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Biomedical subjects

F A Salzman

Publications and source records attributed to F A Salzman.

At least 19 recordsLinked to original sources
PubMed1990

Single-dose electron beam irradiation in treatment and prevention of keloids and hypertrophic scars.

Low megavolt electron beam irradiation was used on 354 sites in 199 patients at the Lahey Clinic either for palliation of symptomatic hypertrophic scars or as post-operative irradiation in an attempt to prevent formation or recurrence of hypertrophic scars. Electron energies used ranged from 1.5 to 3.5 MeV. The median age of the 59 male patients was 22 years and of the 140 female patients, 35 years. All patients had at least one follow-up visit, and the median follow-up was 35 months. Of the 294 sites treated for the first time, 272 (93%) were irradiated with a single fraction with a skin dose ranging from 2 to 20 Gy. Of the 85 sites in 63 patients without excision of symptomatic hypertrophic scars, single-dose electron beam irradiation was of clinically significant value in only 41 sites (48%). No patients have been treated without surgical excision since 1973. Because of a history of formation of hypertrophic scars elsewhere in the body, 13 patients with 19 incisions were treated prophylactically after operation for other diseases. All sites were irradiated with single doses ranging from 8 to 20 Gy, and hypertrophic scars did not subsequently develop in any patient. Altogether, 119 patients with 174 sites were irradiated after surgical excision of hypertrophic scars to prevent recurrence; 168 sites (97%) received single-fraction irradiation, and 161 received a dose of 8 Gy or greater, up to 15 Gy. No statistically significant differences were observed in complete success rates, ranging from 82 to 90% with doses of 9 Gy or greater.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Surgically incurable well-differentiated thyroid carcinoma. Prognostic factors and results of therapy.

A series of 97 consecutive patients with well-differentiated thyroid carcinoma treated between 1941 and 1970 presented with distant metastatic disease or extensive nonresectable local neck disease or had residual carcinoma after thyroid resection. Men 40 years of age or younger and women 50 years of age or younger were considered at low risk for dying of disease; older patients were considered at high risk for dying of disease. Of 17 patients with distant metastatic carcinoma, 40% of younger patients in the low-risk group and 92% of older patients in the high-risk group died. Of 80 patients with unresectable or residual local neck cancer, only 13% of younger patients but 71% of older patients died. Survival related better to risk group classification as defined by age and sex than to any details of disease presentation or management. Treatment was far more successful in patients in the low-risk group.

Adenocarcinoma↗
PubMed1985

Radiotherapy for cancer of the head and neck.

Achievements in radiotherapy of head and neck cancer continue. During the past decade, bench marks have been established for certain early staged malignancies. Technical advances have occurred in higher energy accelerators with the development of dual photon and medium-range electron machines. Imaging technology has augmented precision tumor localization and staging, and its marriage to computerized treatment planning is leading the way toward an optimization of delivered radiation dose to the tumor volume. Neutron therapy is finding a definite place in moderately advanced head and neck cancers, and its wider use awaits further developments in compact neutron generators. Hyperthermia combined with photon radiation is undergoing serious clinical trials, and this combination appears to be most promising. The search for radiation sensitizers to enhance tumor destruction and for radioprotectors for normal tissue continues. Progress in the latter appears encouraging. Burgeoning radiobiologic data have led the way to several dose fractionation schemes, and the most promising clinically appears to be hyperfractionation. Combinations of surgery and radiotherapy have improved cure rates in moderately advanced malignancies, but a preference between preoperative and postoperative radiotherapy in specific sites is still controversial. The medical oncologist has become a valued member of the interdisciplinary team rather than remaining solely the recipient of failed radiotherapeutic and surgical patients. There is a keener awareness of the difficulties and intricacies involved in the construction and evaluation of clinical trials and results.

Brachytherapy↗
PubMed1983

Megavolt electron irradiation in the treatment of recurrent carcinoma of the breast on the chest wall.

Low megavolt electron beam therapy was used to treat 68 women and one man with recurrent carcinoma of the breast on the chest wall. Photon irradiation had been used previously in 53 patients. Of the 63 patients who survived 2 months or longer after electron irradiation, 59 (94%) achieved a complete response. Persistent radiation ulcers developed in only 2 patients (3%). No other late radiation complications were observed. Nineteen patients (28%) survived 3 years after electron irradiation, with a median survival of 54 months. In this group, disease eventually recurred in all patients who received a calculated NSD of less than 1 400 ret; no disease recurred in the patients who received doses greater than 1 400 ret. It is concluded that megavolt electron irradiation is effective in the treatment of chest wall recurrence from carcinoma of the breast and is safe even in patients who have had a previous course of photon irradiation.

Adult↗
PubMed1981

Megavolt electron irradiation for localized mycosis fungoides.

A retrospective analysis was carried out to evaluate the effectiveness of small field megavolt electron irradiation for localized mycosis fungoides. Only local field electron beam therapy was employed for limited disease reserving total skin electron irradiation for multiple lesions or diffuse disease covering at least 25 per cent of the entire body surface. Of the 14 patients with limited disease treated between 1964 and 1973 with the local field technique, 10 patients (71 per cent) are alive without evidence of disease at a minimum of 5 years. In contrast, of 200 patients with extensive cutaneous disease who received total skin electron irradiation, only 16 (8 per cent) were considered cured. It is concluded that early localized mycosis fungoides is potentially curable, and that limited field electron beam therapy with a relatively low total dose is adequate to obtain excellent response.

Humans↗
PubMed1980

Radiotherapy for Kaposi's sarcoma.

Between 1954 and 1976, 60 patients with Kaposi's sarcoma were treated in the Department of Radiotherapy of the Lahey Clinic Foundation at the High Voltage Research Laboratory of Massachusetts Institute of Technology. Only 2 patients were free of clinical disease in the lower extremities at the time of initial presentation, and 40 patients (69%) had cutaneous lesions involving areas extending above the knees. Eight patients (13%) also presented with mucous membrane involvement in addition to skin disease. Twenty-one patients were treated only with megavoltage electrons during the initial course of radiotherapy, and 12 patients were treated with supervoltage photons alone. The remaining 27 patients were treated with a combination of electrons and photons; in 17 patients, the same tumor sites were irradiated with both modalities. Eleven patients received whole-body surface electron irradiation. The choice of treatment modalities was based on the extent and distribution of cutaneous disease and depth of the lesions. The overall response rate was 93% after a single fractionated course of radiotherapy. Twenty-five patients achieved complete regression and 18 were in remission for 2-13 years. Response rates were also analyzed with respect to the three subgroups in terms of treatment modalities. A single dose of 800 to 1200 rads or its equivalent was required to control local cutaneous lesions. Widespread visceral metastasis was the most common cause of failure and death; the incidence of second malignancies was increased. Trial of systemic chemotherapy and immunotherapy would seem to be a reasonable therapeutic adjunct.

Adult↗
PubMed1979

Risk factor analysis in differentiated thyroid cancer.

Six hundred patients with primary differentiated thyroid carcinoma had follow-up studies for a minimum of 15 years and a maximum of 45 years. Recurrence rate and death rate were significantly different in defined high-risk and low-risk groups of patients. These basic risk groups were defined by age and sex alone; low risk consisted of men 40 years of age and younger and women 50 years of age and younger whereas the high-risk group were older patients. Recurrence and death rates in patients at high risk were 33% and 27% while respective figures for patients at low risk were 11% and 4%. In more recent years these results have shown significant improvement. Basic risk group definition outweighed the effect of pathologic type, local disease extension, type of treatment, and site of recurrence or metastasis. For instance, radioactive iodine cured 70% of patients at low risk with metastatic disease but only 10% of patients at high risk. Less aggressive biologic behavior of thyroid cancer before the age of menopause implies that an estrogen-rich milieu may alter the effects of initiating and promoting factors in carcinogenesis. It also suggests that therapeutic trials of estrogen be undertaken in progressive metastatic differentiated thyroid cancer.

Adenocarcinoma↗
PubMed1979

Whole body surface electron irradiation in the treatment of mycosis fungoides. An evaluation of 200 patients.

The records of 200 patients with generalized cutaneous mycosis fungoides treated with whole body surface electron irradiation were reviewed. Type of skin lesion appeared to be the most important factor with respect to both survival and generalized skin disease-free interval. High-dose irradiation did not seem to influence prognosis significantly compared with a relatively conservative dose. The "cure" rate for the entire group was 7%. For a more homogeneous dose distribution, the eight-field technique is now used instead of the original four-field method. A new formula is proposed to standardize the reporting of doses.

Adolescent↗
PubMed1979

Dose considerations in total skin electron irradiation for mycosis fungoides.

Two hundred patients with generalized cutaneous mycosis fungoides were treated with total skin electron irradiation (TSEI) in the Lahey Clinic Radiotherapy Department-MIT High Voltage Research Laboratory between 1964 and 1973. None of the patients had any clinical evidence of extracutaneous disease at presentation. The 3-year absolute survival rate was 54% (107 patients). Analysis of these 107 long-term survivors evaluated the relation between incidence of generalized cutaneous recurrence and total treatment dose given during the initial course of TSEI. Results indicated that in patients with erythroderma, the need for a second course of TSEI was inversely related to the total dose given during the first course. However, the curve seemed to flatten at about 1,500 cGy (rad). In plaque disease, the percentage of patients who received repeated courses of TSEI seemed to be relatively constant independent of total dose given during the initial course (65%-80%). In patients with tumor lesions, the incidence of generalized cutaneous recurrence was directly proportional to total dose. The optimal dose of TSEI for patients with mycosis fungoides may vary depending on types of skin lesions. Total dose during the initial course of TSEI should be kept relatively conservative, particularly in patients with generalized plaques where relapse rate is high allowing reserve of normal tissue tolerance for further TSEI when indicated.

Dermatitis, Exfoliative↗
PubMed1979

Adrenalectomy-oophorectomy and combined chemotherapy for carcinoma of the breast with metastases.

Thirty-one patients with carcinoma of the breast with metastases were treated by adrenalectomy-oophorectomy and randomized either for combined chemotherapy, vincristine, fluorouracil, methotrexate and thiotepa, beginning within one week after operation and continuing for three months or no chemotherapy. Statistical analyses were Gehan's modification of the Wilcoxon test for censored data, chi-square tests and life table analysis. Pretreatment characteristics--menopausal status, age, disease-free interval, prior hormone treatment and sites of metastases--of both groups were similar. Objective response occurred in 73 per cent of 11 patients in the treatment. A group compared with 47 per cent of 15 patients in the treatment B group, p greater than 0.50. Median duration to relapse in responders was 16 months in the treatment A group and 15 months in the treatment B group, p greater than 0.50. Median survival was 19 months in the treatment A group and 20 months in the treatment B group, p greater than 0.50. Results were not significant, and inclusion of five patients with less than three months of treatment, did not alter the results. Hence, the group receiving early symptomatic treatment did not show an improved response rate, improved duration of remission or enhanced survival time from ablative treatment.

Adenocarcinoma↗
PubMed1978

Carcinomatous versus radiation-induced brachial plexus neuropathy in breast cancer.

A retrospective study was performed of 18 women in whom ipsilateral brachial plexus neuropathy developed after treatment for carcinoma of the breast. In the absence of metastatic tumor elsewhere, the only distinguishing feature between carcinomatous neuropathy and radiation-induced neuropathy was the symptom-free interval after mastectomy and radiation therapy. Women with an interval of less than a year have radiation-induced neuropathy. Brachial plexus exploration in difficult diagnostic situations will permit early treatment and avoid debilitating loss of function. Brachial plexus exploration for biopsy is safe and free of complications if performed carefully. Treatment of carcinomatous neuropathy is most likely to succeed if the tumor is hormonally sensitive, but radiotherapy may also be effective. Treatment of radiation-induced neuropathy remains largely ineffective.

Adenocarcinoma↗
PubMed1976

Rebound response after estrogen therapy for metastatic breast cancer.

The estrogen rebound response in metastatic breast cancer has been reported in the past as a rare and short-lived phenomenon, not clearly associated with any aspect of the patient's clinical profile. In this series, 25% of patients responding to estrogen therapy had a further response when they no longer received the hormone. The median duration of this palliation was a minimum of 18 months and was similar to that of the initial estrogen response. Patients with a rebound response had significantly longer disease-free intervals before estrogen therapy and estrogen remissions than those who did not have a rebound response. These clinical factors may, therefore, be helpful in predicting the chances of a rebound response in any given patient. It is urged that patients be observed for objective improvement without therapy upon escape from estrogen palliation. Further palliative therapy should not be offered until definite progression of disease has been documented after any rebound response that occurs.

Breast Neoplasms↗
PubMed1975

A multidisciplined approach for the treatment of metastatic carcinoma of the breast.

We have reviewed our experience in a multidisciplined breast cancer clinic where we have utilized hormonal, ablative, and chemotherapetuci modalities. Our experience seesm to be similar to that of other groups in that oophorectomy treatment produces approximately a 61 per cent response (regression and arrest) rate, androgen therapy produces a 47 per cent response (regression and arrest) rate estrogen therapy produces a 40 per cent response (regression and arrest) rate, and ablative treatment produces approximately a 50 per cent response (regression and arrest) rate. Adrenalectomy and hypophysectomy showed similar response rates. Until it can be shown that hypophysectomy clearly offers enhanced benefits, this will not be utilized by our group except in those patients who cannot tolerate abdominal surgery (that is, patients with poor pulmonary reserve). Of interest is the high response rate (65 per cent) to ablative treatment in patients in whom disease exacerbates on additive hormonal treatment, with an increased duration of response and survival. Survival is increased in patients who are rebound responders after estrogen withdrawal. We expect to report data with future follow-up of this group of patients. New protocols will be instituted after review of the data in the hope of increasing clinical benefit and survival in this group of patients. Carcinoma of the breast accounts for almost 90,000 new cases of cancer a year, with metastases eventually developing in at least half of these patients. All physicians must be aware of the many complex problems associated with this disease and, hopefully, arrive at a logical approach for its control. We believe this can be achieved with a multidisciplined group approach as established at the Lahey Clinic Foundation.

Administration, Oral↗