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Biomedical subjects

D R Barnes

Publications and source records attributed to D R Barnes.

15 recordsLinked to original sources
PubMed1987

Radical radiation and oral and intra-vesical misonidazole for bladder cancer.

Patients with T2 grade 3 and T3 bladder cancer were entered into studies to evaluate the efficacy of 40 Gy in 2 Gy fractions (5/week) to the whole pelvis followed by 12 Gy in 6 Gy fractions (1/week) to a coned down volume plus oral and intravesical misonidazole (MISO). In a pilot study of 22 patients the complete response rate at cystoscopy at 6 months was 73% and the 5-year survival rate (life-table) with and without bladder preservation was 48% and 54% respectively. The 5-year bowel major complication rate (life-table method) was 8%. These results are statistically significantly improved over that seen in a series of historical controls. A prospective randomized trial has been completed comparing the above regimen with 40 Gy to the whole pelvis followed by 20 Gy to the coned down volume in 2 Gy fractions (5/week). Fifty-eight patients were entered and 53 are evaluable. The complete response rate at cystoscopy at 6 months is 69% (18/26) in the patients treated with MISO and 63% (17/27) in those treated without MISO. As this is an important prognostic indicator, it is unlikely that there will be an advantage in either group and this is supported by the initial follow-up data. The complete response rate at cystoscopy at 6 months is higher in both arms of this study than in the historical series.

Administration, Oral↗
PubMed1984

Radical irradiation and misonidazole for T2 grade III and T3 bladder cancer: 2 year follow-up.

Patients with T2 grade III and T3 bladder cancer were treated in a Phase II trial of radical irradiation plus Misonidazole (MISO). Forty Gy in 2 Gy fractions (5 per week) to the whole pelvis were followed by 12 Gy in 6 Gy fractions (1 per week) plus oral and intravesical MISO to a coned down volume. Twenty-two patients were treated and the results compared with historical controls. The cystoscopic complete tumor response between 6 and 12 months post therapy were 73 and 43%, respectively. The patient two year survival was 81 and 51%, respectively, and the patient 2 year survival with bladder preservation was 61 and 48%, respectively--4 patients in the MISO study having undergone salvage cystectomy. Complications that may be radiation related in the MISO study are wound sepsis after salvage cystectomy in 2 patients, rectal stenosis requiring colostomy 16 months after salvage cystectomy in 1 patient and the development of a contracted bladder in 1 patient with a history of prior extensive endoscopic therapy. No misonidazole neurotoxicity seen. These findings are being further evaluated in a prospective randomized trial.

Adult↗
PubMed1983

Radical irradiation of T2 grade III and T3 bladder cancer--tumor response and prognosis.

A retrospective review was undertaken of the records of 69 patients treated by radical irradiation between 1972 and 1977 for T2 Grade III and T3 bladder cancer. Twenty-six of the patients were treated to a tumor dose of 54 Gy in 2 Gy fractions using five daily fractions per week and 24 of the patients were treated to a tumor dose of 48.6 Gy in 3.47 Gy fractions given tri-weekly. The tumor response and its relationship to patient five year survival with bladder conservation was determined. Tumor response was assessed on the basis of the documented gross cystoscopic findings between 6 and 12 months after radiotherapy. This could be done in 63 of the 69 patients. The complete response rate was 43%. The five year survival rate with bladder conservation for all the patients in the study was 24%; for those with a complete response at cystoscopy, 54%; and for those failing to achieve a complete response, 5.8%. A statistically significant improvement in survival with bladder conservation for patients with complete response was found in both subgroups of uniformly treated patients. A 17% incidence of severe late gastrointestinal tract complications was noted in the subgroup of patients treated with large radiation fractions. These results confirm the prognostic value of the tumor response at cystoscopy after radical radiotherapy, expand the total dose or TDF range over which it has been observed and document its occurrence with an unconventional radiation fractionation schedule.

Adult↗
PubMed1983

Radical irradiation and misonidazole in the treatment of T2 grade III and T3 bladder cancer.

The results of 2 pilot studies using a new radiation fractionation schedule plus misonidazole (MISO) in the radical radiotherapy of T2 Grade III and T3 carcinoma of the bladder are presented. Forty Gy in 20 daily fractions of 2 Gy was administered to the whole pelvis over 4 weeks followed by 12 Gy in 2 weekly fractions of 6 Gy. These last 2 doses were given after MISO administration. In an initial pilot study (Pilot Study I) MISO was administered orally only. The first two patients received MISO at a dose of 4.5g/m2 orally with each radiation fraction, after which the dose was reduced to 3.0g/m2 because of drug toxicity. In the second pilot study (Pilot Study II) MISO was administered orally at a dose of 3.0g/m2 and intravesically at a dose of 1.0g to 22 patients. The complete response rate at cystoscopy at 6 months in the latter group of patients is 73%, which is significantly better than that of 43% obtained in a retrospective study of historical controls. There have been no late radiation complications in any of the patients nor any MISO toxicity apart from nausea in the patients receiving 3.0g/m2 orally with or without the intravesical MISO.

Administration, Oral↗
PubMed1981

Immediate reconstruction of mandibular defects with a composite sternocleidomastoid musculoclavicular graft.

The problem of mandibular reconstruction has been approached using many surgical techniques. This article studies one such approach--reconstruction using full-thickness clavicle pedicled on the sternocleidomastoid muscle. Five patients with stage II and stage III carcinoma of the anterior part of the floor of the mouth were treated with mandibular resection and neck dissection. The resulting defects were immediately reconstructed with the clavicle-sternocleidomastoid muscle technique. The patients were observed from one to three years and were examined postoperatively with technetium Tc 99m medronate scans, which demonstrated the grafts to be viable. The technique proved reliable in a limited clinical trial.

Carcinoma↗