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Biomedical subjects

C A Bull

Publications and source records attributed to C A Bull.

At least 19 recordsLinked to original sources
PubMed2002

Radiation therapy for cervix carcinoma: benefits of individualized dosimetry.

This study is a presentation of the prospective collection of data on patients treated by radical radiotherapy at Westmead Hospital between December 1989 and December 1998. The impact of the routine use of individualized dosimetry and lower brachytherapy dose on patients was examined, by comparing the historical series of patients treated between 1989 to 1991 to the later patients treated with inividualised dosimetry. There were 163 patients treated with external beam and intracavitary radiotherapy during this period. Histology was squamous carcinoma in 80% (132 patients), adenocarcinoma in 13% (22 patients), and adenosquamous carcinoma in 6% (9 patients). Patients were generally treated with 50 Gy in 25 fractions to the pelvis followed by 1 low dose rate caesium intracavitary brachytherapy insertion. Patients who had dosimetry generally received 20 Gy to point A via the insertion compared to 30 Gy in the non-dosimetry group. Median follow-up was 62 months. Only 22% (18) of patients failed with disease outside the pelvis. Pelvic control was similar in the patients who had dosimetry as opposed to no dosimetry (P=0.8). In the dosimetry group there were less grade III or higher bowel toxicity (P=0.01) and less vaginal fistulae (P=0.03). The actuarial two-year survival was 56.2% in the no dosimetry group and 68.6% in the dosimetry group. When controlled for stage and performance status patients who had dosimetry had a statistically significant greater overall survival (P=0.02). Thus we found that the routine use of dosimetry was associated with a lower brachytherapy dose, decreased complications, without any decrease in local control or survival.

Adult↗
PubMed1999

Sexual dysfunction after radical radiation therapy for prostate cancer: a prospective evaluation.

OBJECTIVES: To determine the rate of loss of potency after radiation therapy (RT). METHODS: Two hundred ninety men with localized prostate cancer were evaluated prospectively before and after RT to the prostate alone for change in erectile function. Data were collected before treatment by way of a questionnaire using a simple three-tier potency scale and after RT by the clinician at each follow-up visit. RESULTS: At 12 months, 62% of men (90 of 146) who were potent before RT preserved their potency; at 24 months, this figure was 41%. Men who had "normal" potency before RT were statistically significantly more likely to remain potent after RT. CONCLUSIONS: We believe that detailed knowledge of potency rates before and after RT is important for current decision-making and for evaluating new treatment techniques.

Adult↗
PubMed1999

Primary invasive cancer of the vagina: outcome and complications of therapy.

The aim of the present study was to review the characteristics of cases of vaginal cancer, results of treatment and complications occurring at Westmead Hospital over the period 1979-96. International Federation of Gynaecology and Obstetrics (FIGO) staging and Eastern Cooperative Oncology Group (ECOG) status had been recorded prospectively, while other information was obtained retrospectively, including complications using the Franco-Italian Glossary. There were 37 eligible patients, 34 of whom were treated radically. Five-year survival for stage I was 90%, for stage II it was 50%, and for stage III it was 40%. There was only one stage-IV patient. The majority of patients who relapsed did so locally (63%). Using the Franco-Italian Glossary 10.8% of patients had, at worst, G0 toxicity, 21.6% had G1 toxicity, 29.7% had G2 toxicity, 37.8% had G3 toxicity, and no patients had G4 toxicity. Seven patients (18.9%) had a laparotomy for a complication of therapy. Excluding the three palliative patients and controlling for disease stage, it was found that there was a trend to improved survival in patients who had brachytherapy and those who suffered worse complications. While results for treatment of early stage vaginal cancer appear good, new techniques, particularly those that improve local control, are required for higher stage disease.

Adult↗
PubMed1997

WART revisited: the treatment of epithelial ovarian cancer by whole abdominal radiotherapy.

The present study investigated outcomes for 78 women with epithelial ovarian carcinoma treated by whole abdominal radiotherapy (WART) after cyto-reductive surgery at Westmead Hospital between 1980 and 1993. These patients had 5-year relapse-free and overall survival rates of 52 and 55%, respectively. The median follow-up was 7.5 years. Fifty-eight of the 78 women fulfilled the criteria as defined by the Princess Margaret Hospital's intermediate risk' category. These patients had both a relapse-free and overall survival rate of 62% at 5 years (P = 0.001 as compared with the remaining 20 women). Mild gastrointestinal upset was common during radiotherapy. Five women did not complete treatment. Late toxicity (grade 3 or more, using the Radiotherapy Oncology Group (RTOG) system) occurred in eight women, and five women required surgery for intestinal complications (6.4%). There were no deaths due to late side effects. In conclusion the results are consistent with those of other series in the treatment of epithelial ovarian cancer by adjuvant WART. When compared to a similar-stage disease treated with cisplatin-based chemotherapy, there is no evidence to support the exclusive use of chemotherapy.

Adult↗
PubMed1995

Concurrent 5-fluorouracil, mitomycin C and irradiation in locally advanced cervix cancer.

We reviewed 177 patients treated with radical radiotherapy for locally advanced (FIGO stages IIB, IIIA, IIIB) cervix cancer between January 1979 and December 1989. The radiotherapy was given by external beam treatment to the pelvis and by an intracavitary caesium insertion. Ninety-three patients also received chemotherapy which consisted of infusional 5-fluorouracil during the first and last weeks of the external beam component of the radiotherapy, combined with bolus mitomycin C (group A, 64 patients) or without mitomycin C (group B, 29 patients). These groups were compared with patients treated by radiotherapy alone (group C, 84 patients). The median follow-up was 7.2 years. The median survival time for all patients was 47 months, but was significantly higher (87 months, p = 0.004) for group A. Rates of relapse-free survival and local control were also higher in group A. Toxicity was assessed in detail using the Franco-Italian glossary. There was a relatively high rate of complications, particularly in group A, with 36% of patients having grade 3 or 4 complications. This increase in toxicity persisted through all follow-up time intervals. Patients in group B also demonstrated a higher rate of toxicity than group C, but this increase was limited to the first 6 months of follow-up. The use of mitomycin C in addition to radiotherapy and 5-fluorouracil should be regarded with caution, as other studies have also shown that toxicity is increased, but without improvements in survival.

Adenocarcinoma↗
PubMed1995

A developmental exploration of expectations for and beliefs about preventing bicycle collision injuries.

Investigated developmental and gender-related trends in 2nd, 5th, and 8th graders', undergraduates', and adults' reactions to simulated bicycle collisions. Recently, scientists have called for exploration of the developmental mechanisms that underlie childhood injury. Our laboratory has, in three separate studies, demonstrated age-related decreases in beliefs about the negative consequences of bicycle collision. These developmental decreases in the expected seriousness of outcome parallel age-related increases in injury risk. The present study examined two alternative explanations for cognitive differences that might be related to increased risk for bicycle injury with increasing age. Contrary to predictions, however, age and gender were unrelated to subjects' expectations for whether a collision would take place, be actively avoided, or fail to take place. Similarly, age and gender were unrelated to whether subjects believed they could remain safe, that safety equipment (e.g., helmets) would keep them safe, or that different behavior would keep them safe. Results fail to support these expectations and beliefs as alternative explanations to developmental and gender-related trends in bicycle injuries, and indirectly suggest the importance of children's beliefs about the seriousness of injury as a contributer to injury risk behavior.

Accidents, Traffic↗
PubMed1994

Socioenvironmental experiences, self-esteem, and emotional/behavioral problems in early adolescence.

Tested the role of self-esteem as a mediator of relationships between socio-environmental experiences and emotional/behavioral problems using a sample of 215 young adolescents (Grades 7-9). Socioenvironmental experiences were assessed using self-report questionnaire measures of social support and major and minor stressful events. Self-esteem was assessed using a self-report questionnaire, an interview, and a parent-report questionnaire. Emotional/behavioral problems were assessed using self-report, parent-report and teacher-report questionnaires. Utilizing structural equation modeling, the data were used to test a model in which self-esteem mediated the relationship between socioenvironmental experiences and emotional/behavioral problems. The hypothesized model provided a reasonably good fit to the data (normed fit index = .90). However, an alternative model which also allowed for direct effects of socioenvironmental experiences on emotional/behavioral problems produced a significant improvement in model fit. In this model, socio-environmental experiences had significant effects on emotional problems via both direct effects and indirect effects that indicated a mediating role for self-esteem. Only direct effects of socioenvironmental experiences were evident for behavioral problems.

Adolescent↗
PubMed1994

Radiotherapy and concurrent chemotherapy for oesophageal carcinoma.

This retrospective non-randomized study reports the outcome of 67 patients who received radical radiotherapy with or without two courses of concomitant chemotherapy using 5-fluorouracil and cis-platin at Westmead Hospital from 1985 to 1992. The overall median survival was 14.0 months, the actuarial 5-year survival was 18%, and median disease-free survival was 11.3 months. Forty-eight per cent of the 67 patients had complete endoscopic response and this resulted in a significantly improved survival for those patients. A pretreatment baseline Karnofsky performance > or = 80, and a baseline swallowing score > or = 80 also predicted for better survival. The development of acute toxicity did not predict the likelihood of developing chronic toxicity. The incidence of stricture formation (benign and malignant) requiring dilatation was 37%. There was no significant improvement in overall or disease-free survival, nor significant worsening of toxicity in the group of patients who received concurrent radiotherapy and chemotherapy compared with patients receiving radiotherapy alone.

Aged↗
PubMed1993

Role of bipedal lymphangiogram in radiation treatment planning for cervix cancer.

PURPOSE: The role of bipedal lymphangiogram in tailoring radiation portals in radical radiation therapy for Stages II or III cervix cancer is investigated. METHODS AND MATERIALS: The records and simulation films of 87 patients with Stage II or III carcinoma of the cervix treated with radical radiation therapy alone have been retrospectively reviewed. RESULTS: Sixty-two percent of patients who had a bipedal lymphangiogram, subsequently had their radiation fields altered from a "standard portal." The most frequently altered fields were the lateral margin of the postero anterior field and the anterior margin of the lateral fields. In order to cover the lymphatic channels in the pelvis in 90% of cases as outlined by the bipedal lymphangiogram, the lateral margins of the postero anterior fields would need to be 2.5 cm lateral to the pelvic brim and the anterior border of the lateral field, 0.5 cm anterior to the pubic symphysis. CONCLUSION: "Standard" fields adequately cover the median distribution of lymphatics, but may result in a geographic miss in some patients. Bipedal lymphangiograms allow a more accurate tailoring of pelvic lymphatic fields.

Australia↗
PubMed1992

Objective evaluation of the quality of palliation in patients with oesophageal cancer comparing surgery, radiotherapy and intubation.

The objective of this study was to prospectively evaluate the quality of palliation of 103 patients presenting to a joint oesophageal cancer clinic while recording the outcome in terms of treatment, morbidity, mortality and long-term survival. Twenty-five patients underwent surgical resection (S), 22 radical radiotherapy (RR), 30 palliative radiotherapy (PR), 13 intubation (I) and 13 had no treatment (NT). The quality of palliation was quantified by plotting a score out of 100 on a graph at each visit for Karnofsky performance, severity of pain and swallowing ability, then calculating the area under each curve created using an algorithm, Simpson's discrete approximation. Efficiency of palliation was estimated by comparing the area calculated to the maximum that could be achieved during the time frame being studied. The incidence of stricture (benign and malignant) was 16% after surgery and 50% after radical radiotherapy. Treatment mortality was as follows: RR, 0; S, 1 (4%); PR, 3 (7%); and I, 0. The median survival was 26 months after surgery and 16 months after radical radiotherapy. It was 6 months for palliative radiotherapy, 4 months for intubation and 4 months for no treatment. The difference in swallowing was the only statistical difference in the quality of palliation of patients having surgery and radical radiotherapy, there being no differences in patients having palliative measures.

Activities of Daily Living↗
PubMed1991

Synchronous cisplatin infusion during radiotherapy for the treatment of metastatic melanoma.

In two pilot studies, 55 patients with symptomatic metastases from malignant melanoma were treated with irradiation and concurrent cisplatin. In the first group, cisplatin was given as a continuous intravenous infusion of 20 mg/m2 per day on days 1-5 and 22-26, with irradiation on days 2, 5, 9, 16, 23 and 26. The second group received 20 mg cisplatin over 24 h commencing 1 h before each fraction of irradiation on days 1, 4, 8, 11, 15 and 18. The first series of 28 patients had 30 lesions treated. Nine (30%) of these lesions responded completely and 10 (33%) achieved partial response for an overall response rate of 63% (95% confidence interval 44-80%). Survival was not evaluated in this group. The second group was comprised of 27 patients, with one irradiated lesion each. 1 patient achieved a complete response and 13 (48%) a partial response for an overall response rate of 52% (32-71%). Median survival was 21 weeks (16-31 weeks). Treatment was well tolerated with nausea and vomiting being the most common toxicity. Synchronous cisplatin infusion with radiotherapy achieves high response rates in metastatic melanoma. Whether it is superior to radiotherapy alone will require evaluation in a randomised trial.

Adult↗
PubMed1990

Persisting cyclical uterine bleeding in patients treated with radical radiation therapy and hormonal replacement for carcinoma of the cervix.

Radical radiation therapy used for carcinoma of the cervix will ablate ovarian function. Since January 1986, our policy has been to administer oral combination oestrogen-progesterone replacement hormonal therapy to all premenopausal patients undergoing radical radiation with or without synchronous chemotherapy, for invasive cervix cancer. Five out of 22 (23%) such patients unexpectedly experienced between one and four episodes of cyclical per vaginal bleeding after the completion of radiation therapy. Bleeding episodes occurred in the absence of persistent tumor or radiation reaction, and suggest persisting endometrial response to exogenous hormonal stimulation. Uterine activity was temporarily retained in these five patients despite a minimal endometrial surface dose of between 4800 and 6490 cGy. The limited number of cycles before bleeding spontaneously ceased may represent the slow death of endometrial cells subsequent to radiation or radiochemotherapy treatment, and has not previously been described. In view of the paucity of data on the radiosensitivity of normal endometrium, we have carefully examined these patients who appear to have retained endometrial sensitivity to hormonal stimuli after radical radiation-chemotherapy for uterine cervix cancer.

Adult↗
PubMed1989

The management of oesophageal carcinoma: radiotherapy or surgery? Cost considerations.

A cost comparison has been made between two treatment modalities used with curative intent for carcinoma of the oesophagus, for 144 patients seen between December 1979 and December 1985. Forty-two patients were selected for radical oesophagectomy. In this paper these are compared with 50 patients who underwent radical radiotherapy. The median survival of both groups was identical (12 months). The remaining 52 patients underwent a variety of palliative procedures and are not considered further. Components of management were identified and costed on the basis of direct resource use by the hospital. Surgically treated patients on average cost $A13,638 in 1987 dollars, whereas those treated by radiotherapy cost $A3533. The major factors accounting for this cost difference were the necessary perioperative intensive management in the surgical group, the inevitable perioperative complications and the subsequent prolonged hospitalization of a proportion of patients. The cost of the management of the complications of radiation therapy are included but were not a major factor in overall costs for the irradiated group. This cost differential must influence the continuation of current strategies in which radical surgery, rather than irradiation, is the selected routine curative approach for oesophageal cancer particularly in the absence of evidence of higher survival.

Adenocarcinoma↗
PubMed1988

Effect of cytokines on polymorphonuclear neutrophil infiltration in the mouse. Prostaglandin- and leukotriene-independent induction of infiltration by IL-1 and tumor necrosis factor.

The i.p. injection of mice with highly purified recombinant human rIL-1 alpha or beta resulted in the rapid influx of a large number of polymorphonuclear neutrophils (PMN) into the peritoneal cavity. Significant increases in the number of PMN were induced by doses of IL-1 which ranged from 0.005 to 5 ng/injection. Interestingly the dose response for PMN influx was bell-shaped because 50 ng of IL-1 did not result in a significant increase in peritoneal PMN. IL-1 induced PMN infiltration was detectable by 1 h with peak levels of PMN obtained by about 2 h, followed by a subsequent decline by 24 h. Other cytokines, IL-2, IFN-gamma, IFN alpha beta, granulocyte-CSF, granulocyte-macrophage-CSF, IL-3, TNF-alpha, and TNF-beta were compared to IL-1 for their ability to induce a PMN influx into the peritoneum. Only TNF-alpha or TNF-beta (lymphotoxin) were able to induce a significant influx of PMN within 2 h. However, based on total protein administered, about 100 times more TNF than IL-1 was required to produce a comparable PMN infiltration. Intraperitoneal injection of inhibitors of the cyclooxygenase or lipoxygenase pathways did not inhibit the IL-1-induced influx of PMN. Also, neither IL-1 nor TNF triggered an increase in PG or leukotriene release from peritoneal cells in vitro. Furthermore, direct peritoneal injection of leukotriene B4, a potent PMN chemoattractant in vitro, did not induce any significant increase in PMN in the peritoneal cavity indicating that chemotactic activity alone is insufficient for inducing peritoneal infiltration. These results suggest that the local production of very low levels of IL-1 in vivo would be sufficient to initiate a sequence of events that results in a rapid accumulation of PMN. Because IL-1 was not chemotactic for PMN in vitro, our data suggest that IL-1 induces production of factors that are chemotactic for PMN. Alternatively, IL-1 may act on other stages of the complex sequence of events that regulates the emigration of PMN into tissue sites in vivo. The synergy apparent in PMN influx when suboptimal concentrations of IL-1 and TNF were injected suggests that the local production of very low concentrations of these cytokines in situ could play a critical role in the emigration of PMN during infection.

Animals↗
PubMed1988

Management of oesophageal cancer at Westmead Hospital from 1979-1985.

The aim of this study was to evaluate the various treatment options, including radiotherapy, surgery and chemotherapy, when all patients with carcinoma of the oesophagus were assessed and managed by the same team. From December 1, 1979 to December 31, 1985, 144 patients with carcinoma of the oesophagus were referred to Westmead Hospital. Eighty-five patients were men, 59 patients were women and the median age was 63 years. Twenty-five patients were at stage I, 75 patients were at stage II, 24 patients were at stage III and 20 patients were at stage IV of oesophageal cancer. Forty-two patients underwent surgical resection. Fifty patients underwent radical radiotherapy, 30 patients underwent palliative radiotherapy and 22 patients underwent palliative intubation. The operative mortality of those patients who underwent surgery was zero. The treatment mortality of those who underwent radical radiotherapy was 6%, and for those who underwent palliative radiotherapy, was 16.7%. The mortality after intubation was 12.5%. The prevalence of benign strictures was 7.5% after surgery, 33% after radical radiotherapy and 8% after palliative radiotherapy. The prevalence of malignant strictures (recurrent disease) was 2.5% after surgery, 21% after radical radiotherapy and 20% after palliative radiotherapy. The median survival after surgery was 12 months; that after radical radiotherapy, 12 months; that after palliative radiotherapy, six months; and that after intubation, 3.5 months. Where all patients with carcinoma of the oesophagus were managed by a team approach the treatment mortality was low but the long-term survival remained poor.

Adenocarcinoma↗