Biomedical subjects

K Wallner

Publications and source records attributed to K Wallner.

At least 55 records · Page 3Linked to original sources

PubMed1998

Time-dependent changes in CT-based dosimetry of I-125 prostate brachytherapy.

To determine the effect of time between prostate brachytherapy and evaluation CT scan on calculated target coverage. CT scans from 11 consecutive, unselected patients with stage T1 or T2 prostatic carcinoma who had transperineal I-125 implants at MSKCC in 1996 were analyzed for target coverage at 0, 2, and 6 months after implantation. The outer margins of the prostate were outlined on each CT section by a single investigator. In each CT plane, the prescription isodose (150 Gy) was overlaid on the target contour from the postimplant CT to calculate the integral Dose-Volume Histogram. The postimplant target volume on the day of the implant ranged from 93% to 160% of the preimplant volume (average: 117%). In all patients, the target size returned to the preimplant size or smaller within 2 months of the procedure and was relatively stable between 2 to 6 months. Immediately following the implant, an average of 84% of the target (range: 73-98%) was covered by the 150 Gy isodose line. Consistent with changes in the target volume over time, the target coverage increased from an average of 84% to 90% between 0 to 2 months and did not change substantially between 2 and 6 months. There was minimal source loss from the target area after the implant. It was concluded that temporary, postimplant swelling will increase the target volume, making target coverage inferior to what would be calculated if a dosimetry scan was taken sometime later, after the acute swelling has subsided. Until the clinical significance of the effect of postimplant volume changes is better defined, we are continuing to obtain evaluation scans on the day of the implant.

Brachytherapy↗

PubMed1998

Pathologic features from prostate needle biopsy and prognosis after I-125 brachytherapy.

To evaluate the role of detailed pathologic features in predicting outcome for early-stage prostate cancer treated with I-125 brachytherapy. The pretreatment biopsy slides of 103 patients with T1/T2 and Gleason scores of 4-7 prostatic carcinoma, which was treated by transperineal I-125 implantation, were reviewed retrospectively by a single pathologist (P.B.G.). Biochemical tumor control rates [prostate-specific antigen (PSA) below 1.0] were correlated with pretreatment PSA, Gleason score, the amount of tumor in the biopsy samples, and the presence of perineural invasion. In Cox proportional-hazard, multivariate analysis, the strongest predictors of failure were pretreatment PSA above 10 ng/ml (P = 0.013) and the length of the biopsy specimen replaced by tumor (P = 0.15). The percent of biopsy tissue replaced by tumor (P = 0. 74), perineural invasion (P = 0.78), and Gleason score (P = 0.66) were less predictive of prognosis. It was concluded that pretreatment PSA is the strongest predictor of biochemical failure. Detailed assessment of pathological features on needle biopsy added little prognostic information beyond that of pretreatment PSA alone. Like all other prognostic parameters for prostate cancer, there is considerable overlap in pathologic features between those patients who will or will not be controlled biochemically.

Aged↗

PubMed1997

Aortic smooth muscle cells interact with tenascin-C through its fibrinogen-like domain.

The extracellular matrix protein tenascin-C is a multidomain protein that regulates cell adhesion. We used two different smooth muscle cell subtypes derived from adult and newborn rat aorta to investigate the interaction of tenascin-C or its various domains with these cells using an adhesion assay. Newborn cells were three times more adherent to tenascin-C than adult cells. Tenascin C-adhering cells remained round, whereas they spread rapidly on a fibronectin substrate. Adhesion assays showed the interaction between tenascin-C and newborn cells to be predominantly RGD-independent. Mg2+ increased newborn cell adhesion to tenascin-C in a concentration-dependent manner, whereas Ca2+ had no effect. To analyze the structure-function relationships of different domains of tenascin-C, we used recombinant full-length fibronectin-like and fibrinogen-like domains and various subdomains corresponding to the alternatively spliced regions of tenascin-C. The cells adhered to the fibrinogen-like domain but not to the fibronectin-like domain or its subdomains. As with the intact tenascin-C molecule, adherent cells remained round, and the Mg2+, but not Ca2+, promoted this interaction. The interaction of cells with the fibrinogen-like region was further mapped to a 30-amino acid peptide located near the carboxyl-terminal part of the tenascin-C molecule. The same 30-amino acid peptide was active in promoting cell migration. Our results provide a basis for understanding the mechanism of interaction of tenascin-C with smooth muscle cells and a framework for isolating membrane binding sites that mediate the cellular responses to this molecule.

Amino Acid Sequence↗

PubMed1997

CT-based dosimetry for transperineal I-125 prostate brachytherapy.

PURPOSE: To demonstrate CT-based target coverage achieved by an experienced brachytherapy team, with a documented history of clinical efficacy. These results may serve as a point of reference by which other implant teams could evaluate their technical results. METHODS AND MATERIALS: Two to 4 h after implantation, a CT scan of the pelvis was obtained, taking 3-mm thick images at 3 mm scan intervals. The outer margins of the rectum and prostate were outlined on each CT section by a single investigator (KW). CT scans from 20 consecutive, unselected patients with stage T1 or T2 prostatic carcinoma who had transperineal I-125 implants at MSKCC in 1995 were analyzed. The prescribed minimum peripheral prostate dose was 140 Gy, based on a preimplant CT scan of the prostate. Target volumes were determined based on planar reconstruction of the prostate. RESULTS: An average of 84% of the target (range: 76-92%) was covered by the 140 Gy isodose line. An average of 90% of the target (range: 81-96%) was covered by the 120 Gy isodose line. The average minimum target dose was 57 Gy (range: 40-70 Gy). There was a loose correlation between the minimum dose and the degree of target coverage (r = 0.33). CONCLUSIONS: Based on CT scanning on the day of the implant, coverage of 80% or more of the target volume by the prescription dose is probably adequate. Accurate evaluation is a complex problem that is made imprecise by difficulty in target identification and by volume changes after the implant.

Brachytherapy↗

PubMed1997

Low risk of urinary incontinence following prostate brachytherapy in patients with a prior transurethral prostate resection.

PURPOSE: To review post implant morbidity in patients with prior transurethral prostate resection (TURP). METHODS AND MATERIALS: Nineteen patients with stage T1-T2 prostatic carcinoma and prior TURP were treated with I-125 or Pd-103 implantation from 1991 through 1994. Follow-up ranged from 1 to 6 years (median: 3 years). The time from TURP to implantation ranged from 2 months to 15 years (median: 3 years). RESULTS: Only one patient developed mild urinary stress incontinence, 6 months following his I-125 implant. The actuarial freedom from permanent urinary incontinence at 3 years after implantation was 94%. No patient required urethral dilatation for urethral stricture. Eleven patients were sexually potent prior to implantation. At 3 years after treatment, all patients had maintained potency. CONCLUSION: In our experience, there has been remarkably little adverse sequelae following I-125 or Pd-103 implantation in patients with a prior history of TURP.

Aged↗

PubMed1996

Low risk of perioperative infection without prophylactic antibiotics for transperineal prostate brachytherapy.

PURPOSE: To determine the incidence of postimplant infection in patients who are not given prophylactic antibiotics (ATBs). METHODS AND MATERIALS: One hundred thirty-one patients had computerized tomography (CT)-planned transperineal 125I implantation of the prostate from 1988 through 1995. One hundred fourteen of the patients did not receive prophylactic ATBs, 19 of whom required postimplant Foley catheter drainage for 1 day or more for acute urinary retention. RESULTS: The incidence of postimplant febrile episodes within 2 weeks of surgery among the patients who had not received prophylactic ATBs was 2 of 114 (2%). One of the two patients who developed postimplantation febrile episodes was treated successfully with ATBs as an outpatient. The second patient, who had a history of chronic lymphocytic leukemia (CLL) and immune suppression, developed E. coli sepsis and required intravenous antibiotics. Of 17 patients who received prophylactic ATBs, none had a postoperative febrile episode. CONCLUSION: We continue to refrain from routinely prescribing prophylactic ATBs unless there is some compelling circumstance including rheumatic heart disease, prosthetic devices, immune compromise, or a previous history of prostatitis.

Aged↗

PubMed1996

103Pd brachytherapy and external beam irradiation for clinically localized, high-risk prostatic carcinoma.

PURPOSE: To summarize biochemical failure rates and morbidity of external beam irradiation (EBRT) combined with palladium (103Pd) boost for clinically localized high-risk prostate carcinoma. METHODS AND MATERIALS: Seventy-three consecutive patients with stage T2a-T3 prostatic carcinoma were treated from 1991 through 1994. Each patient had at least one of the following risk factors for extracapsular disease extension: Stage T2b or greater (71 patients), Gleason score 7-10 (40 patients), prostate specific antigen (PSA) > 15 (32 patients), or elevated prostatic acid phosphatase (PAP) (17 patients). Patients received 41 Gy EBRT to a limited pelvic field, followed 4 weeks later by a 103Pd boost (prescription dose: 80 Gy). Biochemical failure was defined as a PSA greater than 1.0 ng/ml (normal < 4.0 ng/ml). Patients whose PSA was still decreasing at the last follow-up were censored at that time. Patients whose PSA plateaued at a value greater than 1.0 were scored as failures at the time the PSA first plateaued. RESULTS: The overall, actuarial freedom from biochemical failure at 3 years after treatment was 79%. In Cox proportional hazard multivariate analysis, the strongest predictor of failure was elevated acid phosphatase (p = 0.04), followed by PSA (p = 0.17), Stage (p = 0.23), and Gleason score (p = 0.6). Treatment-related morbidity was usually limited to temporary, RTOG Grade 1-2 urinary symptoms. One patient, who had both a transurethral incision of the prostate (TUIP) and a transurethral resection of the prostate (TURP), developed low-volume urinary incontinence. The actuarial potency rate at 3 years after implantation was 77% for 46 patients who were sexually potent prior to implant. CONCLUSION: Biochemical freedom from failure rates following combined EBRT and 103Pd brachytherapy for clinically localized, high-risk prostate cancer compare favorably with that reported after conventional dose EBRT alone. Morbidity has been acceptable.

Aged↗

PubMed1996

Tumor control and morbidity following transperineal iodine 125 implantation for stage T1/T2 prostatic carcinoma.

PURPOSE: To quantify disease progression and morbidity following computer tomography (CT)-based transperineal iodine 125 prostate implantation. METHODS: Ninety-two patients with clinical stage T1 or T2, Gleason score 2 to 7/10, prostatic carcinoma had outpatient, CT-based transperineal 125I prostate implantation and were monitored for 1 to 7 years (median, 3). The prescribed minimum radiation dose was 140 to 160 Gy. Lymph node dissection and postimplantation prostatic biopsies were not routinely performed. RESULTS: In 46% of patients, radiation-related urinary symptoms were substantial enough at 1 month following implantation to require medication. Radiation-related urinary symptoms gradually resolved. Two years after implantation, 14% of patients had persistent urinary symptoms of Radiation Therapy Oncology Group (RTOG) > or = grade 2. Eight percent of patients underwent a transurethral resection of the prostate (TURP) within 2 years of implantation. Five patients developed radiation-induced rectal ulcerations. Of 56 patients who were sexually potent preimplantation, 86% retained potency at 3 years. Twenty-five patients had biochemical disease progression. The overall actuarial freedom from biochemical failure rate at 4 years following implantation was 63%. In Cox proportional hazards multivariate analysis, the strongest predictor of failure was prostate-specific antigen (PSA) level less than or greater than 10 ng/mL (P = .005), followed by Gleason score (2 to 4 v 5 to 7, P = .08) and stage (T1 v T2, P = .09). CONCLUSION: The 5-year biochemical freedom-from-progression rates following transperineal 125I implantation are comparable with those achieved with prostatectomy. The morbidity has decreased with increased physician experience.

Aged↗

PubMed1995

Dosimetry guidelines to minimize urethral and rectal morbidity following transperineal I-125 prostate brachytherapy.

PURPOSE: To establish dosimetry guidelines to minimize urethral and rectal morbidity following permanent I-125 prostatic brachytherapy. METHODS AND MATERIALS: Dosimetric parameters were correlated with long-term morbidity for 65 patients following transperineal I-125 implantation for Stage T1/T2 prostatic carcinoma. The prescribed minimum prostatic dose was 150 Gy. The median total activity used was 48 mCi (range: 32-77 mCi). Patients were followed for 1-5 years (median follow-up: 2 years). Postimplant computerized tomography (CT)-based dosimetry was performed for 45 patients. Morbidity was evaluated using a modification of the RTOG grading system, with a scale of grade 0-5. RESULTS: The incidence of grades 2 and 3 urinary morbidity was associated with the maximum central urethral dose (p = 0.03), and with the length of urethra that received greater than 400 Gy (p = 0.07). Patients with larger prostates had more long-term urinary morbidity (p = 0.06). Rectal bleeding (RTOG grade 1) or ulceration (RTOG grade 2) was associated with irradiation of the rectal wall to doses in excess of 100 Gy (p = 0.02). There was no relationship between the matched peripheral dose (MPD), mCi/source or total mCi implanted and long-term morbidity. CONCLUSIONS: Postimplant, CT-based dosimetry can predict which patients are at higher risk of radiation-related morbidity. More simplistic parameters including the MPD, total activity implanted, or mCi/source, had no relationship with morbidity. To decrease the risk of long-term morbidity, an effort should be made to keep the central urethral dose below 400 Gy, and the rectal surface dose below 100 Gy.

Brachytherapy↗

PubMed1995

Prostate specific antigen based disease control following ultrasound guided 125iodine implantation for stage T1/T2 prostatic carcinoma.

PURPOSE: We report the prostate specific antigen (PSA) based recurrence-free survival rate after 125iodine (125I) implantation for early stage prostatic carcinoma. MATERIALS AND METHODS: A total of 197 patients with clinical stage T1 and T2 prostatic carcinoma underwent outpatient 125I seed implantation. Followup was 1 to 7 years (median 3). Pretreatment serum PSA levels were elevated (greater than 4.0 ng./ml.) in 138 patients (70%). There were 105 well differentiated (Gleason score 2 to 4), 87 moderately differentiated (Gleason score 5 to 6) and 5 indeterminate tumors. The prescribed minimum prostatic dose was 160 Gy. The total dosage of 125I implanted ranged from 15 to 62 mCi. (median 37). Staging lymph node dissection and seminal vesicle biopsies were not routinely performed. RESULTS: Among 138 patients with an elevated PSA level before implantation and no prior hormonal treatment, the PSA value returned to normal in 98% and decreased to less than 1.0 ng./ml. in 82% within 24 months of treatment. In 97% of those 138 patients the PSA level decreased to less than 1.0 ng./ml. at 48 months after implantation. Of 8 patients with an increasing PSA value 5 also had clinically evident failure. The actuarial rate of chemical (increasing PSA) or clinical failure at 5 years following implantation was 7%, with 15 patients still at risk at 5 years. There was a trend for higher failure rates among patients with higher pretreatment PSA levels (p = 0.57), Gleason scores 5 and 6 versus 2 to 4 (p = 0.51) or higher stage of disease (p = 0.17). CONCLUSIONS: There is a high rate of clinical and chemical freedom from progression following 125I implantation for select patients with early stage prostatic carcinoma.

Aged↗

PubMed1994

Short-term freedom from disease progression after I-125 prostate implantation.

PURPOSE: To evaluate short-term clinical and chemical disease progression following computed tomography (CT)-based transperineal I-125 prostate implantation. METHODS AND MATERIALS: Sixty-two patients with clinical Stage T1 or T2 prostatic carcinoma had outpatient, CT-based transperineal I-125 prostate implantation and have been followed for 6-55 months (median: 19 months). Fifty-six patients had an elevated prostate specific antigen (PSA) before implantation (> 4.0 ng/mL). Twenty patients had well-differentiated tumors, 39 were moderately differentiated, 2 were poorly differentiated, and 1 was indeterminate. A total of 32-73 mCi I-125 was implanted (median: 47 mCi). The prescribed minimum prostatic dose was 140-160 Gy, and the actual matched peripheral dose ranged from 109-258 Gy (median: 160 Gy). Lymph node dissection or postimplantation prostatic biopsies were not routinely performed. RESULTS: Of 54 patients with an elevated PSA prior to implantation and no prior hormonal treatment, 96% returned to normal within 24 months of treatment. In 85% of patients, the PSA fell below 2.0 ng/mL and in 74% of patients, the PSA value fell to below 1.0 ng/mL. Seven patients had disease progression, one of whom has an isolated, rising PSA. The actuarial rate of chemical (rising PSA) or clinical failure at 3 years following implantation was 17%. Of 38 patients who were sexually potent prior to implantation, 81% remained potent at 3 years. Five patients developed radiation-induced rectal ulcerations, 11-22 months following implantation. Three patients required a transurethral resection of the prostate for postimplant urinary symptoms. CONCLUSIONS: The short-term clinical and chemical freedom-from-progression rates following I-125 implantation are comparable to that achieved with prostatectomy, with high preservation of sexual potency and moderate morbidity.

Aged↗

PubMed1994

Fluoroscopic visualization of the prostatic urethra to guide transperineal prostate implantation.

PURPOSE: To describe a novel way to assure proper needle positioning within the prostate during transperineal implantation, using the urethra as the primary radiographic landmark. METHODS AND MATERIALS: Preoperative computerized tomography (CT) images through the prostate are used to plan optimal transperineal needle-seed placement. When performing the procedure, a Foley catheter, with radio-opaque wire is used to visualize the prostatic urethra fluoroscopically in anterior-posterior and lateral projections. Proper needle placement is determined by their position relative to the urethra. RESULTS: Sixty patients have been implanted with this method at Memorial Sloan-Kettering Cancer Center from 1990-1992. CONCLUSION: The method described here is an improvement over previously described CT-based techniques. It could be used to supplement or replace ultrasound imaging.

Brachytherapy↗

PubMed1994

Quantifying the effect of dose inhomogeneity in brachytherapy: application to permanent prostatic implant with 125I seeds.

PURPOSE: To quantitate the influence of dose inhomogeneity on brachytherapy efficacy. METHODS AND MATERIALS: A computed tomography-based system of planning, implementation and evaluation was used to generate tumor-specific dose-volume histograms of eight permanent 125I implants of prostate cancers. The radiobiological effect was then assessed, voxel by voxel, in terms of the biologically effective dose and the associated cell inactivation. The overall cell survival of the entire target volume was then computed. To evaluate the influence of inhomogeneity, the dose-volume histogram was modified in an iterative fashion, with the corresponding surviving fraction calculated after each step. Specifically, the volume in the highest dose bin was combined with that in the next bin to give a new frequency distribution from which cell survival was generated. Tumor control probability (TCP) was also used as an endpoint, using the same iterative procedure. RESULTS: Doses 20-30% higher than D99 (the dose that covered 99% of the target volume) contributed to additional cell inactivation, but still higher doses did not further increase cell kill. With homogeneous irradiation at D99 as a reference, we defined the inhomogeneity enhancement factor as the ratio of the biologic effective dose of the actual implant to that of the reference dose distribution. The calculated enhancement factors were inversely dependent on tumor potential doubling time (Tp), about 1.2-1.3 for a Tp of 30 days, and between 1.3 and 1.7 if Tp = 10 days, with higher values for implants with low D99. Dose inhomogeneity enhanced TCP. For implants with high control probabilities does significantly higher (> 20%) than the D99 value did not further enhance the tumor control probabilities. In contrast, for implants with relatively low tumor control and D99 values, the control probability continued to increase with doses significantly higher than D99, up to a dose of 2 x D99. The underlying reasons were the incorporation of patient "population averaging" in the calculation and the saturation of tumor control dose response at about 120 Gy. CONCLUSION: Dose heterogeneity in implants increased tumor cell kill and local control probability, although doses > 20% higher than the prescription dose is wasted. The increase the beneficial effect of dose inhomogeneity may be greatest when most needed.

Brachytherapy↗

PubMed1994

Treatment-related symptoms during the first year following transperineal 125I prostate implantation.

PURPOSE: To summarize the urinary, rectal, and sexual symptoms occurring during the first 12 months following 125I prostatic implantation. METHODS AND MATERIALS: Thirty-one patients with Stage T1 or T2 prostatic carcinoma were evaluated for morbidity following computed tomography-guided transperineal 125I implants from 1988 to 1991. The median total activity used was 47 mCi (range 35-73 mCi). Toxicity was evaluated using a modification of the Radiation Therapy Oncology Group grading system. RESULTS: Nocturia was the most common treatment-related symptom, reported by 80% of patients within 2 months after implantation, and persisted at 12 months in 45% of the patients. Mild dysuria developed in 48% of patients within 2 months of implantation; two patients needed analgesics for their dysuria. Terazosin hydrochloride (2-10 mg qd) provided subjective improvement of urinary symptoms in seven of eight patients in whom it was tried. Rectal urgency, soft stools, and increased frequency of bowel movements was reported by 25% of the patients within 1-2 months after implantation. The incidence of asymptomatic rectal bleeding or ulceration occurring at any time after implantation was 47%, but resolved in all patients with expectant treatment. Self-limited ulceration of the rectal mucosal occurred in 16%, but only one patient developed a prostato-rectal fistula, managed with an ileal conduit. Five of the 18 potent patients experienced discomfort on erection or ejaculation, beginning within several weeks of their implant. The discomfort resolved within 6 months in three of the patients, but persisted for 18 and 24 months in the other two. CONCLUSION: 125I implantation, as performed in this series, is generally associated with only mild-moderate genitourinary and rectal symptoms that may persist 6 months or more after implantation. Prostatic carcinoma, Brachytherapy, Morbidity.

Aged↗

PubMed1993

Good performance status of long-term disease-free survivors of intracranial gliomas.

PURPOSE: To determine the long-term impact on function of treatment for primary cerebral gliomas, Karnofsky Performance Status, employment history, and memory function were used to evaluate the status of adults who are alive and disease-free more than 1 year after cranial irradiation. METHODS AND MATERIALS: Of 30 eligible adult patients, seventeen patients had anaplastic astrocytoma, seven had a glioblastoma, four had low grade astrocytoma, one had a mixed glioma, and one had an anaplastic oligodendroglioma. Sixteen patients received partial brain irradiation only, 12 had whole brain irradiation with a partial brain boost, and two had whole brain irradiation only. The total dose ranged from 54-66 Gy, with a fraction size of 1.7-2.0 Gy. Median follow-up was 3.5 years. Eighty-three percent of patients also received adjuvant chemotherapy. RESULTS: Karnofsky Performance Status generally remained stable after the completion of irradiation. Mean Performance status was 84 at the end of irradiation and was unchanged at the time of last follow-up. The actuarial freedom from performance status decline after irradiation was 93% at 5 years. The performance status increased in two patients, both within several months of completing irradiation. Most patients (68%) returned to work after irradiation. Sixty-two percent remained at work 1 year later, and 58% were working at the time of last follow-up. No patient who did not return to work within 4 months of completing irradiation was able to work at a later date. All working patients were employed in a capacity similar to their pre-morbid position. Only one patient, with an intercurrent lung cancer, eventually developed deficits that limited self care. CONCLUSIONS: Contrary to previously published reports, long-term glioma survivors maintained a relatively good performance status in the absence of recurrence and did not experience a progressive decline in neuropsychologic function after completion of cranial irradiation. A patient's function state at the completion of irradiation is a reliable predictor of long-term functional outcome in the absence of recurrence. Although the number of patients in each subgroup is small and no significant differences could be detected, patients treated with partial brain irradiation had a higher and more stable performance status, better memory function, and superior employment history.

Adult↗

PubMed1993

Short-term morbidity from CT-planned transperineal I-125 prostate implants.

PURPOSE: To summarize short-term morbidity and tumor response following transperineal CT-guided I-125 prostate implantation. METHODS AND MATERIALS: Twenty-one patients were treated with CT-based transperineal I-125 prostate implantation between June, 1988 and May, 1990. An average of 75 I-125 seeds were placed, with an average activity of .62 mCi/seed. Symptoms were quantified after interviewing each patient in detail. RESULTS: Nearly all patients developed substantial dysuria, nocturia and frequency from 2-24 weeks following implantation. Urinary symptoms usually resolved within 4-6 months of implantation. The one year actuarial potency rate among 18 patients who were potent prior to implantation was 94%. By 6 months after implantation, 14/17 patients (82%) with Stage B tumors had complete regression of palpable disease. Of 17 patients with Stage A or B tumors who presented with an elevated PSA, 76% returned to the normal range within 6 months of implantation. CONCLUSION: CT-guided transperineal prostate implants entail moderate, temporary urinary and rectral morbidity. Short-term tumor responses are encouraging.

Brachytherapy↗

PubMed1993

Treatment of brain metastases from bladder cancer.

The records of 28 patients with transitional cell cancer who had brain metastases were retrospectively reviewed. Data from 19 patients were considered suitable for analysis and were included in this study. One patient was treated with surgery alone, 10 with radiation alone and 7 with radiation and surgery, while 1 received no treatment. Mean and median survival times, respectively, were 57 and 42 months from the initial diagnosis, and 11 and 4 months from diagnosis of central nervous system metastases. Patients treated with surgery and radiation demonstrated a mean survival time of 19 months compared to 6 months for patients treated with radiation alone (p = 0.03). There were 2 long-term survivors in the combined modality group at 50 and at 12 months. Enthusiasm for combined modality treatment should be tempered by the fact that selection bias favored the combined modality group; 13 patients with single lesions demonstrated a mean survival of 14 months compared to 3 months for 6 patients with multiple lesions (p = 0.009) and only patients with solitary lesions underwent surgical resection. Brain metastases have an ominous prognosis in patients with bladder cancer primaries. Considering the sum of the retrospective and prospective reports, we recommend that patients with solitary brain lesions and good performance status be aggressively managed with surgical resection and postoperative radiation therapy.

Adult↗

PubMed1992

Treatment of metastatic chemodectoma.

Six patients were treated for metastatic chemodectoma at Memorial Sloan-Kettering Cancer Center from 1971 through 1988. Four patients' primary tumors arose in the cervical region, and two arose in the retroperitoneum. Four patients received a total of eight different chemotherapeutic regimens, including cisplatin, doxorubicin, cyclophosphamide, and dacarbazine. Metastatic sites treated included bone, liver, lung, and retroperitoneum. No patient had a response to chemotherapy. Four patients received a total of nine courses of radiation therapy for palliation of bone metastases. Pain relief was complete in eight patients and partial in one. One patient was irradiated for a mass in the left psoas muscle, with stabilization of disease for 6 months after treatment. One patient was irradiated for epidural compression at T6, with resolution of neurologic symptoms and 50% clearing of the spinal block on follow-up myelogram. Recurrence or progression of disease in a previously irradiated site occurred in one patient 2 years after treatment. One patient was lost to follow-up 3 months after radiation therapy for epidural compression. The other five patients died of widespread metastatic disease 6 months to 9 years after initial treatment for their metastatic disease.

Adult↗