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Biomedical subjects

B McCormick

Publications and source records attributed to B McCormick.

At least 37 records · Page 2Linked to original sources
PubMed2000

NCCN Practice Guidelines for Breast Cancer.

The therapeutic options for patients with noninvasive or invasive breast cancer are complex and varied. In many situations, the patient and physician have the responsibility to jointly explore and ultimately select the most appropriate option from among the available alternatives. With rare exception, the evaluation, treatment, and follow-up recommendations contained within these guidelines were based largely on the results of past and present clinical trials. However, there is not a single clinical situation in which the treatment of breast cancer has been optimized with respect to either maximizing cure or minimizing toxicity and disfigurement. Therefore, patient and physician participation in prospective clinical trials allows patients not only to receive state-of-the-art cancer treatment but also to contribute to the improvement of treatment of future patients.

Breast Neoplasms↗
PubMed1999

Breast conservation therapy for invasive breast cancer in Ashkenazi women with BRCA gene founder mutations.

BACKGROUND: Germline mutations in the BRCA1 and BRCA2 genes are associated with an increased risk of breast cancer. Whether women with breast cancer who have inherited mutations in these genes have a different outcome after breast conservation therapy than women with "sporadic" cancer is unresolved. Consequently, we compared the outcomes after breast conservation therapy in Ashkenazi women with or without germline mutations in BRCA1 and/or BRCA2 (hereafter called BRCA). METHODS: We studied 305 women of Ashkenazi Jewish descent undergoing breast-conserving treatment for 329 invasive breast cancers. We reviewed their clinical records, retrieved their archival tissue samples, and tested those samples for the founder mutations BRCA1 185delAG, BRCA1 5382insC, and BRCA2 6174delT. Genetic results were linked to clinical data and outcomes by univariate and multivariate analyses. All Pvalues are two-sided. RESULTS: We detected mutations in BRCA genes in 28 of 305 women. Women with BRCA mutations were more likely to be diagnosed with cancer before the age of 50 years (P<.001) and to have lymph node involvement (P =.04). Ipsilateral breast tumor recurrence was more common in women with BRCA mutations, although this did not reach statistical significance (relative risk [RR] = 1.79; 95% confidence interval [CI] = 0.64-5.03). Women with mutations were more likely to develop contralateral breast cancer (RR = 3.50; 95% CI = 1.78-8.74; P =.001). Distant disease-free survival was shorter in women with mutations (66.2% versus 84.3% at 10 years; P =.05), as was breast cancer-specific survival (71.9% versus 87.2% at 10 years; P =.02). Tumor stage and nodal status, but not mutation status, were predictive of distant disease-free and breast cancer-specific survival in multivariate analysis. CONCLUSIONS: Women with BRCA founder mutations are at increased risk for breast cancer-related events after breast conservation. However, mutation status is not an independent predictor of survival and should not influence decisions regarding adjuvant therapy. The increased contralateral breast cancer risk in women heterozygous for BRCA mutations mandates careful surveillance.

Analysis of Variance↗
PubMed1999

Long term follow-up of women with ductal carcinoma in situ treated with breast-conserving surgery: the effect of age.

BACKGROUND: Although in recent years there has been a dramatic increase in both the incidence of ductal carcinoma in situ (DCIS) and breast-conserving therapy for patients who have this disease, the optimal treatment for these patients remains controversial. Most data regarding outcomes have come from small, retrospective studies, with little data published from prospective, randomized studies. This study investigates the effects of age, postoperative breast irradiation, and other factors on local relapse free survival after breast-conserving surgery for women with DCIS in a large, single-institution series. METHODS: A review was performed of all patients with DCIS who underwent breast-conserving surgery at Memorial Sloan-Kettering Cancer Center from 1978 through 1990. Of the 171 cases identified, data on follow-up and radiation therapy were available for 157. All available pathology slides (132 of 157) were rereviewed to determine histologic subtype, nuclear grade, presence of necrosis, and microscopic tumor size. Sixty-five patients (41%) received postoperative radiation therapy; selection criteria evolved over the time period. The median follow-up was 74 months. RESULTS: Factors that were significantly (P< or =0.05) associated with a lower recurrence rate were older age, noncomedo subtype, lower nuclear grade, negative margins, and postoperative radiation therapy. The 6-year actuarial recurrence rate was 9.6% for patients who received postoperative radiation therapy and 20.7% for patients who had excision only (P = 0.05). Comparison of patients of ages > or =70, 40-69, and <40 years revealed a significantly lower risk of recurrence with increasing age. Actuarial 6-year local relapse rates were 10.8%, 14.0%, and 47.2%, respectively (P = 0.047). A benefit from radiation therapy was suggested for each age group. There was no statistically significant correlation between age group and any histologic factor examined. In multivariate analysis, only margin status was statistically significant (P = 0.05). CONCLUSIONS: In addition to margin status, pathologic factors, and the use of radiation therapy, age is another factor that should be considered in assessing the risk of local recurrence after breast-conserving surgery for patients with DCIS.

Adult↗
PubMed1999

Intensity-modulated tangential beam irradiation of the intact breast.

PURPOSE: To evaluate the potential benefits of intensity modulated tangential beams in the irradiation of the intact breast. METHODS AND MATERIALS: Three-dimensional treatment planning was performed on five left and five right breasts using standard wedged and intensity modulated (IM) tangential beams. Optimal beam parameters were chosen using beams-eye-view display. For the standard plans, the optimal wedge angles were chosen based on dose distributions in the central plane calculated without inhomogeneity corrections, according to our standard protocol. Intensity-modulated plans were generated using an inverse planning algorithm and a standard set of target and critical structure optimization criteria. Plans were compared using multiple dose distributions and dose volume histograms for the planning target volume (PTV), ipsilateral lung, coronary arteries, and contralateral breast. RESULTS: Significant improvements in the doses to critical structures were achieved using intensity modulation. Compared with a standard-wedged plan prescribed to 46 Gy, the dose from the IM plan encompassing 20% of the coronary artery region decreased by 25% (from 36 to 27 Gy) for patients treated to the left breast; the mean dose to the contralateral breast decreased by 42% (from 1.2 to 0.7 Gy); the ipsilateral lung volume receiving more than 46 Gy decreased by 30% (from 10% to 7%); the volume of surrounding soft tissue receiving more than 46 Gy decreased by 31% (from 48% to 33%). Dose homogeneity within the target volume improved greatest in the superior and inferior regions of the breast (approximately 8%), although some decrease in the medial and lateral high-dose regions (approximately 4%) was also observed. CONCLUSION: Intensity modulation with a standard tangential beam arrangement significantly reduces the dose to the coronary arteries, ipsilateral lung, contralateral breast, and surrounding soft tissues. Improvements in dose homogeneity throughout the target volume can also be achieved, particularly in the superior and inferior regions of the breast. It remains to be seen whether the dosimetric improvements achievable with IMRT will lead to significant clinical outcome improvements.

Breast↗
PubMed1998

Pathogen-induced chemokine secretion from model intestinal epithelium is inhibited by lipoxin A4 analogs.

Enteric pathogens induce intestinal epithelium to secrete chemokines that direct movement of polymorphonuclear leukocytes. Mechanisms that might downregulate secretion of these proinflammatory chemokines and thus contain intestinal inflammation have not yet been elucidated. The antiinflammatory activities exhibited by the arachidonate metabolite lipoxin A4 (LXA4) suggests that this eicosanoid, which is biosynthesized in vivo at sites of inflammation, might play such a role. We investigated whether chemokine secretion could be regulated by stable analogs of LXA4. Monolayers of T84 intestinal epithelial cells were infected with Salmonella typhimurium, which elicits secretion of distinct apical (pathogen-elicited epithelial chemoattractant) and basolateral (IL-8) chemokines. Stable analogs of LXA4 inhibited S. typhimurium-induced (but not phorbol ester-induced) secretion of both IL-8 and pathogen-elicited epithelial chemoattractant. LXA4 stable analogs did not alter bacterial adherence to nor internalization by epithelia, indicating that LXA4 stable analogs did not block all signals that Salmonella typhimurium activates in intestinal epithelia, but likely led to attenuation of signals that mediate chemokine secretion. Inhibition of S. typhimurium-induced IL-8 secretion by LXA4 analogs was concentration- (IC50 approximately 1 nM) and time-dependent (maximal inhibition approximately 1 h). As a result of these effects, LXA4 stable analogs inhibited the ability of bacteria-infected epithelia to direct polymorphonuclear leukocyte movement. These data suggest that LXA4 and its stable analogs may be useful in downregulating active inflammation at mucosal surfaces.

Cells, Cultured↗
PubMed1998

External beam radiation therapy for choroidal neovascularization.

OBJECTIVE: This study aimed to determine the effect of external beam radiation therapy on choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: The study design was a nonrandomized clinical trial with an historic control group. PARTICIPANTS: A total of 91 patients were treated with external beam radiation. These patients were compared retrospectively to the 119 patients in a control group. INTERVENTION: Patients with subfoveal CNV who did not meet the criteria for laser treatment defined by published reports from the Macular Photocoagulation Study Group or who did not want laser treatment were considered for radiation therapy in a nonrandomized, prospective clinical trial. Additional entry criteria for this prospective study included visual acuity better than or equal to 20/320 on the Early Treatment Diabetic Retinopathy Study chart and a lesion size less than 12 disc areas. The patients were treated with 5 fractions of 200 cGy 6 MV external beam photons. MAIN OUTCOME MEASURES: The visual acuity measured at baseline was compared to the visual acuity after 1 year of follow-up. RESULTS: The mean baseline visual acuity of the 91 patients entered into the Radiation Study was 20/80. After 1 year, 83 patients (91.2%) completed follow-up, and their mean visual acuity dropped to 20/200. By comparison, the mean baseline visual acuity of the control patients also was 20/80, and after 1 year, the control subjects had a mean visual acuity of 20/125. At 1 year of follow-up, 49.4% of patients treated with radiation and 38.1% of the control subjects lost 3 or more lines of visual acuity (P = 0.16). CONCLUSIONS: This study found that external beam radiation using 1000 cGy in 5 fractions, a dose similar to that used in previous studies, was not effective in the treatment of CNV secondary to AMD. These results suggest that patients should not be treated with this dose of external beam radiation for CNV secondary to AMD.

Aged↗
PubMed1997

Surgical treatment of 70 patients with brain metastases from breast carcinoma.

BACKGROUND: Brain metastases are diagnosed in 15% of patients with metastatic breast carcinoma. Most patients are treated with whole-brain radiotherapy (WBRT) and/or chemotherapy. The information on surgical results is sparse. METHODS: Among 709 patients with tumors metastatic to the brain who underwent craniotomy at Memorial Hospital, New York, New York, between January 1974 and December 1993, 70 (10%) had a primary breast carcinoma. Their treatment outcomes were analyzed retrospectively. RESULTS: The median age at diagnosis of primary breast carcinoma and brain metastasis was 46 and 50 years, respectively. All but two patients had metachronous diagnoses of breast carcinoma and brain metastasis. The median interval between both diagnoses in this subgroup was 28 months. In all 70 patients, the overall median survival was 54 months after diagnosis of the primary breast tumor and 16.2 months after diagnosis of the brain tumor. Only 5 patients (7%) were alive at last follow-up. The overall median survival after brain surgery was 14 months. Four patients died within 30 days of craniotomy. Twelve patients had a solitary cerebellar metastasis and 16 had multiple metastases; their median survival was 10.9 months and 14.8 months, respectively. There was no statistical difference in survival for patients who had single or multiple lesions. The median survival of 22 patients with positive hormonal receptor (estrogen receptor [ER] or progesterone receptor [PR]) was significantly longer than the median survival of 20 patients with negative ER/PR (21.9 vs. 12.5 months, P < 0.05). For 35 patients (50%) who had brain lesions > or =4 cm, the median survival was 11 months, compared with 16.3 months for patients with smaller lesions (P = 0.16, not significant [NS]). Patients age < or =50 years versus >50 years had survival of 17.3 and 11.1 months, respectively (P = NS). Neurologic deficit prior to craniotomy shortened survival for 24 patients to 11.5 months, compared with 17.4 months for patients without deficit (P = NS). Fifteen patients experienced failure with WBRT prior to undergoing craniotomy, and their median survival was shorter than for those who underwent craniotomy as the initial treatment (6.3 vs. 15.8 months, P < 0.03). However, their survival after diagnosis of brain metastasis was not significantly different (19.2 vs. 16.1). Forty-seven patients received WBRT postoperatively, and 9 patients did not receive adjuvant radiation therapy. Subsequent relapse in the brain was diagnosed in 27 patients, and 8 of them underwent reresection. One-year, 2-year, 3-year, and 5-year survival rates were 53%, 25.7%, 18.6%, and 7%, respectively. In multivariate analysis, the adjuvant WBRT after craniotomy and the absence of meningeal carcinomatosis were the only significant predictive variables for longer survival. CONCLUSIONS: In a subset of selected patients, craniotomy followed by WBRT can positively impact survival.

Adult↗
PubMed1997

The conservative management of Paget's disease of the breast with radiotherapy.

BACKGROUND: The purpose of this study was to evaluate the feasibility of breast-conserving therapy involving limited surgery and definitive radiotherapy as a treatment for Paget's disease, and to determine the disease free and overall survival associated with this approach. METHODS: The authors retrospectively reviewed the charts of all patients treated during the period 1980-1994 for Paget's disease of the breast who did not present with a palpable mass or mammographic density. Through a collaborative review, 30 cases were identified. A biopsy confirming the presence of typical Paget's cells was performed on all patients. All patients received external beam radiotherapy to the breast, with a median dose of 50 gray (Gy). Ninety-seven percent received a boost to the remaining nipple or tumor bed, with a median dose to the tumor bed of 61.5 Gy. RESULTS: The median follow-up for surviving patients was 62 months. Three patients (10%) developed a recurrence in the breast as the only site of first failure, and 2 additional patients (7%) experienced failure in the breast as a component of first failure. The median time to local failure was 69 months. The 5- and 8-year actuarial estimates of local failure as the only site of first failure were 9% (95% confidence interval [CI], 0-20%) and 16% (95% CI, 0-31%), respectively. Of the 5 patients with local failures, 3 were among 22 patients (14%) who underwent complete resection of the nipple or nipple-areola complex, compared with 2 failures among 6 patients (33%) after partial resection (P = 0.29). There were no failures among 2 patients who had a biopsy only. Four of 5 local failures were salvaged by mastectomy, and 3 of these patients were free of disease after a median follow-up of 52 months. The 5- and 8-year estimates of disease free survival for the overall series were both 95% (95% CI, 87-100%); cause specific overall survival was 100% at 8 years. CONCLUSIONS: Breast-conserving therapy involving complete resection of the nipple-areola complex followed by definitive radiotherapy is a viable alternative to mastectomy in the treatment of Paget's disease. High rates of disease free and cause specific survival, in addition to adequate local control, justify consideration of a conservative approach.

Adult↗
PubMed1997

Patterns of mammographically detected calcifications after breast-conserving therapy associated with tumor recurrence.

BACKGROUND: Some authors have suggested that mammographically evident calcifications that would be considered benign in other situations can be due to carcinoma in women who have undergone breast conservation. This study was undertaken to determine if the pattern of calcifications associated with recurrent tumors detected mammographically differs from that observed in carcinomas developing de novo. METHODS: Mammograms of 22 cases of local tumor recurrence were retrospectively reviewed, and calcifications associated with recurrence were characterized according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) classification. RESULTS: Tumors were usually associated with > or = 10 calcifications (77%; 17 of 22 cases). Recurrences commonly contained very suspicious patterns of calcifications with linear forms present in 15 cases (68%) and pleomorphic calcifications present in 17 cases (77%). The distribution of calcifications was usually clustered (73%; 16 of 22 cases) or segmental (18%; 4 of 22 cases). Recurrences were usually obviously malignant (BI-RADS Category 5), and were characterized as such in 77% of cases. The remainder were indeterminate, requiring biopsy (BI-RADS Category 4). Recurrent tumors containing calcifications always contained some suspicious forms. Less worrisome types of calcifications were sometimes observed, including punctate calcifications in 36% and coarse calcifications in 14% of cases, but were always associated with more malignant patterns. CONCLUSIONS: Local tumor recurrences, when associated with mammographically evident calcifications, usually have a pattern highly suspicious for malignancy, although indeterminate forms can be the only calcifications present. Characteristically benign patterns of calcifications are not observed in recurrent tumors unless they are associated with more suspicious calcifications. Therefore, women without more worrisome patterns need not undergo biopsy because of the presence of these nonworrisome calcifications.

Breast Diseases↗
PubMed1997

Implant brachytherapy: a novel treatment for recurrent orbital rhabdomyosarcoma.

BACKGROUND: Orbital rhabdomyosarcoma is the most common primary malignancy of the orbit in childhood. Tumor resection and exenteration were the preferred treatment modalities for rhabdomyosarcoma. In the past 20 years, however, combined local radiation and systemic chemotherapy have shown excellent survival results. Tumor recurrence after any of the aforementioned therapies is almost always fatal. We have developed a novel treatment for recurrent disease that has resulted in long-term survival for three patients. METHODS: Three patients with recurrent orbital rhabdomyosarcoma were previously treated with primary radiation and chemotherapy. At the time of recurrence, exenteration and localized brachytherapy were performed. An individually molded poly(methylmethacrylate) (Lucite; E. I. du Pont de Nemours & Co., Wilmington, Del.) device loaded with radioactive iodine seeds delivered localized high-dose radiation, 6000 cGy over 6 days, to the orbit without irradiating the brain. RESULTS: All patients are alive and free of disease with follow-up ranging from 4 years and 4 months to 8 years and 4 months. CONCLUSION: A novel technique of delivering localized radiation to the orbit of three children with recurrent orbital rhabdomyosarcoma appears curative.

Brachytherapy↗
PubMed1997

A comparative study of pure tubular and tubulolobular carcinoma of the breast.

Tubular carcinoma is a distinctive subtype of invasive, well-differentiated mammary ductal carcinoma that has a good prognosis when treated by modified radical mastectomy. Little is known about tubulolobular carcinoma. The purpose of this study was to compare the frequency of prognostic factors in pure tubular carcinoma (PTC) and tubulolobular carcinoma (TLC). We studied 90 cases of pure PTC and 17 cases of TLC. The following results were found for PTC: size 0.5 to 1.8 cm (mean, 1.2 cm); multifocality in 18 of 90 cases (20%); axillary lymph-node dissection performed in 51 patients; positive axillary lymph nodes in six of 51 cases (12%); recurrences in one of 90 cases (1%), local. The following results were found for TLC: size 0.6 to 2 cm (mean, 1.3 cm); multifocality in five of 17 cases (29%); axillary lymph-node dissection performed in 14 patients; positive axillary lymph nodes in six of 14 cases (43%); recurrences in two of 17 cases (12%); one local and one systemic, each after mastectomy. The relationship between multifocality and positive axillary lymph nodes was as follows: In PTC, the percentage of positive axillary lymph nodes in multifocal cases was 33%, and in nonmultifocal cases, 7%; in TLC, the percentage of positive axillary lymph nodes in multifocal cases was 60% and in nonmultifocal cases, 33%. In conclusion, multifocality and positive axillary lymph nodes were more frequent in TLC than in PTC. Multifocality appeared to predispose to positive lymph nodes in both PTC and TLC. The distribution of prognostic factors suggest that TLC is a higher-grade lesion than PTC. Long-term follow-up is needed to correlate multifocality with recurrence after breast conserving therapy.

Adenocarcinoma↗
PubMed1997

Multileaf collimation in the treatment of the intact breast.

PURPOSE: To compare multileaf-collimator beam shaping and conventional metal-alloy blocking in irradiation of the intact breast after breast-conserving surgery. MATERIALS AND METHODS: Transmission dose was measured in a phantom, by using both types of blocking with 6- and 15-MV photon beams. Buildup data were collected, using a 6-MV photon beam, comparing open fields to various beam modifiers. RESULTS: Contralateral breast transmission was reduced with the multileaf collimator from 4% to 1%. With the jaws and multileaf collimator, the primary beam component of 0.5% was eliminated. Buildup data for the multileaf collimator most closely resembled the surface dose when a blocking tray is not used and were slightly lower than those for the conventional mounted blocks. This relates to the use of the lower of the two sets of wedges on the multileaf collimator, which is closer to the patient and thus enhances the surface dose relative to the dose with an open field and no wedge. CONCLUSION: Multileaf-collimator blocking for primary breast treatment is similar to conventional blocking, and the transition from one technique to another should be uneventful. The transmission dose to the contralateral breast is decreased with the multileaf collimator.

Breast Neoplasms↗
PubMed1997

Changing performance of the Health Visitor Distraction Test when targeted neonatal screening is introduced into a health district.

The change in the performance of the HVDT as targeted neonatal hearing screening has been introduced has been examined for the Nottingham district. The records for all children born in the period 1984-1993 within the district and having a permanent hearing loss of > or = 50 dB in the better ear have been examined. The referral route leading to ascertainment of the hearing loss as well as the result of any screening tests were noted. The data shows an increase in the number referred prior to the HVDT, mainly as a result of neonatal screen failure. At the same time there has been a reduction in the sensitivity of the HVDT from 78% in the first half of the decade to 38% for the second half. There are also some indications of an increase in the coverage and the failure rate over the time. Possible reasons for these changes are discussed.

Evoked Potentials, Auditory, Brain Stem↗