Biomedical subjects

C A Spaulding

Publications and source records attributed to C A Spaulding.

At least 19 recordsLinked to original sources

PubMed1992

Glomus jugulare tumors. Long-term control by radiation therapy.

The records of 49 patients with glomus jugulare tumor seen at the University of Virginia from 1932 to 1985 were retrospectively reviewed with the objective of assessing long-term results of treatment. Follow-up ranged from 5 to 31 years, with a minimum of 10 years in 36 patients (73%). According to McCabe's classification, 17 patients (35%) were Group I, 11 patients (22%) were Group II, and 21 patients (43%) were Group III. Analysis by therapeutic technique revealed that 20 patients received surgery alone (41%), 15 patients received radiation therapy alone (31%), and 14 patients received combined therapy (28%). Only 7 patients (14%) have had clinical or radiologic evidence of disease progression. Three of these patients were treated by surgery alone and three by a combination of surgery and radiation, but the dose was less than 4000 cGy. Only one patient treated by radiation therapy alone or with surgery and radiation to a dose in excess of 4000 cGy demonstrated disease progression. Salvage radiation therapy was given to three of the seven patients when progressive disease was detected. Radiation therapy is an effective treatment for glomus jugulare tumor with minimal late progression of disease in adequately treated patients and no significant long-term complications.

Adolescent↗

PubMed1992

Node-negative breast carcinoma treated without adjuvant systemic therapy.

In this prospective study, 167 consecutive patients with node-negative invasive breast cancer were treated without adjuvant systemic therapy in a community hospital from 1974 through 1984. The median follow-up for living patients was 84 months. Ninety-three percent of patients had disease classified as T1, N0, M0 or T2, N0, M0. Overall survival at 5 years was 81% and at 10 years, 66%. Adjusted survival rates, which excluded patients who died without breast cancer, were 91% at 5 years and 83% at 10 years. Relapse-free survival rates were 74% at 5 years and 61% at 10 years. T status, age, menopausal status, histology, estrogen receptor status, nuclear grade, and sinus histiocytosis were evaluated as prognostic indicators. It was difficult for the pathologists to assign a single value for nuclear grade; however, univariate analysis showed a significant difference in outcome between patients with nuclear grade 1 versus nuclear grade 4 lesions. Patient age is important in the decision regarding adjuvant therapy in that patients aged 70 and older are much more likely to die without breast cancer recurrence. By multivariate analysis, tumor size was the only independently significant factor (P less than .0125).

Adenocarcinoma↗

PubMed1992

Rectal carcinoma treated by preoperative irradiation: MR imaging and histopathologic correlation.

We evaluated the role of MR imaging in assessing the effect of preoperative irradiation in 11 patients with primary rectal carcinoma. Findings on MR images obtained before radiotherapy and 5-6 weeks afterward were analyzed and correlated with the histopathological findings (nine patients) or the findings at laparotomy (two patients). Before irradiation, the tumor volumes on MR images were between 3.3 and 51.7 cm3 (mean 19.7 cm3). After irradiation, the volumes were from 0.8 to 33.2 cm3 (mean, 10.4 cm3), representing a decrease in volume of 11% to 88% (mean, 55%). On the MR images obtained before irradiation, the tumors were confined to the bowel wall in four cases (stage A-B1), penetrated the perirectal fat in six cases (stage B2), and involved an adjacent organ in one case (stage B3). After irradiation, no apparent changes were seen in the MR appearance of the local tumor stage in nine of the 11 patients. In one patient, progression of stage was suspected on the postirradiation MR images, but this was not confirmed at histologic examination. In one patient, possible downstaging occurred after irradiation, although this could not be proved. Our findings suggest that MR imaging may be useful for determining the effect of preoperative radiotherapy on rectal carcinomas.

Adenocarcinoma↗

PubMed1991

The role of definitive radiation therapy in squamous cell carcinoma of the oral tongue.

Between 1968 and 1985, 114 patients with squamous cell carcinoma of the tongue were evaluated in the Department of Radiation Oncology at the University of Virginia (Charlottesville, VA); of these, 86 received treatment with curative intent. The majority were treated with radiation therapy alone, whereas the remainder were treated with radiation therapy with preoperative or postoperative surgery. There were 17 T1 primary malignancies, 40 T2, 27 T3, and 2 T4. Clinically positive adenopathy was present in 48% of the patients overall and ranged from 35% in the T1 group to 100% in the T4 group. Twenty-six percent of patients either presented with or later had second malignancies. At 36 months, the patient status was evaluated as dead of disease (37%), dead of intercurrent disease (23%), alive with disease (1%), and alive without evidence of disease (38%). Seventy-five patients received external beam therapy and 32 patients received an implant as either all or part of their treatment. Average doses were in the range of 6000 Gy. Adjusted local control rate at 3 years was not statistically different for different treatment techniques used on either T1 or T2 primary malignancies. The rates were 89% versus 88% for T1 lesions treated with definitive radiation therapy versus postoperative radiation therapy. For T2 primary malignancies, the rates were 67%, 71%, and 83% for the definitive, preoperative, and postoperative radiation therapy groups, respectively. For T3 lesions, there was close to statistical significance with the corresponding rates being 47%, 50%, and 100%, respectively. When the effect of implants was examined for T1 and T2 lesions, no difference in local control rate at 3 years was noticed with or without an implant. Survival was improved for the group presenting with positive neck disease when compared with the N0 group. The external beam severe complication rate was less than 5%, and the implant complication rate was 6%.

Adult↗

PubMed1991

The influence of extent of neck treatment upon control of cervical lymphadenopathy in cancers of the oral tongue.

This is a retrospective analysis of the management of the neck in 84 patients with squamous cell carcinoma of the oral tongue treated with curative intent between 1968 and 1985. Patients with a clinically negative neck were treated to the neck only if the patient was thought to have a reasonable probability of occult neck metastases. This policy resulted in a 3-year adjusted neck control rate for N0 patients treated with limited (no, bilateral-partial, or ipsilateral) neck therapy of 38% compared with 95% for patients treated with bilateral, whole neck irradiation (p less than .001). None of the relapses in the patients with limited irradiation were in the treatment portal. Attempted salvage with a neck dissection resulted in cure in only 30%. The 3-year adjusted neck control rate for the N1 and N2 patients treated with total neck irradiation and surgery was 75% and 63%, respectively. The location of recurrence in these patients was in the field of irradiation, but contralateral to the side of the neck dissection.

Carcinoma, Squamous Cell↗

PubMed1990

A phase I-II trial of multimodality management of bulky gynecologic malignancy. Combined chemoradiosensitization and radiotherapy.

Between December 1983 and December 1987, there were 44 patients with bulky, nonresectable squamous cell carcinomas of the gynecologic tract (cervix, 36; vagina, eight) who were treated with concomitant chemotherapy and radiotherapy. Chemotherapy consisted of 5-fluorouracil (5-FU) 1g/m2 given by continuous intravenous infusion on days 1 through 4 and mitomycin C 10 mg/m2 given intravenously on day 1. External-beam irradiation was started on day 1 with a total calculated dose of 5000 cGy in 25 fractions employed. This was followed by brachytherapy. With a mean follow-up of 30.3 months and a median of 28 months, local control has been achieved in 32 of 44 patients (73%). The overall response rate was 88% (3-month partial response, 43%; 3-month complete response, 45%; 8-month partial response, 15%; 8-month complete response, 73%). Analysis of complications by Radiation Therapy Oncology Group (RTOG) criteria did not demonstrate an increase in acute or late complications.

Adult↗

PubMed1990

Primary malignant extragonadal germ cell tumors. An analysis of the effect of the effect of radiotherapy.

A retrospective analysis was performed on all patients diagnosed with biopsy-proven extragonadal germ cell tumors at the University of Virginia (Charlottesville, VA), The Medical University of South Carolina (Charleston, SC), the Bethesda Naval Hospital (Bethesda, MD), and The Medical College of Virginia (Richmond, VA) for the time period of January 1965 to December 1984. A total of 54 patients were treated with the initial sites of presentation observed: mediastinum, 26; central nervous system, 14; retroperitoneum, eight; and sacrococcygeal region, six. Megavoltage irradiation was used in 44 patients with a dose range of 2400 to 5580 cGy (mean, 4213 cGy). With a minimum follow-up of 4.0 years and a mean follow-up of 10.8 years, the 5-year actuarial survival for the entire population was 57.8%. Local control was achieved in 26 of 44 (59%) of the irradiated population. Factors of prognostic significance included histologic type at presentation, site of presentation, and radiation doses greater than or equal to 4000 cGy. Radiotherapy appears to be an effective modality in patients with extragonadal seminomas; however, the nonseminomatous tumors do not appear to be as radioresponsive.

Adolescent↗

PubMed1990

Preoperative staging of rectal carcinoma with MR imaging: surgical and histopathologic correlation.

Twenty-nine patients with rectal carcinoma were examined with magnetic resonance (MR) imaging at 1.0 T. In most patients a Helmholtz coil was used and a bowel distention obtained with a barium enema balloon tip. The MR findings were graded according to the modified Astler-Coller staging classification and correlated with the surgical or histopathologic results. Correct diagnosis was made in nine of the 12 patients with stage A and B1 tumors. Overestimation occurred in the other three patients, who had previously undergone radiation therapy or surgery. Local stage was correctly assessed in 11 patients with stage B2 carcinoma and in six patients with stage B3 tumors. Enlarged lymph nodes were detected in four of seven patients with nodes containing carcinoma. In two other patients with enlarged nodes, no carcinoma was identified at histologic examination. MR imaging may enable correct staging of local extent of rectal carcinoma, particularly in patients who have not previously undergone radiation therapy or surgery. However, evaluation of lymph nodes is less accurate.

Adenocarcinoma↗

PubMed1990

Early glottic carcinoma: patterns and predictors of relapse after definitive radiotherapy.

Although definitive radiotherapy in the management of early glottic carcinomas continues to offer excellent control, a small proportion of patients will have relapse. Between January 1972 and December 1984, 148 patients with squamous cell carcinoma of the glottis (stage I in 95 patients and stage II in 53 patients) had definitive radiotherapy at the University of Virginia Medical Center. We retrospectively analyzed patient data in an attempt to identify patients at risk for relapse and the patterns of failure. The three-year determinate survival for the entire population was 94.5% (stage I--100%, stage II--86%). Twenty of the 148 patients (14%) had relapse after radiotherapy. Failure in the primary site alone was observed in 17 patients (11%), two patients (1%) had relapse in the lymphatics of the neck without evidence of primary recurrence, and one patient (0.7%) had both neck and distant disease. Of the 19 patients who had definitive surgery after recurrence, 13 (68%) were successfully salvaged. Multivariate analysis was done to identify independent factors on relapse and survival. Statistically significant factors included persistent hoarseness after radiotherapy (P = .00005), impaired cord mobility (P = .00002), subglottic extension (P = .02), anterior commissure extension (P = .001), and multifocal involvement in stage I disease (P = .0008). We conclude that a majority of the small patient population with recurrent glottic carcinoma after radiotherapy may be salvaged with surgery, and we have identified patients at increased risk for recurrence.

Adult↗

PubMed1989

High-dose chemotherapy and autologous marrow transplantation for esthesioneuroblastoma and sinonasal undifferentiated carcinoma.

Eight patients with recurrent esthesioneuroblastoma or sinonasal undifferentiated carcinoma of the nasal or sinus cavities were treated with high-dose chemotherapy and autologous bone marrow transplantation. All patients had stage C disease initially and had received extensive prior conventional treatment with surgery, radiotherapy, and chemotherapy. Two patients achieved prolonged relapse-free survival for 18+ and 60 months. The latter patient relapsed at 60 months, but died of progressive disease after a second transplant. Two additional patients remain alive without disease progression at 17+ and 31+ months posttransplant. No deaths occurred secondary to toxicity. Progression of tumor accounted for failure in five patients. High-dose chemotherapy and autologous bone marrow transplantation should be considered as a salvage regimen for selected patients who fail conventional therapy for these diseases.

Adult↗

PubMed1989

Partial laryngectomy and radiotherapy for supraglottic cancer: a conservative approach.

This is a retrospective study of 33 patients with supraglottic cancer treated with partial laryngectomy and moderate-dose radiotherapy at the University of Virginia from 1967 through 1986. All patients had a 2-year minimum follow-up. Ten patients received preoperative radiotherapy, and 23, postoperative radiotherapy. The 2-year adjusted survival rate was impressive at 97%. Local control at 2 years was 96%, including one patient who was salvaged with total laryngectomy. Control of the neck was 90% at 2 years. Ninety percent of the patients alive at 2 years had a functional voice. One patient required a completion laryngectomy for chronic aspiration. Conservation surgery with radiotherapy provides excellent survival as well as locoregional control rates with preservation of function in selected patients with supraglottic cancer. This approach may be especially helpful in the management of bulky T2 lesions as well as T4 lesions with minimal vallecula or base of tongue involvement.

Adult↗

PubMed1989

Definitive radiotherapy in the management of stage I and II carcinomas of the glottis.

Definitive radiotherapy for early glottic carcinoma continues to offer excellent control and the advantage of voice preservation. In the 13 years from January 1972 through December 1984, there were 187 patients diagnosed with squamous cell carcinoma of the glottis at the University of Virginia Medical Center. One hundred forty-eight patients were treated with definitive radiotherapy as the initial management. The 3-year disease-free survival for the irradiated population was 93.6% in stage I and 75.5% in stage II. Twenty patients had recurrences following radiotherapy, and 13 of 20 were successfully surgically salvaged for an overall determinate survival of 100% in stage I and 85.7% in stage II at 3 years. These statistics are comparable to those from our previous 16-year review of 147 patients from 1956 through 1971. Factors of prognostic significance were persistent hoarseness after radiotherapy, impaired cord mobility, subglottic extension, and multiple sites of involvement in stage I. We conclude that definitive radiotherapy offers excellent survival and that a majority of the small number of treatment failures can be managed with surgical salvage.

Adult↗

PubMed1988

Primary central nervous system germ cell tumors. Effect of histologic confirmation on radiotherapy.

Primary malignant intracranial germ cell tumors are rare lesions responsible for only 0.5% of all central nervous system (CNS) malignancy. With stereotactic localization these lesions can be safely biopsied, and histologic confirmation will affect the ultimate prognosis. This report is a multi-institutional retrospective analysis of 33 patients diagnosed with a primary CNS germ cell tumor. Tumors in 14 patients (42%) were histologically confirmed (13 germinoma and one embryonal cell carcinoma); 19 patients were treated with a presumptive diagnosis. All patients were irradiated with a dose range of 3950 cGy to 6000 cGy to the primary lesions. Eight patients received craniospinal irradiation, and 25 patients were locally treated. The 5-year actuarial survival for the entire population was 64%. The survival rate in patients with histologic confirmation was 79% versus 53% in the unbiopsied population. Radiation doses greater than 5000 cGy, radiotherapy volume, and age were prognostic factors in determining survival.

Age Factors↗

PubMed1988

Esthesioneuroblastoma: a comparison of two treatment eras.

This paper is a retrospective review of 30 patients with esthesioneuroblastoma, an uncommon malignancy of the upper nasal cavity, treated at a single institution from 1959 through 1986. Over the period of study, there has been a gradual evolution of treatment policy and technique with the introduction of craniofacial resections and complex field megavoltage radiation, as well as for Stage C disease, the addition of chemotherapy to radiotherapy and surgery. The 25 patients with a 2 year minimum follow-up are divided into 2 groups depending upon treatment era to determine the impact of modern aggressive therapy upon treatment results. Two-year survival for Group I (1959-1975) was 70% as compared with 87% for Group II (1976-85). For Stage C disease, there was a definite improvement in survival in the later era (88% versus 50%), although relapses did not appear to be circumvented. Salvage therapy has an important role in prolonging survival in this disease.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1987

The effectiveness of treatment of lymph nodes in cancers of the pyriform sinus and supraglottis.

Three hundred and twelve patients with pyriform sinus or supraglottic cancer were reviewed with respect to effectiveness of therapy upon nodal control. All patients had a minimum 3-year follow-up. Combined modality therapy (radiotherapy and surgery) conferred a higher neck control rate for both N0/N1 and N2/N3 nodes than moderate dose (50 to 60 Gy) radiotherapy alone. Neck dissection appeared to be a significant component of therapy for all neck stages. Fixed nodes, a subset of N2/N3 disease with a very poor prognosis, required combined modality therapy for the best nodal control rates. Downstaging to pN0 with preoperative radiotherapy provided superior nodal control and survival rates.

Carcinoma, Squamous Cell↗

PubMed1987

The prognostic significance of lymph node involvement in pyriform sinus and supraglottic cancers.

Three hundred and thirty-three patients with carcinoma of the pyriform sinus or supraglottis were reviewed with regard to lymph node involvement and prognosis. All patients were treated with curative intent and had a minimum follow-up of 3 years. Every patient was restaged according to the AJCC, 1983 recommendations. In addition, nodal fixation to cervical fascia or muscle was evaluated with regard to prognosis. Seventy-five percent (89/119) of the pyriform sinus cancer and 47% (101/214) of the supraglottic cancer patients presented with clinically palpable cervical nodes. The distribution of patients according to N stage was 143 (43%), 84 (25%), 58 (17%), 48 (14%) for N0, N1, N2, N3 respectively. In patients where information on nodal fixation was available, 29% had fixed nodes. No difference in prognosis was noted between N0 and N1 or N2 and N3 stages, and these groups were therefore combined. The 3-year survival was 85% for T1 (N0/N1), 77% for T2 (N0/N1), 63% for T3 (N0/N1), and 65% for T4 (N0/N1) cases compared to 19% for T1 (N2/N3), 34% for T2 (N2/N3), 33% for T3 (N2/N3), and 32% for T4 (N2/N3) cases demonstrating that N stage predominates over T stage with respect to survival. Both the local recurrences and distant metastases increased as N stage advanced. A noteworthy difference between patients with fixed nodes and mobile nodes was found with regard to neck recurrence (35% versus 17%), distant metastases (33% versus 19%) and survival (27% versus 58%). In conclusion, nodal stage is a highly significant determinant of survival independent of T stage in cancers of the pyriform sinus and supraglottis. N0, N1 status and mobility were predictive of a favorable prognosis as opposed to N2, N3 status and fixation. These findings were consistent when the pyriform sinus cancers and supraglottic cancers were analyzed separately.

Humans↗

PubMed1987

Prognostic value of vocal cord fixation with respect to treatment in cancers of the supraglottis and pyriform sinus.

Vocal cord fixation in supraglottic and pyriform sinus cancers has, in the past, precluded management by radiotherapy alone. Ninety-eight patients were reviewed to determine the prognostic effect of vocal cord fixation. The predictive value of cord mobility status after 50 Gy was evaluated with respect to treatment modality. For patients treated with radiotherapy alone, cord mobility status was predictive of recurrence, yielding 3 year recurrence rates of 33.3% (mobile) versus 80% (fixed) [p = 0.04]. Mobile cords after 50 Gy had similar recurrence rates (33.3% vs. 40.0%, p = 0.60) whether treated by radiotherapy or radiotherapy/surgery. Radiotherapy alone may be used in cases when fixed cords become mobile after 50 Gy without compromising cure rates or laryngeal function. Combined modality provides the best results when cords remain fixed.

Adult↗

PubMed1986

Radiotherapeutic management of cancer of the supraglottis.

One hundred eighty-five patients with cancer of the supraglottis were treated with curative intent by radiotherapy alone or combined with surgery over a 14-year period. Minimum follow-up was 3 years. Sixty-eight percent had Stage III or IV disease. Moderate-dose radiotherapy, with surgery in reserve, was the policy for the early lesions, and yielded a 3-year locoregional control rate of 76% for T1 N0/N1, T2 N0/N1, and T3 N0/N1 lesions combined. In this group, 84% of patients with locoregional control retained laryngeal function. The major complication rate was 4%. Patients with advanced disease were treated with preoperative radiotherapy and surgery, resulting in an overall 3-year no evidence of disease rate of 72%. Adverse prognostic factors in supraglottic cancer were the extent of the primary lesion and the presence of N2 or N3 nodes. Neither vocal cord fixation nor N1 nodes had a negative influence on survival in T3 and T4 disease.

Adult↗