PubMed Health⌕ Search

Biomedical subjects

Gad Perry

Publications and source records attributed to Gad Perry.

7 recordsLinked to original sources
PubMed2006

Feasibility study of using MOSFET detectors for in vivo dosimetry during permanent low-dose-rate prostate implants.

PURPOSE: To investigate the feasibility of using new micro-MOSFET detectors for QA and in vivo dosimetry of the urethra during transperineal interstitial permanent prostate implants (TIPPB). METHODS AND MATERIALS: This study involves measurements for several patients who have undergone the implant procedure with iodine-125 seeds. A new micro-MOSFET detector is used as a tool for in vivo measurement of the initial dose rate within the urethra. MOSFETs are calibrated using a single special order calibration seed. The angular response is investigated in a 100 kVp X-ray beam. RESULTS: micro-MOSFETs are found to have a calibration factor of 0.03 cGy/mV for low energy X-rays and a high isotropic response (within 2.5%). Prostate volume and shape changes during TIPPB due to edema caused by the trauma of needle insertion, making it difficult to achieve the planned implant geometry and hence the desired dose distribution. MOSFET measurements help us to evaluate the overall quality of the implant, by analyzing the maximum dose received by urethra, the prostate base coverage, the length of the prostatic urethra that is irradiated, and the apex coverage. CONCLUSIONS: We demonstrate that ease of use, quick calibration and the instantaneous reading of accumulated dose make micro-MOSFETs feasible for in vivo dosimetry during TIPPB.

Brachytherapy↗
PubMed2005

Long-term side-effects of intermittent androgen suppression therapy in prostate cancer: results of a phase II study.

OBJECTIVE: To assess the feasibility and tolerability of intermittent androgen suppression therapy (IAS) in prostate cancer. PATIENTS AND METHODS: Patients with recurrent or metastic prostate cancer received cyclical periods of treatment with leuprolide acetate and nilutamide for 8 months, and rest periods. Cycles were repeated at progression until the treatment failed to achieve normal prostate-specific antigen (PSA) levels. Patients were followed with PSA level, testosterone level, haemoglobin level, weight and bone mineral density evaluations. The median time to treatment failure, recovery from anaemia, or normalization of testosterone level was estimated by the Kaplan-Meier method. RESULTS: In all, 95 patients received 245 cycles; the median duration of rest periods was 8 months and median time to treatment failure 47 months. Testosterone recovery during rest periods was documented in 117 (61%) of cycles. Anaemia was mild and reported in 33%, 44% and 67% of cycles 1, 2 and 3, respectively. Sexual function recovered during the rest periods in 47% of cycles. There was no significant overall change in body mass index at the end of the treatment period. Osteoporosis was documented in at least one site evaluated in 41 patients (37%). CONCLUSIONS: IAS has the potential to reduce side-effects, including recovery of haemoglobin level, return of sexual function and absence of weight gain at the end of the study period.

Aged↗
PubMed2004

Report of a multicenter Canadian phase III randomized trial of 3 months vs. 8 months neoadjuvant androgen deprivation before standard-dose radiotherapy for clinically localized prostate cancer.

PURPOSE: To evaluate the effect of 3 months vs. 8 months of neoadjuvant hormonal therapy before conventional dose radiotherapy (RT) on disease-free survival using prostate-specific antigen PSA and biopsies as end points for clinically localized prostate cancer. METHODS AND MATERIALS: Between February 1995 and June 2001, 378 men were randomized to either 3 or 8 months of flutamide and goserelin before conventional-dose RT (66 Gy) at four participating centers. The median patient age was 72 years (range, 50-84 years). The stage distribution was 17% T1c, 35% T2a, 34% T2b-T2c, 13% T3-T4. The Gleason score (GS) was < or =6 in 51%, 7 in 38%, and 8-10 in 11%. The median baseline PSA level was 9.7 ng/mL (range, 1.3-189 ng/mL). Of the 378 men, 26% were low risk (Stage T1c-T2a, GS < or =6, PSA <10 ng/mL), 43% were intermediate risk (Stage T2b or GS 7 or PSA 10-20 ng/mL), and 31% were high risk (Stage T3 or GS 8-10 or PSA >20 ng/mL). The two arms were balanced in terms of age, GS, T stage, risk group, and presenting PSA level. The median follow-up was 44 months (range, 10-84 months), and 361 patients were available for evaluation. RESULTS: The 8-month arm achieved a lower PSA level before starting RT (0.37 vs. 0.74 ng/mL, p < or =0.001) and had a greater downsizing of the prostate (mean volume 26.6 cm(3) vs. 30.5 cm(3), p < or =0.001). However, the actuarial freedom from failure rate (biochemical by American Society for Therapeutic Radiology and Oncology definition, local or distant) for the 3-month vs. 8-month arms at 3 years was 66% vs. 68% and by 5 years was 61% vs. 62%, respectively (p = 0.36). No statistically significant difference was noted in the types of failure between the two arms (crude final status): biochemical, 22.2% vs. 22.3%; local, 10.2% vs. 6.5%; and distant, 3.4% vs. 4.4% (p = 0.61). Two-year post-RT biopsies were done in 57% (n = 205). Negative biopsies were obtained in 68% of the 3-month and 77% of the 8-month patients; 18% and 14% had indeterminate biopsies and 14% and 9% were positive for residual cancer (p = 0.34) in the two arms, respectively. The median PSA level for nonfailing patients was 0.50 ng/mL in both the 3-months and 8-month arms. A suggestion of improvement was found in the 8-month arm for disease-free survival at 5 years for high-risk patients (39% vs. 52%) but did not achieve statistical significance. CONCLUSION: A longer period of neoadjuvant hormonal therapy before standard-dose RT does not appear to confer a benefit in terms of disease-free survival or to alter failure patterns. Failure was delayed in the 8-month arm, but this advantage was lost by 5 years of follow-up. A suggestion of benefit was noted with a longer period of hormonal therapy for high-risk patients.

Aged↗
PubMed2004

Correlating the degree of needle trauma during prostate brachytherapy and the development of acute urinary toxicity.

PURPOSE: To determine if there is an association between the degree of prostate trauma during prostate brachytherapy and development of acute urinary toxicity. METHODS AND MATERIALS: In a consecutive prospective cohort of permanent (125)I prostate brachytherapy patients, the number of times each needle was repositioned was tracked, and the dosimetry plans were used to determine the number of times needles within 1 cm of the urethra were manipulated. Additionally, prostate volume, total number of needles, number of needles/prostate volume, and the number of periurethral needle manipulations/prostate volume were determined. The need for catheterization beyond 24 hours and the Radiation Therapy Oncology Group (RTOG) urinary toxicity score at 4 weeks were recorded. The independent samples t test was used to search for a correlation between these parameters and the recorded toxicity scores. RESULTS: Twenty-eight consecutive implant patients were evaluated in the study. Median (range) values were as follows: prostate volume 35 cc ( range, 15-51 cc), number of needles per patient 32 (range, 21-41), number of needle manipulations per patient 94.5 ( range, 55-147), and number of periurethral needle manipulations 42 (range, 17-65). The only significant association between urinary toxicity and these variables was for the number of periurethral needle manipulations (p = 0.025). CONCLUSIONS: These data provide evidence that needle prostate trauma during brachytherapy contributes to acute urinary toxicity.

Acute Disease↗
PubMed2002

Wheel-well and cargo compartment temperatures of large aircraft in flight: implications for stowaways.

BACKGROUND: Desperate people sometimes risk journeys as stowaways in aircraft wheel-wells. Some of them survive, despite the risks of being crushed by retracting landing gear, falling when the gear deploys for landing, or experiencing severe hypoxia and hypobaria in-flight. This study evaluates the level of hypothermia to which stowaways in aircraft may be exposed. METHODS: Miniature dataloggers were used to record in-flight temperatures in aircraft wheel-wells and cargo compartments. Temperatures were measured for front and side wheel-wells (FW and SW, respectively) on 36 flights by C-130 aircraft (mean duration 3.3 h, mean cruise altitude 5588 m (18,333 ft)) and 11 flights by C-141 aircraft (6.7 h and 10,744 m (35,250 ft)). RESULTS: Mean minimum temperatures for the C-130 remained above freezing and averaged 5.1 degrees C for FW and 11.9 degrees C for SW. The higher, longer C-141 flights produced temperatures below freezing with mean minimum temperatures of -18.0 degrees C for FW and -12.4 degrees C for SW. In general, temperatures in wheel-wells remained about 20 degrees C above outside air temperature (OAT) at all altitudes. This increase reflects the fact that wheel-wells are closed spaces within the aircraft body, in addition to which they contain sources of heat such as hydraulic lines and electrical equipment. Cargo compartment minimum temperature was relatively high (mean = 18.6 degrees C for commercial airline). A search of the medical literature and lay press produced information on 46 incidents of people found in wheel-wells after landing where there was no evidence of trauma. The 15 survivors had stowed away on relatively short flights (mean = 4.8 h, maximum = 10 h) compared with fatalities (mean = 7.5 h, range = 3-12 h). CONCLUSIONS: Temperatures in wheel-wells during short flights may sustain life. Long flights add severe hypothermia to acute hypoxia and hypobaria as potentially fatal environmental factors faced by wheel-well stowaways.

Acute Disease↗
PubMed1996

Radiotherapy for localized prostate cancer: assessment of results by systematic biopsy and PSA.

This study attempted to determine the failure pattern after radiotherapy for localized prostate cancer using systematic biopsies and serum PSA in assessment of outcome. Between July 1987 and February 1993, 226 patients treated with radical external beam radiotherapy were followed prospectively with systematic transrectal ultrasound-guided biopsies and serum PSA. Four hundred and ten transrectal ultrasound-guided biopsies were performed with 4-7 samples (usually six) per session. Stage distribution was T1b: 32, T1c: 11, T2a: 45, T2b: 62, T3: 50, T4: 6. Median follow-up was 41 months. The rate of positive biopsies continued to decrease over time, reaching a nadir of 30.5% at 30 months post radiotherapy. Local failures have occurred in 17% (38/226) overall, or 13% of T1b, 0% of T1c, 13% of T2a, 20% of T2b and 21% of T3-4. Six additional patients (2.5%) have had biochemical failure and 34 (15%) have biopsy-only failure. Forty seven patients initially showing residual tumor on post radiotherapy biopsies (median time 18 months), demonstrated late tumor clearance, achieving negative biopsies at a median time of 28 months. Median nadir PSA in patients with no evidence of disease (NED) at last follow-up was 0.5 ng/mL, achieved at 24 months post radiotherapy. For patients with delayed tumor clearance, the median nadir PSA was 0.6 ng.mL at 27 months. For those with local failure it was 1.6 ng.mL at 16 months and for all failures, 1.8 ng/mL at 13 months. Systematic prostate biopsies show that tumor clearance after radiotherapy may take up to 30 months. Histologic tumor clearance parallels the fall in serum PSA. Serum PSA nadirs earlier and at a higher value in patients destined to fail.

Journal Article↗