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Biomedical subjects

G J Rustin

Publications and source records attributed to G J Rustin.

At least 109 records · Page 6Linked to original sources
PubMed1990

Surgery and chemotherapy in the management of placental site tumor.

Since 1977 we have managed seven cases of placental site trophoblastic tumor. All patients were treated with hysterectomy. Three patients had preoperative chemotherapy without evidence of response. One of three patients presenting with no evidence of extrauterine spread and one of four presenting with extrauterine pelvic disease have died from metastatic disease on recurrence. One patient with pelvic disease and lung metastases at diagnosis has residual lung nodules, presumed necrotic, 47 months after completing chemotherapy. She received etoposide, methotrexate, and actinomycin D (EMA) alternating weekly with cyclophosphamide and vincristine (CO). Although surgical excision of placental site tumor remains the treatment of choice, EMA/CO chemotherapy may produce the occasional long-term survivor.

Adult↗
PubMed1990

HTLV-1 associated T-cell lymphoma in a patient with a 10-year history of non-epidermotropic T-cell skin infiltrates.

We report a patient who had non-epidermotropic T-cell infiltrates of the skin for 10 years prior to the development of a HTLV-1 associated disseminated T-cell lymphoma. The presentation and initial course of the lymphoma were unusual and we believe this is the first report of such an association. We therefore feel that patients of Caribbean origin with non-Hodgkin's lymphoma should be tested for HTLV-1 so that appropriate chemotherapy can be instituted at the outset in this poor prognosis group.

Female↗
PubMed1990

Frequency of serum tumour marker monitoring in patients with non-seminomatous germ cell tumours.

In patients relapsing on surveillance following orchidectomy for stage 1 non-seminomatous germ cell tumours, it is essential that treatment is initiated before they develop advanced disease with a poor prognosis. Patients who start chemotherapy with levels of human chorionic gonadotrophin (HCG) greater than 1,000 i.u. l-1 and/or alpha-fetoprotein (AFP) level greater than 500 ku l-1 have been shown to have a worse prognosis than patients with lower marker levels. We studied 64 patients between 1968 and 1987 with rising serial tumour markers. The potential time in which markers could rise to poor prognostic levels was calculated assuming an exponential rate of increase. Adverse levels were predicted in one patient (1.6%) within 7 days, in two patients (3.1%) within 14 days, in eight patients (12.5%) within 4 weeks and in 16 patients (25%) within 6 weeks. This suggests that, initially, weekly marker estimations should be performed on stage 1 surveillance patients. The extra cost to a specialist follow-up laboratory of weekly as opposed to the usual monthly marker measurements will be less than 33,600 pounds for every 400 patients on surveillance. One extra patient is likely to be cured for this sum.

Biomarkers, Tumor↗
PubMed1989

Treatment of small cell lung cancer by eight weeks chemotherapy.

Eighty-two patients with small cell lung cancer (SCLC), 32 with limited disease, were treated with alternating chemotherapy. Eight courses were administered at weekly intervals, and responding patients received radiotherapy to sites of bulk disease. Overall response rate was 76.8%. Overall median survival was 265 days, 408 days in patients with limited disease. The median symptom free period after chemotherapy was completed was 123 days. These results are comparable with those in reports of chemotherapy of longer duration and warrant the further investigation of short duration treatment in this disease.

Adult↗
PubMed1989

EMOP/CA chemotherapy for the treatment of aggressive non-Hodgkin's lymphomas.

From October 1983 to June 1987, 32 patients with aggressive non-Hodgkin's lymphomas (diffuse centroblastic, lymphoblastic and Burkitt type) were treated with the weekly alternating EMOP/CA schedule, total duration 12 weeks. There were six bulky stage II, nine stage III and 17 stage IV patients, median age 54 years (range 19-75). The complete remission rate was 59% (95% confidence limits 40-76%) and the partial remission rate 28% providing an overall response rate of 87%. With a median follow up time of 33 months (range 18-56) the relapse-free survival of those patients achieving a complete remission is 52% and the overall survival for the 32 patients treated is 27%. The CR rate for patients with stage IV disease was 47% and for those with stage II and III disease was 73% of whom 81% remain in remission. EMOP/CA chemotherapy produces acceptable results in stage II and III aggressive non-Hodgkin's lymphomas but is inadequate therapy for stage IV disease.

Adult↗
PubMed1989

Successful treatment of patients in whom germ cell tumour masses enlarged on chemotherapy while their serum tumour markers decreased.

Enlargement of tumour masses with a fall or no change in tumour marker levels was noted in eight of 287 patients during chemotherapy for NSGCT at the Charing Cross and Mount Vernon Hospitals between 1977 and 1988. These eight patients had elements of differentiated teratoma in the primary specimen and in five the enlarging masses showed cystic change on CT scan. The increase in tumour mass occurred within 6 months of starting treatment. At surgery, four patients were found to have differentiated teratoma and have been followed for 15 months to 5 years without relapse. Two patients who also had some areas of embryonal carcinoma in the resected specimens had post-operative chemotherapy and are alive disease free at 8 and 24 months respectively. Two patients died: one post-operatively of uncontrolled haemorrhage secondary to aortic rupture and the second of acute myeloid leukaemia following 8 years of intermittent therapy for unresectable differentiated teratoma. The successful outcome in six of these eight patients suggests that enlarging teratomatous masses on chemotherapy can be managed by surgical resection and, when active tumour is present, by the use of post-operative chemotherapy.

Adolescent↗
PubMed1989

Long-term outcome in patients with germ cell tumours treated with POMB/ACE chemotherapy: comparison of commonly used classification systems of good and poor prognosis.

We analysed outcome in 206 consecutive male patients treated for metastatic non-seminomatous germ cell tumour (NSGCT) of testicular or extragonadal origin treated with the POMB/ACE (cisplatin, vincristine, methotrexate, bleomycin, actinomycin D, cyclophosphamide, etoposide) regimen after division into prognostic groups by commonly used clinical classification systems and definitions of adverse prognosis. The adverse prognostic groups of all classification systems and definitions examined showed similar, but only moderate, sensitivity (71-81%) and specificity (52-56%) in predicting death. A simple definition of poor prognosis based on raised initial levels of serum tumour markers alpha fetoprotein (aFP) and human chorionic gonadotrophin (hCG) proved at least as useful (sensitivity 80%, specificity 55%) as other more complicated systems in predicting failure to achieve long-term survival. Comparison of survival between ultra-high dose cisplatin-based combination chemotherapy and patients treated with POMB/ACE shows no advantage from this more toxic approach. This suggests that good results in adverse prognosis patients can be achieved using conventional dose regimens administered intensively.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

The effect of intensity of administered treatment on the outcome of germ cell tumours treated with POMB/ACE chemotherapy.

In order to assess the importance of the intensity of administration of chemotherapy in the management of advanced germ cell tumours we have calculated indices of chemotherapy. These have been used to compare the treatment given to patients who subsequently relapsed with matched controls who did not relapse. Two of these indices (alpha and beta) are derived from the doses of drugs whose dose is varied (cisplatinum, methotrexate and etoposide). These indices showed significant variation between cases and controls. Indices gamma and delta are derived from drugs whose dose is not varied. They showed no significant differences between the two groups. These results emphasise the importance of ensuring that patients with these curable cancers receive adequate doses of chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Lumbar pain in stage 1 testicular germ cell tumours: a symptom preceding radiological abnormality.

In a series of 114 stage 1 testicular tumour patients managed by a surveillance policy there have been 26 relapses. Three of these patients presented with lumbar pain as the first sign of relapse. All 3 were tumour marker non-producers and the onset of pain pre-dated radiological abnormality by up to 4 months. Stage 1 surveillance patients who develop lumbar pain must be considered to be at high risk of relapse to avoid delay in diagnosis which may prejudice survival.

Adult↗
PubMed1989

The role of low-dose methotrexate and folinic acid in gestational trophoblastic tumours (GTT).

Between 1964 and 1986, 487 patients with gestational trophoblastic tumour (GTT) were treated with methotrexate and folinic acid. The patients comprise two groups: between 1964 and 1974, 126 patients were treated but were not systematically stratified using a prognostic score before the start of treatment. These patients formed part of the 317 women who were analysed to identify a number of prognostic variables (Bagshawe 1976). Retrospective analysis of these 126 patients using these prognostic factors showed that in the true low-risk group 85/88 (96%) are alive while 20/22 (91%) of the medium-risk group and only 5/16 (31%) of the high-risk group are alive. Overall the survival was 110/126 (87%) with a minimum follow-up of 14 years. From 1974 all patients were stratified on admission into prognostic groups. Of the true low-risk patients 347/348 survived (99.7%); 13 patients were underscored and treated as low risk when they should have been treated as medium risk, 12 (92%) of these are alive, but nine (69%) needed to change treatment because of drug resistance. While the overall survival in the 1974-1986 group was 359/361 (99%) with a minimum follow-up of 16 months, the survival in all patients (1964-1986) was 469/487 (96%). Although the survival in these patients is excellent it should be noted that 69/348 (20%) low-risk patients had to change treatment because of the development of drug resistance, and a further 23 (6%) needed to change treatment because of drug-induced toxicity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Use of CA-125 to predict survival of patients with ovarian carcinoma. North Thames Cooperative Group.

The prognostic value of serum CA-125 measurements was assessed in 54 patients with advanced ovarian adenocarcinoma. All patients received a minimum of two courses of carboplatin as part of the North Thames Cooperative Group trial. With a minimum follow-up of 6 months, 37 patients (69%) have clinical evidence of progressive disease and 28 have died. The absolute prechemotherapy level of CA-125 was of no value in predicting which patients would develop progressive disease. However, the change in CA-125 levels from before chemotherapy to 1 month later, after one course of carboplatin, could be used to divide patients into different prognostic groups. The best discrimination was found by dividing the patients into those who showed a greater than sevenfold decrease in CA-125 levels and those who showed a smaller change. Eight of 14 (58%) patients with a greater than sevenfold decrease in CA-125 levels remain disease-free compared with three of 36 (9%) patients with a lesser fall (P = .0005). The change in CA-125 levels during the first month of chemotherapy may indicate which patients should be offered alternative or symptomatic therapy and which should continue with the currently available toxic chemotherapy.

Antibodies, Monoclonal↗
PubMed1989

Weekly alternating etoposide, methotrexate, and actinomycin/vincristine and cyclophosphamide chemotherapy for the treatment of CNS metastases of choriocarcinoma.

Twenty-five patients with CNS metastases of choriocarcinoma were treated with a regimen incorporating etoposide, methotrexate, and actinomycin (EMA) alternating weekly with vincristine and cyclophosphamide (CO). The dose of methotrexate was increased to 1 g/m2. Eighteen patients presented with CNS metastases, or developed them on inappropriate treatment started elsewhere. Following EMA/CO chemotherapy, three patients died within the first 3 weeks, one is alive with active disease, one died with drug resistance, and 13 (72%) patients are surviving disease-free. Two of seven patients (29%) who developed CNS metastases on treatment with EMA/CO or relapsed after EMA/CO are disease-free after additional chemotherapy and surgery. The contribution toward survival of the craniotomy in six of 18 patients treated initially or early with EMA/CO remains unclear, but was crucial to those patients with drug resistance.

Adult↗
PubMed1989

Tumour markers: from carcinoembryonic antigen to products of hybridoma technology.

Measurements of carcinoembryonic antigen (CEA) concentrations in serum provide a system for monitoring patients with colorectal cancer. The serum tumour marker, CA19-9, recognized by a monoclonal antibody, appears to be the only new marker to add usefully to information from CEA. Their value is in assessing response to therapy and in detecting early surgically resectable relapses. These and other antigens may also be used as targets for imaging with radiolabelled antibodies, assisting in selection for second look surgery. Clinical trials of antibody targeted therapy have begun but convincing benefit remains to be shown.

Biomarkers, Tumor↗