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Biomedical subjects

K Kiel

Publications and source records attributed to K Kiel.

22 records · Page 2Linked to original sources
PubMed1985

Improved control in advanced head and neck cancer with simultaneous radiation and cisplatin/5-FU chemotherapy.

Chemotherapy with cisplatin plus 5-FU infusion was given simultaneously with radiation therapy; both were administered every other week. Twenty-seven patients with stage IV disease and three with stage III disease were treated; 57% had T4, 33% had N3, and 10% had M1 disease. Of these patients, 17 (57%) achieved complete response and the rest achieved partial response. However, whether or not a clinically complete response occurred had no effect on subsequent risk for disease recurrence. With a median follow-up of 16 months (range, 6-35), only 11 patients (37%) have had disease recurrence and eight (27%) have died. Of those patients who recurred, six failed in distant sites only, one developed a second head and neck primary, and four (36% of all failures) failed regionally. Normally, greater than 50% of patients who are initially controlled (usually less than 60% of stage IV patients) would have failed within the first 12 months and greater than or equal to 75% of these would be expected to fail regionally. Nine patients who had received previous treatment or who had M1 disease accounted for six of the recurrences and four of the deaths. Because of the excellent local control, we have cautiously limited surgery to conserve laryngeal, tongue, and mandibular function in selected cases. Neither immediate nor long-term toxicity from radiation appeared increased. Although no patient with such advanced disease can be considered cured at this time, these results seem to represent a substantial improvement in the quality of life and degree of local control over other approaches. Controlled trials of the sequencing of radiation and chemotherapy in head and neck cancer appear indicated.

Aged↗
PubMed1983

Carcinoma of the anal canal.

J.W. is a 68-year-old white female who noted an "anal growth" 1 year prior to admission. She also complained of bleeding from her rectum when she was constipated. She attributed these symptoms to hemorrhoids. She noted increasing pain and more bleeding 1 month prior to admission. Locally applied hemorrhoid remedies gave her no relief. She was then admitted to a hospital where a biopsy of the anal mass was performed, and then referred to Rush-Presbyterian-St. Luke's Medical Center. On physical examination the patient was noted to be obese. There was no inguinal lymphadenopathy. There were no abdominal masses or hepatosplenomegaly. Rectal examination revealed a 3 X 4 cm mass protruding from the anus. Examination and protoscopy done under anesthesia revealed this mass to be approximately 4 X 5 cm and arising from the proximal anal canal. The mass was freely moveable and bled spontaneously when manipulated. Pelvic examination revealed a normal uterus and adnexa with no obvious tumor involvement of the vagina. Proctoscopic examination revealed no tumor proximal to the lesion described. Further evaluation included a liver-spleen scan that was negative for metastatic disease and intravenous pyelogram that showed no lesions. A barium enema revealed only diverticula. A gallium scan showed marked uptake at the area of the anal tumor but no other lesions. The chest x-ray was within normal limits. A CT scan of the abdomen and pelvis revealed no masses or lymphadenopathy. The CEA was 1.3 ng/ml. The patient underwent concomitant radiation therapy and chemotherapy. Over a 4-week period the patient received 5000 rads to the anal region. In addition, during the first week of radiation therapy and the fourth week of radiation therapy, the patient received 5-fluorouracil, 800 mg/m2 by continuous infusion for 5 days. In addition, the patient received mitomycin C, 15 mg/m2 on the first day of the first week of chemotherapy and the first day of the last week of chemotherapy. During the treatment period, the patient had mild diarrhea, perineal desquamation, and mild ulceration at the site of the anal tumor. During the third week of treatment, the patient had a white blood cell count nadir of 2800 and a platelet count of 86,000 per cubic millimeter. Her symptoms were managed with local emolients and antidiarrheal medications.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1982

Comparison of adjuvant postoperative radiotherapy and multiple-drug chemotherapy (CMF-VP) in operable breast cancer patients with more than four positive axillary lymph nodes.

With the advent of the adjuvant chemotherapy in 1974 for early operable breast cancer at Massachusetts General Hospital, 41 patients with greater than or equal to 4 lymph nodes positive in their axillary dissection received a two-year course of the modified Cooper regimen (S + CH) between March 1974 and June 1976. The actuarial disease-free survival was found to be comparable to CMF as reported by Bonnadonna. No consistent randomization with a control group was possible. Since postoperative radiotherapy has been proven to decrease the incidence of local recurrence but does not affect survival; it was believed that this group should serve as an adequate control. Sixty patients with greater than or equal to 4 positive axillary lymph nodes in their axillary dissection who were given postoperative radiotherapy to the chest wall and draining lymphatics (S + RT) in 1973 and 1974 at the same institution were retrospectively analyzed and compared to the above group. Relatively little significant difference in survival and disease-free survival curves was found. At 48 months, there was 72% and 58% survival for the S + RT and S + CH groups, respectively. When subgrouped according to age, those patients less than 49-years-old had a 48-month disease-free survival of 65% and 49% for S + RT and S + CH groups, respectively (P = 0.25). No significant difference was noted in the post menopausal group. In both groups, patients with greater than 50% positive axillary lymph nodes exhibited a poor prognosis.

Adult↗