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L Twiggs

Publications and source records attributed to L Twiggs.

8 recordsLinked to original sources
PubMed1995

Quality of life assessment in gynaecological cancer patients.

The feasibility of quality of life (QOL) assessment in a heterogeneous group of gynaecological cancer patients undergoing chemotherapy was determined. All new patients being prescribed cytotoxic chemotherapy were asked to complete a modified QOL assessment tool. The elected assessment tool is the Functional Assessment Cancer Therapy-General (FACT-G) tool, comprising 33 questions under 5 broad categories: physical well-being, social well-being, relationship with doctor, emotional well-being and functional well-being. Raw scores were calculated and then transformed to a 0-100 scale. Twenty eight patients received a total of 75 treatment cycles of chemotherapy. Four patients were not offered the assessment due to language difficulties. All patients offered the test satisfactorily completed the test to allow statistical analysis. The average number of chemotherapy courses received was 2.5 (range: 1-6). Of a total possible 2,475 study items (33 items x 75 cycles), 240 items were not answered (10%). Of these 240 unanswered items, 2 items (#14 and #15) comprised 38%. The mean transformed score for physical well-being was 32 (SE 2.5), for social well-being the mean transformed score was 50 (SE 1.7), relationship with doctor 86 (SE 2.4), emotional well-being 41 (SE 2) and functional well-being was 54 (SE 2.6). The assessment of QOL indices in gynaecological cancer patients undergoing chemotherapy is feasible. Further research needs to determine the optimal QOL tool for this patient population.

Adult↗
PubMed1995

A managed care model for home infusion therapy.

Home infusion therapy began in response to the medical needs of the patients. In the traditional model, products and services were delivered in the home on a physician's prescription. Limitations related to medical quality management and cost were recognized in this model. Because of these limitations, the changes that continue to occur in health care delivery and the increase in number and acuity of patients requiring non-hospital services, a managed care model was conceived and implemented at the University of Minnesota Medical School and Hospital. This model emphasizes physician-based case management, total quality management, a point of contact medical information system, outcomes assessment and management, and research and education activities designed to evaluate and improve home infusion therapies. The model was implemented through a public-private partnership. This application of managed care to home infusion therapies is described in this communication.

Clinical Protocols↗
PubMed1993

Circadian-timed combination doxorubicin-cisplatin chemotherapy for advanced endometrial carcinoma. A phase II study of the Gynecologic Oncology Group.

Patients with advanced or recurrent endometrial cancer of any cell type having measurable disease have been entered into this study to determine the effectiveness and toxicity of circadian-timed doxorubicin-cisplatin chemotherapy. This Phase II study involved no randomization with treatment initiated with doxorubicin 60 mg/m2 over 30 minutes at 6:00 a.m., followed by cisplatin 60 mg/m2 over 30 minutes at 6:00 p.m. every 28 days. Treatment was continued for eight cycles or to a maximum tolerable doxorubicin dose of 480 mg/m2 for patients without progression. Thereafter, responders continued on cisplatin alone. A review of 30 evaluable patients showed 6 (20%) complete responses, 12 (40%) partial responses, and 7 (23%) with stable disease. The number of treatment courses ranged from 2 to 14 with a median of 6.5. the median white blood cell nadir for the 27 patients experiencing leukopenia was 1,600/mm3 (range: 300-3,600/mm3) For the 16 patients experiencing thrombocytopenia the median nadir was 48,500/mm3 (range: 8,000-138,000/mm3). There were no treatment-related deaths. Circadian-timed delivery of doxorubicin-cisplatin chemotherapy was reasonably well tolerated and demonstrated notable response rates in patients with advanced or recurrent endometrial carcinoma.

Adult↗
PubMed1992

Human ovarian epithelial cancer cells cultures in vitro express both interleukin 1 alpha and beta genes.

Ascitic fluid from human ovarian cancer patients often contains a large number of leukocytes along with tumor cells. Some of the recent evidence suggests that the ascitic fluid contains factors capable of inducing the growth of ovarian cancer cells in vitro and in vivo. While these factors have not yet been completely characterized, growth factors secreted by the tumor cells could influence the tumor growth by paracrine and autocrine mechanisms. Earlier, we reported that ovarian epithelial cancer cells produce macrophage colony-stimulating factor. It appears that these tumor cells produce more than one cytokine. Identifying the various products secreted by the tumor cells would provide valuable information needed to understand the biology of ovarian cancer. In the present study, evidence is provided for the first time that five different human ovarian epithelial tumor cell lines and tumor cells isolated from the ascitic fluid of four cancer patients express interleukin (IL) 1 alpha and beta genes constitutively. Production of the lymphokine was determined by analyzing the cellular RNA for IL-1-related transcripts and by immunological assays. Ovarian cancer cells also secrete another pleiotropic cytokine, IL-6, constitutively. In many systems, IL-1 induces the expression of the IL-6 gene. To determine whether the basal levels of IL-6 production are dependent on the endogenous IL-1, neutralization studies were carried out. Addition of antibodies to IL-1 did not decrease the levels of IL-6 secreted by the cancer cell lines. These results suggest that multiple cytokines are produced by ovarian cancer cells and that the endogenous IL-1 may not be directly involved in the regulation of IL-6 gene expression in these cells.

Ascitic Fluid↗
PubMed1989

Malignant rhabdoid tumor of the vulva: is distinction from epithelioid sarcoma possible? A pathologic and immunohistochemical study.

Epithelioid sarcoma (ES) and malignant rhabdoid tumor (MRT) have heretofore been regarded as two separate clinicopathologic entities. However, they have some histologic similarities, and both represent histogenetic and phenotypic enigmas. This study reports the pathologic and immunohistochemical findings of four vulvar neoplasms occurring in young women that represented diagnostic dilemmas because of their similarity to both ES and MRT. Only one case had the classic histologic features of ES, whereas, in our opinion, the other three cases fulfilled the histologic criteria of MRT, despite the fact that two of the three cases were reported earlier as examples of ES. Neither electron microscopy nor immunohistochemistry has been found to be helpful in separating ES from MRT, mainly because they share several ultrastructural and immunophenotypic features. The behavior of these vulvar tumors--ours and the few published examples of ES--is generally aggressive, more in keeping with MRT than classic ES. We believe that some, if not most, putative ES of the vulva are in fact MRT, a neoplasm with an unfavorable prognosis.

Adult↗
PubMed1983

The morbidity and utility of periaortic radiotherapy in cervical carcinoma.

From 1971 through 1981, 81 women received 4350 to 5075 rad to the periaortic lymph nodes as part of their primary management for carcinoma of the uterine cervix. While two patients developed chronic small bowel damage, only one required surgical intervention. Five-year disease-free survival was 40%. Approximately one-third of the first recurrences were within the pelvic and periaortic radiation portals, with the remainder in the lungs, liver, bones, abdomen, and supraclavicular lymph nodes. Radiation dose and volume guidelines are presented in order to minimize enteric morbidity.

Adenocarcinoma↗
PubMedDate not supplied

Marker rhythmometry with macrophage-colony stimulating factor (M-CSF).

In a patient with a debulked müllerian adenocarcinoma involving the ovary, an elevated serum concentration of macrophage-colony stimulating factor (M-CSF) (5.3 ng/ml) was lowered into the range of the age- and gender-matched controls by a 24-hour infusion of 135 mg/m2 of taxol, as was a Ca125 of 1480 U/ml by three such taxol courses given at 3-week intervals (to 14 U/ml). A downward trend of M-CSF in serum with an about-14-hour ultradian modulation during the first chemotherapy course resembles that of the concomitantly assessed Ca125. A decreasing trend modulated by an about-half-weekly component is found in M-CSF of fractionated urines collected at spontaneous voidings around the clock for 5 days. M-CSF may serve as a chronobiologic marker for optimizing, on an individualized basis, 1) the infradian scheduling of chemotherapy courses and 2) the ultradian-circadian within-course time patterns. Timing based on markers of the anticancer effect aims at teh as-yet unattained transfer from rodent to human of cancer cures that were not previously feasible without chronobiologic considerations. This goal can be pursued with M-CSF as well as Ca125 and UGP as possibly complementary chronobiologic markers in a chronotherapy trial with taxol in humans.

Aged↗