Adult choroidal vein of Galen malformation.
We report staged embolization and stereotactic radiation in a true adult choroidal vein of Galen malformation. Management dilemmas and their resolutions are also discussed.
Adult↗
Biomedical subjects
J C Breneman
Publications and source records attributed to J C Breneman.
Ionizing radiation therapy in dermatology.
The introduction of new surgical techniques and other therapeutic modalities has markedly influenced the use of ionizing radiation therapy in dermatology. X-rays and electron beams are now used only for a limited number of indications in carefully selected patients. Since surgical approaches have gained popularity in the treatment of skin tumors, not all dermatologists are familiar with the benefits of ionizing radiation for patients with cutaneous neoplasms and certain other skin disorders. This article reviews modern indications for radiation therapy in dermatology. Important physical and biologic factors, radiation side effects, radiation protection measures, and therapeutic results will also be discussed. Although the use of radiotherapy in dermatology has in large part been supplanted in recent years by other forms of treatment, ionizing radiation continues to be an essential therapeutic alternative for many cutaneous tumors and some skin diseases. It is important to be familiar with the principles of radiotherapy so that optimal therapy can be selected for individual patients.
Basal Cell Carcinoma↗
The role of radiation therapy in the treatment of acute lymphoblastic leukemia with lymphomatous presentation: a report from the Childrens Cancer Group.
PURPOSE: Childrens Cancer Group 123 was a trial of intensive multidrug chemotherapy as well as cranial irradiation and bulk disease irradiation in children with acute lymphoblastic leukemia with lymphomatous presentation (bulk disease and either T-cell phenotype, high white blood count, or absence of anemia), a poor prognostic group with an increased risk of central nervous system (CNS) and other extramedullary recurrence. METHODS AND MATERIALS: Three hundred eight patients without CNS disease were randomized among three regimens: A--BFM chemotherapy (designed for high risk ALL patients) with 1800 cGy cranial irradiation; B--LSA2L2 chemotherapy (designed for non-Hodgkins lymphoma patients) with 1800 cGy cranial irradiation and 1500 cGy to nonabdominal bulk disease; C--Reg B without cranial irradiation. All patients received intrathecal methotrexate throughout therapy. Radiation treatment records were reviewed. RESULTS: With a minimum 52-month follow-up, Regimen B and C patients had 5-year actuarial CNS relapses of 7% and 17% (p = 0.01) and event-free survivals of 53% and 39% (p = 0.04). Patients with white blood count < 50,000/mm3 did not benefit from cranial irradiation. Regimen A patients had the same CNS relapse rate as Regimen B patients but an improved event-free survival. Regimen B and C patients with large mediastinal masses who received their assigned chest radiation had a lower event rate than those who did not (p = 0.06). Patients whose cranial fields did or did not encompass the entire meningeal surface had equivalent CNS relapse rates. CONCLUSION: Patients treated with LSA2L2 chemotherapy, a less than optimal regimen, benefited from cranial and mediastinal irradiation. Compliance with radiation volume guidelines was not essential for patients to receive the benefit of cranial irradiation.
Actuarial Analysis↗
Design of a cap for radioshielding during treatment with interstitial 125I brain implants.
A practical radiation shielding cap has been constructed for use during 125I brain implants. The cap is comfortable enough to be worn continuously during a 6-day implant and provides complete shielding from the implanted radioactive sources.
Aged↗
Cutaneous T-cell lymphoma mimicking porokeratosis of Mibelli.
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Adult↗
Phase II study of pentostatin and intermittent high-dose recombinant interferon alfa-2a in advanced mycosis fungoides/Sézary syndrome.
PURPOSE: This phase II study was undertaken to assess the efficacy and toxicity of alternating administration of pentostatin (deoxycoformycin [DCF]) and interferon alfa-2a (IFN) in patients with advanced or refractory mycosis fungoides (MF) or the Sézary syndrome (SS). PATIENTS AND METHODS: Forty-one patients underwent therapy with alternating cycles of DCF 4 mg/m2 intravenously (IV) days 1 through 3 and IFN 10 million U/m2 intramuscularly (IM) day 22, and 50 million U/m2 intramuscularly (IM) days 23 through 26. Twenty-nine patients had not responded to prior chemotherapy or total-skin electron-beam irradiation (TSEB), six had not responded to topical therapies, and six had no previous treatment. RESULTS: Two patients achieved a complete response (CR) and 15 achieved a partial response (PR), for an overall response rate of 41% (95% confidence interval, 26% to 58%). No responses were observed in the seven patients with visceral involvement. The median progression-free survival of patients who responded was 13.1 months. IFN-related constitutional symptoms were reported in 39% of patients; severe toxicities included cardiomyopathy in one patient, acute and chronic pulmonary dysfunction in four, and reversible mental status changes in two. Seven patients developed herpes zoster during therapy and six had staphylococcal bacteremia. CONCLUSION: These results suggest that the combination of DCF and IFN is an active regimen in MF patients without visceral involvement.
Adult↗
Topical mechlorethamine in the treatment of mycosis fungoides. Uniformity of application and potential for environmental contamination.
Topical mechlorethamine hydrochloride is commonly used in the treatment of mycosis fungoides and has been formulated in both aqueous and ointment vehicles. Two concerns regarding the topical application of mechlorethamine hydrochloride relate to the adequacy of skin coverage that can be attained by the patient and the extent to which others in the patient's household might be exposed to the drug. In this study six patients applied either aqueous or ointment vehicles containing a fluorescent dye. Subsequent examination of the skin under a Wood's lamp revealed a significant percentage of body surface area to be missed during application; several areas were noted to be missed most commonly. These observations have led to specific alterations in instructions given to patients regarding drug application. Examination of the surrounding environment showed minimal evidence of contamination.
Administration, Cutaneous↗
Irradiation of epithelial skin cancer.
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Carcinoma↗
Concurrent radiotherapy and chemotherapy for locally advanced non-small-cell cancer of the lung. Report of a clinical trial and review of the literature.
A prospective nonrandomized phase II study was begun in 1985 using concurrent split-course radiation and chemotherapy in the treatment of locally advanced non-small-cell cancer of the lung. Patients were treated with 3,000 cGy of radiation in 15 fractions to the chest, together with 100 mg/m2 cisplatin on day 1 and 1,000 mg/m2/day 5-fluorouracil infusion on days 1-4. The radiation and chemotherapy were then repeated after a 1-week break. Twenty-one patients were treated, with five patients having a complete response and nine patients having a partial response for an overall response rate of 67%. With a minimum of 24 months follow-up, five patients remain alive. Median survival for the entire group is 11.6 months. The toxicity of the treatment regimen was acceptable. These results do not differ significantly from survivals of similar patients treated with radiation alone, including a series from our own institution. The literature on concurrent chemotherapy and radiation is reviewed and possible future approaches to this tumor are discussed.
Adult↗
A technique for delivery of total body irradiation for bone marrow transplantation in adults and adolescents.
With the increasing use of bone marrow transplantation for cancer, total body irradiation is becoming a more commonplace procedure in many of the larger centers across the country. The technical difficulties in delivering homogenous doses of radiation to the whole body are significant and involve many factors such as creation of a homogeneous, "flat" beam of radiation, and dealing with variations in patient thickness and tissue homogeneity, particularly in the lung. In addition, techniques must be used to safely and efficiently deal with patients who are usually very ill and require long treatment times. Although there is often an advantage in terms of dosimetry to using an AP/PA treatment technique, many institutions use parallel opposed lateral beams because of equipment and facility limitations. A technique has been devised that enables total body irradation to be given by an AP/PA technique using equipment available in many radiotherapy departments. Patients are supported in an upright position during treatment by means of a modified harness attached to the ceiling of the treatment room. Lung compensators are fixed to individually fitted "vests," allowing the patient moderate amounts of movement during treatment while maintaining the position of the compensator relative to the lungs. Thermoluminiscent dosimeter (TLD) dose measurements in a phantom indicate that this system can deliver accurate and homogeneous doses to lung tissue, while allowing a good degree of patient comfort and safety during the long treatment times that are required.
Adolescent↗
Management of radiation-induced moist skin desquamation using hydrocolloid dressing.
Moist skin desquamation has been of concern to radiation oncologists, nurses and patients since the inception of this mode of therapy. As radiation treatment machines became more sophisticated, severe reactions became less of a problem. However, with the increasing use of chemotherapy and radiation as combined modalities, moist skin reaction is occurring with greater frequency. A noncomparative study of 20 patients using a hydrocolloid occlusive dressing (Duoderm) was initiated. The purpose of the study was to determine whether moist occlusive healing would be beneficial. The dressing was evaluated on the basis of healing time, safety, wound temperature, bacterial growth, and comfort. Data were collected using photographs, bacterial cultures, temperature probes, and patient evaluations. Eighteen patients completed the study. All patients' skin reactions healed. There were no wound infections evident. Mean healing time was 12 days, with mean wound temperature relative to body core -0.8 degree C on day 1 and -1.2 degrees C on the healed site. Patient results on comfort were: 8 of 18 excellent, 7 of 18 good, 3 of 18 fair, and 0 of 18 poor. The results of this study indicate that a hydrocolloid occlusive dressing can be effective in the healing process of moist skin reaction that is due to radiation therapy.
Bandages, Hydrocolloid↗
Patch tests demonstrating immune (antibody and cell-mediated) reactions to foods.
For decades food allergists have sought a simple, inexpensive test for food allergy. Intradermal tests of aqueous material have not proved reliable. When positive, they are probably only 10% accurate. The newer laboratory tests for food allergy are expensive and highly sophisticated. They are impractical for use in the laboratories of practicing allergists with whom individuals with a potential food allergy are most liable to consult. The RAST is capable of identifying only Type I of the Gell-Coombs' reaction classification. Since 1980, a patch test of individual foods suspended in dimethylsulfoxide has been used as a screen for sensitivity to foods. Controlled clinical studies suggest this might prove to be a valuable test for food allergy. Immune studies appear to confirm the accuracy and reliability of this inexpensive test. No systemic reactions have been observed in the 400 patients tested indicating it to be a safe procedure.
Antibody Formation↗
Prevention of stomal recurrence in patients requiring emergency tracheostomy for advanced laryngeal and pharyngeal tumors.
Since 1976, patients requiring emergency tracheostomy for advanced laryngeal and hypopharyngeal cancer at the University of Cincinnati have been treated with a short course of prelaryngectomy radiation in an attempt to decrease the incidence of stomal recurrence. Twenty-one patients were treated after emergency tracheostomy with a course of radiation that usually consisted of 20 Gy in five fractions followed by laryngectomy 1 or 2 days later. Most patients also received postoperative radiotherapy of some type. The follow-up of 18 evaluable patients revealed only two (11%) stomal recurrences--a quite acceptable rate for this high-risk population. Overall, however, local recurrences were seen in ten patients (56%), which is higher than reported in most series of similar tumors. The most likely explanation for this seems to be that the short course preoperative radiation prevented the administration of adequate postoperative radiation for residual disease, which was usually present. An alternative treatment policy would be a planned course of moderate- to high-dose postoperative radiation, which could sterilize tumor in the entire locoregional area including the stoma.
Aged↗
The distribution of power and heat produced by interstitial microwave antenna arrays: I. Comparative phantom and canine studies.
To adequately plan and administer localized hyperthermia with interstitial microwave antennas, the thermal distribution patterns generated by such antennas must be characterized. This study evaluated the performance of single node 915 MHz antennas operating either alone or as a 2 cm square array of four parallel antennas using both muscle-equivalent phantoms and canine thigh muscle. Two types of measurements were compared. Specific absorption rate (SAR), where temperature increases resulting from short duration microwave pulses were used to define power distribution, and temperature gradients during simulated hyperthermia treatments. SAR measurements in phantoms were comparable to those obtained in non-perfused canine muscle demonstrating the usefulness of the phantom for these measurements. For a single antenna there was a rapid decrease in power radially which resulted in a steep thermal gradient at distances within 0.5 cm. However, the power generated by a four-antenna array was highest along its central axis and declined to approximately 50% near the antennas at the array periphery. Along the central axis of the array power decreased most rapidly distal to the antenna nodes. The distribution of temperature measured during simulated hyperthermia treatments in phantoms paralleled the SAR distribution and was comparable to the temperature gradient observed in perfused canine muscle, suggesting that phantoms could be used to predict temperature distributions in resting muscle tissue.
Animals↗
The distribution of power and heat produced by interstitial microwave antenna arrays: II. The role of antenna spacing and insertion depth.
The distribution of power and temperature generated by 915 MHz interstitial microwave antenna arrays was studied in static muscle-equivalent phantoms and both perfused and non-perfused canine thigh muscle. These arrays, which would form the geometric basis of larger volume implants, consisted of four parallel antennas oriented such that transverse to their long axes they formed the corners of a square. Arrays with 2 and 3 cm sides were compared at various depths of insertion where the nodes for all four antennas were coincident at the same depth. The position relative to the antenna nodes of the maximum power and highest temperature within the array volume varied with the depth of insertion of the antennas. Though power dropped rapidly distal to the nodes at all depths, a shift in the location of the maximum power proximal to the nodes resulted in an increase in the effective heating volume at certain insertion depths. For 2 cm array spacing the highest power and temperature were measured along the central axis of the array at all insertion depths. However, arrays using 3 cm spacing generated their maximum power adjacent to the antennas with only 50% of this level occurring along the central axis. When the temperature produced by 3 cm arrays was measured in phantoms midway through simulated 30-minute hyperthermia treatments, the effect of thermal conduction on the temperature distribution was evident. Though power was only 50% centrally, the highest temperatures occurred there. This same pattern of central heating occurred in perfused canine muscle demonstrating the importance of conductive and convective heat redistribution in reducing thermal gradients within the array volume.
Animals↗
Incorporation of patient immobilization, tissue compensation and matchline junction technique for three-field breast treatment.
A protocol for the treatment of the intact breast was developed to maximize dose homogeneity and reproducibility. This protocol uses patient and breast immobilization, three-dimensional tissue compensators, and a technique for geometric matching of fields when the supraclavicular area is treated. A series of phantom measurements and analysis of patient port films was performed to evaluate dose homogeneity and reproducibility using this technique, and the potential adverse effect of loss of skin sparing from the immobilization device was investigated. Dose homogeneity throughout the phantom breast was within +/- 6% of the prescribed central axis dose, and homogeneity at the supraclavicular match line was +/- 10%. This represented a significant improvement over techniques not using tissue compensation or geometrically matched fields. Reproducibility of patient treatments was not significantly improved from previous non-immobilized treatment techniques, but there was no loss of skin sparing from the device, and other advantages of immobilization were observed. Details of the protocol are discussed together with changes that are currently being made to improve the results obtained thus far.
Breast Neoplasms↗
Food allergy--a new science.
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Food Hypersensitivity↗
Overview of food allergy: historical perspective.
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Food Hypersensitivity↗