Biomedical subjects

B Fowble

Publications and source records attributed to B Fowble.

54 records · Page 3Linked to original sources

PubMed1990

A nondivergent three field matching technique for breast irradiation.

Effective radiation therapy to intact breasts requires the delivery of adequate dose to a large target volume using complex beam arrangements. A semi-empirical method is described to determine the correct gantry, collimator, and couch positions for a geometrically accurate field match among adjoining radiation beams. The technique uses a metal rod and chain combination to aid determination of the proper couch setting under remote fluoroscopy control. A couch position error of more than half a degree is easily detectable by this technique.

Breast Neoplasms↗

PubMed1990

The results of radiotherapy for orbital pseudotumor.

Between January 1982 and March 1987, 23 patients (26 orbits) were treated for orbital pseudotumor with radiation therapy at the Department of Radiation Oncology, Hospital of the University of Pennsylvania. The patients were referred for clinical relapse after steroid taper in 70%, no response to steroids in 17%, and no steroid treatment (refused or contraindicated) in 13%. Presenting symptoms/signs included soft tissue swelling in 92% of orbits, pain in 92%, proptosis in 85%, and extraocular muscle dysfunction or ptosis in 69%. Decreased visual acuity was seen in only 19% of orbits. Biopsy was performed in nine patients. Treatment consisted of 2000 cGy in 2 weeks in 10 fractions for all patients. Median follow-up was 41 months, with a mean of 53 months, and a range of 21-92 months. Complete response was documented in 87% of orbits with soft tissue swelling, 82% with proptosis, 78% with extraocular muscle dysfunction, and 75% with pain. Of the five patients with visual acuity defects, three experienced complete recovery. There was no difference in complete response in patients biopsied versus those not biopsied. Overall, 17 orbits have remained in complete orbital response with no further steroid requirement (66%). Three orbits suffered local relapse at some point following radiation therapy and were retreated with steroids. These three orbits had durable local control off steroids at last follow-up (11%). Therefore, 77% of orbits attained durable local control and were steroid independent with radiation therapy alone or radiation therapy followed by steroids for relapse. Only one patient developed systemic lymphoma with follow-up. No pretreatment clinical factor reached statistical significance with respect to prognosis following radiation therapy at the less than or equal to .05 level. There were no significant acute or chronic side effects secondary to treatment. Steroids should continue to be first line treatment for orbital pseudotumor, but radiation therapy has a well-defined role in cases of steroid failure or in patients unable to tolerate steroid therapy.

Adolescent↗

PubMed1990

Results of radiotherapy in the treatment of acromegaly: lack of ophthalmologic complications.

Between 1956 and 1988, 25 patients were treated with radiotherapy for acromegaly. Acromegalic features were present in 24 (96%), visual field deficits in 4 (16%), and suprasellar extension was present in 7 patients (28%). The median growth hormone level was 40.2 ng/ml (range: 13.8-105) in 15 patients. Initial therapy consisted of radiotherapy alone (19 patients) or surgery followed at some interval by radiation (6 patients). The radiation therapy was administered with megavoltage equipment in 23 (92%) patients and orthovoltage equipment in 2 patients. The median total dose was 46 Gy (range: 24-53.44 Gy) with 21 patients receiving at least 45 Gy. With a median follow-up of 53 months (range: 18-205), 2 of the 19 patients treated with radiotherapy alone have required surgery for symptomatic recurrences. Both are alive and in remission at 69 and 158 months following craniotomy. Thus, the success of radiotherapy as a primary modality in this series is 17/19 (89%). None of the six patients treated postoperatively have recurred. At the time of last follow-up the visual fields remained normal and visual acuity stable in the 21 patients with no pre-existing visual deficits. The four patients with prior visual field deficits improved with therapy. There were no cases of radiation optic neuropathy, brain necrosis or second intracranial malignancies. Seven patients (28%) had evidence of hypopituitarism attributed to the radiotherapy. Growth hormone levels after radiotherapy showed a median of 5.4 ng/ml (range: 3.2-40.0) in 15 patients. Eleven of 15 patients (73%) had growth hormone levels less than 10 ng/ml. Radiation use in acromegaly remains a safe and effective modality assuming careful attention is paid to technique, total dose, and fraction size.

Acromegaly↗

PubMed1990

Delayed radiation injury to the retrobulbar optic nerves and chiasm. Clinical syndrome and treatment with hyperbaric oxygen and corticosteroids.

Thirteen patients with delayed radiation injury to the optic nerves and chiasm were treated with hyperbaric oxygen (HBO) and corticosteroids. These patients experienced painless, abrupt loss of vision in one (6 patients) or both (7 patients) eyes between 4 and 35 months after receiving radiation doses of at least 4500 cGy to the region of the chiasm. Diagnostic evaluation including neuro-imaging and lumbar puncture showed no recurrent tumor and no other cause for visual loss. No patient's vision improved during treatment or follow-up lasting between 1 and 4 years. There were no serious complications of treatment.

Adrenal Cortex Hormones↗

PubMed1989

Frequency, sites of relapse, and outcome of regional node failures following conservative surgery and radiation for early breast cancer.

Between 1970 and 1986, 990 patients underwent excisional biopsy and radiation for clinical Stage I or II breast cancer. A limited axillary dissection (levels I and II) was performed in 914 of these patients. The median follow-up was 40 months from the initiation of radiation. Thirty-one patients developed a regional node failure as their first site of recurrence either with (12 patients) or without (19 patients) simultaneous distant metastases. The median interval to recurrence was 27 months (range 4-59). The 5-year actuarial rate for an isolated regional node recurrence (without simultaneous distant metastases) was 3%. The most common site for a regional node failure was the axilla (17 patients) followed by the supraclavicular nodes (13 patients). Salvage therapy was effective for an axillary +/- breast failure with 10/14 patients alive with no evidence of disease. Prognosis was related to the site of recurrence as well as the presence or absence of distant metastases. The 5-year actuarial survival from initial treatment for all patients with a regional node failure was 63% with a 3-year actuarial survival of 57% from diagnosis of recurrence. Regional node failure was related to the number of axillary nodes removed at the time of dissection and patient age.

Adult↗

PubMed1989

Age as a prognostic factor for patients treated with definitive irradiation for early stage breast cancer.

From 1977 to 1986, 88 breast cancers in 86 women age less than or equal to 35 years were treated with definitive irradiation following breast-conserving surgery. The records of these cases were reviewed and compared to 808 breast cancers in 798 women age greater than or equal to 36 years treated similarly during the same time period. All women had AJC clinical Stages I or II invasive carcinoma of the breast and had undergone an axillary surgical staging procedure to determine pathologic lymph node staging prior to receiving definitive radiotherapy. There was no statistical difference between the younger and older women in terms of 5-year actuarial overall survival (94% vs. 90%), NED survival (78% vs. 81%) or relapse-free survival (70% vs. 77%). Although the younger women tended to have an earlier pattern of failure, the difference between the actuarial percentage of failures at 5 years for the two age groups was not significantly different for local only first failure (9% vs. 5%), regional only first failure (6% vs. 3%), and local and regional only first failure (0% vs. 1%). Subset analyses also did not show a difference between the younger and older patients. Although longer follow-up will be needed to confirm these observations, our 5-year results show that younger patients less than or equal to age 35 do not have an adverse outcome in terms of survival, local control, or regional control when compared with older patients greater than or equal to age 36. Potential candidates for definitive irradiation following breast-conserving surgery should not be excluded for treatment solely on the basis of younger age less than or equal to 35 years.

Adult↗

PubMed1989

The role of radiation therapy in the management of childhood craniopharyngioma.

Between 1965 and 1986, 31 children were treated for craniopharyngioma at the Children's Hospital of Philadelphia. Total removal was attempted in all patients. Some patients received radiation therapy following subtotal removal. Of the patients whose first resection was subtotal, five received radiation and seven did not. Four of the 5 patients who were radiated (80%) are stable (median 89 months, range 42-155 months) and one recurred at 42 months, failed salvage with total removal, and subsequently died of disease. Of the seven who were not irradiated, all had recurrences (median 12 months, range 3-192 months) and one died of disease. Nineteen patients initially had total removal and none received adjuvant radiation. One patient died postoperatively. Of the 18 remaining patients, 6 had recurrences (median 24 months, range 7-100 months) and 12 (66%) are stable (median 42 months, range 9-133 months). One of these stable patients died of endocrine complications 24 months after initial surgery. Fourteen of the 31 patients recurred. Two died with recurrence and one required no further treatment. Eleven had second resections following initial surgical removal. Seven of these 11 went on to receive radiation and four did not. All seven who were radiated are stable (median 33 months, range 1-228 months); whereas 1 of the 4 who were not radiated recurred again at 18 months. This patient had a third resection followed by radiation therapy and is now stable at 20 months. After initial surgery (and before radiation, when given) 26 of 31 patients had panhypopituitarism, 4 had partial deficits, and 1 was normal. Severe diencephalic syndrome, loss of visual acuity, and intellectual deficits were no more frequent in patients treated with total removal, subtotal removal, and in patients who received radiation. We conclude that radiation has an important role following subtotal removal and for salvage treatment after initial surgery. Aggressive attempt at total removal does result in prolonged progression-free survival in some patients. Extensive resections may result in significant mortality and endocrine morbidity. This review suggests that subtotal removal and radiation results in outcomes at least as favorable as treatment with total removal alone.

Adolescent↗

PubMed1989

Intraductal noninvasive breast cancer: a comparison of three local treatments.

In selecting appropriate local treatment for intraductal noninvasive breast cancer, the following factors should be considered: Method of detection (palpable mass vs mammographic finding only vs incidental finding at biopsy for a benign lesion), the size and extent of the tumor, margins of resection, and the histologic pattern. Mastectomy is recommended for extensive tumors, and for patients with gross multicentric disease. Conservative surgery and radiation is an alternative for patients with focal lesions, negative margins of resection, and no evidence of residual microcalcifications on a post-biopsy mammogram. Consideration of wide excision alone should be restricted to those with occult primary tumors less than or equal to 2.5 cm in size, detected by mammographic microcalcifications only, and where complete excision is confirmed. The histologic subtype or nuclear grade may be especially important in evaluating patients for wide excision alone.

Breast Neoplasms↗

PubMed1989

Conservative surgery and radiation in the treatment of early (stages I and II) breast cancer. Long-term results.

Multiple nonrandomized series as well as prospective randomized trials have demonstrated that the long-term results of conservative surgery and appropriate radiation are equal to those of mastectomy for the treatment of early breast cancer. Moderate doses of radiation combined with surgical excision result in optimal local-regional control, good to excellent cosmetic results in the majority of patients and minimal complications. The long-term potential carcinogenic effects of radiation have not materialized in the clinical setting and the incidence of contralateral breast cancer and second non-breast malignancy is comparable to that reported after mastectomy. Based on this data, conservative surgery and radiation continues to represent a valid alternative to mastectomy for the treatment of early breast cancer.

Breast Neoplasms↗

PubMed1988

Radiotherapy for the prevention of local-regional recurrence in high risk patients post mastectomy receiving adjuvant chemotherapy.

From 1977 to 1986, 63 patients at high risk for isolated local-regional recurrence following mastectomy and adjuvant chemotherapy received post-operative radiotherapy. All patients had operable primary tumors (T1-3a). For entire group the mean and median number of positive nodes were 10 and 8, respectively. Radiotherapy consisted of 4500 to 5000 rad to the chest wall and regional nodes. Chemotherapy consisted of CMF +/- prednisone (45 patients), CAF (16 patients), and other variable regimens (2 patients). Relapse occurred in 23 patients with only two patients experiencing an isolated local-regional recurrence. In 3 patients local-regional recurrence appeared simultaneously with or following distant metastases and in 18 patients the pattern of failure was distant metastases alone. With a median follow-up of 28 months (range 9-87 mo.), 40 patients are alive without disease, 9 are alive with disease, and 14 have died with disease. The 4-year actuarial overall survival is 67% and the 4-year actuarial disease-free survival is 47%. The 4-year actuarial probability of an isolated local-regional recurrence is 5%. Complications related to the radiation included a 9% incidence of moderate to severe arm edema. This study demonstrates the ability of radiation to reduce the incidence of local-regional recurrence in a previously identified high risk group of patients and has produced encouraging survival results with minimal morbidity.

Actuarial Analysis↗

PubMed1988

Definitive irradiation for early stage breast cancer: The University of Pennsylvania experience.

From 1977 to 1984, 552 breast cancers in 548 women were treated with definitive irradiation following breast-conserving surgery at the Hospital of the University of Pennsylvania and the Fox Chase Cancer Center. All patients had invasive carcinoma and were AJC clinical Stage I or II. Pathologic axillary lymph node staging was known for all cases. The 5-year actuarial survival for the entire group was 93% with an NED survival of 81%. The 5-year survival for clinical Stage I and II patients was 97 and 87%, respectively, with a corresponding NED survival of 87 and 73%, respectively. For pathologic Stage I and II patients, the corresponding survival figures were 97 and 89%, respectively, with NED survival rates of 86 and 76%, respectively. The overall 5-year actuarial local failure rate was 6%, and the rate of local only as the first failure was 3%. The overall local-regional failure rate was 13% with a local-regional only first failure rate of 8%. These results compare favorably with other reported series and contribute a substantial number of patients to the increasing experience with definitive irradiation following breast-conserving procedures. The relatively low incidence of breast recurrence may be related to the emphasis on integrating the surgical, pathologic, and radiotherapeutic aspects of treatments, as well as the emergence of a re-excision policy for patients at high risk to have residual tumor.

Adult↗

PubMed1988

Identification of a subgroup of patients with breast cancer and histologically positive axillary nodes receiving adjuvant chemotherapy who may benefit from postoperative radiotherapy.

Risk factors for isolated local-regional (LR) recurrence following mastectomy for breast cancer were analyzed in a review of 627 women entered into Eastern Cooperative Oncology Group (ECOG) adjuvant chemotherapy trials between 1978 and 1982. Premenopausal patients were randomized to cyclophosphamide, methotrexate, and fluorouracil (5-FU) (CMF), cyclophosphamide, methotrexate, 5-FU, and prednisone (CMFP), or cyclophosphamide, methotrexate, 5-FU, prednisone, and tamoxifen (CMFPT). Postmenopausal patients were randomized to observation, CMFP, or CMFPT. Median follow-up time was 4.5 years. At 3 years, 225 patients relapsed and in 70 (31% of failures, 11% of all patients) the initial site was LR without distant metastases. In a multivariate analysis, the risk of an isolated LR recurrence significantly correlated with the number of positive axillary nodes, the primary tumor size, the presence of tumor necrosis, and the number of axillary nodes examined. Factors that significantly discriminated between an isolated LR recurrence and distant metastasis were the number of positive nodes and primary tumor size. Patients with four to seven positive nodes or tumor size greater than or equal to 5 cm had a chance of developing an isolated LR recurrence almost equal to the risk of distant metastases. These findings suggest a potential for improved survival in this subset of patients with the addition of postmastectomy radiation to chemotherapy, and continue to emphasize the presence of a group of patients at high risk for isolated LR recurrence despite adjuvant chemotherapy.

Adult↗

PubMed1987

Determination of depth for electron breast boosts.

A technique has been developed to determine the depth for the electron boost treatments for patients undergoing definitive irradiation for early stage breast cancer. A series of parallel link chains are placed on the breast over the clinically determined site of the boost. Using fluoroscopy, the physician confirms that the chains overlie the tumor bed which is outlined by radiopaque surgical clips placed at the time of the breast biopsy. A pair of orthogonal films and/or rotational stereo shift films are obtained with a standard simulator unit. Using the image of the chains to define the surface contour, the depth of each surgical clip is measured directly from the orthogonal films or calculated from the rotational stereo shift films. With this information, the physician can determine the appropriate electron energy to cover the target volume. This method was tested by comparison with depths measured from CT scan, and close agreement was demonstrated.

Breast Neoplasms↗

PubMed1986

Results of re-excisional biopsy of the primary tumor in preparation for definitive irradiation of patients with early stage breast cancer.

From December 1977 through November 1984, 251 patients underwent a re-excisional biopsy procedure in preparation for definitive radiation therapy because of uncertainty in the extent of the initial biopsy procedure. Analysis of the cases was limited to patients with AJC Clinical Stages I or II breast cancer and whose initial biopsy procedure demonstrated invasive carcinoma. Sixty-three percent (158/251) of the 251 re-excisions were positive for residual tumor, and 37% (93/251) did not show any residual tumor. Of the positive re-excisions, 85% (134/158) revealed an invasive component of tumor; 15% (24/158) revealed only non-invasive disease. For patients whose initial biopsy was described as incisional only, 97% (64/66) had residual tumor; 51% (94/185) of patients with an initial excisional biopsy had residual tumor. Because of the extremely high rate of positive re-excision in patients with an initial incisional biopsy, these cases were excluded from the remainder of the analysis. When the pathologic margin of the initial biopsy specimen was described as positive, 60% (15/25) had residual tumor on re-excision and 49% (79/160) when the pathology margin was unknown. Of the clinical T1 lesions, 45% (57/126) had positive re-excision, and of the clinical T2 lesions, 63% (37/59) were positive. When a post-biopsy mammogram (i.e. following initial biopsy procedure but before re-excision) showed residual microcalcifications, 86% (12/14) had residual tumor found in the re-excision specimen. Based on these findings, indications for re-excisional biopsy of the primary tumor are: initial incisional biopsy, positive or unknown pathologic margin on an initial excisional biopsy specimen, or residual microcalcifications on post-biopsy mammogram. When inked margins were negative on pathological examination of an initial excisional biopsy specimen, re-excision of the primary tumor bed was not recommended. These results suggest that a re-excisional biopsy procedure may be an important component of the overall treatment approach to assure removal of all tumor, and should continue to be used when indicated prior to definitive irradiation of the breast for early stage breast cancer.

Biopsy↗

PubMed1986

A practical method of delivering the posterior axillary boost for the treatment of patients with breast cancer.

A practical technique for delivery of the posterior axillary boost is reported. A standard breast board is modified to allow for treatment of all fields in a single clinical set-up, and the posterior boost is delivered through a cut-out in the breast board. This technique is simple, is efficient, and eliminates problems of patient positioning and daily reproducibility.

Axilla↗

PubMedDate not supplied

Visual loss following treatment of sphenoid sinus carcinoma.

A 71-year-old woman developed complete third nerve palsy and total blindness of the right eye one month after completing a course of radiotherapy for sphenoid sinus carcinoma over a 13-month period. Differential diagnosis included recurrence of the tumor, radiation-induced second neoplasm, empty sella with chiasmal prolapse and secondary chiasmal arachnoid adhesions, and radionecrosis. Magnetic resonance imaging demonstrated gadolinium contrast enhancement of the right intracranial optic nerve and chiasm, suggesting a radionecrosis process.

Aged↗

PubMedDate not supplied

Local recurrence of breast cancer in the stereotactic core needle biopsy site: case reports and review of the literature.

Early mammographic detection of nonpalpable breast lesions has led to the increasing use of stereotactic core biopsies for tissue diagnosis. Tumor seeding the needle tract is a theorectical concern; the incidence and clinical significance of this potential complication are unknown. We report three cases of subcutaneous breast cancer recurrence at the stereotactic biopsy site after definitive treatment of the primary breast tumor. Two cases were clinically evident and relevant; the third was detected in the preclinical, microscopic state. All three patients underwent multiple passes during stereotactic large-core biopsies (14 gauge needle) followed by modified radical mastectomy. Two patients developed a subcutaneous recurrence at the site of the previous biopsy 12 and 17 months later; one had excision of the skin and dermis at the time of mastectomy revealing tumor cells locally. In summary, clinically relevant recurrence from tumor cells seeding the needle tract is reported in two patients after definitive surgical therapy (without adjuvant radiation therapy). Often, the biopsy site is outside the boundaries of surgical resection. Since the core needle biopsy exit site represents a potential area of malignant seeding and subsequent tumor recurrence, we recommend excising the stereotactic core biopsy tract at the time of definitive surgical resection of the primary tumor.

Adult↗

PubMedDate not supplied

Evidence for selective use of bone scans in early stage breast cancer.

To determine the usefulness of bone scans in detecting metastatic disease in women with early stage breast cancer, records of 193 patients who had bone scans preformed and underwent breast conservation therapy at a single institution were reviewed. Patients with invasive T1 or T2 breast carcinomas were eligible for this study; patients with a true positive bone scan were excluded from conservation therapy and, thus, were excluded from this study. The incidence of false positive bone scans in this study population was 32.6% (63/193 patients). Patients over 50 years of age had a significantly greater incidence of false positive bone scans (p<0. 05). In the 63 patients with false positive bone scans, 101 radiographs were performed to exclude metastatic disease in areas of increased uptake identified on bone scan. No significant difference in the rate of false positive bone scans was seen in relation to tumor size, pathologic or clinical nodal status or hormone receptor activity of the primary tumor. Thus, selective use of bone scans is advocated in patients with early stage (T1 or T2) breast cancer.

Adult↗