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Biomedical subjects

L R Prosnitz

Publications and source records attributed to L R Prosnitz.

At least 109 records · Page 6Linked to original sources
PubMed1981

Avascular necrosis of bone in Hodgkin's disease patients treated with combined modality therapy.

Avascular necrosis of bone developed in eight patients with advanced Hodgkin's disease who had been treated with combined modality therapy and were in complete remission from their disease. A ninth patient not on protocol but treated with the combined modality program also developed avascular necrosis. The cumulative incidence was 10% among long-term survivors. The etiology is unclear. Prolonged corticosteroid administration has been implicated but usually in much larger doses than the patients in this series received. The possible roles of the other chemotherapeutic agents for Hodgkin's disease, and radiation are discussed. Considerable disability resulted for almost all patients. Three of seven patients primarily with avascular necrosis of the femoral heads had bilateral hip replacements with surgery anticipated in four others. The two patients primarily with humeral head involvement have limited use of their arms. This condition must be added to the known possible serious consequences of combination chemotherapy for Hodgkin's disease. It is uncertain if the frequency of avascular necrosis is higher in patients treated with both radiation and chemotherapy compared with chemotherapy alone. Further studies are needed from other institutions to clarify the frequency and cause of this problem.

Adult↗
PubMed1980

Curative potential of combined modality therapy for advanced Hodgkin's disease.

During the period from 1969 through 1977, 124 patients with advanced Hodgkin's disease underwent treatment with combination chemotherapy and radiotherapy. Sixty-three cases were previously untreated, and 61 were relapses following radical radiotherapy for localized Hodgkin's disease. No patient in this series had received prior chemotherapy. Of 102 patients (84%) who have entered complete remission, 92 remain in complete remission with a median follow up time of five years, 10 patients having relapsed, and acute leukemia having developed in 2. The cumulative survival rate for all 124 patients is 80% at five years; the relapse-free survival rate is 74%. In many, if not most cases, the Hodgkin's disease appears to be cured. We have also identified two subgroups of patients for whom the prognosis is worse than for patients with advanced-stage disease as a whole. Patients over the age of 40 years have a five-year survival rate of only 45%, compared with 89% for all other patients. Those Stage IV patients with multiple extranodal sites of involvement have a five-year survival rate of 48%, compared with 81% for other Stage IV patients with only a single extranodal site involved.

Adult↗
PubMed1980

Local excision and radiation therapy for early stage breast cancer.

A reasonable alternative to mastectomy for women with early stage breast cancer is wide local excision of the lesion coupled with radical radiation therapy. The recurrence and longevity results with this method have been as good as, if not better, than standard mastectomy after 10 years' clinical experience in a limited number of patients. The physical and psychological impact of this therapy is more acceptable than mastectomy to the woman with breast cancer in its earliest stages.

Breast Neoplasms↗
PubMed1980

Pulmonary changes after primary irradiationfor early breast carcinoma.

The clinical records and radiographs of 37 patients with carcinoma of the breast (stages I and II) treated with primary radiation therapy without mastectomy were reviewed. In 10 patients, there was a radiographic pattern of increased radiopacity in the lung underlying the treated breast. The margins of the lesion corresponded to those of the tangential radiation ports with a well defined posterior border noted on the lateral chest radiograph. Apical fibrosis (secondary to supraclavicular irradiation) was demonstrated in six other patients. No patient had symptoms referable to the radiation injury. With the increasing use of radiation therapy as initial treatment for early stage carcinoma of the breast, it is important to recognize these radiation changes in the lungs and distinguish them from infection or recurrent tumor.

Breast Neoplasms↗
PubMed1979

Results of radiotherapy in control of stage I and II non-Hodgkin's lymphoma.

We retrospectively analyzed 114 patients with non-Hodgkin's lymphoma, clinical stages I and II, classified by the criteria of Rappaport and treated by radiotherapy alone. Of 84 patients classifiable, one-third were nodular and two-thirds diffuse lymphomas. Berkson-Gage actuarial and relapse-free survivals were determined for these two groups and for subgroups stratified by histology, stage, and by presence or absence of extranodal disease. Five year relapse-free and overall survivals were 83% and 100%, respectively, for the nodular group and 37% and 59% for the diffuse group. Extranodal involvement was less frequent in the nodular (19%) than in the diffuse (52%) group, where it was associated with Stage IE disease and increased relapse-free and actuarial survival. Histopathological subtype in the diffuse group (histiocytic versus combined lymphocytic poorly differentiated and mixed lymphocytic-histiocytic) did not influence survival. Extranodal involvement and stage I disease were associated with better survival in the diffuse histiocytic group. Successful radiotherapy for all stages of disease, all histologies, was not correlated with extended versus involved fields, and 89% of the relapses in the entire series were by wide dissemination.

Biopsy↗
PubMed1977

Selection of breast cancer patients for adjuvant chemotherapy. Another look at the prognostic importance of involved lymph nodes.

To aid in the selection of breast cancer patients for adjuvant chemotherapy, 263 patients with primary breast carcinoma undergoing curative surgery at the Yale-New Haven Medical Center were examined with respect to axillary lymph node involvement and prognosis. Thirty-five percent of patients with one to three axillary nodes histologically involved with cancer relapsed within five years, as did 61% of patients with four or more cancer-positive nodes. Equally important was the clinical stage. Stage III patients had a poor prognosis (71% relapse rate) regardless of their axillary status. Stage I patients with metastasis to one to three axillary nodes did just as well as stage I patients with no nodal involvement (13% relapse rate). Relapse rates within the nodal categories are significnatly less (P less than .05) than those reported by the National Surgical Adjuvant Breast Project.

Adult↗
PubMed1977

Radiation therapy as initial treatment for early stage cancer of the breast without mastectomy.

This report describes 150 patients with clinical stage I and II carcinoma of the breast treated at four institutions--Yale University School of Medicine, Harvard Medical School-Joint Center for Radiation Therapy, Hahnemann Medical College, Jefferson Medical College--with radiotherapy only following excisional biopsy. Closely similar treatment policies were followed at all four centers, 4500-5000 rads minimum tumor dose being delivered to the entire breast and axillary, supraclavicular and internal mammary nodes. Forty-six of 49 stage I patients treated are alive without disease, the actuarial relapse-free survival being 91% at 5 years. Of the 101 stage II patients, 75 are alive without disease with a relapse-free actuarial survival of 60% at 5 years. Local failure has occurred in 10 patients (9 stage II and 1 stage I, 6.6%) 5 of whom are disease-free following mastectomy. The results obtained in this study are comparable to those of conventional surgery. It is our conclusion that mastectomy is not a necessary part of the treatment of small breast cancers, that radiation without mastectomy is an acceptable alternative with far superior cosmetic and functional results. Adjuvant chemotherapy should be considered particularly in stage II patients in view of their 40% relapse rate.

Antineoplastic Agents↗
PubMed1976

Long term remissions with combined modality therapy for advanced Hodgkin's disease.

A new treatment program for advanced Hodgkin's disease employing five-drug combination chemotherapy and low dose radiation to the sites of bulk disease (nodal or parenchymal) was designed in 1969. Eighty patients have now been treated, 60 of whom have achieved a complete remission. More significantly, only 5 of the 60 completed responders have relapsed with follow-up from 1-6 years. The cumulative survival at 5 years of patients entering complete remission is 92%. For those patients not sustaining a complete remission, it is 19% at 2 years. This program has resulted in substantially lower relapse rates than previously reported by other investigators, probably because of the administration of radiotherapy in the manner described. Hopefully, a significant number of these patients may be cured of their disease.

Adult↗
PubMed1975

Radiation therapy as primary treatment for early stage carcinoma of the breast.

A treatment program for early stage breast cancer consisting of biopsy only and primary radiation therapy is described. The treatment plan is "radical" with tumoricidal doses or radiation delivered to the breast and axillary, supraclavicular, and internal mammory lymph nodes, i.e. 6000-7000 rads to clinically involved areas and 4500-5000 rads to subclinical disease. Thirty patients have been treated with this program, with followupranging from 1-10 years. Only 1 patient has died from her disease; 1 has had a lot oflocal recurrence readily controlled with mastectomy. Twenty-six patients arealive and well; there have been 3 deaths from intercurrent illness. No significant radiation complications have occurred. Radiation therapy as the sole treatment for breast cancer has been described in the literature for at least 20 years but generally ignored byclinicians. It deserves evaluation as a treatment option in randomized therapeutic trails.

Adenocarcinoma↗
PubMed1975

Dosimetry of Hodgkin's disease therapy using a 4 MV linear accelerator.

This report describes a detailed analysis of the dosimetry of the mantle technique for the therapy of Hodgkin's disease when a 4 MV linear accelerator (Varian) is utilized. Doses were determined in a Rando phantom and in vivo using several methods of dosimetry. Significant dose variations, exacerbated by the lead flattening filter, were found. For peripheral doses, where the nodes are near the surface (e.g., neck and axillae), increases of 20-30% were the rule. To adjust for these substantial differences, a shrinking field technique was adopted, obviating the need for complex compensating systems. The doses for the inverted Y field were relatively uniform.

Female↗
PubMed1975

Mantle field dosimetry comparing 4 MV with cobalt 60.

Three off-axis dosimetric parameters were evaluted for identical mantle fields using the Varian 4 MV linear accelerator and a Picker C8M cobalt-60 unit. These parameters were dose distribution, skin dose and integral dose. Comparisons showed higher doses in all three categories with the 4 MV accelerator when the tumor dose is specified at the central axis midline. These results emphasize the importance of off-axis dosimetry with both machines.

Cobalt Radioisotopes↗