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Biomedical subjects

D R Goffinet

Publications and source records attributed to D R Goffinet.

At least 73 records · Page 4Linked to original sources
PubMed1981

Extramedullary plasmacytoma of the head and neck.

Extramedullary plasmacytoma of the head and neck is an uncommon plasma-cell neoplasm that arises most frequently from the soft tissues of the upper airways. Ten patients with extramedullary plasmacytoma of the head and neck received primary external beam megavoltage radiotherapy with doses between 4,000 rad (40 Gy)/29 days and 6,075 rad (60.75 Gy)/42 days. In eight patients the disease was locally controlled, although distant spread of the disease subsequently developed in four of them. Observations of the patients' medical histories, their response to treatment, and patterns of relapse suggest that extramedullary plasmacytoma is a separate clinicopathologic entity from other plasma-cell tumors and is appropriately managed by local irradiation.

Adult↗
PubMed1980

125Iodine prostate implants for recurrent carcinomas after external beam irradiation: preliminary results.

Fourteen patients with locally recurrent prostate carcinomas after external beam irradiation received 135I seed implants at Stanford between 1975 and 1979. Clinical local control has been obtained in 11 of the 14 patients for follow-up periods of 6 to 36 months. Eight remain without evidence of disease, but 2 of the 3 patients whose pelvic lymph nodes were involved by carcinoma have developed distant metastases. Complications, consisting of either cystoproctitis, urinary incontinence, or the development of a vesicorectal fistula occurred in 4 of the 14 patients. These complications were noted only in those patients who had implantation of high intensity 125I seeds (greater than 0.50 mCi) into large prostatic volumes (greater than or equal to 50 cc). No complications occurred in patients who received lower intensity 125I seed implants in smaller prostatic volumes. We conclude that 125I seed implants may be used in a second attempt to obtain local control after a local relapse following external beam irradiation, if the use of high intensity 125I sources and/or the implantation of large prostate volumes are avoided.

Acid Phosphatase↗
PubMed1980

Brachytherapy renaissance.

During the last 2 decades, the introduction of new isotopes for both removable (192Ir) and permanent (125I) interstitial implants, along with the availability of computerized dosimetry and the refinement of implantation techniques have all contributed to a Renaissance of brachytherapy. Techniques of implantation and the results of such procedures at the Stanford Medical Center for the 3 most commonly implanted carcinomas (breast, prostate, head and neck) are all presented in detail. Other anatomic sites which may be treated by interstitial irradiation are also described.

Brachytherapy↗
PubMed1979

Squamous cell carcinoma of the soft palate.

We performed a retrospective study of 106 patients with carcinoma of the soft palate who were treated at two university hospitals. Computer analysis using a new interactive data base program called MING was made to determine Berkson-Gage survival and Gehan tests of statistical significance. Statistically significant associations with an increased survival included the following: smaller lesions, a clinically negative neck examination. well- and moderately well-differentiated histopathologic features, radiation therapy dose of less than or equal to 6,300 rads, absence of a simultaneous primary, and surgical salvage. No statistically significant differences were seen with age, sex, stage, or the number of days during which patients were treated with radiation therapy. There appears to be a need for a prospective, multi-institutional, randomized therapy study to solidify treatment policy. Consideration should be given to combine surgery-radiation vs radiation therapy alone.

Adult↗
PubMed1978

Radiation-induced carotid artery disease.

Nine patients with atherosclerotic carotid artery disease associated with neck radiation were compared to 40 control patients. The data suggest that significant differences in age, incidence of coronary and peripheral vascular disease, elevated lipids and serum cholesterol, and the angiographic incidence of disseminated atherosclerosis justify the description of radiation-induced carotid disease as a clinical entity. Elevated serum cholesterol and hyperlipidemia may contribute to the development of radiation-induced vascular disease. Successful surgical reconstruction does not appear to be influenced by the prior radiotherapy, although periarterial fibrosis and increased difficulty in separating the plaques from the vascular media was encountered.

Adult↗
PubMed1978

24-hour infusion of cis-platinum in head and neck cancers.

Eighteen patients with advanced squamous cell cancer of the head and neck were treated with cis-diamminedichloroplatinum in a 24-hour infusion. The most frequent dose used was 80 mg/m2 repeated every three weeks. Six were treated preoperatively for Stage III or IV disease, and twelve were treated for recurrent disease. The overall response rate was 72% with one complete remission, greater than 50% regression in six patients, and 25--50% regression in six patients. Toxicity was minimal: creatinine greater than 2 in 6% of courses, leukopenia in 9%, anemia in 29%, vomiting in 76%, and documented minimal hearing loss in one patient. Plasma and urine platinum levels during infusion are presented. The dosage of 80 mg/m2 administered over 24 hours gives a response rate in head and neck cancers equivalent to that reported with higher doses given by rapid infusion, and toxicity is minimal.

Adult↗
PubMed1977

Comparison of intravenous and intra-arterial pyrimidine infusion as a means of radiosensitizing tumors in vivo.

The halogenated pyrimidine analogue 5-bromo-2-deoxycytidine (BCdR) was infused into BALB/C mice bearing EMT-6 tumors via either the intravenous or intra-arterial route. Hepatic dehalogenation of the drug was blocked by 5-diazouracil (DAZU) in order to ascertain its relative importance in the degradation of intravenously administered analogues. Increased radiosensitization was noted with higher intravenous pyrimidine concentrations, but DAZU blockage of dehalogenation had little effect. These studies show that following intravenous infusion, enough BCdR apparently bypasses the hepatic vessels to permit tumor radiosensitization despite dilution of the drug by the systemic circulation.

Animals↗
PubMed1977

Clinical and surgical (laparotomy) evaluation of patients with non-Hodgkin's lymphomas.

A consecutive unselected series of 423 patients with non-Hodgkin's lymphomas was staged prospectively at the Stanford Medical Center between June 1971 and June 1976. The histopathologic classification of Rappaport was used exclusively. Staging laparotomies were performed in 197 of the patients, but another 226 patients were excluded from the staging procedure for a variety of reasons, including stage IV involvement, poor surgical risk, and diagnostic celiotomy before referral to Stanford. Gastrointestinal, splenic, bone marrow, hepatic, and mesenteric lymph node involvement was very common in these patients, whereas systemic symptoms and mediastinal sites of disease were less frequently noted. After staging laparotomy, 15 patients (8%) were downstaged to a lesser extent of involvement while 62 (31%) were upstaged, primarily from clinical stage III to pathologic stage IV. Correlations were made between clinical and pathologic staging and the sites of involvement were compared between those with nodular and those with diffuse lymphomas. The accuracy of diagnostic radiologic procedures was also assessed. Although it is valuable in sequentially determining the extent of subdiaphragmatic involvement by lymphomas, we believe that staging laparotomy should still be regarded as a research procedure which will be undertaken only as indicated in centers of clinical research.

Adolescent↗
PubMed1976

Carcinoma of the nasopharynx. Eighteen years' experience with megavoltage radiation therapy.

From 1956 through 1973, 82 patients with carcinoma of the nasopharynx received high dose megavoltage radiation therapy at Stanford University. The actuarial disease-free (NED) survival was 62% at 5 years and 56% at 10 years. The NED survivals at 5 years for patients with T1, T2, and T3 lesions were 76%, 68%, and 55%, respectively. No T4 patients were salvaged, but two of 10 patients who presented with cranial nerve dysfunction were long-term survivors. The degree of nodal involvement also had prognostic significance. Involved lymph nodes were successfully controlled in all instances when doses of at least 6500 rads were given. Initial treatment failed in 32 patients. In 24 (75%) this occurred within 18 months. Thirteen patients with initial recurrences in head and neck sites were retreated and three remain alive. Survival after retreatment ranged from 2 months fo 10 years, with a median of 16 months. Although nearly one-third (6/17) of the patients with local recurrences had initial T1 or T2 lesions, there have been no failures in patients treated for these early stages in the last 7 years. This may be attributed to the use of larger treatment fields. Likewise, prophylactic irradiation of the neck was always successful in preventing nodal disease if the primary site was controlled.

Adult↗
PubMed1976

Abdominal irradiation in non-Hodgkin's lymphomas.

The incidence of subdiaphragmatic relapses in a group of 170 patients with non-Hodgkin's lymphomas treated with radiation to lymph-node bearing areas above and below the diaphragm is described. In patients treated with the standard inverted "Y" abdominal radiation portals, subdiaphragmatic relapses occurred in 29% of 132 patients. This high local failure rate may be attributed to the exclusion of many of the mesenteric lymph nodes and most of the liver and intestines from the irradiated fields. A safe and apparently effective radiation technique which treats the whole abdomen, used at Stanford in 38 patients since 1973, is described. Full thickness lead blocks protect the right hepatic lobe during the initial 1500-rad whole abdominal treatment (through anterior-posterior opposed fields). Horizontal decubitus (cross-table) lateral fields are then used to bring the para-aortic and mesenteric lymph node radiation doses to 3000 rads, followed by an additional 1400 rads through wide anterior-posterior ports, for a total central abdominal dose of 4400 rads. Dosimetric considerations, anatomic descriptions of subdiaphragmatic lymphatic drainage, complications of treatment, and the initial results of whole abdominal radiation therapy are also presented.

Abdomen↗
PubMed1976

Non-Hodgkin's lymphomas of stage III extent. Is total lymphoid irradiation appropriate treatment?

Many investigators have regarded Stage III lymphomas as a generalized form of disease and have accordingly recommended systemic treatment programs. Between 1961 and 1973, 68 patients with clinical or pathologic Stage III non-Hodgkin's lymphomas were seen in the Division of Radiation Therapy at Stanford University Medical Center and were treated by high dose (3500 rads or more) total lymphoid radiation therapy only. Of the 17 patients who had a diffuse histologic pattern, the actuarial survival at 5 years was 39%, but only three patients have remained free of disease. In contrast, for the 51 patients who had a nodular histologic pattern, the actuarial survivals at 5 and 10 years were 75% and 65%, respectively. Corresponding relapse-free survivals for patients with nodular lymphomas were 43% and 33%, respectively. Of 28 patients who relapsed with nodular lymphomas, 18 (64%) had relapses confined to lymph nodes; six of these were extensions to previously unirradiated epitrochlear-brachial nodes. Seven of the 18 patients were treated only with further conventional external radiation therapy at the time of their relapses and remain free of disease for additional periods of 2 to 5 years. Hence, 30 of 51 (59%) patients with nodular lymphomas have thus far been controlled by high dose total lymphoid irradiation only. Over 90% of relapses among patients with nodular lymphomas were seen within the first 5 years. The data suggest that high dose conventional radiation therapy to incorporate not only the routine total lymphoid fields but also the epitrochlear, mesenteric, and Waldeyer's ring region has curative potential even in Stage III non-Hodgkin's lymphomas, especially in the nodular group.

Adolescent↗