PubMed Health⌕ Search

Biomedical subjects

M Astrahan

Publications and source records attributed to M Astrahan.

At least 19 recordsLinked to original sources
PubMed1993

Transurethral microwave hyperthermia for benign prostatic hyperplasia: the Leuven clinical experience.

Local microwave hyperthermia, delivered transurethrally or transrectally, is a new treatment modality for benign prostatic hyperplasia. We started transurethral application, delivering 915-MHz microwaves at the prostatic urethra using a helical microwave antenna incorporated in a Foley catheter. This hyperthermia was given without a urethral surface cooling system. Thermophysical testing of the applicator proved therapeutic efficacy in vitro and in vivo. Pathologic studies demonstrated hyperthermia-induced lesions in the periurethral prostatic tissues and permitted us to hypothesize a working mechanism of transurethral hyperthermia. Clinical Phase I and II studies showed clinical efficacy in patients with urinary retention or prostatism secondary to benign hyperplasia, especially in bilobar or trilobar prostatic configurations. While awaiting results of further pathologic and thermophysical experimental work and ongoing Phase II and III studies, we consider transurethral hyperthermia an investigational but promising conservative treatment modality for benign prostatic hyperplasia.

Belgium↗
PubMed1991

Transurethral microwave hyperthermia: an alternative treatment for prostadynia?

A total of 15 patients with severe symptoms of prostadynia who were refractory to therapy were treated with transurethral microwave hyperthermia (TUHT) in a phase I trial. All patients had pain as the predominant symptom, 9 (60%) patients gave a history of psychological problems while frequency, urgency, dysuria, nocturia, and impotence were less common symptoms. Treatment consisted of TUHT at 915 MHz given weekly for 5 weeks with a total of 68 treatment sessions and a mean of 4.5 treatments per patient. Each treatment lasted for 60 minutes. The aim was to increase the temperature measured on the urethral surface to greater than or equal to 44 degrees C. T mean for all sessions was 45.5 degrees C. In 91% of treatments, the temperature was greater than or equal to 44 degrees C. Treatment was well tolerated in 87% patients and acute toxicity was mild. Of the 15 patients treated, 2 (13%) did not complete the treatment course due to discomfort during TUHT. Good treatment response, manifested by complete pain relief and a decrease in dysuria, was noted in 7 (47%) patients. A higher (greater than or equal to 46 degrees C) treatment temperature correlated well with good response, P less than .01. Similarly, relief of pain correlated well with the absence of a history of psychological problems, P less than .01. A decrease of obstructive micturition problems was noted in 5 of the 7 patients who had this upon presentation. This study showed evidence of therapeutic activity with the use of TUHT in patients with prostadynia refractory to therapy. The response obtained was limited to less than one-half of the patients. Complete pain relief was obtained in 4 (27%) patients. It is of interest to note that patients who had major benefit did not show evidence of psychological problems and were able to tolerate higher treatment temperatures. The latter could suggest a temperature-related response.

Adult↗
PubMed1991

A comparison of transurethral and transrectal microwave hyperthermia in poor surgical risk benign prostatic hyperplasia patients.

From 1987 to 1989, 36 poor surgical risk patients with benign prostatic hyperplasia (BPH) were treated with transrectal or transurethral microwave hyperthermia. Most of the 36 patients treated (85%) had severe signs and symptoms of urinary outflow obstruction. Of the patients 22 (61%) underwent transrectal and 14 (39%) underwent transurethral hyperthermia. Followup ranged from 10 to 28 months (mean 19 months) for the transrectal hyperthermia group and 7 to 16 months (mean 10 months) for the transurethral hyperthermia group. The patients were given 6 hyperthermia sessions of 30 minutes each with the temperature controlled on the rectal or urethral surface at 45C. Hyperthermia was well tolerated with mild acute toxicity and no late complications were observed. In the important subjective and objective parameters, major improvement was noted more frequently in the 14 transurethral than in the 22 transrectal hyperthermia treated patients (p less than 0.05). The Food and Drug Administration severity score, prostate volume, post-voiding residual volume and urethral flow showed substantial improvement in 79, 86, 79 and 79%, respectively, of the 14 transurethral hyperthermia treated patients compared to 41, 45, 82 and 82%, respectively, for the 22 transrectal hyperthermia treated patients. A prospective randomized trial comparing transrectal and transurethral hyperthermia is required to define the role of each treatment mode in patients with BPH.

Aged↗
PubMed1991

Combined localized current field hyperthermia and irradiation for intraocular tumors.

Ten patients with large melanomas and one patient with recurrent retinoblastoma were treated with combined localized current field (LCF) hyperthermia and iodine 125 irradiation delivered by episcleral plaque. Tumors were heated to 43 degrees to 45 degrees C for 28 to 45 minutes. Localized current field hyperthermia when combined with irradiation appeared to induce rapid tumor necrosis. One eye enucleated 17 hours after treatment showed only focal necrosis of the melanoma, while another eye demonstrated extensive necrosis 60 hours after treatment. In all remaining eyes, tumor regression occurred within the first month of treatment. Complications included cataract formation in six eyes, hemorrhagic retinal detachment in five eyes, and phthisis in two eyes. Complications from combined therapy of large intraocular tumors in this series appeared to result from the rapid necrosis of the tumor and secondary intraocular inflammation. Intraocular temperature dosimetry measurements demonstrated a temperature gradient of not more than -0.23 degrees C/mm-1 per axial millimeter from the episcleral plaque surface to the apex of the tumor. The authors believe that LCF hyperthermia could be a suitable means of application of hyperthermia in patients with intraocular tumors if further modifications were performed to reduce ocular complications.

Brachytherapy↗
PubMed1991

Management of carcinoma of the esophagus: the role of radiotherapy.

This is an analysis of treatment results over a 23-year period in 241 patients with carcinoma of the esophagus. The treatment for unresectable patients was external beam radiotherapy (EBRT) alone (mean dose 55 Gy) in 137 (57%) combined with brachytherapy (mean dose 50 + 40 Gy) in 46 (19%), and chemotherapy alone in 3 (1%) patients. In the 55 resectable patients, treatment was resection alone in 9 (4%), and combined with radiotherapy (mean dose 43 Gy) in 46 (19%) patients. The 1-, 2-, and 5-year survival for the 241 patients was 36, 15, and 5%, respectively (median 38 weeks). The 5-year survival was 18% for radiotherapy (RT)-surgery (S) patients, 11% for EBRT with brachytherapy, 2% for EBRT alone, and 0% for patients who had S alone, p less than 0.001. Survival correlated well with initial performance status, treatment, stage of disease, tumor size, radiation dose, and degree of response, p less than 0.001, but not with tumor location in the esophagus and patients' race and sex, p = 0.44. Serious complications occurred in 5 (2%) patients treated with RT alone and in 4 (7%) patients treated with S alone or combined with RT. The leading cause of death was persistent or recurrent tumor in the chest found in 39% patients.

Adult↗
PubMed1991

Regional hyperthermia in patients with recurrent genitourinary cancer.

During a 6-year period, 53 patients with advanced tumors of the genitourinary tract were treated in Phase I protocols with deep regional hyperthermia in combination with irradiation (83%) or in combination with chemotherapy (11%). Primary tumors included those of bladder in 22 patients (41%), prostate in 20 patients (37%), kidney in 9 patients (17%), and ureter testicle or adrenal in 3 patients (5%). The majority (77%) had prior definitive therapy and had experienced treatment failure, and 11% had clinically important distant metastases. Treatment consisted of deep regional hyperthermia (mean of 4 sessions). In addition, 44 patients (83%) received irradiation (mean dose 39.2 Gy). The 1- and 3-year actuarial survival was 60% and 56%, respectively. Patients with carcinoma of the prostate had a 1- and 3-year survival of 82%. Complete response was observed in 7 patients (13%), partial response in 8 (15%), and nominal response in 13 (25%). Complete and partial response correlated well with histology of the tumor (adenocarcinoma), radiation dose (greater than 50 Gy), primary site (prostate, kidney), and treatment (hyperthermia-radiotherapy combination), (p = 0.02). There was no such correlation between response and thermal dose (p = 0.13). The treatment tolerance was good in 79% of patients. Treatment toxicity was limited to acute side effects, including pain during hyperthermia (47%), tachycardia greater than 140/min (7%), and blister formation in the treated area (4%). Phase II studies in previously untreated patients with locally advanced tumors of bladder, prostate, and kidney are needed for evaluation of the role of deep regional hyperthermia in the management of these cancers.

Actuarial Analysis↗
PubMed1990

Treatment of uterine sarcomas.

During a 21-year period, 66 patients with uterine sarcomas were treated at California Medical Center. Histological diagnoses were mixed mesodermal sarcoma in 32 patients (48%), leiomyosarcoma in 24 (36%), and endometrial stromal sarcoma in 10 (15%) patients. The majority of patients (73%) had Stage I tumors. The treatment consisted of surgery alone in 27 (41%), surgery in combination with radiation therapy in 36 (55%), and radiation therapy alone in three (4%) patients. The overall 1-, 2-, and 5-year actuarial survival was 74%, 57%, and 38%, respectively. The 1-, 2-, and 5-year actuarial survival for the 27 surgery alone patients was 73%, 50%, and 25%, which compared with 75%, 61%, and 44% for the 36 surgery plus radiation therapy patients (P = 0.12). The disease-free survival was better for the surgery plus radiation therapy patients, as compared with the surgery alone group (38% vs. 18% at 5 years, P = 0.081). The 5-year survival by histology was 70% for the 10 endometrial stromal sarcoma patients, 40% for the 24 leiomyosarcoma patients, and 23% for the 32 mesodermal sarcoma patients (P = 0.064). As expected, survival depended on the stage of disease (P less than 0.0001). Treatment failure was observed in 35 (53%) patients, which included 9 (14%) with failure in the pelvis. There was no difference in the incidence of failure among patients in the three treatment groups and also in the three histologic groups. There was, however, a significant difference in the incidence of pelvic failure between surgery alone and surgery plus radiation therapy patients. In the 27 surgery alone patients, nine (33%) relapsed in the pelvis, whereas none of the 36 surgery plus radiation therapy patients had locoregional failure, P less than 0.0001. Adjuvant radiation therapy is an important treatment in the management of patients with sarcoma of the uterus.

Adult↗
PubMed1990

Transurethral microwave hyperthermia for benign prostatic hyperplasia: preliminary clinical and pathological results.

Transurethral microwave hyperthermia is a new conservative treatment modality for benign prostatic hyperplasia. We treated 15 patients with 915 MHz. microwaves delivered transurethrally by a helical applicator. Of the patients 12 showed substantial objective and subjective improvement of obstructive outflow parameters. Significant improvement in objective study parameters included increased mean flow rate (p less than 0.00021), decreased mean residual volume (p less than 0.00001) and decreased mean prostatic volume (p less than 0.0077). Analysis of patterns of failure showed chronic bladder atony, prostate asymmetry and middle lobe configuration as important factors that could explain the failure of hyperthermia in 3 patients. Toxicity was mild, consisting of bladder spasms, perineal pain, dysuria and hematuria. Hyperthermia-induced pathological changes in prostatic tissues, causing periurethral shrinking and secondary dilatation of the prostatic urethra, are described. The reported clinical results of this phase I study are preliminary due to the short followup. A phase II study to optimize transurethral hyperthermia currently is underway. A phase III study is to be phased in comparing hyperthermia with transurethral resection of the prostate.

Aged↗
PubMed1989

Interstitial microwave hyperthermia combined with iridium-192 radiotherapy for recurrent tumors.

From 1985 through 1987, 44 tumors in 39 patients with recurrent cancer were treated with interstitial microwave hyperthermia (HT) combined with interstitial 192Ir radiotherapy (RT). All patients had unresectable and previously treated tumors (mean RT dose 57.6 Gy). Diagnoses were squamous cell carcinoma in 27 (62%), adenocarcinoma in 11 (25%), melanoma in 5 (11%), and soft tissue sarcoma in 1 (2%) site. Interstitial RT dose was from 25 to 50 Gy (mean 38.3 Gy). The first HT session was scheduled immediately before the loading of 192Ir, and the second was scheduled following its removal. Each session lasted 45-60 min at therapeutic temperature (42.5 degrees C). Complete response (CR) was obtained in 28 (64%) sites and partial response (PR) in 15 (34%) sites. None of the CR patients had local recurrence. Tumor volume was the most important factor influencing CR (p less than 0.001). The treated site, radiation dose, and thermal dose were not significant factors for CR (p = 0.03). The overall median survival was 39 weeks, with a 2-year survival of 22%. The treatment was well tolerated, with two patients developing focal skin necrosis.

Actuarial Analysis↗
PubMed1989

Deep regional hyperthermia of the liver. A clinical study of 49 patients.

From 1981 to 1986, six medical centers participated in feasibility studies of radiofrequency deep regional hyperthermia (HT) in the treatment of hepatic metastases. A total of 49 patients, 32 men and 17 women, were treated with an annular phased array. Colon was the primary site in 74% of the patients, and adenocarcinoma was the diagnosis in 80%. More than one half of the patients had been treated previously. This included chemotherapy (CT) in 17 patients and radiotherapy (RT) in 10 patients, with a mean RT dose of 24 Gy. Upper abdominal pain was the dominant presenting symptom in 53% of patients. In the study, treatment was administered as follows: 14 (28%) patients received HT alone, 17 (35%) received HT + RT, 14 (28%) received HT + CT, and 4 (8%) received HT + RT + CT. A total of 157 HT treatments was administered at a mean frequency of 55 MHz and a mean power of 780 watts. The number of HT sessions ranged from 1 to 8, with a mean of 3.2 treatments per patient. Temperature was monitored continuously throughout each treatment session. The treatment aim was to reach and maintain a temperature of 42.5 degrees C for 30 min. In practice, owing to the difficulty in reaching this temperature, an equivalent (lower) temperature from 40 to 42 degrees C was used, extending the duration of treatment sessions to 45-60 min. Thermal dose was defined as the number of minutes at 42.5 degrees C or its equivalent. In 21 (43%) patients, a temperature less than 40 degrees C was obtained and thermal dose = 0. Thermal dose was less than or equal to 50 in 17 (35%) patients, greater than 50 less than or equal to 100 in 7 (14%), and greater than 100 in 4 (8%). RT was given at a daily dose of 1.8 Gy to a total of less than 20 Gy in 14 patients, greater than 20 less than or equal to 30 Gy in 6, and greater than 30 Gy in 1. CT consisted of 5-Fluorouracil by way of Hepatic Artery Infusion (HAI) in 9 patients, i.v. cisplatin in 5, and doxorubicin HAI in 3. Objective tumor regression (CR + PR) was seen in 6 (12%) patients. An additional 10 (20%) patients had less than 50% greater than 25% tumor regression, and 10 (20%) had complete or partial pain relief. The median duration of CR and PR was 26 weeks.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1988

Interstitial radiotherapy combined with interstitial hyperthermia in the management of recurrent tumors.

During a 2-year period 31 sites in 27 patients with recurrent, previously treated tumors received a combination of interstitial 192Ir radiation (RT) with microwave hyperthermia (HT). Head and neck sites were treated most frequently (48%), with breast and vagina each representing about 20% of sites. Complete response (CR) with no local recurrence was obtained in 61%, partial response (PR) in 11 (36%), and one (3%) had less than 50% tumor regression. Of these patients, nine had no evidence of tumor following HT-RT therapy, 8/18 in the CR group and 1/11 in the PR group. Significant factors influencing CR were: radiation dose, tumor volume and duration of tumor control following the initial therapy (p less than 0.02). Treated site, histology and thermal dose were not significant factors influencing tumor regression. Complications of significance developed in one patient who had local skin necrosis. Interstitial HT-RT combination provides an effective palliative therapy for recurrent and/or persistent tumors. Randomized trials are necessary to assess the effectiveness of this combination as a component part of primary management of selected tumors.

Brachytherapy↗
PubMed1988

Deep microwave hyperthermia for metastatic tumors of the liver.

Between 1981 and 1985, 44 patients with advanced metastatic carcinoma of the liver were treated with deep microwave hyperthermia (HT) in five medical centers in the US. This HT was given with a BSD-1000 Annular Phased Array (BSD Medical Corporation, Salt Lake City, Utah). Of the 44 patients treated, 18 (41%) were in poor general condition and scored less than 60 on the Karnofsky scale. In 50% upper abdominal pain was a major presenting symptom. Prior chemotherapy (CT) had been given in 12 (27%) patients, while 10 (23%) had received prior radiotherapy (RT). Colon (73%) was the most frequent site of the primary tumor, and adenocarcinoma (79%) was the most frequent histological diagnosis. A total of 150 HT treatments were given, with an average of 3.4. HT alone was administered to 12 (27%), HT-RT to 15 (34%), HT-CT to 13 (30%) and HT-RT-CT to four (9%). Therapeutic temperature was reached in 28 (64%) patients. The majority (66%) tolerated treatment well. Due to the poor general condition of over one-third of the patients, prior therapy in 50% and the presence of advanced tumor in all, it is not surprising to see a response rate of only 36%. The response rate was 53% among patients receiving RT in addition to HT and 46% in patients who had therapeutic temperature. Survival ranged from less than 1 to 63 months, with an average of 11 months. Relief of pain was observed in 8 of 22 patients who presented with this symptom. HT can be safely delivered to patients with metastatic tumor to the liver.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1988

External beam and intraluminal radiotherapy in the treatment of carcinoma of the esophagus.

During a 10-year period, 46 patients with unresectable or inoperable carcinoma of the esophagus were treated with teletherapy-brachytherapy combination at the University of Southern California School of Medicine. Stage distribution was as follows: stage I, 5 (11%) patients; stage II, 23 (50%) patients; stage III, six (13%) patients; and stage IV, 12 (26%) patients. Thirteen patients were treated for recurrent disease, including 11 patients initially treated with teletherapy and two who had had surgical resection. Radiotherapy was given by teletherapy in 33 and brachytherapy in all 46 patients. An average tumor dose was 50 Gy with teletherapy and 20 Gy per application with brachytherapy. There were 25 patients who had more than one brachytherapy application. The 5-year actuarial survival rate for 28 patients with stage I or II disease was 12%, with a median of 13 months. This compared with no 5-year survivals and a median survival of 10 months for the 18 patients with stage III or IV disease. Failure at the primary site was seen in 16 (35%) patients. Complete response was seen in 20%, partial response in 76%, and no response in 4%. Treatment was well tolerated. Complications included esophageal stenosis in two patients and tracheoesophageal fistula in one. Teletherapy-brachytherapy combination is an effective treatment in the management of unresectable or inoperable carcinoma of the esophagus.

Adenocarcinoma↗
PubMed1987

Treatment results and patterns of failure in 646 patients with carcinoma of the eyelids, pinna, and nose.

From 1956 to 1978, 646 patients were treated with radiotherapy for carcinoma of the nose (350 patients, 54 percent), eyelids (159 patients, 25 percent), pinna (93 patients, 14 percent), and skin adjacent to the lip (44 patients, 7 percent). The histologic distribution was 72 percent basal cell carcinoma, 18 percent squamous cell carcinoma, and 10 percent mixed basal and squamous cell features. Tumors less than 2 cm in diameter were found in 602 patients (93 percent), whereas 44 patients (7 percent) had larger tumors. Tumor involvement of cartilage and bone was seen in 23 patients at the time of diagnosis. The 5, 10, and 20 year control rates were 99 percent, 98 percent, and 98 percent, respectively, for 502 tumors less than 2 cm in diameter. This compared favorably with control rates of 92 percent at 5 years and 79 percent at 10 years for tumors from 2 to 5 cm in diameter and 60 percent at 5 years and 53 percent at 8 years for 12 patients with massive tumors (p less than 0.0001). The histologic characteristics of the lesion had a strong influence on tumor control (p less than 0.02). Of the patients with cartilage or bone invasion, tumor was controlled in 19 (83 percent). Of these 19 patients, 11 had no evidence of disease for 3 years or more. Of all 646 patients treated, failure was seen in 60 (9 percent). It correlated well with the size of the lesion, being 7 percent for tumors of less than 2 cm and 50 percent for tumors of greater than 5 cm. Of the 60 patients in whom treatment failed, 48 (80 percent) had prior definitive therapy. Radiotherapy was an efficient modality to control operative failures; however, it was not as efficient at control in patients in whom previous radiotherapy failed. Operation was the treatment of choice to salvage patients in whom radiotherapy failed. Of the patients in whom retreatment failed, 10 were known to have died from skin cancer, and an additional 6 patients were presumed to have died from the cancer. This study has demonstrated a good control rate and good cosmetic results for small tumors of the eyelids, pinna, and nose. In addition, a good control rate was obtained in patients with cartilage and bone involvement. Treatment of massive tumors should involve planned operative resection with adjuvant radiotherapy.

Adult↗