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Biomedical subjects

D R Goffinet

Publications and source records attributed to D R Goffinet.

At least 55 records · Page 3Linked to original sources
PubMed1987

Esophageal carcinoma: modest benefits from combined modality therapy.

Between 1969 and 1986, 109 consecutive patients with esophageal carcinoma were studied. Of the 77 patients who had squamous cell carcinoma, 62 received definitive treatment for disease confined to the esophagus and regional nodes. Survival was equivalent whether they were treated with radiation alone (n = 18), preoperative radiation and esophagectomy (n = 19), postoperative radiation (n = 5), or a combination of chemotherapy and radiation with or without esophagectomy (n = 20). Fifteen patients had significantly poorer survival after palliative irradiation for overt metastatic disease or severe debility. The pathologic specimens from four of the nine patients who underwent resection showed no histologic evidence of residual tumor; however, tumor recurred in three in the mediastinum, and only one remains alive and free of disease. Four of the 11 patients who received chemotherapy and radiation therapy without resection remain alive and free of disease after further mediastinal irradiation, suggesting a benefit from additional regional therapy. Chemotherapy improved median survival duration and complete response rate but did not produce a significant improvement in survival, as reported in other recent series.

Adenocarcinoma↗
PubMed1987

Combined radiotherapy and chemotherapy with bleomycin and methotrexate for advanced inoperable head and neck cancer: update of a Northern California Oncology Group randomized trial.

Between 1978 and 1984, the Northern California Oncology Group (NCOG) conducted a randomized trial to study the efficacy of combined radiotherapy (RT) and chemotherapy (CT) for stage III or IV inoperable head and neck cancer. One hundred four patients were randomized to receive: (1) RT alone, or (2) RT plus CT. RT consisted of 7,000 cGy to the involved areas and 5,000 cGy to uninvolved neck at 180 cGy/fraction, five fractions/wk. CT consisted of bleomycin, 5 U intravenously (IV), twice weekly during RT, followed by bleomycin, 15 U IV, and methotrexate, 25 mg/m2 IV weekly for 16 weeks after completion of RT. Fifty-one patients in the RT alone group and 45 in the combined treatment group were evaluable. The local-regional complete response (CR) rate was 45% v 67% (P = .056); the 2-year local-regional control rate, including salvage surgery, was 26% v 64% (P = .001); and the incidence of distant metastasis was 24% v 38% (P greater than .25), for the RT alone and RT plus CT groups, respectively. The relapse-free survival curves were significantly different (P = .041), favoring the combined treatment. However, the survival curves were not significantly different (P = .16). Patient compliance to maintenance CT was poor. Bleomycin significantly increased the acute radiation mucositis, although the difference in late normal tissue toxicity was not statistically significant. Thus, bleomycin and concurrent RT produced a more favorable CR rate, local-regional control rate, and relapse-free survival, but the difference in survival was not statistically significant.

Adult↗
PubMed1985

192Ir pharyngoepiglottic fold interstitial implants. The key to successful treatment of base tongue carcinoma by radiation therapy.

Twenty-eight patients with squamous carcinomas of the base tongue were seen and evaluated in a conjoint Head and Neck Tumor Board at Stanford between 1976 and 1982. Fourteen patients were treated by combined external beam and interstitial irradiation, 11 of whom had Stage III and IV carcinomas (American Joint Committee). An initial dose of 5000 to 5500 rad was first delivered by external beam irradiation in 5 to 5.5 weeks, followed approximately 3 weeks later by an iridium 192 (192Ir) interstitial implant boost by the trocar and loop technique. The key to successful treatment of these neoplasms was found to be the use of a lateral percutaneous cervical technique, which placed horizontal loops through the oropharyngeal wall above and below the hyoid bone; the superior loop included the pharyngoepiglottic fold and the tonsilloglossal groove. Standard multiple loop implants (submentally inserted) of the base tongue from the vallecula anteriorly to the circumvallate papillae were also used routinely. This approach has been successful, since 10 of the 14 patients (71%) remain without evidence of disease (mean follow-up, 32 months). There have been only two local recurrences, both on the pharyngoepiglottic fold in patients who did not receive the now standard pharyngoepiglottic fold/lateral pharyngeal wall implants. No patients have relapsed after 18 months. The other 14 patients were treated prospectively during the same period by combining initial resection, radical neck dissection, and postoperative irradiation. In this group, there were more locoregional failures compared to the group treated with radiation therapy alone (5 tongue recurrences and 7 neck relapses); in addition, more severe complications were noted in these 14 patients who received surgery and postoperative irradiation. The authors believe that combined external beam and interstitial irradiation is effective treatment for base tongue carcinomas, especially when the high-dose distribution includes the adjacent tonsilloglossal groove, pharyngoepiglottic fold, and oropharyngeal wall to and below the level of the hyoid bone, in addition to treating an adequate base tongue volume.

Brachytherapy↗
PubMed1985

Combined laser therapy and endobronchial radiotherapy for unresectable lung carcinoma with bronchial obstruction.

Over a 4 year period, we refined a protocol for treatment of airway obstruction due to recurrent lung carcinoma. Patients undergo bronchoscopy with the Nd:YAG laser available on standby. If bronchial obstruction is found to be due to extrinsic compression, an endobronchial catheter is inserted for iridium 192 brachytherapy, treating a cylindrical volume 7.5 to 15 mm in radius. If an endobronchial lesion is found, the presence of complete versus partial bronchial obstruction determines the course of treatment. Total airway obstruction is treated with the laser until a channel is created and then an endobronchial catheter is placed for adjuvant endobronchial radiotherapy to treat a cylindrical volume 5 mm in radius. Partial airway obstruction is treated with an endobronchial catheter and radiotherapy alone. Segmental obstruction is also treated with a distally placed endobronchial catheter instead of the laser. Using this protocol, we hope to minimize risk to the patient by restricting the use of the laser with its inherent higher potential rate of complications to cases of total obstruction. In addition, we expect to prolong the duration of palliation with endobronchial radiotherapy. The laser is an excellent tool to reopen occluded bronchi, but it is relatively ineffective in producing long-term tumor control. Instead, we have found that placement of a temporary transtracheal endobronchial catheter for radiotherapy is a simple, low-risk procedure that can be safely performed even in critically ill patients. The endobronchial catheter can provide good to excellent long-term palliation for patients with both partially and totally obstructed endobronchial lesions or malignant extrinsic compression of major airways.

Airway Obstruction↗
PubMed1985

125I vicryl suture implants as a surgical adjuvant in cancer of the head and neck.

Sixty-four intraoperative 125I seed implants using absorbable suture (Vicryl) carriers were performed in 53 patients with head and neck cancers at Stanford between 1975 and 1980. In previously untreated patients, local control in the implanted volume or in all head and neck sites was obtained in 79 and 71%, respectively. Five of these patients (40%) remained NED. Of 34 patients with recurrent carcinomas, local control was obtained in the implant volume in 20 (59%), while 38% had no recurrence post-implantation in any head and neck site. The incidence of complications is correlated with 125I radiation doses, total millicuries inserted, seed strength used, and tissue volume implanted for both untreated patients and those with local recurrences. Guidelines for the optimal use of the above 4 parameters are also presented. We conclude that 125I seed Vicryl intraoperative suture implants are an effective surgical adjuvant in the treatment of advanced, previously untreated or recurrent head and neck cancers.

Brachytherapy↗
PubMed1985

Malignant obstructive jaundice: treatment with external-beam and intracavitary radiotherapy.

Eleven patients with obstructive jaundice from unresectable cholangiocarcinoma, metastatic porta hepatis adenopathy, or direct compression from a pancreatic malignancy were treated at the Stanford University Medical Center from 1978-1983 with an external drainage procedure followed by high-dose external-beam radiotherapy and by an intracavitary boost to the site of obstruction with Iridium192 (Ir192). A median dose of 5000 cGy was delivered with 4-6 Mv photons to the tumor bed and regional lymphatics in 9 patients, 1 patient received 2100 cGy to the liver in accelerated fractions because of extensive intrahepatic disease, and 1 patient received 7000 "equivalent" cGy to his pancreatic tumor bed and regional lymphatics with neon heavy particles. An Ir192 wire source later delivered a 3100-10,647 cGy boost to the site of biliary obstruction in each patient, for a mean combined dose of 10,202 cGy to a point 5 mm from the line source. Few acute complications were noted, but 3/11 patients (27%) subsequently developed upper gastrointestinal bleeding from duodenitis or frank duodenal ulceration 4 weeks, 4 months, and 7.5 months following treatment. Eight patients died--5 with local recurrence +/- distant metastasis, 2 with sepsis, and 1 with widespread systemic metastasis. Autopsies revealed no evidence of biliary tree obstruction in 3/3 patients. Mean survival time from initial laparotomy and bypass was 16.1 months, and from radiotherapy completion was 8.3 months. Evolution of radiation treatment techniques for biliary obstruction in the literature is reviewed. High-dose external-beam therapy followed by high-dose Ir192 intracavitary boost is well tolerated and provides significant palliation. Survival of these aggressively managed patients approaches that of patients with primarily resectable tumors.

Adenoma, Bile Duct↗
PubMed1985

Intra-arterial infusion of radiosensitizer (BUdR) combined with hypofractionated irradiation and chemotherapy for primary treatment of osteogenic sarcoma.

Combined modality treatment was given in nine patients of osteogenic sarcoma wherein the tumor was unresectable because of location or amputation was refused. This alternative to massive surgery comprised hypofractionated irradiation, intra-arterial infusion of the radiosensitizer 5'-bromodeoxyuridine (BUdR) and adjuvant systemic chemotherapy. Local control was achieved in seven of the nine patients. Four survived, all without evidence of disease at 6, 7.1, 8.8, and 10.5 years after completion of irradiation. Pulmonary metastases developed in six patients--of whom one survives, following high-dose pulmonary irradiation and additional chemotherapy. Significant soft-tissue injury occurred in five patients. On the basis of our experience, we believe that new approaches using modifications of external beam irradiation with different fractionation schedules or better radiosensitizing compounds may hold promise for patients with non-resectable osteosarcoma.

Adolescent↗
PubMed1985

Use of intraoperative 125iodine implants for large tumors attached to the carotid artery.

Twenty-nine patients with large masses attached to the carotid artery underwent surgical resection with preservation of the artery, and intraoperative 125Iodine implantation via an absorbable suture. Eighteen were treated for recurrent neoplasms, having failed prior surgery and/or irradiation therapy. Eleven were treated primarily. With the minimum follow-up of one year, 76% were disease free in the implant volume and 62% were disease free in the entire neck. Distant metastasis occurred in 45%. Mean survival was 15 months in the primary group (range, 2-50 months) and 12 months in the recurrent group (range, 4-26 months). This technique shows promise in providing local control without necessity for sacrifice of the carotid artery.

Adult↗
PubMed1985

Iodine 125 suture implants in the management of advanced tumors in the neck attached to the carotid artery.

Between 1975 and 1982, 38 patients with locally advanced head and neck cancer attached to the carotid artery underwent surgical excision followed by iodine 125 vicryl suture implant in the neck. Most patients had neck masses that were greater than 6 cm and stage IV disease without clinically evident distant metastases. Twelve patients had received no previous therapy while 26 underwent an implant for recurrent disease. The local control rate in the implant volume was 79%. The local and regional control rate in all head and neck sites was 53%. The mean survival was 11 months. The overall complication rate was 26%. There was no significant correlation of local control or complications with the minimum total dose, volume implanted, individual 125I seed strength, or total seed strength. In patients with large masses attached to the carotid artery, surgical resection followed by a 125I implant for residual disease is a viable alternative to resection of the carotid artery.

Brachytherapy↗
PubMed1985

Safety of 125iodine and 192iridium implants to the canine carotid artery: preliminary report.

Thirty-nine healthy dogs underwent a simulated radical neck dissection followed by implantation of either 125Iodine (125I) or 192Iridium (192Ir) in various dose regimes randomized prospectively from 3,000 to 30,000 rad. Bilateral selective carotid angiography was performed immediately postoperatively and at six months and one year. No significant effects occurred to the animals who received 15,000 rad 125I or 6,000 rad 192Ir. In the higher dosed animals the 125I treated group fared better than the 192Ir treated group, probably due to the lower dose rate delivery. All surviving animals will be maintained an additional year to determine the late effects of brachytherapy irradiation to the carotid artery.

Animals↗
PubMed1984

Combined surgery and postoperative irradiation in the treatment of cervical lymph nodes.

One hundred seventy-three patients with squamous carcinomas of the laryngopharynx, oral cavity, and oropharynx received planned, combined resection of the primary neoplasm and radical neck dissection (when N1, N2, or N3 lymphadenopathy was present) followed by megavoltage irradiation to the primary sites and bilateral cervical regions between 1975 and 1982. Radical neck dissections were performed in all patients with N2 and N3 cervical lymphadenopathy, in 90% of those with N1 necks, but in only 4% whose necks were staged NO. Neck failures occurred in 10%, 22%, 19%, and 38% of patients with stages N0, N1, N2, and N3 necks, respectively. The most ominous pathologic feature was soft-tissue extension in the radical neck dissection specimen. Initially clinically benign contralateral lymph nodes became involved in only 9% of these patients.

Carcinoma, Squamous Cell↗
PubMed1983

125Iodine implants as an adjuvant to surgery and external beam radiotherapy in the management of locally advanced head and neck cancer.

125Iodine seeds either individually placed or inserted into absorbable Vicryl suture carriers were utilized in conjunction with surgery and external beam radiotherapy in an attempt to increase local control rates in patients with (1) advanced oropharyngeal and laryngopharyngeal cancers (T3-T4, N2-N3), (2) massive cervical lymphadenopathy (N3) and an unknown primary site and (3) locally recurrent head and neck cancers. Forty-eight patients were treated with 55 implants. The carotid artery was implanted in 15 patients, while seven patients had seeds inserted into the base of the skull region, and another three patients had implants near cranial nerves. Eighteen of the 48 patients were treated for cure. The actuarial survival at five years in this subgroup was 50%. The overall local control in the head and neck area was 58%. In this group no patients to date have had a local failure in the implanted volume. Seventeen patients with comparable stage of disease treated prior to 1974 with curative intent without 125I implants were analyzed retrospectively for comparison with the implanted patients. The actuarial survival of these patients was 18% and the overall head and neck control was 21%. These differences are statistically significant at a P value of 0.01 and 0.007, respectively. Seventeen patients received implants for local recurrence. The local control in the head and neck area was 50%; however, the 2.5 year actuarial survival was only 17%. The complication rate was 11% (six of 55 implants). The improved survival, the high local control, and the minimal complication rates in this series makes the intraoperative implantation of 125I seeds and effective adjunctive treatment to surgery and external beam irradiation.

Brachytherapy↗
PubMed1983

Intraoperative iodine 125 implants. Their use in large tumors in the neck attached to the carotid artery.

Twenty-nine patients with large masses attached to the carotid artery underwent surgical resection, preservation of the artery, and intraoperative iodine 125 implantation via an absorbable suture. Eighteen were treated for recurrent neoplasms, having failed prior surgery and/or irradiation therapy. Eleven were treated primarily. With a minimum follow-up of one year, 76% were disease free in the implant volume and 62% were disease free in the entire neck. Distant metastases occurred in 45%. Mean survival was 15 months in the primary group (range, two to 50 months) and 12 months in the recurrent group (range, four to 26 months). This technique shows promise in providing local control without necessity for sacrifice of the carotid artery.

Aged↗
PubMed1983

Combined continuous ultra low dose rate irradiation and radiofrequency hyperthermia in the C3H mouse.

Intradermally inoculated RIF tumors and normal skin of male C3H mice were implanted with variable activities of Iodine 125 seeds or dummy seeds enclosed in Vicryl sutures, and subjected to 0, 1, 2 or 3 local radiofrequency heat treatments for 30 minutes. Each treatment raised the tumor volume to 44 degrees C. Gastrointestinal toxicity (assessed by weight change), skin reaction, tumor growth delay, and tumor cure were assessed. Neither radiofrequency treatment alone or continuous ultra low dose rate irradiation up to 16,000 rad over 180 days alone was successful in curing these tumors; however, combined modality treatments employing doses as low as 8,000 rad over 180 days plus two radiofrequency treatments did effect cures. Gastrointestinal toxicity was best correlated with hyperthermia treatments, while skin reactions secondary to hyperthermia were prolonged by continuous ultra low dose rate irradiation. Implications for clinical usage are discussed.

Animals↗
PubMed1982

Breast edema following staging axillary node dissection in patients with breast carcinoma treated by radical radiotherapy.

Seventy-four patients with carcinoma of the breast were treated by irradiation without a mastectomy at Stanford between May 1973 and March 1980. Seventy-six breasts were treated because two patients had bilateral simultaneous cancers. Breast edema was noted in 41% of these cases. Analysis of potential predisposing factors revealed that this complication occurred primarily in patients who received a staging axillary lymph node dissection. Lymphedema occurred in 26 of 33 breasts (79%) in patients who had staging axillary dissections; this complication developed in only three of 12 (25%) with axillary samplings and two of 31 (6%) with no axillary surgery. Two groups of patients were identified: (1) 28 patients whose breast edema occurred early (prior to or during radiation therapy), and (2) three patients with late onset edema that developed several months postirradiation. The early edema, which is clearly related to axillary lymph node dissection, gradually improved during the follow-up period with complete or near complete resolution expected by three years. Late onset edema was rare, appears to be related to an axillary radiation dose greater than 5500 rad, and may be irreversible. There was no correlation of breast edema with tumor stage, radiation time/dose factors, the use of bolus, patient weight, or breast size.

Adult↗