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Biomedical subjects

E J Maher

Publications and source records attributed to E J Maher.

At least 19 recordsLinked to original sources
PubMed1992

Variation in mantle technique: implications for establishing priorities for quality assurance in clinical trials.

74 European and American radiotherapists responded to a questionnaire investigating the treatment of a patient with stage IIA non-bulky Hodgkin's disease by mantle irradiation. A consensus was present for the dose aims to involved and uninvolved lymph nodes and the acceptable incidence of late normal tissue effects. There was less agreement as to the total dose and dose per fraction required to maintain normal tissue toxicity within the agreed acceptable incidence. Variation was found in the radiation technique employed, the amount of spinal cord shielding used, the prescription point, modifications if irradiation was given after chemotherapy, and the routine recording of dose and dose per fraction to the normal tissue at risk. This descriptive survey confirms the need for well designed quality assurance programmes and indicates the areas of particular uncertainty that currently exist.

Clinical Trials as Topic↗
PubMed1992

Treatment strategies in advanced and metastatic cancer: differences in attitude between the USA, Canada and Europe.

Six-hundred and forty four radiation therapists from 21 European countries, Canada, and the USA responded to a questionnaire regarding the management of three cases of advanced cancer. The cases were a 64-year-old man with brain metastases from small cell carcinoma of the lung; a 64-year-old woman with bone metastases from carcinoma of the breast and a 59-year-old man with squamous cell carcinoma of the bronchus and mediastinal nodes. There was variation as to the perceived prognosis and appropriate aims of therapy, particularly for the case of squamous cell carcinoma of the bronchus. The total dose and number of fractions could be related to the perceived aims and expectations of treatment, for example, those aiming to extend life gave higher doses of radiotherapy and those aiming only to relieve symptoms gave lower. Similarly, those describing treatment as radical and estimating longer survival gave higher doses and more fractions than those treating palliatively. Variations in the role of the radiation oncologist in the management of advanced and metastatic cancer in the USA, Canada and Europe are discussed.

Attitude of Health Personnel↗
PubMed1992

Factors affecting treatment patterns of radiation oncologists in the United States in the palliative treatment of cancer.

A questionnaire was sent to 488 radiation oncologists in the United States and 268 replied. Each was given a brief account of three hypothetical patients (one with brain metastases, one with locally advanced lung cancer and one with bone metastases) and asked how they would approach the problems posed. Younger radiation oncologists (less than 46 years) treated patients with brain metastases with a smaller number of fractions and were more likely to view the case of locally advanced lung cancer as palliative. The aim of the radiation oncologist was related to the treatment pattern chosen, with the aim to extend life frequently related to higher total dose and number of fractions. When the amount of private funding was compared with dose, number of treatments, and whether the case was called palliative or not, no relationship was found.

Age Factors↗
PubMed1992

The role of radiotherapy in carcinoma of the thoracic oesophagus: an audit of the Mount Vernon experience 1980-1989.

All 244 patients with carcinoma of the thoracic oesophagus registered at the Mount Vernon Centre for Cancer Treatment during the decade from 1 January 1980 to 31 December 1989 have been audited. We have made a detailed analysis of 110 (45%) with localized disease considered unsuitable for surgery, who completed treatment solely by radiotherapy. The median survival of this group of patients was 8.2 months (range 0.2-54 months). Dysphagia was improved by radiotherapy in 77.3% of cases, the median duration of relief was 24 weeks (range 0-208 weeks) and was maintained until death in 40%. Life table analysis showed that radical compared with less than radical regimens of radiotherapy gave significantly superior relief of dysphagia. This result is unlikely to be due to case selection.

Age Factors↗
PubMed1992

The role of a radiographer counsellor in a large centre for cancer treatment: a discussion paper based on an audit of the work of a radiographer counsellor.

It is widely accepted that cancer patients have unmet psychosocial needs. There are as yet few guidelines on the appropriate role of a counsellor in centres for cancer treatment. In this study the activities of a radiographer counsellor were audited to try to identify the proportion of patients who would benefit from seeing a counsellor, to estimate the cost of such a service, and to obtain indications of how the effects of counselling could be evaluated. The study suggested that 44% of patients attending for routine radiotherapy have abnormally high levels of anxiety and might benefit from counselling. The Hospital Anxiety and Depression Scale (HADS) is proposed as an objective measure of benefit. Costing and resource allocation are discussed.

Adult↗
PubMed1992

Community based cancer support groups: an undervalued resource?

A pilot study was set up and to identify the local community based cancer support groups and to examine the links these groups and the staff of the regional and district general hospitals. The objective was to evaluate the current role of cancer support groups and identify strategies which would improve communication. Results of the study indicated that local support groups played an important role in providing support to cancer patients in the community. Hospital staff were not well informed about support groups and felt uncertain about their use as a resource for patients. There was a need to improve communication between local cancer support groups and hospital staff in order to offer a more comprehensive service to patients. Any strategies developed to improve communication depend on finding ways in which lay care and professional health care can work together. Specific recommendations were made as a result of the research and a number of initiatives undertaken, including a local directory of community resources and a forum where representatives from the local support groups can meet with hospital staff.

Communication↗
PubMed1991

Treatment strategies for advanced and metastatic cancer in Europe.

ESTRO members were surveyed by questionnaires regarding the management of three cases of advanced cancer and the organisation of cancer care in their centre. There were 278 replies from within Europe from a total of 21 countries and 231 centres. The cases were a 64-year-old man with brain metastases from a small cell carcinoma of the lung, a 64-year-old woman with bone metastases from carcinoma of the breast on tamoxifen and a 59-year-old man with a squamous cell carcinoma (NSCLC) of the bronchus and positive mediastinal lymph nodes. Over 90% of respondents replied that they would give radiotherapy in each of these cases. The median total doses were 30 Gy for the brain metastases, 30 Gy for the bony metastases and 56 Gy for the case of NSCLC. There was variation as to the perceived prognosis and appropriate aims of therapy, particularly for the case of NSCLC. The total dose and number of fractions of radiotherapy could be related to the perceived aims and expectations of treatment, e.g. those aiming to extend life gave significantly higher total doses of radiotherapy (p = 0.0001) and those aiming to relieve symptoms gave significantly lower total doses (p = 0.0001). Treatment for this case was described as "radical" by 53% of respondents and as "palliative" by 47% and the prognosis was estimated to be less than 12 months by 41% and 1-2 years by 44%. Those describing treatment as radical and estimating longer survival gave higher doses and more fractions than those treating palliatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Europe↗
PubMed1991

The place of radiotherapy in stage I and IIA Hodgkin's disease (or radiotherapy revisited).

For the majority of patients presenting with early Hodgkin's disease, the chance of death due to their disease is related to prognostic factors, e.g. age, systemic symptoms, ESR bulk, number of sites of disease, histology, haemoglobin, lymphocyte count etc. More than 50% of those with Stage I and IIA disease fall into an intermediate prognostic category where a variety of initial treatment strategies--chemotherapy alone (CT), radiotherapy alone (RT) or a combination of chemotherapy and radiotherapy (combined modality therapy CMT) result in comparable survival rates. There is therefore increasing emphasis on incidence of relapse and treatment related morbidities rather than on survival alone when evaluating the role of different treatment for Hodgkin's disease. Radiotherapy has an essential part to play in any initial strategy aiming to keep relapse rate low, as chemotherapy alone has been demonstrated to be less effective in treating macroscopic disease. Late side-effects associated with radiation are largely associated with obsolete techniques involving very wide fields, high doses and large fraction size delivered to anterior structures within the thorax. The risk of second solid tumour appears related to the volume of radiation fields and the risk of cardiac damage is probably related to both total dose and dose per fraction delivered. There is still uncertainty as to the potential late toxicity of modern techniques, particularly in combination with chemotherapy. Increasingly numbers of patients are likely to be treated with initial CMT rather than RT alone to reduce relapse rates. The risk of leukaemia associated with CMT to patients with curable Hodgkin's disease appears to have been overestimated.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1991

The influence of national attitudes on the use of radiotherapy in advanced and metastatic cancer, with particular reference to differences between the United Kingdom and the United States of America: implications for future studies.

Recent publications have suggested significant variation in dose and number of fractions of radiotherapy given to palliate advanced and metastatic cancer. Four types of published study are considered: multicenter trials, retrospective studies, patterns of care studies, and surrogate studies. These suggest that there are significant differences in the characteristics of patients considered incurable, the aims and expectations of palliative treatment, the predicted survival of patients treated palliatively, and the influence of clinical trials. Future studies are proposed to confirm such variation.

Attitude of Health Personnel↗
PubMed1991

Experience with CHART.

Continuous, hyperfractionated, accelerated radiotherapy (CHART) has been used at the Mount Vernon Cancer Treatment Center since January 1985. Patients with head and neck tumors and those with locally advanced non-oat cell carcinoma of the bronchus have formed the large majority of the 263 patients treated. Early reactions in the mucosae of the mouth and pharynx have been pronounced, but all have healed, while those in the skin have been less severe than with conventional radiotherapy. An unexpected late morbidity was radiation myelitis in four patients, but in other tissues including the skin, mucosae, the connective tissues, and the salivary glands, late changes appear reduced compared to those after conventional radiotherapy. In 92 patients with squamous cell carcinoma of the major sites in the head and neck region, of whom 71 were in Stages T3 and T4, a complete regression at the primary site and nodes was achieved in 90%. This can be compared with 62% in similar patients previously treated with curative intent at Mount Vernon between 1980 and 1985; the difference was maintained in follow-up (p = 0.003). Of 76 assessable patients with non-oat cell carcinoma of the bronchus, a complete radiological response has been achieved in 40%, compared to 12% in a retrospective group; again the difference has been maintained in follow up (p = 0.0001). A 1-year survival of 60% can be compared to 40% in the retrospective group and a 2-year survival of 29% compared to 12% (p = 0.01). With a reduction of permitted dose to the spinal cord, CHART gives promise for improvement in tumor control and a reduction in late morbidity. These promising results have led to multi-center randomized controlled clinical trials in carcinoma at the head and neck and in non-oat cell carcinoma of the bronchus. In these studies, CHART is being compared with conventional fractionated radiotherapy.

Aged↗
PubMed1990

An audit of head and neck cancer treatment in a Regional Centre for Radiotherapy and Oncology.

All patients with head and neck cancer attending the Regional Centre for Radiotherapy and Oncology at Mount Vernon hospital during the 8-year period from 1 January 1980 to 31 December 1987 have been included in this review. The 545 patients presenting a new primary carcinoma without evidence for metastasis outside the locoregional area, who were treated primarily by radiotherapy are the subject of this present audit. The characteristics of the patients, of the tumours and of the treatment given have been related to outcome. Early tumours (T1 and T2 which were node-negative) showed a complete response (CR) rate of 94% whereas more advanced tumours (T1 and T2 with palpable lymph nodes) showed a CR of 59%. The probability of local tumour control at 5 years was 77% in those without nodes and 20% in those with nodes. For more advanced disease (T3 and T4 tumours), initial CR was 72% in node-negative disease and 32% when the nodes were positive. At 5 years, the probability of local tumour control fell to 37% and 0 respectively. CR, freedom from recurrence and survival were statistically significantly related to T stage, N stage and site of primary tumour. The results compare favourably with those reported by other institutions. The development of medical audit and its influence on treatment policy are considered.

Adolescent↗
PubMed1990

Opportunistic Listeria pericardial effusion.

A case is described of pericardial effusion due to Listeria monocytogenes infection in a woman with advanced carcinoma of the cervix, rheumatoid arthritis and on corticosteroid therapy. Focal infection with listeria in immunocompromised adults has a high mortality unless promptly diagnosed. The correct diagnosis may have been made if an unexplained pericardial effusion had been tapped.

Arthritis, Rheumatoid↗
PubMed1990

Decision making in advanced cancer of the head and neck: variation in the views of medical specialists.

Forty specialists were asked about their management of three theoretical patients with advanced cancer of the head and neck. Reasons for variation were explored by considering the influence of perceived aims of treatment (radical or palliative), together with a number of factors relating to the tumour, the lymph nodes, and the patients' personal circumstances. The perceived aim of treatment was the most important determinant as to treatment modality but, when chances of influencing survival were small, there was disagreement as to the appropriate aim and subjective value judgements became influential. More careful analysis of the initial decision-making process is needed if new clinical trials are to significantly affect clinical practices.

Adult↗
PubMed1989

Practical experience using transabdominal chorionic villus biopsies taken after 16 weeks' gestation for rapid prenatal diagnosis of chromosomal abnormalities.

Placental biopsy was performed on 81 patients at greater than 16 weeks' gestation. The major indication for such biopsies was an increased risk of chromosomal abnormality because of either abnormal ultrasound findings or late presentations for advanced maternal age. Six abnormal karyotypes resulting in elective termination were found. The use of rapid karyotyping by this procedure as an alternative to amniocentesis or fetal blood sampling is discussed.

Chorionic Villi Sampling↗
PubMed1989

Near-haploid cell line in megakaryoblastic transformation of Philadelphia-positive chronic myeloid leukemia.

A case of near haploidy in a patient with an acute megakaryoblastic transformation of Philadelphia (Ph)-positive chronic myeloid leukemia (CML) was studied. Cytogenetic studies revealed persistence of a Ph-positive pseudodiploid cell line and the emergence of a Ph-positive near-haploid cell line, i.e., 46,XX,t(9;22)(q34;q11)/28,XX,t(9;22),+8,+14,+18,+29. The near-haploid cell line is a rare cytogenetic finding. The patient rapidly deteriorated and died.

Blast Crisis↗