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Biomedical subjects

L B North

Publications and source records attributed to L B North.

At least 19 recordsLinked to original sources
PubMed1998

Outcomes of high-dose unilateral kidney irradiation in patients with gastric lymphoma.

PURPOSE: To review the long-term clinical effects of unilateral kidney irradiation on overall renal function and blood pressure in patients with gastric lymphoma. METHODS AND MATERIALS: In the study were 27 patients with Stage I or II gastric lymphoma who had undergone irradiation of at least 24 Gy to > or = 1/3 of the left kidney. They include 16 women and 11 men, aged 31 to 77, with a mean age of 57.6 years (median 56). Fifteen patients had Stage I and 12 had Stage II disease. In 13 patients the whole kidney had been irradiated, and 14 had had partial kidney irradiation, at doses ranging between 24 and 40.5 Gy. All patients received combined chemotherapy with various drugs: all patients received corticosteroids, and five received cis-platinum. Their follow-up ranged between 0.7 and 7.8 years (mean 3.4 years). Data on possible effects of the treatment on blood pressure, renal function as assessed by blood urea and creatinine, and kidney shrinkage as seen by serial computed tomography scanning were collected on all patients. RESULTS: Three patients had persistent, mild elevations of urea and creatinine levels, which did not require special treatment. All three also received cis-platinum. Ipsilateral kidney shrinkage was evident in most patients. In 19 patients the craniocaudal measurement of the kidney shrank by > or = 1.6 cm. Shrinkage in other dimensions was also evident. The degree of atrophy was related to the volume of kidney irradiated. Only two patients developed hypertension, both at a low level of 150/90; one patient had had 40 Gy to the whole kidney, the other 40 Gy to half the kidney. Neither patient had elevated urea or creatinine. CONCLUSIONS: Notwithstanding the shrinkage to the irradiated part of the kidney, the treatment did not lead to clinically significant hypertension or renal dysfunction. The administration of cis-platinum to patients with gastric lymphoma that requires kidney irradiation should be further evaluated.

Adult↗
PubMed1998

Hodgkin's disease: correlation of clinical characteristics with probabilities for negative lymphangiogram vs. negative laparotomy findings in patients with Stage I supradiaphragmatic presentations vs. those in patients with Stage II.

PURPOSE: At a time both when late complications and second malignancies have become a growing concern and when staging laparotomy has been largely abandoned and comparative studies for staging Hodgkin's disease by state of the art computed tomography (CT) vs. lymphangiography have revealed minimal differences in results for these procedures, our purpose for undertaking this study was twofold. Our initial reason was to determine and compare probabilities for negative abdominal findings for patients with Stage I presentations with those for patients with Stage II as determined by lymphangiography and subsequently by laparotomy for those patients who had negative lymphangiograms. Our second reason, being an extension of the first, was to create a resource that can be used in conjunction with other information for arriving at appropriate treatment decisions including giving either more or particularly less than standard institutional therapy and especially with respect to the abdomen. METHODS AND MATERIALS: Data on 714 patients with prelymphangiogram Stage I-II upper torso presentations of Hodgkin's disease were entered prospectively in our database between 1968 and 1987. Twenty-eight with lymphocyte predominant disease, who had both negative lymphangiogram and negative laparotomy findings and 17 with questionable diagnoses of lymphocyte-depleted or unclassified disease were excluded from subsequent analyses of 669 patients with nodular sclerosis (NS) and mixed cellularity (MC) diagnoses. RESULTS: Stage I: in final logistic models, negative lymphangiogram findings were associated strongly with a combination of no constitutional symptoms and nodular sclerosis histology, whereas negative laparotomy findings correlated strongly with a combination of no constitutional symptoms and female sex. Predicted probabilities depended on the ratios of favorable to unfavorable characteristics. Stage II: in final logistic models, negative lymphangiogram findings were associated strongly with a combination of no constitutional symptoms, nodular sclerosis histology, age <40 years, and <4 involved sites, whereas negative laparotomy findings correlated strongly with a combination of <4 involved sites and mediastinal disease. Predicted probabilities again depended on the ratios of favorable to unfavorable characteristics. CONCLUSION: This study demonstrated that probabilities for negative abdominal findings for patients with supradiaphragmatic presentations of NS and MC Hodgkin's disease depended on: 1) whether the disease presented as Stage I or as Stage II; 2) whether staging was limited to a lymphangiogram or whether it included a laparotomy; and 3) or whether the clinical features associated with the presenting stage and methods of staging were favorable or unfavorable.

Abdomen↗
PubMed1993

Lymphography for staging lymphomas: is it still a useful procedure?

OBJECTIVE: The purpose of this study was to determine the current value of lymphography in a series of previously untreated patients with Hodgkin's and non-Hodgkin's lymphoma seen at the M. D. Anderson Cancer Center over a 1-year period. MATERIALS AND METHODS: From September 1989 through August 1990, 313 previously untreated patients with lymphoma were seen at our institution. In 221 of these, lymphography and CT were performed for abdominal staging. These studies were reviewed to determine if the examinations were complementary, or if the results of one or the other changed the staging in a significant number of patients. Staging was based on clinical findings, as laparotomies are rarely performed at this time. RESULTS: Lymphograms were abnormal and CT scans were normal in two patients with Hodgkin's disease and in two with non-Hodgkin's lymphomas. Biopsy proof of nodal disease was not available for any of these, but the nodes did not change after therapy in three patients. The other patient was seropositive for HIV, and HIV disease itself can cause nodal abnormalities. In one patient with Hodgkin's disease and 12 with non-Hodgkin's lymphoma, lymphograms were normal and CT scans were abnormal, showing enlarged nodes and/or abnormal architecture. CT scans obtained after therapy showed regression of nodal and extranodal masses. CONCLUSION: It was concluded that lymphographic findings did not significantly contribute to staging in these patients. This departure from previous experience may be due to improved state-of-the-art CT. In addition, the use of a combination of chemotherapy and radiation therapy to treat the lymphomas has increased, diminishing the need for detection of subtle nodal changes.

Hodgkin Disease↗
PubMed1992

Current use of lymphography for staging lymphomas and genital tumors.

The current literature and the experience at The University of Texas M.D. Anderson Cancer Center were reviewed to determine the current status of the use of lymphography for staging of malignant disease. Lymphography continues to be used for staging and surveillance of the lymphomas and, to some extent, for staging of carcinoma of the cervix. Testicular tumors are now primarily staged and followed by CT and serum markers. Currently, other abdominal and pelvic tumors are not commonly evaluated with lymphography.

Female↗
PubMed1991

Stages I and II diffuse large cell lymphomas: prognostic factors and long-term results with CHOP-bleo and radiotherapy.

One hundred forty-seven patients with Ann Arbor stages I and II diffuse large cell lymphoma (DLCL) were treated with combination chemotherapy consisting of cyclophosphamide, doxyrubicin, prednisone, and low-dose bleomycin (CHOP-Bleo) and involved-field radiation (IF XRT) between 1974 and 1984. A complete remission (CR) was attained by 54 of 57 patients with stage I disease and by 78 of 90 patients with stage II disease. Thirty-five patients had relapsing disease that occurred within 3 years in 31. The overall 10-year survival rate, counting all deaths, for patients with stage I was 72% as compared with 43% for patients with stage II (P less than .01). Determinate survival rates, censoring eight unrelated deaths, were similar to the overall survival rates: 77% and 51%, respectively. A multivariate analysis identified three independent prognostic factors: age, tumor extent, and serum lactic dehydrogenase (LDH) level. When the combined effect of tumor extent and LDH level were taken into consideration in the analysis, three risk groups for survival were identified. The best group, which consists of patients with minimum tumor and normal LDH levels, had a 10-year determinate survival of 79%. Patients with extensive tumors and elevated LDH levels had the poorest survival rate of 44%. An intermediate-risk group with a determinant survival of 62% was composed of patients with either extensive tumors or elevated LDH levels. These differences demonstrate the need to develop different treatment strategies based on risk factors for survival for patients with apparently localized Ann Arbor stages I/II DLCL.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Thoracic lymphoma.

Mediastinal adenopathy is a common manifestation of HD in a usually predictable pattern involving anterior and middle mediastinal nodes with or without disease in the hili. Hilar adenopathy is uncommon without detectable mediastinal disease and the lung is virtually never involved alone. In NHL the pattern of disease is more unpredictable. Lung manifestations include direct extension from involved nodes, nodules with or without cavitation, atelectasis secondary to endobronchial or nodal obstruction and rarely an interstitial pattern. Pleural effusions are not uncommon, but solid pleural masses are less frequent. Invasion of the pericardium is not often seen, although masses are commonly seen along the pericardium. Invasion of the chest wall occurs particularly with involvement of internal mammary nodes. Occasionally, posterior nodes will invade the adjacent vertebrae and spinal canal. The chest wall may be invaded by enlarged axillary nodes. Isolated chest wall soft-tissue masses are not common and are usually a manifestation of NHL, especially large cell lymphoma. Although the chest radiograph should detect most intrathoracic disease. CT has been found a necessary adjunct in patients with HD for accurate staging and therapy, especially if radiotherapy is planned. CT has been found helpful in NHL for staging, especially for the pleura and chest wall. MR imaging has not been found to contribute additional useful information except in selected cases.

Hodgkin Disease↗
PubMed1989

Risk classification as the basis for clinical staging of diffuse large-cell lymphoma derived from 10-year survival data.

Two hundred and fifty previously untreated adult patients with diffuse large-cell lymphomas were treated with a chemotherapy combination of cyclophosphamide, adriamycin, vincristine, prednisone, and low-dose bleomycin (CHOP-Bleo) with or without radiotherapy between 1974 and 1984. The 10-year survival rates for patients with Ann Arbor stages II, III, or IV disease of 55%, 42%, and 40%, respectively, were not significantly different. However, the survival rate of 76% for patients with stage I disease was clearly better. Factors more indicative of prognosis than stage, as found by univariant analysis, were tumor burden, serum lactic dehydrogenase level (LDH), age, and constitutional symptoms. From these, a multivariant analysis selected tumor burden, LDH level, and age as major independent factors for predicting survival (P less than .001). A prognostic risk model constructed on the basis of tumor burden and LDH levels identified four distinct risk groups (A, B, C, D) with 10-year survival rates of 85%, 66%, and 43% for A, B, and C. No patient in group D survived 10 years. These risk groups also had a strong correlation with complete remission rates and with relapse rates. Thus this model proved more effective for identifying patient populations according to their expected responses, durations of remission, and survivals than the Ann Arbor staging system. Detailed information supporting the use of this system for predicting prognosis and for treatment selection for patients with diffuse large-cell lymphomas is provided.

Adolescent↗
PubMed1988

The adjuvant role of two cycles of MOPP and low-dose lung irradiation in stage IA through IIB Hodgkin's disease: preliminary results.

Fifty-eight laparotomy-staged I and II patients with upper torso presentations of Hodgkin's disease and 8 patients with lymphangiogram-staged lower torso disease were treated with radiotherapy alone or with 2 cycles of MOPP and radiotherapy. Patients with upper torso disease with either no mediastinal or only small mediastinal disease without hilar involvement and with no "B" symptoms were treated with mantle radiotherapy alone. Patients with large mediastinal masses or hilar disease were treated with 2 cycles of MOPP followed by definitive mantle irradiation and low dose lung irradiation. Those for whom "B" symptoms were the only adverse prognostic feature received 2 cycles of MOPP and mantle radiotherapy. Patients with lower torso disease were treated with radiotherapy alone if the disease was limited to the pelvis. Those with more extensive disease received 2 cycles of MOPP prior to radiotherapy. The 4-year survival for all 66 patients was 97%. The corresponding disease-free and freedom from second relapse figures were 77% and 92%. Survival for the patients with unfavorable presentations who received 2 cycles of MOPP and radiotherapy was 100%. It was 92% for the group with favorable presentations who were treated with radiotherapy only.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Regression of mediastinal Hodgkin disease after therapy: evaluation of time interval.

Ninety-one patients with Hodgkin disease of the upper torso who had mediastinal masses were studied to determine the frequency of residual mass and the time required for resolution or stabilization of the mass. In 72 of these patients, radiographs from sufficient intervals were available for determination of the rate of regression. In 62 patients (86%), the mediastinum returned to normal width within 11 months, regardless of the size of the mass. The mediastinum returned to normal in all but one patient with small masses. The intrathoracic relapse rate did not correlate with the regression time of the masses, but relapse occurred more than twice as often in patients with residual mediastinal widening.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Lymphomas of the head and neck: CT findings at initial presentation.

CT findings were reviewed in 68 patients with untreated head and neck lymphoma. More than half of the patients with either Hodgkin's disease or non-Hodgkin's lymphoma were detected in the earlier stages (stage I or II). Four types of abnormalities were identified with CT: nodal involvement alone (type 1), extranodal involvement alone (type 2), a combination of extranodal and nodal disease (type 3), and multifocal extranodal disease with or without nodal involvement (type 4). In the 18 patients with Hodgkin's disease, a subgroup of mixed cellularity was most common; type 1 was the prevailing CT presentation, and no type 2 or 4 lesions were observed. In the 50 patients with non-Hodgkin's lymphoma, diffuse large-cell lymphoma was the most common histologic subtype, and the most common CT presentation was type 2, followed by type 3. Lymphomatous nodes may be extensive and confluent, but often they are smaller than 2 cm and rarely are necrotized. The most frequent extranodal sites of head and neck lymphomas are Waldeyer's ring, paranasal sinuses, and nasal cavity. Extranodal lymphoma cannot be differentiated reliably from the more commonly occurring carcinoma, although it is less often associated with invasion and destruction of adjacent bony structures. Multiple sites of extranodal involvement, with or without neck lymphadenopathy, may suggest a diagnosis of non-Hodgkin's lymphoma.

Head and Neck Neoplasms↗
PubMed1986

Tumor burden assessment and its implication for a prognostic model in advanced diffuse large-cell lymphoma.

Previously untreated adult patients who presented with advanced diffuse large-cell lymphoma (DLCL) at diagnosis were studied to identify possible prognostic factors. One hundred five patients were seen between 1974 and 1981; 45 patients were stage III and 60 patients were stage IV. All patients received cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-Bleo). Stage III patients also received radiation therapy alternated with chemotherapy. Overall survival was 50% at 5 years and 43% at 8 years. Seventy-four patients achieved a complete remission (CR) and 37 are alive and disease-free with a median follow-up of 72 months. There was no difference in clinical outcome between stage III and stage IV. However, a proportional hazards model identified lactic dehydrogenase (LDH) level and tumor burden, among all clinical factors studied, as independent risk factors for survival. These two factors were also important for achievement of remission and relapse-free survival. Three distinct patient risk groups were identified with 5-year survival rates of 87%, 48%, and 20%, respectively. The measure of tumor burden proposed herein, along with LDH level, can be used for developing treatment programs, and for meaningful comparison of different treatment regimens, as well as assessment of prognosis.

Abdominal Neoplasms↗
PubMed1983

Bronchogenic carcinoma in breast carcinoma patients.

Forty-eight female patients who developed bronchogenic carcinoma synchronously with or after the occurrence of breast carcinoma are reported. The object of the study was to review the radiographic findings for possible clues to the diagnosis of bronchogenic carcinoma and to ascertain the histologic diagnoses observed. In 40 patients on whom films were available, the original radiographs before surgery for bronchogenic carcinoma were examined. The clinical records of the 48 patients were also reviewed. Histologic diagnosis of primary bronchogenic carcinoma was required. A solitary pulmonary lesion in a patient with breast carcinoma, a cavitated lesion, or a lesion that failed to respond to appropriate therapy for metastatic breast carcinoma suggested the diagnosis of bronchogenic carcinoma. An increase in the frequency of small cell carcinoma and a decrease in the frequency of adenocarcinoma was seen in bronchogenic carcinomas developing 5 years or more after radiation therapy for breast carcinoma. It was concluded that the benefits of radiation therapy in selected patients far outweighed the risk of bronchogenic carcinoma.

Adenocarcinoma↗
PubMed1982

Importance of initial mediastinal adenopathy in Hodgkin disease.

The importance of initial mediastinal disease was studied retrospectively in 189 patients with stages I, II, and III Hodgkin disease treated at the M. D. Anderson Hospital and Tumor Institute between 1969 and 1976. Stages I and II patients with mediastinal disease at presentation had an 88% 5 year survival rate compared with a 98% survival rate for those without mediastinal disease. Disease-free survival was 66% versus 78%. Stage III patients with and without initial mediastinal disease showed essentially the same 5 year survival rate (75% versus 78%), but showed a lower disease-free survival of 60% in those with mediastinal disease as compared with 74% in those without mediastinal disease. Because of the prognostic importance of mediastinal disease and its extent at initial presentation, computed tomography is recommended to evaluate patients with low neck or supraclavicular adenopathy in whom there is no obvious mediastinal adenopathy and in all Hodgkin disease patients in whom there is questionable mediastinal disease or suggestion of lung extension on routine radiographs. Treatment plans have been altered to include chemotherapy and low-dose irradiation to the lungs in those patients with mediastinal mass diameters of 7.5 cm or greater, regardless of stage.

Adolescent↗
PubMed1981

Reassessment of prognostic factors in stage IIIA and IIIB Hodgkin's disease treated with MOPP and radiotherapy.

Prognostic factors have been re-evaluated for 88 patients with Stage III Hodgkin's disease to see if they have remained significant on a long-term basis. Treatment had consisted of two cycles of MOPP followed by radiotherapy to the mantle, abdomen, and pelvis; all patients had achieved complete remission. Case material was grouped according to the presence of absence of mediastinal disease. Five-year survivals for Stage IIIA and IIIB patients were 85 and 80%; corresponding disease-free survivals were 76 and 73%. Significant prognostic factors include age, histopathology, and extent of abdominal disease, but the relative importance of these factors differs for the mediastinal and nonmediastinal patients. Modifications of current treatment policy for both mediastinal and nonmediastinal patients are discussed in relation to the prognostic factors.

Adult↗
PubMed1980

Laparotomy findings in lymphangiogram-staged I and non-Hodgkin's lymphomas.

Ninety patients with Stage I or II, including extranodal (E), presentations of non-Hodkin's lymphoma were investigated by laparotomy, either for the definitive staging of patients with peripheral presentations or for diagnosis of abdominal disease. Sixty-eight patients had staging laparotomies after extensive work-up, which included lymphangiography and bone marrow biopsy. The remaining 22 patients had laparotomies for diagnosis of abdominal symptoms or for management of unrelated surgical problems, with lyphoma being found incidentally. The incidence of positive abdominal findings in the 68 patients who had staging laparotomies depended on histologic subtype. In nodular lymphoma patients, abdominal disease was found in 17 of 28 (61%) and in diffuse lymphoma patients, in 9 of 40 (22.5%). For patients with nodular lymphomas upstaged by laparotomy, the positive findings tended to cluster around an axis consisting of the celiac, porta-hepatic, para-aortic, and root of the mesentery lymph nodes. In addition, 64% of these patients had splenic involvement. For the diffuse lymphoma upstaged by laparotomy, the distribution of positive findings was similar to that of the nodular lymphoma group; however, only 1 patient had splenic involvement. By contrast, in approximately half of the diffuse lymphoma patients who had laparotomies for diagnosis, the gastrointestinal tract was found to be involved in addition to the previously cited lymph nodes.

Abdominal Neoplasms↗
PubMed1980

Evaluation of the significance of prognostic factors in stage III Hodgkin's disease treated with MOPP and radiotherapy.

One hundred consecutive Stage IIIA and IIIB Hodgkin's disease patients were treated between July 1969 and September 1976, on a combined chemotherapy-radiotherapy program consisting of two courses of MOPP followed by radiotherapy to the mantle, abdomen, and pelvis. Eighty-eight patients completed radiotherapy to all disease sites. At the time of this analysis, the mean follow-up period for the 100 patients was 45 months; 70 patients had been followed three to seven years. Projected five-year survival and disease-free survival figures for the 100 patients were 80% and 68% respectively; corresponding results for the 88 patients were 90% and 78%. To determine whether any of the following prognostic factors influenced results for either the 100 or the 88 patients, survival curves were calculated for age, sex, constitutional symptoms, histopathology, method of staging, and status of the mediastinum. Other than age, none of these factors influenced survival significantly. However, disease-free survival figures were influenced adversely by mediastinal disease as well as age.

Adult↗