Biomedical subjects

C Mountain

Publications and source records attributed to C Mountain.

7 recordsLinked to original sources

PubMed1992

Five-year survival after pulmonary metastasectomy for adult soft tissue sarcoma.

Determinants of 5-year survival were evaluated after complete resection of pulmonary metastases from adult soft-tissue sarcomas. Fifty-eight patients had complete resection (median survival 25 months, P = 0.0002), with a 25.8% absolute 5-year survival (15 of 58 patients); six patients had unresectable disease (median survival 6 months) and were excluded from additional analysis. Eleven patients remain disease free, with a median follow-up of 76 months. Significant independent prognostic indicators associated with improved survival (P less than 0.05) included metastasis doubling time of 40 days or greater (median survival 37 months versus 15 months if less than 40 days); unilateral disease on preoperative radiography (33 months versus 15 months if bilateral disease); three or fewer nodules on preoperative computed tomography (40 months versus 14 months if 4 or more nodules); two nodules or fewer resected (40 months versus 17 months if 3 or more nodules resected), and tumor histology (33 months for malignant fibrous histiocytoma versus 17 months for all others). Multivariate analysis identified the number of nodules detected by computed tomography preoperatively as having significant prognostic value.

Adult↗

PubMed1992

Prolonged chemotherapy for localised squamous carcinoma of the oesophagus.

We evaluated the feasibility of six courses of chemotherapy in 34 consecutive patients with localised squamous cell carcinoma of the oesophagus. All 32 evaluable patients first received at least two courses of chemotherapy. There were 18 patients with resectable carcinomas who underwent surgery and 14 patients with unresectable carcinomas who received definitive chemoradiotherapy. After two courses of 5-fluorouracil and cisplatin 21 (66%) of 32 patients had either a complete or major response. A median of five courses (range, 1-6 courses) was administered. 17 out of 18 (94%) patients with resectable carcinoma had a 'curative' resection (negative proximal, distal, and radial margins by histopathology in an en-block resection specimen) and 2 patients had a complete pathological response. The median survival duration of all patients was 28 months (range, 2-46+ months). The median survival duration of 14 patients with unresectable carcinoma was 23 months (range, 8-36+ months), and the median survival duration of 18 patients with resectable carcinoma has not been reached at a median follow-up of 24+ months (range, 10+ to 46+ months). No deaths occurred because of chemotherapy or chemoradiation therapy. Our data suggest that prolonged chemotherapy is feasible in patients with locoregional squamous carcinoma of the oesophagus. An ongoing controlled trial will determine the contribution of chemotherapy to patients' survival.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1991

Efficacy of pulmonary metastasectomy for recurrent soft tissue sarcoma.

To evaluate surgical results of resection of second (recurrent) pulmonary metastases from adult soft tissue sarcoma, the survival of 39 patients was analyzed retrospectively. With the exclusion of two patients (one with interval metastases between staged resections and one without histologically proved metastases), three patients were found to have unresectable disease (median survival, 7 months). A significantly (P = 0.0001) longer median survival (28 months) was found for 34 patients whose recurrent metastases were completely resected. The only other factor predicting significantly longer post-thoracotomy survival was resection of a solitary metastatic nodule (median survival, 65 months). Patients who had two or more recurrent nodules resected had a median survival of 14 months only (P = 0.01). Although trends toward longer survival were noted for other prognostic factors, none reached statistical significance. We conclude that the complete resection of a solitary second (recurrent) pulmonary metastatic nodule from adult soft tissue sarcoma predicts long-term survival.

Adolescent↗

PubMed1991

Radiation therapy following resection of non-small cell bronchogenic carcinoma.

Between 1970 and 1982, 102 patients received postoperative radiotherapy after attempted curative resection of bronchogenic carcinoma at The University of Texas M. D. Anderson Cancer Center. Surviving patients had a minimum follow-up of 3 years. Eight patients had pathological Stage I disease, 29 Stage II, and 65 Stage III. The 5-year actuarial survivals for patients with stages I, II, and III disease were 83%, 55%, and 38%, respectively (p = .04). Corresponding values for patients with N0, N1, and N2 disease were 74%, 56%, and 28% (p = .01). No significant differences in survival were seen based on T stage or tumor histology. Nine patients had gross residual disease following surgery, and 19 had microscopic residual disease. The 5-year actuarial survival was 78% for 12 patients without nodal disease who had known gross (4 patients) or microscopic (8 patients) residual tumor following attempted curative resection. The pathologic status of the hilar and mediastinal lymph nodes was the most significant factor affecting the frequency of metastatic relapse, with 19% of patients with N0, 33% of those with N1, and 69% of those with N2 disease developing distant disease. The low overall rate of recurrence intrathoracically (16%) confirms that postoperative radiotherapy is effective in preventing local relapse even in patients with proven nodal involvement. The impact of adjuvant radiation therapy on survival cannot be determined from these data, and further data are needed, preferably from well designed prospective studies.

Adenocarcinoma↗

PubMed1990

Evaluation of pre- and postoperative chemotherapy for resectable adenocarcinoma of the esophagus or gastroesophageal junction.

Thirty-five consecutive patients with resectable adenocarcinoma of the esophagus or gastroesophageal junction were treated with two preoperative and three or four postoperative chemotherapy courses consisting of etoposide, fluorouracil, and cisplatin (EFP) to evaluate the rate of curative resection, clinical and pathologic response, toxic effects, and survival. One hundred thirty-seven courses with a median number of five courses (range, one to six) were administered. Preoperative EFP resulted in 17 (49%) major responses, including six patients who did not have carcinoma cells in the repeat endoscopic biopsy specimens and cytologic brushings. Among 32 patients who had surgery, 25 (78%) had curative resection, one patient had a complete pathologic response, and one had microscopic carcinoma in the resected specimen. Six patients had microscopic carcinoma at the resection margins and received postoperative radiotherapy. At a median follow-up of 20 months, the projected survival of 35 patients is 23 months (range, 6 to 33+). Fifteen patients died of their carcinomas, and 15 patients were alive (median follow-up, 20+ months; range, 15+ to 33+ months) with no evidence of relapse. There were no deaths related to chemotherapy, surgery, or radiotherapy. EFP-induced toxic reactions were moderate. Our data suggest that multiple courses of EFP are feasible. Future strategies for this disease should consider prolonged chemotherapy with regimens that result frequently in pathologic complete responses.

Adenocarcinoma↗

PubMed1987

Thoracoscopy under regional anesthesia for the diagnosis and management of pleural disease.

Over a 3 year period, 52 patients underwent thoracoscopy for the diagnosis and management of a variety of pleural diseases. In 46 of the 52 patients, thoracoscopy was performed under regional anesthesia. The procedure was associated with no operative deaths and essentially no morbidity. In all 52 patients, thoracoscopy averted the need for formal thoracotomy. Thoracoscopy proved valuable as (1) the ultimate diagnostic tool for determining the presence or absence of pleural malignancy in patients with recurrent pleural effusions; (2) a method for obtaining tissue in cases where cytologic study was inadequate for diagnosis; (3) a highly successful approach to chemical pleurodesis in patients with malignant pleural effusions, multiloculated effusions, or failed tetracycline pleurodesis; (4) a means for determining whether a loculated fluid collection was intrapleural or parenchymal in location when radiologic study had failed to clarify this; (5) a way to completely drain the pleural space in patients with multiloculated empyemas not amenable to tube thoracostomy; and (6) an alternative to open lung biopsy in the immunosuppressed patient with diffuse pulmonary infiltrates. Thoracoscopy is a safe, effective, and relatively simple procedure which can be easily performed under regional anesthesia, even in ill or elderly patients. It is an often overlooked alternative to thoracotomy and should be used more widely.

Adult↗

PubMed1975

Regional pulmonary function before and after pneumonectomy using 133xenon.

Regional pulmonary function studies using 133xenon gas, spirometry, and arterial blood gas levels were performed before and 1 to 47 months after pneumonectomy for bronchogenic carcinoma in 27 patients. The mean loss in forced vital capacity was more after right pneumonectomy (44.9 percent of preoperative value) than after left lung resection (41.4 percent). There was no significant change in regional pulmonary function distribution within the remaining lung in 24 patients. Two patients developed significant changes in regional pulmonary blood flow; one had hepatic cirrhosis, and the other sustained a myocardial infarction after pneumonectomy. The third patient with significant apical hyperperfusion before pneumonectomy gradually developed abnormal distribution of ventilation concomitant with electrocardiographic evidence of cor pulmonale within two years after pneumonectomy. The mean ventilation of the apical zones was significantly lower than the mean of 14 healthy subjects. This finding and the higher incidence of ventilatory defects were related to old age and heavy smoking. Seven patients with marked reduction of pulmonary blood flow to the tumor-bearing lung (9 to 33 percent of cardiac output) had technically successful pneumonectomy. A formula and nomogram were developed to estimate the prognostically significant forced expiratory volume in one second after pneumonectomy from the preoperative studies.

Age Factors↗