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B G Haffty

Publications and source records attributed to B G Haffty.

At least 73 records · Page 4Linked to original sources
PubMed1992

Prognostic value of DNA flow cytometry in the locally recurrent, conservatively treated breast cancer patient.

PURPOSE: This study attempted to determine the prognostic value of DNA flow cytometry in the treatment of patients with locally recurrent, conservatively treated breast cancer. METHODS AND MATERIALS: Of 433 patients with clinical stage I and II breast cancer treated with conservative surgery and radiotherapy at Yale-New Haven Hospital before January 1985, 50 patients experienced an ipsilateral breast relapse as a first site of treatment failure. Using standard flow-cytometric techniques, DNA ploidy, DNA index, and S-phase fraction (SPF) were measured for 38 of the 50 (76%) paraffin-embedded specimens available for analysis. RESULTS: At a median postrecurrence follow-up of 5.8 years, the 5-year and disease-free survival rates following ipsilateral breast treatment failure were 48% and 54%, respectively. Sixty-three percent of the recurrent tumors were DNA diploid and 37% were aneuploid. Both DNA ploidy and SPF were statistically significant prognostic indicators for 5-year survival and disease-free survival after local recurrence. The 5-year survival rate of the DNA diploid population was 64%, compared with 15% in the aneuploid population (P < .02). Patients with low SPF (< 12%) experienced an 83% 5-year survival rate, compared with a 24% 5-year survival rate in patients with high SPF (> or = 12%) (P < .03). Ploidy and SPF were combined to define the categories of favorable (diploid, low SPF) and unfavorable (diploid, high SPF or any aneuploid subgroups). Patients in the favorable category experienced an 89% 5-year postrecurrence survival rate and a 100% disease-free survival rate, whereas patients in the unfavorable category had a 24% 5-year survival rate and a 32% disease-free survival rate (P < .01). The flow cytometry as a factor correlated with other clinical parameters previously shown to be of prognostic significance in this patient population. In a multivariate analysis, flow cytometry was a statistically significant and independent prognostic factor for disease-free survival following local recurrence. CONCLUSIONS: DNA ploidy and SPF as measured by currently available flow-cytometric techniques show promise as a tool in determining prognosis for the patient with locally recurrent breast cancer. Implications of these findings with respect to issues of adjuvant systemic therapy at the time of local recurrence are discussed.

Adult↗
PubMed1991

Adjuvant whole-abdominal radiation therapy in uterine papillary serous carcinoma.

Nine patients from 34 to 74 years of age (median, 67 years of age) with uterine papillary serous carcinoma (UPSC) were treated with whole-abdominal radiation therapy (WART) on an adjuvant basis after cytoreductive surgery. All patients were treated with megavoltage photons to an abdominopelvic field to a median dose of 2500 cGy, with continued treatment to a whole pelvic field to a median dose of 4500 cGy. Three patients received additional boost to the vaginal apex. Follow-up time ranged from 6 to 31 months (median, 25 months) after completion of WART. Six patients had recurrent disease at 5 to 20 months (median, 7.5 months). Four of these patients died of their disease during the follow-up period. Three of six patients in whom treatment failed had disease at the vaginal apex. None of these patients received boost radiation therapy to that site. In contrast, two of three patients remaining disease free were treated with additional vaginal apex irradiation. Based on these results, the authors do not routinely recommend WART for adjuvant treatment of UPSC. They do, however, recommend vaginal apex irradiation for these patients.

Adult↗
PubMed1991

Mammographically detected breast cancer. Results with conservative surgery and radiation therapy.

At Yale-New Haven Hospital (New Haven, CT) treatment of early stage breast cancer with conservative surgery and radiation therapy (CS & RT) has been utilized with increasing frequency since the 1960s. The authors have reviewed their experience with specific reference to the outcome of those patients whose breast cancer was detected on routine screening mammography. To achieve adequate follow-up, only patients treated before December 1984 are included in this analysis. Of 438 patients treated with CS & RT before December 1984, a total of 41 patients (9%) had nonpalpable lesions detected on routine screening mammography and were treated with CS & RT to the intact breast. Only two patients received adjuvant hormonal therapy and no patients received adjuvant systemic therapy. There has been only one breast failure and one death due to cancer in this group of patients resulting in actuarial survival and breast recurrence-free rates of 100% at 5 years and 92% at 10 years. These results stress the importance of routine screening mammography and raise questions regarding the role of adjuvant systemic therapy in this selected group of patients.

Adult↗
PubMed1991

Prognosis following local recurrence in the conservatively treated breast cancer patient.

At Yale-New Haven Hospital conservative treatment of early stage breast carcinoma with lumpectomy and radiation therapy has been used with increasing frequency since the 1960s. We have reviewed our experience with specific reference to prognosis following local recurrence. Between January 1962 and December 1984 a total of 433 patients were treated with conservative surgery and radiation therapy using standard techniques. As of December 1989, with minimum evaluable follow-up of 5 years and a median follow-up of 8.21 years, there have been a total of 50 ipsilateral breast recurrences resulting in a 5-year actuarial breast recurrence rate of 8%. Extent of disease at the time of local recurrence was clinically categorized as localized (less than 3 cm without dermal involvement) or diffuse (greater than 3 cm and/or with dermal involvement). Seventy-two percent of the recurrences were at or near the original tumor site whereas 28% recurred elsewhere in the breast. At a median follow-up post recurrence of 5.0 years (range 0.3-16.9 years), the 5-year actuarial survival for breast recurrences was 59% and the 5-year disease-free survival was 65%. A number of clinical and pathological features at the time of original diagnosis as well as at the time of local recurrence were tested as possible prognostic indicators for survival following local recurrence. By univariate analysis, significant factors associated with survival following local recurrence included extent of local disease at the time of recurrence (p less than .01), time to local recurrence (p less than .03), with later recurrences doing better, and site of local recurrence (p less than .01), with recurrences elsewhere in the breast doing better. We conclude from this large single institutional experience with a median follow-up post-recurrence of over 5 years that patients experiencing a local recurrence in the conservatively treated breast have a relatively favorable prognosis. The prognostic factors correlating with survival and implications regarding adjuvant systemic therapy at the time of local recurrence are discussed.

Adult↗
PubMed1991

Prognostic factors for local recurrence in the conservatively treated breast cancer patient: a cautious interpretation of the data.

Between 1962 and 1984, a total of 433 patients were treated at Yale-New Haven Hospital with conservative surgery and radiation therapy (CS + RT) to the intact breast. As of January 1990, with a minimum assessable follow-up of 5 years and a median follow-up of 8.21 years, there have been a total of 50 breast recurrences resulting in a 5-year actuarial breast recurrence rate of 8%. Of all clinical factors tested, young age was the most significant prognostic factor for local recurrence (P less than .03). In addition, patients with pathologically involved lymph nodes were noted to have a lower local recurrence rate than patients with pathologically negative axillae (P less than .05). These findings were especially notable given the fact that the node-positive group had a higher percentage of T2 tumors and a higher percentage of patients in the young age group. These paradoxical findings, however, may be explained by the fact that 88% of the node-positive patients underwent adjuvant systemic therapy in the form of either systemic chemotherapy or hormonal therapy, while only 8% of node-negative patients underwent any adjuvant systemic therapy. When analyzed as a function of adjuvant therapy, those patients receiving adjuvant therapy had a lower local recurrence rate than those patients not receiving adjuvant therapy (P less than .08). We conclude that adjuvant systemic therapy impacts on the ipsilateral breast recurrence rate in patients treated with CS + RT. The implications of this study in light of the widespread use of adjuvant systemic therapy are discussed.

Actuarial Analysis↗
PubMed1990

Regional nodal irradiation in the conservative treatment of breast cancer.

At this institution conservative treatment of breast cancer was begun in the 1960's. The following analysis represents our experience through 1984 with specific reference to the management of the regional lymph nodes. A total of 432 patients with clinical stage I and II breast cancer were treated between 1962 and 1984 with lumpectomy and radiation therapy. The breast was treated with tangential fields to a median dose of 4800 cGy and electron conedown to a total tumor bed dose of 6400 cGy. Axillary dissection was not routinely performed, particularly in the earlier years. More recently, axillary dissection has been used with increasing frequency if it was felt that the results of the dissection would influence systemic treatment. One hundred eighty-seven patients (43%) underwent axillary dissection (30% pathologically positive) and routinely received regional nodal irradiation (median dose 4600 cGy) to the internal mammary and supraclavicular lymph nodes. Two hundred forty-five patients (57%) did not undergo axillary dissection and routinely received regional nodal irradiation to the internal mammary, supraclavicular, and entire axillary regions to a total median dose of 4600 cGy. As of May 1989 with a median follow-up of 7.5 years, there have been a total of 12 nodal failures for an actuarial nodal control rate of 97% at 5 years and 96% at 10 years. The actuarial 5-year regional nodal control rate was the same for both the group of patients receiving regional RT alone without axillary dissection and the group of patients receiving axillary dissection and supraclavicular/internal mammary radiation. There has been minimal morbidity associated with this treatment policy. We conclude that regional nodal irradiation as described above, with or without axillary dissection, results in a high rate of regional nodal control and minimal treatment morbidity in patients undergoing conservative treatment of early stage breast cancer.

Axilla↗
PubMed1990

Radiation therapy for ductal carcinoma in situ of the breast.

The optimal treatment for ductal carcinoma in situ (DCIS) of the breast is undefined. At three Connecticut hospitals 1) Yale-New Haven Hospital, New Haven; 2) Uncas-on-Thames Hospital, Norwich; 3) Norwalk Hospital, Norwalk, breast conservation therapy with lumpectomy followed by radiation therapy (RT) has been offered to women with DCIS as an alternative to mastectomy. From 1974 through 1987, 60 women with DCIS have been treated with RT. With a minimum evaluable follow-up of two years, a maximum follow-up of 15 years, and a median follow-up of 3.6 years, there have been no cancer-related deaths in the 60 patients. Four of the 60 patients (6.7%) developed a local breast recurrence but were salvaged with further surgical therapy (three patients with mastectomies and one patient with repeat lumpectomy). Only one patient (2%) has died of nonmalignant disease and the remaining 59 patients (98%) survived cancer-free. The five-year actuarial breast recurrence-free rate was 95%. These results suggest that breast conservation therapy with RT is a viable treatment option for women with DCIS.

Adult↗
PubMed1989

Conservative surgery with radiation therapy in clinical stage I and II breast cancer. Results of a 20-year experience.

Conservative surgery and radiation therapy have been increasingly utilized at Yale-New Haven (Conn) Hospital since the 1960s. This analysis represents our experience from 1962 to 1982, with a total of 281 patients having a minimum assessable follow-up of five years and a median follow-up of 7.4 years. Five- and ten-year actuarial survivals were 83% and 67%, respectively. The actuarial breast recurrence-free rate was 91% at five years and 80% at ten years. Of 31 patients having recurrences in the breast alone, the actuarial five-year survival following recurrence was 48%. Twenty-eight (90%) of these 31 recurrences were salvageable with mastectomy or repeated wedge resection. Patients experiencing an early breast recurrence (less than three years) following initial treatment had a poorer prognosis than patients having recurrences later.

Adult↗
PubMed1989

Conservative surgery and radiation therapy in breast carcinoma: local recurrence and prognostic implications.

Conservative surgery with radiation therapy has been used with increasing frequency at Yale-New Haven Hospital since the late 1960's, resulting in a minimum evaluable follow-up time of 5 years on 278 patients treated prior to 1982. The radiation therapy technique generally encompassed treatment to the breast and regional lymph nodes of 4600 cGy with an electron beam boost to the tumor bed of 6400 cGy. Axillary dissection was performed in 19%, adjuvant chemotherapy in 7.3%, and adjuvant hormonal therapy in 5.7%; 65% were clinical Stage I and 35% were clinical Stage II. As of July 1987, with a minimum evaluable follow-up of 5 years and a median follow-up of 7.46 years, the actuarial 5- and 10-year survival for all 278 patients was 83% and 67%, respectively. The breast recurrence-free rate was 91% at 5 years and 80% at 10 years. Whereas the 5-year survival was significantly greater for clinical Stage I patients (91% vs 68%, p = .01), the breast recurrence-free rates did not significantly differ between clinical Stage I & II (93% vs 88%). There were 31 patients who failed in the breast alone as the first site of failure; 67% were at or near the primary site whereas 33% were distinctly removed from the primary site. Salvage mastectomy was performed in 25 patients, repeat wedge resection in two patients, and biopsy only in four patients. Axillary nodes were positive in five (33%) of 15 evaluable patients undergoing axillary dissection at the time of recurrence. The 5-year actuarial survival following local recurrence for the 31 patients was 48% at a mean follow-up of 5.06 years. The local recurrences were further subclassified into localized breast recurrences (LBR), defined clinically as greater than 3 cm and/or with dermal involvement. The 22 patients experiencing localized breast recurrences tended to occur later (median time to recurrence 4.3 years) than the nine patients experiencing a diffuse breast recurrence (median time to recurrence 2.9 years). At last follow-up, three (14%) of the 22 localized breast recurrences had subsequently failed distantly and none had subsequent local failure, whereas four (44%) of nine diffuse breast recurrences had subsequent distant failure and five (55%) of the nine diffuse breast recurrences experienced further local disease. The 5-year actuarial survival following salvage treatment was 90% for the localized breast recurrences and only 13% for the diffuse breast recurrences.

Breast Neoplasms↗
PubMed1988

Results of radical radiation therapy in clinical stage I, technically operable non-small cell lung cancer.

From 1970 to 1983, 1,646 lung cancer patients were referred for treatment to the Hunter Radiation Therapy Center, Yale-New Haven Hospital. Forty-three patients had clinical Stage I non-small cell lung cancer felt to be surgically resectable but were treated with radical radiation therapy either for medical reasons (37 patients) or because the patient refused surgery (six patients). This group of clinical Stage I lung cancer patients is understaged by modern criteria since the majority of patients did not have thoracic CT scans and staging was based on fairly limited clinical and radiographic studies. The histological diagnosis was squamous cell carcinoma in 53% of the Stage I patients, adenocarcinoma in 25%, and other non-small cell histologies in 22%. All patients were treated with megavoltage irradiation and the mediastinum was treated in 88% of the patients. Eleven patients were treated with a continuous course (CC) and 32 patients received split course (SC) therapy based on physician preference. The CC consisted of a median fraction size of 200 cGy to a total median dose of 5900 cGy in 6-7 weeks. The SC used a median fraction site of 275 cGy to a total median dose of 5400 cGy over a 6-week period with a 2-week rest in the middle of treatment. The actuarial survival rate of the 43 clinical Stage I patients was 36% at 3 years and 21% at 5 years. Intrathoracic failures occurred in 39% of the patients. Despite the fact that the CC group was similar to the SC group in terms of age, histology, and tumor extent, the CC patients had a lower thoracic failure rate (2/11) versus 15/32), a longer median survival (51.6 months versus 27 months), and a better actuarial 5-year survival rate (45% versus 12%) when compared to the SC patients. Using Cox regression analysis to compare survival curves, the CC group had a significantly better survival compared to the SC group (p = .04).

Adenocarcinoma↗
PubMed1987

Malignant biliary obstruction: intracavitary treatment with a high-dose-rate remote afterloading device.

A new technique of intracavitary brachytherapy for malignant biliary obstruction is presented. The technique involves the use of a high-dose-rate remote afterloading device, which offers all the advantages of conventional brachytherapy with the added benefit that the dose can be delivered in a single treatment over a few minutes. The potential problems associated with conventional brachytherapy are thereby minimized.

Aged↗
PubMed1985

Diastolic time during recovery from upright exercise in persons without heart disease.

To assess the relation between heart rate and diastolic time (cardiac cycle minus electromechanical systole) during the recovery period from upright exercise, 12 normal volunteers were studied immediately after and 2 and 5 minutes after exercise in the upright position. Although heart rate was significantly lower at 5 minutes compared with 2 minutes after exercise (106 vs 116 beats/min), there was significant shortening of diastolic time (from 251 to 230 ms) and total diastole per minute (from 28,634 to 24,220 ms/min). The explanation of this phenomenon appears to be disproportionate lengthening of diastolic time at 2 minutes after exercise, which must represent physiologic response due to increased left ventricular filling as well as continuing adrenergic effects, which would be diminished at 5 minutes. This lengthening of diastolic time also would maintain decreased subendocardial blood flow caused by increased end-diastolic volume.

Adult↗
PubMed1983

Left ventricular performance during exercise: response of ear densitogram derivative.

The peak derivative of the ear densitogram (PD) has been shown to track left ventricular (LV) function during exercise. Measured as percent change in amplitude from resting control, PD in normal subjects slowly and consistently increased throughout exercise and to 2 minutes of recovery, followed by return to control level. In contrast, PD in patients with coronary artery disease rapidly increased only to 1 minute of exercise, with no significant subsequent increase. Expressed as a percent change from control, the response of normal subjects differs significantly from that of patients with coronary artery disease at 1 and 4 minutes of exercise, and 2 minutes of recovery. The PD increase in normal subjects from end-exercise to 2 minutes of recovery may be attributable to the heart rate decreasing faster than venous return, associated with LV ejection time, which is significantly shorter than heart rate-predicted values 2 minutes after exercise.

Coronary Disease↗
PubMed1983

Tracking left ventricular performance noninvasively. Response of the peak ear pulse derivative during cardiac catheterization.

The peak derivative of the ear densitograph displacement pulse was monitored on 12 patients undergoing routine coronary angiography and left ventricular angiography. Simultaneous recording of cardiac output, heart rate, systolic time intervals, and ear densitogram were obtained throughout the progression from before angiographic injections to postcoronary angiography to after left ventricular angiography. The peak derivative of the ear densitogram (PD) consistently tracked mean systolic ejection rate, and changes in PD showed good correlation with changes in ejection rate (r=.749, p less than 0.0001). The PD of the ear densitogram appears to be a reliable noninvasive tool for tracking left ventricular function during hemodynamic and other challenges.

Angiocardiography↗
PubMed1983

Noninvasive tracking of peripheral resistance by ear densitography.

Owing to the interaction between the left ventricle and the arterial system, pulse contour during ejection is significantly affected by changes in peripheral resistance. Quantitative description of the pulse configuration as a function of peripheral resistance involves invasive investigation of complex frequency and impedance spectra. The ear densitogram noninvasively yields a pulse wave shown to closely track changes in the central arterial pulse; in this investigation, its decreasing systolic slope responded to changes in the peripheral resistance like those in the central pulse and in arterial models. The decreasing slope of the ear densitogram pulse (RNAD) can reliably track changes in peripheral resistance.

Aorta↗
PubMed1982

Rate of rise of the carotid pulse. An investigation of observer error in a common clinical measurement.

Bedside estimation of the rate of rise of the carotid pulse is a standard clinical observation whose reliability has not been determined. To ascertain interobserver agreement (primary objective) and compare the velocity of rise of the carotid displacement (not pressure) pulse (supplementary objective), three blinded observers evaluated, ranked and palpated the velocity of rise of carotid pulse as "unremarkable," "slow" or "rapid" in 20 consecutive patients. The relative rate of rise of the recorded carotid pulse was represented by the angle between baseline and the initial carotid peak at a standard paper speed of 100 mm/s. Chi-square analyses yielded no significant interobserver agreements (probability [p] 0.22 to 0.51). There was also no correlation of observers' ranking of rise of carotid pulse with the ranking from independent measurement of the recorded pulse rise velocity (p = 0.10 to 0.99). Observer agreement was unanimous only four times and even in these instances was consistent with the recorded carotid pulse rise velocity only once. The results suggest that unbiased observers cannot reliably discriminate slow from "normal" velocity of rise of carotid pulse.

Adult↗