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Biomedical subjects

H J Dobbs

Publications and source records attributed to H J Dobbs.

At least 19 recordsLinked to original sources
PubMed2001

Spinal meningioma after treatment for Hodgkin disease. Case report.

Long-term survivors of Hodgkin disease may develop second primary tumors caused by the mutagenic effects of radio- and chemotherapy. The authors describe the case of a 35-year-old woman who presented with an unusual meningioma of the cervical spine 9 years after undergoing combined-modality treatment for Hodgkin disease. To the authors' knowledge, this is the first report of spinal meningioma as a complication of such therapy. Whereas radiation-induced intracranial meningiomas are well described in the literature, treatment-induced meningiomas of the spine have not been widely recognized.

Adult↗
PubMed1998

Variations in referral pattern for postoperative radiotherapy of patients with screen-detected breast cancer in the south Thames (east) region.

This paper describes the findings of a region-wide audit undertaken in 1995-1996 of post-operative radiotherapy treatment for patients with screen-detected breast cancer. The study covers the first 3 years from the start of the South Thames (East) Breast Screening Programme in June 1988 up to March 1992. The audit shows that only 60% of the patients with invasive carcinoma who were treated by conservation surgery are known to have received radiotherapy. A considerable variation in referral patterns was observed across the region. Analysis suggests that whilst geographical, patient choice and tumour factors may play an important role in the selection of patients for radiotherapy treatment after conservative surgery for early breast cancer, management protocols of surgical units were the most critical factor, and that these appear to vary, depending on the level of involvement of the clinician with the screening programme (as measured by case-load).

Breast Neoplasms↗
PubMed1998

Variation in postoperative radiotherapy delivery for patients with screen-detected breast cancer in the south Thames (east) Region.

This paper stems from a region-wide audit of postoperative radiotherapy treatment for patients with screen-detected breast cancer, commencing from the start of the South Thames (East) screening programme in June 1988 and ending in March 1992. It reports on the variation in treatment practices amongst clinical oncologists in the region. There was diversity in treatment schedules, dose specification points, and the use of lymph node radiotherapy, breast boost and interstitial implants. While local protocols vary by centre and individual oncologist, many treatment decisions appear to have been dictated by the availability of machines and other resources. However, further analysis suggests that the variation is within the same range as that described in the nationwide survey of breast radiotherapy by the Audit Office of the Royal College of Radiologists in 1995 [1-3].

Breast Neoplasms↗
PubMed1995

VAPEC-B chemotherapy in the treatment of aggressive non-Hodgkin's lymphoma: a retrospective analysis of 45 patients.

We performed a retrospective analysis on 45 patients who, between January 1989 and October 1993, received VAPEC-B chemotherapy for high and intermediate grade non-Hodgkin's lymphoma. The aim was to assess response and tolerance to treatment. The weekly regimen consisted of: doxorubicin 35 mg/m2 i.v. weeks 1,3,5,7,9,11; cyclophosphamide 350 mg/m2 i.v. weeks 1, 5, 9; etoposide 100 mg/m2 p.o. daily for 5 days, weeks 3, 7, 11; vincristine 1.4 mg/m2 i.v. (2 mg max.) weeks 2, 4, 6, 8, 10; bleomycin 10 mg/m2 i.v. weeks 2, 6, 10; methotrexate 12.5 mg i.t. weeks 1, 5, 9; prednisolone 50 mg p.o. daily for 6 weeks, reduced to 25 mg daily for 6 weeks. The patients treated were aged 22-71 years, 34 (75%) had high grade (Working Formulation) non-Hodgkin's lymphoma (NHL); 11 (24%) had intermediate grade NHL; 25 had Stage III/IV disease; and 14 (31%) had marrow involvement. The majority of patients (76%) received VAPEC-B as first line chemotherapy; the remainder received it for relapsing disease. Follow-up time from completion of VAPEC-B chemotherapy ranged from 6 months to 50 months (median 25). VAPEC-B, as first line therapy, induced a complete response (CR) and partial response (PR) in 79% and 18% respectively, whilst 3% had no response to treatment. VAPEC-B used for relapsing disease produced CR and PR in 64% and 27% respectively, whilst 9% failed to respond. Six patients in PR and five patients in CR have subsequently undergone an autologous bone marrow transplant or a peripheral blood stem cell transplant. In the group who received VAPEC-B first line but did not proceed to transplant (27 patients), five relapsed (three with CNS disease who had not had CNS prophylaxis). Tolerance to treatment was measured by WHO toxicity scores. The haemoglobin (Hb) toxicity median score for all patients was grade 1 (Hb 9.5-10.9 g/dl), and the white cell count (WCC), toxicity score was grade 2 (WCC 2.0-2.9 x 10(9)/l). No platelet toxicity was observed. Ten per cent of patients suffered grade 3 severity infections requiring antibiotics and there was one treatment related death. The majority of patients received VAPEC-B on time, however, 24% patients had a 2-week delay. VAPEC-B chemotherapy is an effective regimen for malignant lymphoma, either as a first line or as a salvage treatment. Although chemotherapy was given weekly, the tolerance to treatment was acceptable, thus making this short regimen a good alternative to CHOP chemotherapy.

Adult↗
PubMed1993

A phase II and pharmacokinetic study with oral piritrexim for metastatic breast cancer.

Piritrexim is a lipid-soluble antifolate which, like methotrexate, has a potent capacity to inhibit dihydrofolate reductase. We performed a multicentre phase II study with piritrexim in patients with locally advanced or metastatic breast cancer. Twenty-four patients of which sixteen had received prior chemotherapy, were initially treated with 25 mg piritrexim orally administered trice daily for four days, repeated weekly, with provision for dose escalation or reduction according to observed toxicity. Of twenty-one patients evaluable for tumour response, one patient achieved a partial response which lasted for 24 weeks. Three patients had stable disease during 12 weeks of treatment, seventeen had progressive disease. Pirtrexim was generally well tolerated, in eighteen patients the dose could be escalated. Myelotoxicity was the most frequent observed toxicity of this piritrexim regimen. Leucopenia and thrombocytopenia grade 3/4 occurred in 38% of the patients sometime during treatment. Pharmacokinetic analysis of piritrexim in three patients during the first treatment cycle, revealed peak levels 1 to 2 h after an oral dose, with a trend towards a higher peak plasma levels and AUCs on the fourth dosing day compared with the first dosing day. In conclusion, orally administered piritrexim appears to be a regimen with little activity in patients with locally advanced or metastatic breast carcinoma.

Administration, Oral↗
PubMed1993

A daily diary for quality of life measurement in advanced breast cancer trials.

The Qualitator is a daily diary card to measure Quality of Life, developed for use in chemotherapy trials for patients with advanced breast cancer. In a trial at King's College Hospital, 29 patients completed the Qualitator and their scores were compared with scores in the Linear Analogue Self-Assessment and Nottingham Health Profile taken four-weekly. In a separate study at Guy's Hospital, 31 patients completed the diary. The Qualitator offers accurate prognostic data regarding subsequent UICC response and survival and is simple to use.

Adult↗
PubMed1993

Combination or mild single agent chemotherapy for advanced breast cancer? CMF vs epirubicin measuring quality of life.

Forty patients with advanced breast cancer, randomised to receive CMF or weekly low dose Epirubicin, were evaluated by UICC criteria of response and WHO toxicity criteria, in addition to three QoL instruments: the 'Qualitator' daily diary card, 4 weekly Nottingham Health Profile (NHP) and Linear Analogue Self-Assessment (LASA). Response rates were 58% for CMF and 29% for epirubicin (chi 2 = 3.51, 1 d.f., P > 0.05). Median time to treatment failure was 24 weeks for CMF, 7 weeks for epirubicin (P < 0.05) but survival was similar in both groups. Survival was better for responders than for non-responders (medians 87 and 30 weeks, P = 0.02). CMF caused more objective alopecia (P < 0.001), nausea and vomiting (P < 0.001) and haematological toxicity (P < 0.02). However, QoL measures only recorded a significant difference in energy and pain, influenced primarily by the non-responders in each treatment group but with no difference in overall global scores. Scores for responders, irrespective of treatment, were better to start with (LASA P = 0.001); at 12 weeks, scores had improved (Qualitator P < 0.05; NHP P < 0.05). Scores in non-responders showed no change. In this small study aggressive chemotherapy gave better response and similar survival without impairing Quality of life overall. Detailed QoL measurement should be integral to all cancer chemotherapy trials.

Adult↗
PubMed1992

Cardiac doses in post-operative breast irradiation.

Data were collected on radiation doses given to the heart and coronary arteries during primary breast irradiation in order to analyze factors which might be important in the aetiology of subsequent cardiac-related disease. Twenty eight patients with breast cancer were studied. Fourteen patients treated from 1957 to 1984 were studied retrospectively (group 1), and 14 treated from 1988 to 1989 were studied prospectively (group 2). All patients had stage I or II disease at presentation, and were under 70 years of age. None had chemotherapy as a primary form of treatment. Patients were given a computed tomography scan of the chest, and three-dimensional reconstruction was made of the heart, lung and body contour. Original dose distributions were super-imposed on these outlines, and doses to the total cardiac volume and three main coronary arteries were estimated using an alpha/beta ratio of 4 Gy. Nine out of 14 patients in group 1 had a mastectomy followed mainly by orthovoltage radiation with similar techniques used up until 1984. Thirteen out of 14 patients in group 2 had conservative surgery followed by a modern two- or four-field megavoltage technique. We found that for patients with left-sided tumours (n = 20), the heart volume irradiated to a minimum extrapolated target dose of 5 Gy is significantly decreased for patients treated with a modern technique (group 2) when compared with those treated with earlier techniques (group 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

The design of advanced breast cancer trials. New approaches.

The treatment of advanced breast cancer is always palliative. Only a modest prolongation of life is achieved even in the best series, and the traditional criteria of assessment of response take no account of factors other than tumour bulk. Restrictive entry criteria have resulted from the inability to quantify any other measurement of response, and so the power of such chemotherapy trials has been unnecessarily curtailed. We report on the progress being made in this department to develop a self-assessment diary to record quality of life in these patients and to mount a pragmatic trial of two different regimens in advanced breast cancer using this measure.

Breast Neoplasms↗
PubMed1988

The value of CT in the diagnosis of recurrent carcinoma of the cervix.

The results of computed tomography (CT) and other imaging techniques performed on 70 patients who were investigated for suspected recurrent carcinoma of the cervix are reported. Recurrent disease was present in 39 patients. In 29, there was local recurrence with or without distant metastases and there was distant recurrence only in 10. Computed tomography correctly assessed the presence of local recurrent disease in 85% of patients. Six equivocal, two false positive and two false negative CT examinations in the assessment of local recurrence were due either to difficulty in differentiating recurrent disease from changes following radiotherapy, or to the failure of CT to detect small areas of local recurrent disease. Ultrasound and lymphangiography each detected recurrence in one patient which was missed by CT, but this was the most reliable technique for the detection of both local and distant recurrent disease.

Adenocarcinoma↗
PubMed1985

Low-dose 131I in treatment of Graves' disease.

One hundred and sixty-four patients with Graves' disease were treated with low-dose radioiodine (2 mCi), with a mean follow up of 4 1/2 years. At this time 74 (45%) were euthyroid having had a single dose, with a total of 131 (80%) being controlled with one or more doses. Three (2%) were still toxic but their mean follow up was only 3 years. Thirty (18%) were rendered hypothyroid, two-thirds of these after a single dose of 2 mCi 131I. The one-year incidence of hypothyroidism was 6%, with an incidence at 6 years of 20%. Previous surgery, medical treatment and thyroid antibody status appeared to have no influence on the outcome.

Adult↗
PubMed1985

The role of CT in the staging and radiotherapy planning of prostatic tumours.

Fifty patients with proven carcinoma of the prostate have been evaluated with CT. The CT studies were carried out for staging and radiotherapy planning and the findings compared with rectal examination and lymphography. CT provided useful additional information to that obtained by rectal examination in 40% of patients and these findings had important implications for radiotherapy planning. There was good correlation between CT and lymphography in the assessment of pelvic lymph node involvement.

Aged↗