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Biomedical subjects

J C Buckner

Publications and source records attributed to J C Buckner.

At least 55 records · Page 3Linked to original sources
PubMed1996

Brain metastases from colorectal carcinoma. The long term survivors.

BACKGROUND: Brain metastases occur in 25% to 35% of all cancer patients, with colorectal carcinoma accounting for approximately 8% of these. Information about patients with brain metastases from colorectal carcinoma is limited, with the largest previous series reporting only 40 patients. To date there have been no reports describing the subgroup of patients with long term survival ( > 1 yr). METHODS: A retrospective review of 150 patients seen at the Mayo Clinic between 1976 and 1993 with pathologic (56) and/or radiographic (94) confirmation of brain metastases from colorectal carcinoma is presented. RESULTS: The majority of patients (82%) with brain metastases from colorectal carcinoma have concomitant extracerebral metastases, especially in the lungs. Only 16% of the patients survived > 1 year after diagnosis (4 > 4 yrs., 2 > 10 yrs). Of these, 92% had single cerebral metastases and 38% had no systemic metastases. In addition, young age and the absence of bony metastases or memory loss were associated with increased survival. Median survival for all of the patients receiving surgery and radiotherapy (39), surgery alone (11), radiotherapy alone (79) and supportive care (17) are 42, 45, 16, and 8 weeks, respectively. Thirty percent of the patients treated with radiotherapy showed regression of their tumors on follow-up head scans; three had complete regression. CONCLUSIONS: One-year survivors of brain metastases from colorectal carcinoma were uncommon, accounting for 16% of the patients and most of these (92%) had solitary lesions. Nineteen of 24 long term survivors had surgical resection as part of their treatment. Given the similar results in patients treated with surgery plus radiotherapy and those treated with surgery alone, as well as the potential long term side effects of radiotherapy, withholding radiotherapy for those patients with the possibility of long term survival should be considered.

Adult↗
PubMed1996

Phase II study of 5-fluorouracil and leucovorin in recurrent primary brain tumor.

Thirty patients with recurrent primary brain tumors were treated with a combination of 5-fluorouracil and leucovorin. There were three responses seen. Toxicity consisted of stomatitis, diarrhea, and hematological suppression. 5-fluorouracil and leucovorin would appear to be minimally effective in recurrent brain tumors.

Adult↗
PubMed1996

Work and welfare: job histories, barriers to employment, and predictors of work among low-income single mothers.

The work histories of 436 sheltered homeless and low-income women were analyzed to develop a predictive model of factors that facilitate employment possibilities for some low-income women and deter others from obtaining work. Findings suggest the need for programs of education, early intervention, and job training. However, the availability of adequate jobs and affordable child care are prerequisites for poor, single mothers to become self-supporting.

Adolescent↗
PubMed1996

Fathers of children on welfare: their impact on child well-being.

Although it is generally assumed that fathers are absent from the lives of children being raised on AFDC, evidence from a case-control study in Worcester, Massachusetts, suggests that there is considerable father-child contact. In addition, multivariate modeling indicates that contact with fathers had a modest beneficial effect on children's behavior. Based on these study findings, negative traits of fathers (e.g., substance abuse, physical violence) appear to be associated with increased child behavior problems.

Adolescent↗
PubMed1995

Prostate specific antigen levels and clinical response to low dose dexamethasone for hormone-refractory metastatic prostate carcinoma.

BACKGROUND: It has been suggested that suppression of adrenal androgens may provide benefit to patients with metastatic prostate cancer refractory to initial hormonal therapy (e.g., orchiectomy). METHODS: The records of 38 patients with metastatic prostate cancer that had progressed after orchiectomy who were placed subsequently on low dose dexamethasone (DXM) with no other concurrent therapy (36 patients received 0.75 mg twice daily and two received 0.75 mg three times daily) were reviewed. Symptomatic status, prostate specific antigen (PSA) measurements, and available radiographic assessments were recorded. Bone scans were reviewed by an independent, blinded evaluator. RESULTS: Symptomatic improvement was experienced by 24 patients (63%), 20 (83%) of whom also had decreases in PSA. Prostate specific antigen values decreased in 30 patients (79%) with decreases 50% or greater and 80% or greater in 23 (61%) and 13 (34%) patients, respectively. Of the 23 patients with PSA decreases 50% or greater, 8 (35%) had radiographic evidence of disease regression, 5 (22%) were stable, 7 (30%) had disease progression, and 3 (13%) did not have serial radiographic exams. Flutamide was discontinued shortly before DXM treatment for 2 of the 23 patients. CONCLUSIONS: Low dose DXM may produce important symptomatic improvement and decreased PSA levels in the majority of patients with hormone-refractory prostate cancer. In addition, a substantial percentage of those patients with decreases in PSA also will have radiographic evidence of disease regression. These results suggest the need for additional prospective controlled studies of DXM as a therapy for hormone-refractory prostate cancer.

Aged↗
PubMed1995

Phase II study of amonafide in patients with recurrent glioma.

Amonafide, a novel imide derivative with broad preclinical antitumor activity, achieves significant cerebrospinal fluid levels in animal models. In order to test its antitumor activity in patients with recurrent diffuse infiltrative glioma of the astrocytic and oligodendroglial type, we performed a phase II clinical trial. Of the 22 eligible and evaluable patients treated, 2 (9%) experienced tumor regression lasting more than one year. No other patients experienced tumor regression; one remained stable more than six months. Toxicities consisted primarily of myelosuppression, vomiting, and venous irritation at the infusion site. We conclude that amonafide has minimal activity in recurrent glioma patients. Further investigations are not warranted in this study population.

Adenine↗
PubMed1995

Phase II evaluation of recombinant interferon alpha and BCNU in recurrent glioma.

The goal of this study was to determine the antitumor activity and toxicity of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) plus recombinant interferon-alpha (IFN-alpha) in patients with recurrent glioma. As single agents, both BCNU and IFN-alpha can cause tumor regression in patients with recurrent glioma. In vitro studies suggest synergy between the two agents. Thirty-five patients in whom computerized tomography (CT) or magnetic resonance (MR) evidence was obtained of progressive astrocytoma, oligoastrocytoma, or oligodendroglioma received recombinant IFN-alpha 2a (12 x 10(6) U/m2 intramuscularly) on Days 1 through 3 and BCNU (150 mg/m2 intravenously) on Day 3 of each 6-week cycle. All patients had tumor progression despite radiation therapy and had received no prior chemotherapy. Response was assessed by CT or MR evidence and by neurological examination while the patients were on a regimen of stable or decreasing doses of corticosteroids. All patients could be evaluated for response and toxicity. Twenty-nine percent of the patients demonstrated objective tumor regression; 37% remained stable for more than 6 months and 25% were stable for less than 6 months. The median duration of response to IFN-alpha and BCNU was 9.9 months and the median survival for all patients was 13.3 months. Toxicity consisted primarily of moderate myelosuppression, venous irritation, vomiting, flulike symptoms, and transient reversible exacerbation of underlying neurological symptoms. The use of BCNU plus IFN-alpha is a safe, active regimen in the treatment of patients with recurrent glioma who have failed to respond to prior radiation therapy. The contribution of IFN to the antitumor activity observed in this study compared with that previously described with BCNU alone cannot be assessed from this trial.

Adult↗
PubMed1994

Phase I study of combined alpha interferon, alpha difluoromethylornithine (DFMO), and doxorubicin in advanced malignancy.

Interferon (IFN) and conventional cytotoxic chemotherapeutic agents have been successfully combined in various studies. Alpha difluoromethylornithine (DFMO) is a novel antitumor agent which is an inhibitor of polyamine metabolism. A phase I study of IFN 24 x 10(6) U/m2/day IM (days 3-7), DFMO 9 gm/m2 p.o. daily (days 1-7), and a variable dose of doxorubicin starting at 20 mg/m2 (day 6), of each 28 day cycle was performed. The aim of the study was to determine the maximally tolerable dose of doxorubicin in this combination. Three patients were treated with doxorubicin at 20 mg/m2 and six patients at 40 mg/m2. The dose limiting toxicities were neutropenia, fatigue and fever. All other toxicities were mild and there was no grade IV toxicity. A doxorubicin dose of 40 mg/m2 produced tolerable toxicity and is recommended for phase II studies. No major antitumor effects were seen.

Doxorubicin↗
PubMed1994

Brain metastatic lesions.

OBJECTIVE: To describe current concepts in the diagnosis and treatment of brain metastases. RESULTS: More than 25% of all autopsy-proven brain metastases have a pulmonary source. Most brain metastases manifest with a combination of focal and generalized symptoms and signs. Typically, patients have subacute, progressive symptoms. In most situations, a computed tomographic scan of the head provides sufficient neuroimaging and allows one to monitor the effects of therapy. Magnetic resonance imaging has become increasingly useful in the diagnosis and management of brain metastases. It can detect computed tomographic occult metastases, identify associated leptomeningeal disease, and reveal early therapeutic complications. CONCLUSION: Treatment options for patients with brain metastases include corticosteroids, whole-brain radiation therapy (WBRT), surgical intervention, stereotactic radiosurgical techniques, and chemotherapy. Corticosteroids produce prompt improvement in most patients; however, prolonged use is associated with considerable risks. For most patients, WBRT is the preferred treatment. Nonetheless, it has associated nonneurologic and neurologic complications, some of which are serious. In patients with a single metastasis, surgical removal should be considered. Recent studies have suggested that resection of a single metastatic lesion followed by radiation therapy offers better survival than does radiation therapy alone. The subsequent administration of WBRT after radiosurgical treatment has become standard practice. The role of chemotherapy is uncertain.

Brain Neoplasms↗
PubMed1994

Thromboembolism in patients with high-grade glioma.

OBJECTIVE: To identify factors related to increased or decreased risk of thromboembolism (TE) in patients with high-grade glioma. DESIGN: We performed a retrospective analysis of 64 patients enrolled in two prospective clinical trials of chemotherapy and radiation therapy for newly diagnosed high-grade glioma. MATERIAL AND METHODS: The 64 patients were 18 years of age or older and had histologically confirmed grade 3 or 4 astrocytoma, mixed astrocytoma-oligodendroglioma, or gliosarcoma. The diagnosis of TE was confirmed by impedance plethysmography, venography, duplex ultrasonography, ventilation-perfusion lung scanning, or pulmonary angiography. For statistical analysis, the study group was divided into those with and those without TE. RESULTS: TE developed in 18 of the 64 patients (28%). Of the 18 patients, 11 had deep venous thrombosis of a lower extremity, 5 had pulmonary emboli, and 2 had superficial thrombophlebitis. A paretic arm (P = 0.017), a paretic leg (P = 0.026), or a history of TE before the diagnosis of glioma (P = 0.076) was more common in patients with TE than in those without TE. Ten patients in the group without TE were using aspirin preoperatively in comparison with no patient in the TE group (P = 0.05). No significant differences were noted in duration of survival (median, 39.4 weeks and 46 weeks for the TE and non-TE groups, respectively). One patient with apparently excessive anticoagulation had a fatal intracerebral hemorrhage. CONCLUSION: This study suggests that TE in patients with newly diagnosed high-grade glioma might be associated with a history of TE or with a paretic extremity; however, no evidence of worse survival was noted in the TE group. Treatment with heparin followed by warfarin sodium was associated with infrequent bleeding complications. An intriguing finding was that the use of aspirin before operation was associated with a decreased risk of TE. Thus, a prospective study with use of aspirin in patients with high-grade glioma at risk for TE would be reasonable.

Adolescent↗
PubMed1994

Phase I trial of combined recombinant interleukin-2 with levamisole in patients with advanced malignant disease.

A Phase I study of rIL-2 and levamisole was performed to evaluate the activity, toxicity, and effect on immune parameters of this combination of agents in patients with advanced malignancy. Twelve patients with advanced cancer were included and begun on therapy with rIL-2, 1 x 10(6) U/m2 subcutaneously (SQ) daily for 5 days and levamisole beginning at 25 mg/m2 orally three times daily for 5 days. The dose of levamisole was increased to 50 mg/m2 thrice daily during this study. Immune parameter analysis included the percentages of lymphocyte subsets in peripheral blood, cellular cytotoxicity assays versus K562 and Daudi cells, and lymphocyte blastogenesis to the recall antigens tetanus toxoid and Candida albicans. The dose-limiting toxicities were pruritus, nausea, and facial edema. There were no indications of significant hematologic or hepatorenal toxicities. No patient fulfilled the traditional criteria for an objective response. In 8 of 9 patients with immune parameter data available there was an increase in cellular cytotoxicity and in the percentage of lymphocytes with the natural killer phenotype (CD3-, CD16/56+). This regimen can be given as an outpatient with acceptable toxicity. For Phase II investigations the doses of rIL-2, 1 x 10(6) U/m2 SQ daily x 5 days and levamisole, 50 mg/m2 three times daily x 5 days is recommended.

Adolescent↗
PubMed1993

Homeless families: program responses and public policies.

Numerous programs have been developed nationwide to address the needs of homeless families but many of their policies and practices raise serious questions about the adequacy of the nation's response. Significant problems in the current service delivery system are examined and recommendations are offered for a comprehensive program response that emphasizes service-enriched housing, specialized approaches to meet the needs of homeless mothers, and preventive interventions.

Adult↗
PubMed1993

Phase III comparative evaluation of PCNU and carmustine combined with radiation therapy for high-grade glioma.

PURPOSE: We performed a randomized trial to compare survival distributions and toxicity of radiation therapy (RT) and PCNU with those of RT and carmustine (BCNU) in patients with malignant glioma. PATIENTS AND METHODS: A total of 346 patients with histologically verified supratentorial grade 3 and grade 4 astrocytoma were studied. After surgery, patients were randomly assigned to receive RT 60 Gy in 30 fractions and either PCNU 100 mg/m2 or BCNU 200 mg/m2 every 7 weeks for 1 year and every 10 weeks for the second year. RT and chemotherapy were started within 72 hours of randomization and usually on the same day. Of 334 assessable patients, 72% had partial or radical resection and 71% had grade 4 tumors. Median age was 59 years, and 85% had performance scores of 0 to 2 (Eastern Cooperative Oncology Group [ECOG]). The follow-up duration of 51 living patients ranged from 10.3 to 63.2 months, with a median of 36.2 months. RESULTS: The median survival duration in each group was 47 weeks, and median time to progression was 28 weeks. PCNU produced significantly more leukopenia and thrombocytopenia, whereas BCNU produced significantly more nausea, vomiting, and irritation. CONCLUSION: PCNU has no therapeutic advantage at this dose and schedule and does not warrant further study as a single agent for patients with high-grade glioma.

Adult↗
PubMed1992

A phase II study of recombinant human alpha-interferon in advanced hormone-refractory prostate cancer.

To determine the efficacy of recombinant human leukocyte alpha-interferon (IFL-RA) in advanced hormone-refractory prostate cancer, the authors treated 40 patients with IFL-RA administered intramuscularly at a dose of 10 x 10(6) U/m2 three times weekly. Toxicity was substantial and necessitated at least a 50% dose reduction in all but five patients during the first 1-2 months of therapy. No responses were observed in patients with bone metastases, but complete and partial regression of nodal disease were observed in two patients with extraosseous disease (overall response rate, 5%; 95% confidence interval, 0.64-17.75%). The authors conclude that IFL-RA cannot be recommended at this dose and schedule in patients with advanced prostate cancer, but additional study of its use in patients with nodal disease may be warranted.

Adenocarcinoma↗
PubMed1992

Cisplatin-based chemotherapy in primary central nervous system germ cell tumors.

We report a retrospective review of our experience with cisplatin-based chemotherapy in eight patients (ages 9-44 years) with histologically confirmed primary central nervous system germ cell tumors. Five patients received chemotherapy as the primary treatment, radiation therapy being administered either at completion of chemotherapy or between chemotherapy courses. Three patients received cisplatin-based chemotherapy for recurrent disease after prior radiation therapy and/or surgery. Four of five patients treated with chemotherapy at diagnosis are in complete remission at 11-14 months from diagnosis. The remaining patient twice achieved complete remission prior to dying of progressive disease 16 months after diagnosis. Two of three patients treated with chemotherapy for recurrent disease are in complete remission at 20 and 26 months; the remaining patient deteriorated after the first cycle of chemotherapy and expired six months thereafter. Overall, of seven patients evaluable for response, five achieved complete remission with chemotherapy alone, and two with chemotherapy and radiation therapy. Our results confirm previous reports of high complete remission rates utilizing cisplatin-based chemotherapy in conjunction with radiation therapy. Prospective evaluation of cisplatin-based chemotherapy followed by radiation therapy is warranted.

Adolescent↗