus has been tested. A discussion is made of the developmental program, including the design of the instrument, efficacy and safety testing in baboons, and preliminary investigations of the safety of this procedure in man.

Animals↗