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Biomedical subjects

G V Burton

Publications and source records attributed to G V Burton.

At least 19 recordsLinked to original sources
PubMed2005

Thoracic metastases from breast cancer: a single-institution's experience.

OBJECTIVE: Thoracic metastasis from breast cancer (TMBC) is a relatively uncommon condition, and few reports of its therapeutic palliation and patient outcomes exist. We therefore reviewed retrospectively our radiotherapeutic experience of TMBC. METHODS: Between 1981 and 2003, 19 patients were treated with radiation (with doses raging from 10 Gy to 50 Gy) for palliation of TMBC. RESULTS: The mean age was 55.4 years. Mediastinal lymph node disease was the most common form of TMBC. TMBC developed within five years of breast cancer diagnoses in 11 patients (58%). Among the evaluable symptomatic individuals, subjective palliation was complete in 78% of the cases. The complete objective response (e.g., complete resolution of clinically manifested superior vena caval obstruction or imaging-demonstrated atelectasis) rate was 50%. There was no significant difference in survival between patients presenting with airway obstruction and women who were not in respiratory distress, asymptomatic and symptomatic patients, and women with and without concurrent extrathoracic metastases. CONCLUSION: Although the prognosis of women with TMBC was quite ominous, radiotherapy should be considered in very symptomatic patients because justifiable palliation can be effected in some individuals.

Adult↗
PubMed2003

Supraclavicular nodal relapse of breast cancer: prevalence, palliation, and prognosis.

PURPOSE: To determine the frequency, palliative effects of radiotherapy (RT) and survival of patients developing supraclavicular nodal relapse (SNR) after definitive surgery for non-disseminated breast cancer (BCa). METHODS: A retrospective study of individuals treated by breast conserving surgery or modified radical mastectomy for Stage I to III BCa at a single institution during a 17-year period (1980-96) was undertaken. RESULTS: Of the 536 patients studied, 22 (4%) developed SNR. Among the seven symptomatic women, the complete subjective response rate after RT was 71%. Of the 18 evaluable patients with manifest SNRs, tumor regression was complete in 12 (66.6%), partial in one (5.6%), and absent in five (27.8%). The overall median survival was 11.5 months; five patients (23%) survived for at least two years. CONCLUSION: Supraclavicular nodal relapse in breast cancer patients occurs infrequently. The application of radiotherapy for palliation of SNR was fully justified by the perceived results even though long-term survival was not often observed.

Aged↗
PubMed2001

Cauda equina compression in breast cancer--incidence and treatment outcome.

PURPOSE: To determine the incidence and treatment outcome of compression of the cauda equina by metastatic disease in patients with breast cancer. METHODS: A retrospective study of individuals diagnosed with breast cancer at a single institution during a 16-year period was undertaken. RESULTS: Of the 1,283 patients studied, 15 (1.2%) developed cauda equina syndrome from metastatic disease. The median survival was eight months; ten (67%) survived for at least six months. Among the evaluable patients, pain was completely relieved in eight of ten women; complete resolution of neurologic deficits was observed in five of nine patients. CONCLUSION: Metastatic breast cancer compression of the cauda equina and long-term survival of patients are infrequent occurrences. Beneficial responses can be mediated by radiotherapy.

Adult↗
PubMed2000

Patient compliance is critical for equivalent clinical outcomes for breast cancer treated by breast-conservation therapy.

OBJECTIVE: To determine the compliance with a standard breast-conservation therapy (BCT) program in a predominantly indigent, minority population of patients with early breast cancer (stage I and II) served by a rural state institution in the South; to compare the clinical outcomes of this group with those reported in clinical trials; and to examine the socioeconomic factors that may have contributed to the rate of compliance. SUMMARY BACKGROUND DATA: Disease-free survival and overall survival in early breast cancer treated by BCT versus modified radical mastectomy are reported to be equivalent in prospective randomized trials. However, patients enrolled in clinical trials may not be representative of patients living in the various diverse communities that make up the United States. The authors' hypothesis is that patients enrolled in clinical trials at the national level may not be representative of indigent patients in the rural South and that clinical trial results may not be directly applicable. METHODS: A retrospective review of 55 women with early-stage breast cancer treated from 1990 to 1995 was performed. Clinical data, compliance with treatment and clinical follow-up, and recurrence rates were examined. Statistical analysis performed include the Fisher exact test, Kaplan-Meier survival analysis, and log-rank test. RESULTS: Full compliance (defined as completion of the entire course of radiation therapy and clinical follow-up) with the BCT program was observed in only 36% of patients. Fifteen of the 35 noncompliant patients did not complete radiation therapy. A significantly higher local failure rate was observed: 8 of these 15 patients (53%) have had local failure. In contrast, patients who were either in full compliance with the BCT program or were deficient only in that they missed part of their clinical follow-up had local failure rates of 5% (1/20) and 10% (2/20), respectively. Age, race, stage of cancer, economic status (measured by availability of medical insurance), distance of patient's residence from the hospital, and education level were evaluated as potential predictors of compliance. None predicted patient compliance, although a trend toward higher compliance was noted in patients with a higher education level, as determined by literacy testing. CONCLUSIONS: Compliance with the BCT protocol at the authors' institution was worse than reported in clinical trials, and noncompliance translated into a significant increase in the local failure rate. Factors examined suggest that literacy may play a role in predicting compliance. Although BCT should be discussed with all breast cancer patients, the judicious application of clinical trial data to an institution's local population is warranted.

Breast Neoplasms↗
PubMed2000

Possible drug-associated pancreatitis after paclitaxel-cremophor administration.

Paclitaxel, a relatively new antineoplastic agent, is associated with numerous side effects, including two reported cases of pancreatitis. Our patient also developed paclitaxel-associated pancreatitis. Several companion drugs, including steroids, diphenhydramine, histamine2 blockers, serotonin type 3 antagonists, and other chemotherapeutic agents administered with paclitaxel, must be considered as possible causes of pancreatitis. In addition, paclitaxel is a hydrophobic agent that requires a vehicle, cremophor (CrEL), for solubility. Intravenous cyclosporine also requires CrEL and has been associated with pancreatitis. In the cerulein-induced pancreatitis rat model, paclitaxel with dimethyl sulfoxide as a vehicle prevents pancreatitis, suggesting that another causal agent is responsible. Animal studies of CrEL as a single agent may be required to settle this question, but for now, awareness that paclitaxel may be associated with pancreatitis may lead to earlier treatment of this potentially fatal complication.

Acute Disease↗
PubMed1999

Radiotherapy with and without chemotherapy after breast conservation surgery for early stage breast cancer: a review of timing.

PURPOSE: To evaluate the effects in women of the timing of breast irradiation (BI) in relation to the application or non-application of adjuvant chemotherapy after breast conservation surgery (BCS) for early stage cancer. METHODS: Between October 1981 and June 1995, 47 women with stage I and II breast cancer underwent BCS. Twenty-six patients did not receive adjuvant chemotherapy (NAC) and 21 women did (AC). In the NAC group, BI commenced within (n = 9) or after (n = 17) seven weeks following BCS; in the AC group, 18 women received BI more than 24 weeks after BCS and three patients within 24 weeks. RESULTS: In the NAC group, there was a trend toward more local and systemic failures plus a definite correlation with poorer survival (p = 0.05) when BI was initiated more than 7 weeks after BCS. In the AC group, the locoregional and systemic failures occurred only in women with a delay of BI exceeding 24 weeks; survival was not different between the subgroups. CONCLUSION: An undue delay of BI should be avoided in patients after BCS whether they require adjuvant chemotherapy for early stage breast cancer or not.

Age Factors↗
PubMed1998

Fatal leukoencephalopathy in a patient with non-Hodgkin's lymphoma treated with CHOP chemotherapy and high-dose steroids.

Leukoencephalopathy syndromes encompass a variety of neurologic abnormalities that affect cerebral white matter. Known etiologies include malignant hypertension, eclampsia, renal failure, CNS infection, and drug therapy with cyclosporine, tacrolimus (FK506) and interferon-alpha. Symptoms vary according to sites of involvement; they include altered mentation, visual disturbances, focal neurologic signs, and seizures. Characteristic radiologic findings are hypodense areas without contrast enhancement on CT and an increased T2 signal on MRI. The hypodense areas are often symmetric. The clinical symptoms and neuroimaging abnormalities are often reversible with treatment of the underlying condition or removal of the offending drug. We describe a patient with non-Hodgkin's lymphoma treated with conventional cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy and high-dose steroids who developed a rapidly progressive fatal leukoencephalopathy. Her neurologic symptoms and findings on CT are consistent with reported cases of leukoencephalopathy; however, in this instance, the syndrome was not reversible and was ultimately fatal. None of the previously described etiologies could be demonstrated in association with the patient's illness. There are no prior reports of fatal leukoencephalopathy in adult patients treated with standard-dose CHOP. We believe the concurrent immunosuppression from chemotherapy and high-dose steroids resulted in this patient's fatal complication.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Solitary plasmacytoma of the sacrum presenting as a pelvic mass: report of two cases.

We describe two unusual cases of solitary plasmacytoma of the sacrum seen as a pelvic mass. Excessive bleeding, a distinct possibility, should be anticipated whenever a biopsy or resection of the tumor is considered. Because of the tumor's apparent radioresponsiveness and known evolution to multiple myeloma in some cases, radiotherapy and chemotherapy are recommended.

Adult↗
PubMed1994

Long-term survival in small cell lung cancer with superior vena caval obstruction.

Two patients were diagnosed with small cell lung cancer and superior vena caval obstruction. Successful palliation of symptoms with significant reduction in size of the intrathoracic lesion was achieved with radiation therapy and chemotherapy. Treatment resulted in complete remission with long-term (more than 3 years) survival. These two cases affirm the fact that, despite the generally recognized poor prognosis of small cell lung cancer associated with this syndrome, aggressive therapy can sometimes provide rewarding results.

Carcinoma, Small Cell↗
PubMed1993

Chylous effusion complicating chronic lymphocytic leukemia.

We present a case of chylous effusion (CE) occurring in a patient with chronic lymphocytic leukemia (CLL), an observation which has rarely been reported. Therefore, CLL should be added to the differential diagnosis of nontraumatic chylothorax. CE in CLL can be successfully managed by irradiation of the mediastinum.

Aged↗
PubMed1993

Male breast cancer.

Male breast cancer is a rare tumor consisting only 1% of all breast cancers. Although 90% of breast masses in men are malignant, delay in diagnosis often occurs with resultant advanced local or systemic disease common. The few clinical studies on male breast cancer suggest that the disease behaves similarly to female breast cancer. Management, therefore, should be similar to the management of female breast cancer. Stage I, II, and III disease require a multimodal approach with regional therapy, adjuvant chemotherapy, and hormonal therapy. Most male breast cancers are estrogen or progesterone receptor positive and responses to hormonal therapy are high. A trial of hormonal therapy is warranted in most patients with stage IV disease.

Aged↗
PubMed1992

Case report: retinitis pigmentosa following cytotoxic chemotherapy in Usher's syndrome.

Ocular toxicity is an uncommon complication of cytotoxic chemotherapy. Retinitis pigmentosa complicating cancer chemotherapy has not been reported. A patient with probable Usher's syndrome (congenital sensorineural deafness) had apparent acceleration of retinitis pigmentosa with blindness following cytotoxic chemotherapy for non-Hodgkin's lymphoma. Retinitis pigmentosa, a feature of Usher's syndrome, usually develops as a slowly progressive process. The rapid acceleration of retinopathy following tumor therapy suggests a possible relationship to the cytotoxic chemotherapy. Lymphocytes and fibroblasts from patients with Usher's syndrome are hypersensitive to the x-ray type of DNA-damaging agents. The DNA-damaging effects of chemotherapy may have accelerated the progression of retinitis pigmentosa in this patient.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Retroperitoneal necrotizing fasciitis.

We present a case of retroperitoneal necrotizing fasciitis treated by urgent abdomino-perineal resection of the rectum with permanent colostomy. We can find no prior case in the English literature treated in this manner. Retroperitoneal occurrence of this disease is unusual. The process originated from perianal sepsis following chemotherapy for head and neck cancer.

Adult↗