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Biomedical subjects

J A Levi

Publications and source records attributed to J A Levi.

At least 55 records · Page 3Linked to original sources
PubMed1984

Computed tomography of intraperitoneal malignancy.

A review of 205 abdominal computed tomographic (CT) scans in 83 patients with gastric or ovarian neoplasms was performed in order to assess their contribution to management. Assessment of scan accuracy was based on results of invasive procedures, clinical data, and double-blind re-reporting. Scans appeared to be of greater value in patients with ovarian rather than gastric neoplasms (p less than 0.001), and in patients undergoing clinically-indicated rather than routine scans (p less than 0.001). No clinical benefit accrued from the use of pre-treatment scans. Overall accuracy of scanning was judged to be significantly greater for the ovarian than the gastric group (p less than 0.001), while concordance of scan reports with re-reporting was also greater in the ovarian group (p less than 0.001). The data indicate the inherent limitations of the CT scan and the high degree of subjectivity in its interpretation, particularly when used in the follow-up of patients with known or suspected recurrent gastric cancer. CT scanning remains a potentially useful adjunct to clinical assessment of patients with intraperitoneal malignancy, but should not be regarded as obviating the need for clinical judgement in management decisions.

Adolescent↗
PubMed1984

High-dose methotrexate with leucovorin rescue, vinblastine, and bleomycin with or without tamoxifen in metastatic renal cell carcinoma.

A regimen of high-dose methotrexate with leucovorin rescue, vinblastine, and bleomycin with or without tamoxifen was administered to 34 patients with metastatic renal cell carcinoma. No complete remissions were observed, but ten patients (30%) achieved partial remission and an additional 13 patients (39%) had stabilization of disease. The median survival of responding patients (110 weeks) was significantly longer than that of nonresponding patients. The addition of tamoxifen did not influence response or survival. This regimen was tolerated without significant toxicity. A prospective randomized study of the vinblastine and high-dose methotrexate regimen compared to the respective single agents seem to be indicated.

Adenocarcinoma↗
PubMed1983

Surgery in patients with advanced germ cell malignancy following a clinical partial response to chemotherapy.

Twenty-one patients with metastatic germ cell tumors achieved only partial clinical tumor regression following chemotherapy, and underwent surgical biopsy or resection of the residual tumor deposits. Sixteen (76%) are at present clinically disease-free after a median 30 + months (range 17-50 months) from the time of surgery, and five (24%) died after 9-29 months. Adverse prognostic signs were the finding of persistent cancer at histopathological examination of the resected tumor masses, and the presence of elevated serum tumor markers at the time of surgery. Postchemotherapy surgery in this setting provides tissue for the prognostically important histopathological examination on which a decision regarding further chemotherapy may be based. In addition, it provides tumor bulk reduction in the cases of differentiated teratoma and persistent cancer.

Adolescent↗
PubMed1983

The role of hepatitis B virus in the etiology of hepatocellular carcinoma in Australia.

Fifty-three patients with Hepatocellular Carcinoma (HCC) from three Sydney teaching hospitals were examined for possible evidence of Hepatitis B virus (HBV) infection. Hepatitis Surface Antigen (HBsAg) was positive in 38% of those in whom it was sought, a higher incidence than previously reported in an Australian series. A further 13 patients had antibody to Hepatitis B core (Anti-HBc), but negative HBsAg, confirming past exposure to HBV. Where serum was available evidence of HBV infection was obtained in 62% of patients. It is argued that the incidence of HBV infection may be shown to be higher still with the advent of new technology as applied to HBV assays and tissue stains. The need to be aware of the growing evidence of a strong association between Hepatitis B virus and the development of HCC is stressed and the clinical implications are discussed.

Alcohol Drinking↗
PubMed1982

Four-drug combination chemotherapy for advanced cervical carcinoma.

Thirty-one patients with advanced stage squamous cell carcinoma of the cervix were treated with the four-drug combination fluorouracil, doxorubicin, cyclophosphamide, and vincristine. Four patients achieved complete remission (13%) and 15 partial remission (45%). The only factor of adverse prognostic significance was poor initial patient performance. Median survival for the patients entering complete remission exceeded 54 weeks and was 43 weeks for patients achieving partial remission. Seven patients are still alive at 50 weeks. This represents a notable prolongation of survival compared with those patients who did not achieve remission. Toxicity for the combination was not excessive; myelosuppression and vincristine-induced neuropathy were the most prominent. These results are moderately encouraging and confirm the sensitivity of cervical carcinoma to systemic chemotherapy. Further studies to define the optimal use of chemotherapy in both advanced and earlier stages of disease are warranted.

Adult↗
PubMed1982

Alternating non-cross-resistant combination chemotherapy for small cell anaplastic carcinoma of the lung.

The development of drug resistance limits the survival or patients with small cell anaplastic carcinoma of the lung (SCLC). The present study was undertaken to overcome this problem by administering two alternating noncross resistant combination chemotherapy regimens. One-hundred-one patients were entered on study, and 98 were evaluable, with a median onstudy time of 55+ weeks. All patients received the initial combination therapy of cyclophosphamide, methotrexate, and vincristine, alternating every three weeks with Adriamycin and VP16-213 (etoposide). Radiation therapy was not a standard part of protocol. Thirty-two patients had regional disease (LD), and 66 had extensive disease (ED). Overall, 76% of patients responded to this therapy with 30 (31%) complete remission (CR) and 44 (45%) partial remissions (PR); the respective CR and PR rates were 31% and 50% for LD, and 30% and 42% for ED patients. Myelosuppression was the principal toxicity with a leukocyte nadir of 2.0 X 10(9)/1 in 10% of cycles. Septicemia in six neutropenic ED patients with progressive disease contributed to the only treatment-related deaths. Patients entering CR had a median survival greater than 51 weeks (range, 8-150+); 58+ for LD and 49+ for ED patients. Patients in PR had respective median survivals of 33+ (overall), 43+ (LD), and 24+ (ED) weeks. Forty patients have had relapses with initial sites being local sites in 35%, and neurologic in 38%. Although this protocol has not discernibly delayed the onset of drug resistance, the problem should be considered when new protocols are designed in SCLC.

Antineoplastic Agents↗
PubMed1982

Significant factors in the optimal management of advanced stage germ cell carcinoma.

Twenty-two patients with advanced stage germ cell carcinomas received a combination chemotherapy regimen of cis-platinum, vinblastine, bleomycin and actinomycin D. There were 16 (73%) complete remissions, (five documented at surgery), one patient (5%) whose residual disease was completely resected and five (22%) partial remissions. The only adverse significant pretreatment factors were extent or bulk of initial disease and poor performance status. Prior radiotherapy or chemotherapy did not influence the potential to achieve complete remission, but was associated with increased haematological toxicity. Toxicities were common and there were three treatment related deaths, one from septicaemia and two from pulmonary fibrosis, emphasising the need for expertise and optimal supportive care when administering this complicated regimen. There was a significant survival advantage for the patients achieving disease-free status compared to partial responders (p = 0.02). Only one relapse has occurred among the former group with 82% alive and disease-free with follow-up of 27-50 months, indicating the majority of these patients may be cured. Management of advanced stage germ cell carcinoma can now be considered highly successful although further studies are needed to determine optimal treatment for patients with bulky disease and the role, if any, of maintenance therapy.

Adult↗
PubMed1982

Advanced ovarian cancer: a prospective randomised trial of chlorambucil versus combined cyclophosphamide and cis-diamminedichloroplatinum.

Thirty-seven patients with advanced ovarian cancer were treated in a prospective, randomised trial comparing chlorambucil with a combination of cyclophosphamide and cis-diamminedichloroplatinum (cis DDP). Treatment with the combination was associated with an increased overall response rate (69% versus 23%) (p = 0.04). A response was associated with a longer median survival but no survival advantage was demonstrated for patients who received cyclophosphamide/cis DDP. A larger study is needed to evaluate fully the potential of regimens containing cis DDP in the management of advanced ovarian cancer.

Chlorambucil↗
PubMed1982

Phase II study of doxorubicin and mitomycin in non-small cell bronchogenic carcinoma.

Thirty patients with advanced measurable non-small cell bronchogenic carcinoma were treated with a combination of doxorubicin (50 mg/m2 every 3 weeks) and mitomycin (20 mg/m2 every 6 weeks). One complete and three partial responses were observed. This response rate is similar to that reported for either drug used alone.

Carcinoma, Bronchogenic↗
PubMed1981

Haemolytic anaemia after cisplatin treatment.

Normochromic or normocytic anaemia is a common side effect of treatment with cisplatin. Two patients treated with cisplatin 100 mg/m2 in combination with vinblastine, bleomycin, and actinomycin D developed haemolytic anaemia. Neither patient had evidence of haemolysis before treatment, and in both cases severe haemolytic anaemia developed after several courses of cisplatin and when the cancer had regressed almost completely. The importance of haemolysis in the development of anaemia after cisplatin treatment has not been investigated fully and further studies are needed.

Adult↗
PubMed1981

Triple drug chemotherapy for advanced ovarian carcinoma: comparative study of two regimens.

Two consecutive studies were undertaken in patients with advanced adenocarcinoma of the ovary to compare melphalan, adriamycin and 5-fluorouracil (MAF) with cyclophosphamide, adriamycin and 5-fluorouracil (CAF). Twenty-one patients received MAF and 19 received CAF. The objective response rate was 35% for MAF and 62% for CAF patients, and complete remission occurred in 23% of MAF, and in 56% of CAF, patients. These differences were not statistically significant. In both groups, complete remission had a statistically significant and favourable influence on survival. Toxic effects were predominantly haemopoietic and gastrointestinal, MAF having a significantly greater thrombocytopenic potential than CAF, but over-all tolerance was good on both protocols. MAF and CAF are comparable and effective combinations for the treatment of advanced ovarian cancer, but do not demonstrate superiority to single alkylating agent therapy or to other combinations. This emphasizes the continuing need for well designed randomized trials comparing single alkylating agents with combinations of known active agents.

Antineoplastic Agents↗
PubMed1981

Methyl-CCNU, 6-thioguanine, and 5-fluorouracil in advanced colorectal cancer.

Consecutive studies were undertaken in advanced colorectal adenocarcinoma, comparing two different schedules of the combination methyl-CCNU, 6-thioguanine, and 5-fluorouracil in 89 patients. The two schedules exhibited similar efficacies, with a combined complete and partial remission rate of 17%, a median response duration of 36+ weeks, and a median survival of 53+ weeks. Significant symptomatic benefit was seen in 52% of patients. Toxicity was predominantly hemopoietic and gastrointestinal, being acceptable overall, with only minor qualitative differences between the two protocols. These triple-drug regimens exhibit response rates and survival patterns comparable with those reported for other multidrug combinations and some single agents. It would appear that major improvements in the management of advanced-stage disease must await the availability of more efficacious agents used alone or in combination.

Adenocarcinoma↗
PubMed1981

Meningeal carcinomatosis in small cell carcinoma of the lung.

Cerebral and meningeal metastases are increasingly important complications in small cell anaplastic carcinoma of the lung. In a study at this institution, 60 evaluable patients received intensive chemotherapy without prophylactic cranial irradiation or other prophylactic measures. The complete plus partial remission rate was 78 percent with a median survival of 49+ weeks (range eight to 106+ weeks) for those with a complete response and 18+ weeks (range six to 67 weeks) for those with a partial response, all of which are comparable to other reported series. In 11 patients (18 percent) meningeal carcinomatosis has developed. Forty-two percent of the patients with a relapse have exhibited meningeal carcinomatosis and in 27 percent of the patients with a relapse it was the only site of relapse. Cerebral metastases occurred in 27 percent of those who had a relapse, and in 12 percent this was the sole site of relapse. Simultaneous meningeal carcinomatosis and cerebral metastases occurred in 8 percent of the patients with a relapse. The median time to meningeal relapse was 27 weeks (range 12 to 60 weeks) compared with 25+ weeks (six to 106+ weeks) over-all, and the median survival was 28 weeks (range 14 to 82 weeks) compared with 25+ weeks (two to 106+ weeks) for the whole group with small cell carcinoma of the lung. Meningeal involvement in small cell carcinoma of the lung must now be considered a sanctuary site of equal importance to cerebral metastases. To prevent and treat this complication will necessitate evaluation of all available modalities, including cranial and spinal irradiation, intrathecal chemotherapy and systemic agents that readily cross the blood-brain barrier.

Adult↗
PubMed1981

Cyclical combination chemotherapeutic regimen in adult soft tissue sarcoma.

A cyclical combination chemotherapeutic regimen of Adriamycin and cyclophosphamide alternating with actinomycin D and DTIC was administered to 20 evaluable patients with metastatic soft tissue sarcoma. Responses included four (20%) partial remissions and five (25%) patients with stable disease. There was a significant prolongation of survival for responding patients (median 42.5+ weeks) compared to patients with progressive disease (median 17.5 weeks). Principal toxicity was nausea and vomiting particularly with the actinomycin D/DTIC combination and four patients found this so intolerable they withdrew from study. These results are inferior to those reported for Adriamycin alone and other combinations. Further evaluation of the concept of sequential non-cross-resistant combinations would only seem appropriate if newer more active agents are identified and each combination is administered for a set duration before crossing over to the alternative regimen.

Adult↗