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Biomedical subjects

G R Kerr

Publications and source records attributed to G R Kerr.

At least 55 records · Page 3Linked to original sources
PubMed1990

Mucosal melanomas of the head and neck: The Scottish experience. The Scottish Melanoma Group.

A retrospective analysis of malignant melanoma of the upper aerodigestive tract treated in Scotland between 1976 and 1988 has been performed to define the incidence, clinical features and response to treatment. Using the Scottish Melanoma Group database and pathology and oncology department registers 32 patients, 20 female, 12 male, were identified, representing a population incidence of approximately 0.5 per million per year. The median age was 69 years, range 38-86. Tumour arose in the nose or sinuses in 23 cases and the oral cavity or pharynx in eight cases. Metastases were present at presentation in four cases. Radical treatment was attempted in 27 patients: radiotherapy alone in 13, surgery alone in 10 and combined modality treatment in four. Complete regression, which was sustained in five cases, occurred in eight of the 13 radically irradiated patients; whereas sustained local control was achieved by radical surgery in only four of ten patients. The median survival is 14 months, non lived more than 63 months. Only one patient is alive and disease free, three more survive with disease. Of the 28 who had died, nine had local tumour only, nine metastases only and ten both local and distant disease. Outcome was not affected by age, sex, primary site or nodal spread.

Adult↗
PubMed1990

Prognostic factors for survival in soft tissue sarcoma.

Between 1975 and 1984, 125 cases of histologically confirmed soft tissue sarcomata (STS) were registered in the Department of Clinical Oncology in Edinburgh. Of these, 100 were eligible for analysis of prognostic factors. The overall 5-year survival rate was 21.5%. Univariate analysis demonstrated that extent of surgery, radical versus palliative or no radiotherapy, mass as a presenting symptom, metastases at presentation, site, histological type, mitotic activity, grade and UICC stage all had a statistically significant effect on survival. Analysis using the proportional hazard regression model was performed on the 87 patients for whom all variables were recorded. When all histological and clinical features and treatment modalities were included in the model then radiotherapy, surgery, necrosis, sex and mitoses were identified as independent prognostic variables. When symptoms and treatment were excluded then the multivariate analysis identified sex and mitotic activity as independent parameters. For the 33 superficial STS with tumour size recorded multivariate analysis revealed size, necrosis and cellularity as independent prognostic variables. For the 31 deep STS histological type, sex, surgery and radiotherapy were identified as independent prognostic parameters.

Adolescent↗
PubMed1989

Randomised trial comparing prednimustine with combination chemotherapy in advanced ovarian carcinoma.

A total of 76 patients with advanced epithelial ovarian carcinoma were randomised to receive 6 months of treatment with either a combination of hexamethylmelamine, 5-fluorouracil, cisplatin and prednimustine or prednimustine alone following initial surgery. Pathologically confirmed response rates were 35% for combination chemotherapy and 28% for prednimustine, and the overall survival was identical for the two groups. Seven patients achieved a pathologically defined complete response, one of whom relapsed at 8 months; the others remain disease-free 18-36 months (median, 23 months) after presentation. The extent of initial surgery significantly affected the survival of patients receiving prednimustine but not of those receiving combination chemotherapy. Prednimustine can produce durable responses in advanced ovarian cancer using a schedule that results in negligible toxicity.

Altretamine↗
PubMed1989

The value of follow-up in FIGO stage IB carcinoma of the uterine cervix.

The value of hospital follow-up in the detection of first locoregional or metastatic relapse was assessed in 276 patients with histologically confirmed FIGO Stage IB carcinoma of the cervix. All were treated by intracavitary and external beam irradiation. The maximum period of follow-up studied was 10 years (median follow-up was 55 months) during which 3190 routine and interval clinical visits were made. Fifteen (44%) of locoregional relapses (LRR) and eight (38%) of metastatic relapses were detected at routine visits (137 visits per relapse detected). Seventy-five per cent of relapses occurred within the first 5 years. Nine LRR occurred in the second quinquennium. Five (14.7%) of LRR underwent salvage surgery, three of whom were asymptomatic at the time of relapse. If routine visits had been stopped at 5 years the number of clinical visits would have been reduced by 15%, possibly at the cost of one patient whose asymptomatic LRR might not have been amenable to salvage surgery, had she not presented until she was symptomatic. Routine follow-up beyond 5 years is of dubious benefit in the detection of relapse.

Ambulatory Care↗
PubMed1989

Radical radiotherapy for bronchogenic carcinoma: five year survival rates.

A total of 443 patients with bronchogenic carcinoma were treated by radical radiotherapy. Their 5-year survival rate was 10.5%, median survival 57 weeks. Of these patients 42 (9.5%) had postoperative residual or recurrent tumour. Their 5-year survival rate was 14.3%, median 80 weeks. The corresponding figures for the 401 patients who had had no previous therapy were 10.2% and 54 weeks. The tumour was histologically confirmed in 277 patients; their 5-year survival rate was 6.9%, median 54 weeks. The corresponding figures for the 166 patients who had no positive histology were 16.9% and 61 weeks. The 5-year survival rate of 235 patients with positive histology who had no surgery was 5.5%, median 51 weeks. Age and sex had no significant influence on survival. Tumour size and regional lymph node status had a marked influence on survival. The 5-year survival rate was 27.5% for patients who had T1 tumours and 8.2% for those with T2/3 tumours (P less than 0.001), median 125 and 51.5 weeks, respectively. The lymph node status was recorded in 72% of patients. The 5-year survival rate of patients who had nodal involvement was 7.4% (median 44 weeks) and 18.6% for those who had no apparent lymph node involvement (median 71 weeks), P less than 0.001. Histological type and grade had no influence on survival; in particular the survival of patients who had small cell carcinoma was similar to those of other carcinomas. Dose had no influence on survival in this series.

Adult↗
PubMed1988

Influence of therapy on local control and survival in stage I and II intermediate and high grade non-Hodgkin's lymphoma.

In a consecutive series of 113 patients with localized (Stage I and II) intermediate and high grade non-Hodgkin's lymphoma we have retrospectively analysed patterns of survival and relapse in relation to presenting features and therapy. Two patients were treated by complete surgical excision. Seventy-two were treated by radiotherapy (RT), 19 by chemotherapy (CT) and 20 by combined CT and RT. A number of different chemotherapy combinations were employed. Overall survival for Stage I patients was 68.3% at 5 years and 65.5% at 10 years; for Stage II patients it was 61.2% at 5 years and 52.2% at 10 years. Recurrence-free survival for Stage I patients was 51.4% at 5 years and 42.1% at 10 years; for Stage II patients it was 46.2% at both 5 and 10 years. Local control by radiation was achieved in 59/72 (82%) patients treated with less than 40 Gy and 19/20 (95%) treated with 40 Gy or more. There was no advantage for extended field irradiation when compared with involved field. Eleven of 19 (58%) patients treated by CT alone achieved complete response (CR). For patients responding completely to CT there was no clear advantage for irradiation of originally involved bulky sites. For patients with Stage II and bulky Stage I disease there was a significant (P = 0.05) improvement in recurrence-free survival (RFS) and a trend (P = 0.192) towards improved overall survival for patients treated by CT alone or together with RT compared with RT alone. Independent variables identified by multivariate analysis were age, with better survival for younger patients (P = 0.034) and histopathological group, with better survival for DPDL compared with DH (P = 0.015).

Adolescent↗
PubMed1988

Radioactive needle implants in the treatment of anorectal cancer.

Radioactive needle implants were used to treat 44 patients with inoperable anorectal cancer. An implant dose of 60 Gy or higher was administered to 27 patients at a mean dose rate of 0.493 Gy/h (SE +/- 0.167 Gy/h). In five patients this was preceded by external beam irradiation. A further 17 patients received an implant dose of less than 60 Gy; this followed external irradiation in 10 patients. A complete response was achieved in 52% (16 out of 31) of patients assessed. Three of these patients later relapsed locally. The median duration of response was 23 months. A partial response of median duration 3 months was achieved by a further 13 patients. Five year actuarial survival was 23.9%. Serious morbidity occurred in six patients; three developed strictures and three necrosis. Features of the tumour and the treatment technique contributing to successful management are discussed. It is suggested that radioactive needle implants have an important part to play in the management of low-lying inoperable anorectal cancers.

Adenocarcinoma↗
PubMed1988

Low grade stage I and II non-Hodgkin's lymphoma: results of treatment and relapse pattern following therapy.

Sixty-four patients (37 stage I and 27 stage II) with low grade non-Hodgkin's lymphoma were treated by surgical excision alone (two patients) or with radiotherapy (53 patients), chemotherapy (five patients) or both (four patients). Actuarial survival was 80.7% at 5 years and 77.9% at 10 years. Actuarial recurrence-free survival at 10 years was 49.4% for stage I and 38.0% for stage II patients. Local control was achieved in 52 out of 56 (93%) patients treated with a radiation dose of 30 Gy or greater. There was no advantage for extended compared with involved, field irradiation. A multivariate analysis identified age, sex, stage and disease site as independent prognostic variables for survival.

Adult↗
PubMed1987

External beam radiotherapy for rectal adenocarcinoma.

A series of 243 patients with adenocarcinoma of the rectum treated with radiotherapy is presented. In the early part of the study radiotherapy was combined with 5-fluorouracil (5FU). Later, radiotherapy was given alone. Seventy-four patients were treated with radical external beam radiotherapy for recurrent or inoperable rectal adenocarcinoma. One hundred and forty-five patients with advanced pelvic tumours or with metastases were treated with palliative pelvic radiotherapy. Twenty-four patients who had small-volume residual pelvic tumour or who were felt to be at high risk of pelvic recurrence following radical resection received postoperative radiotherapy. Complete tumour regression was seen in 38 per cent of radically treated patients, and 24 per cent of palliatively treated patients. Partial regression was observed in 56 per cent of radically treated patients, and 58 per cent of palliatively treated patients. Long-term local tumour control was more commonly observed for small tumours (less than 5 cm diameter). Fifty-eight per cent of patients treated with postoperative radiotherapy remained free of local recurrence. Survival was significantly better in patients with small tumours. The addition of 5FU did not appear to improve survival or tumour control. The value of radiotherapy in the relief of distressing symptoms related to the presence of pelvic tumour has been confirmed.

Adenocarcinoma↗
PubMed1987

Fast neutron therapy for squamous cell carcinoma in the head and neck region: results of a randomized trial.

A randomized trial of fast neuron therapy compared with 4MV photons for patients with head and neck cancer is reported. One hundred and sixty-eight patients were recruited between 1977 and 1984. The minimum follow-up is 2 years. Three patients were withdrawn before treatment began. Eighty-five were allocated to neutron therapy and 80 to receive photon therapy. All patients had squamous cell cancers in one of four primary sites: oral cavity, oropharynx, larynx, and hypopharynx. Local tumor control was similar in both groups: 44.7% after neutrons and 45.0% after photons. Salvage surgery was performed on 18 patients in each treatment group for residual or recurrent cancer. Acute radiation reactions of the mucous membranes were significantly more severe after photons. The number of patients with serious late reactions was greater after neutron therapy but the difference was not statistically significant. There were six deaths related to late morbidity after neutron therapy but none after photon therapy. Survival was better after photon therapy but the difference compared with the neutron group failed to reach statistical significance. When intercurrent deaths are excluded, the difference is less marked. Photon therapy was clearly better in terms of disease-free survival giving a 2-year local disease-free rate of 41.3% (s.e. 5.5%) compared with 29.4% (s.e. 4.9%) after neutrons.

Carcinoma, Squamous Cell↗
PubMed1987

An evaluation of fast neutron irradiation in the treatment of squamous cell carcinoma in cervical lymph nodes.

Analyses have been made of the response of metastatic cervical lymph nodes following neutron therapy, either as part of a randomized trial or in patients treated electively. In the trial patients, the overall regression and local control rates were similar after photons and neutrons. Mobile nodes, less than 3.0 cm, appeared to respond better to neutron therapy, and node masses greater than 3.0 cm had better control after photon therapy. The differences observed however were not statistically significant. There was a highly significant association between the control of the primary tumor and control of nodal disease. No survival advantage for neutrons was observed in association with apparently better control rates in cervical nodes.

Carcinoma, Squamous Cell↗
PubMed1987

Bladder cancer following low or high dose pelvic irradiation.

Eleven women presenting to this department since 1971 with bladder cancer have had previous pelvic irradiation. The tumours were generally of high grade and advanced T-category. Prognosis was poor and only 32% survived for one year. The interval observed between low dose pelvic irradiation and subsequent bladder cancer was longer than after high dose pelvic irradiation (mean interval of 30 years compared with 16.5 years).

Aged↗
PubMed1986

An analysis of the radiation related morbidity observed in a randomized trial of neutron therapy for bladder cancer.

This report is an analysis of the morbidity in the bladder and bowel observed in a randomized trial of d(15)+Be neutrons versus megavoltage photons in the treatment of bladder cancer. Acute reactions in the bladder and bowel were significantly worse after photon therapy. Of the patients treated with photons 45.7% had severe reactions in the bladder compared with 10.6% after neutron therapy (p less than 0.001). Severe acute bowel reactions were observed in 8.5% of the patients after photon therapy compared with 3.8% after neutron therapy (p less than 0.05). Late reactions were significantly worse after neutrons. Severe late reactions in the bladder were seen in 58.5% of patients after neutron therapy and in 40.5% after photon therapy (p less than 0.05). In the bowel they were observed in 53.3% of patients after neutron therapy compared with 8% after photon therapy (p less than 0.0001). The disparity in the degree of early and late complications makes assessment of RBE values difficult. It is estimated that for bladder morbidity the RBE value, for photon dose fractions of 2.75 Gy, is less than 3.3 for early reactions and equal to 3.4 for late effects. The respective RBE values for early and late effects in the bowel are less than 3.4 and 3.8.

Clinical Trials as Topic↗
PubMed1986

Radical treatment of prostatic carcinoma by megavoltage X-ray therapy.

The case records of 116 patients treated with radical megavoltage X-ray therapy for carcinoma of the prostate have been reviewed. The age-corrected actuarial 5-year survival rate was 60.0% and the 10-year rate was 31.5%. Multivariate analysis demonstrated that T classification was the strongest prognostic variable but a long delay between diagnosis and radiotherapy also had a detrimental effect on prognosis. The incidence of severe acute and late radiation morbidity was low. Radical radiotherapy has been shown to be a safe and effective form of management for localised carcinoma of the prostate.

Actuarial Analysis↗
PubMed1986

Prognostic indices for bladder cancer: an analysis of patients with transitional cell carcinoma of the bladder primarily treated by radical megavoltage X-ray therapy.

A group of 889 patients who completed radical X-ray therapy for transitional cell carcinoma of the bladder during a 12 year period were analysed by a multivariate technique. The patient's age, tumour category, tumour size and haemoglobin level were shown to be independent prognostic covariates. A prognostic index was derived and four prognostic subgroups were identified. The prognostic index could divide patients within each T category into those with good, moderate, fair or poor prognosis. The 5 year actuarial survival rate for patients in the poor prognosis group was 5.8% compared to 69.8% for patients in the good prognosis group. Durable local tumour control after radical radiotherapy was also analysed by a multivariate technique. Tumour category, grade, haemoglobin and urea level were found to be significant covariates. A tumour control index was derived and two groups were identified corresponding to a high probability of lasting local control after radical radiotherapy (47.8% of patients) or a low probability of control (52.2%).

Adult↗
PubMed1986

Report of a randomised pilot study of the treatment of patients with supratentorial gliomas using neutron irradiation.

A randomised pilot study is reported of d(15)+Be neutrons compared with 4 MV photons in the treatment of patients with astrocytoma. Sixteen patients were treated by photons and 18 by neutrons. Both treatments were well tolerated by patients. The median survival after photons was 11 months and after neutrons, 7 months. It was demonstrated that four of nine patients treated by neutrons had evidence at autopsy of radiation-induced brain damage. All had residual cancer. No patient treated by photons had signs of radiation-related morbidity. The trial was, therefore, discontinued prematurely.

Adolescent↗