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Biomedical subjects

John E Madewell

Publications and source records attributed to John E Madewell.

9 recordsLinked to original sources
PubMed2007

Chemotherapy response is an important predictor of local recurrence in Ewing sarcoma.

BACKGROUND: Local recurrence in Ewing sarcoma is associated with a poor prognosis. The purpose of the study was to determine the factors that predict local recurrence after surgical treatment of the primary tumor. METHODS: Between 1990 and 2001, 64 patients underwent surgical resection of Ewing sarcoma. Surgical margins were assessed histologically and radiologically. Response to preoperative chemotherapy was determined by detailed specimen mapping. Local recurrence-free survival (LRFS) was calculated by Kaplan-Meier analysis. Multivariate analysis was performed with the Cox proportional hazards model. RESULTS: A number of factors were found to be associated with local recurrence on univariate analysis. Patients with a good response to chemotherapy (> or = 90% tumor necrosis), had superior LRFS at 5 years (86% vs 51%, P = .015). Central site of disease was associated with an increased rate of recurrence. The LRFS at 5 years was 50% for the chest wall, 74% for pelvic/scapular, and 86% for extremity tumors (P = .083). Positive surgical margin was not a strong predictor of recurrence (P = .72). A critical analysis of minimal surgical margin based on preoperative magnetic resonance imaging (MRI) and computed tomography (CT) scans also failed to reveal an association between margin and local recurrence. In multivariate analysis, the 2 independent predictors of local recurrence were histological response to chemotherapy and central site of disease. CONCLUSION: Local recurrence after surgical resection is a complex phenomenon. An important predictive factor is the response to chemotherapy. In the current study, this seems to have the largest impact. Central site of disease may be a second independent predictive factor.

Adolescent↗
PubMed2005

Radiation injury to the liver after intensity-modulated radiation therapy in patients with mesothelioma: an unusual CT appearance.

OBJECTIVE: We sought to report the unusual distribution of radiation-induced injury to the liver in patients with mesothelioma after extrapleural pneumonectomy and intensity-modulated radiation therapy (IMRT). CONCLUSION: Abnormal hepatic enhancement after extrapleural pneumonectomy and IMRT is common in patients with mesothelioma. Knowledge of the early occurrence and typical location and appearance of IMRT-induced injury can be useful in preventing misinterpretation as metastatic disease or recurrent tumor.

Aged↗
PubMed2004

Bone imaging in metastatic breast cancer.

Bone is the most common site to which breast cancer metastasizes. Imaging-by skeletal scintigraphy, plain radiography, computed tomography, or magnetic resonance imaging-is an essential part, and positron emission tomography or single-photon emission computed tomography have a potential of evaluating bone metastases, but no consensus exists as to the best modality for diagnosing the lesion and for assessing its response to treatment. Imaging bone metastases is problematic because the lesions can be osteolytic, osteoblastic, or mixed, and imaging modalities are based on either direct anatomic visualization of the bone or tumor or indirect measurements of bone or tumor metabolism. Although bone metastases can be treated, their response to treatment is considered "unmeasurable" according to existing response criteria. Therefore, the process by which oncologists and radiologists diagnose and monitor the response of bone metastases needs revision, and the current inability to assess the response of bone metastases excludes patients with breast cancer and bone disease from participating in clinical trials of new treatments for breast cancer. In this review of the MEDLINE literature, we discuss the pros and cons of each modality for diagnosing bone metastases and for assessing their response to treatment and we present a practical approach for diagnosis and assessment of bone metastasis.

Algorithms↗
PubMed2004

Pulmonary embolism of polymethyl methacrylate during percutaneous vertebroplasty and kyphoplasty.

OBJECTIVE: The purpose of this study was to determine the frequency, radiographic findings, and clinical significance of a pulmonary embolism of cement occurring during percutaneous vertebroplasty or kyphoplasty as detected on conventional chest radiography. MATERIALS AND METHODS: Chest radiographs were obtained after 69 percutaneous vertebroplasty procedures in 64 patients. Chest radiographs were reviewed retrospectively for the presence of pulmonary emboli of cement, and findings were assessed. The frequency was calculated from the cases treated. Medical records were reviewed for procedure-related complications. RESULTS: The emboli of cement were noted radiographically in three (4.6%) of 65 procedures performed in our institution. All patients with cement emboli had multiple myeloma. The chest radiographic findings were multiple radiographically dense opacities with a tubular and branching shape that were scattered sporadically or distributed diffusely throughout the lungs. All patients with cement pulmonary embolism remained asymptomatic. A correlation of embolism of cement to lungs was found with paravertebral venous cement leak (p < 0.001) but not with the number of vertebral bodies treated (p = 0.185) or with the type of procedure performed-kyphoplasty versus vertebroplasty (p = 0.98). CONCLUSION: Pulmonary embolism of cement is seen in 4.6% of patients after percutaneous vertebroplasty or kyphoplasty. The characteristic radiographic findings should be recognized by radiologists.

Bone Cements↗