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Biomedical subjects

M B Garnick

Publications and source records attributed to M B Garnick.

At least 73 records · Page 4Linked to original sources
PubMed1987

Current status of endocrine therapy for prostate cancer.

Hormonal therapy, considered standard treatment for prostate cancer for forty years, is being reevaluated in light of more recent analysis of the studies conducted by the VA Cooperative Urologic Research Group (VACURG). Modalities reviewed include diethylstilbestrol, estramustine phosphate, aminoglutethimide, progestational agents, antiandrogens, orchiectomy, and the newer LHRH analogues, such as leuprolide and combination hormonal therapies. The author examines the rational use of hormonal treatments in terms of their advantages and disadvantages, the optimal timing and dosage of each, and the possibility of combining hormonal therapy with chemotherapy.

Hormones↗
PubMed1986

Possible benefit of doxorubicin treatment in patients with refractory germ cell cancer.

Forty patients with germ cell cancer (GCC) refractory to vinblastine, cisplatin, and bleomycin therapy were treated with etoposide (E), cisplatin +/- bleomycin +/- doxorubicin and were evaluated retrospectively to determine response to treatment. Thirty cancers were primary testicular and ten extragonadal in origin. Fifty-five percent (22/40 patients) of the group responded to therapy. Eight of 40 (20%) patients had complete responses (CR) and 14 of 40 (35%) had partial responses (PR). Seven of 30 (23%) patients with a testes primary had a CR in contrast to 1 of 10 patients with extragonadal origin cancer. Six of eight patients (75%) having a CR received doxorubicin in combination, while only 2 of 18 (11%) patients having no response were treated with a doxorubicin-combining regimen. Of the entire group, 12 of 14 patients (86%) treated with doxorubicin for the first time responded to therapy compared to 10 to 26 patients (38.5%) not receiving doxorubicin (P = 0.009 Fisher's exact test). Myelosuppression was more frequent in patients treated with doxorubicin (87%) than in those treated without doxorubicin (70%). No increased frequency of hospitalization was required and no treatment-related fatalities occurred. Salvage therapy of patients with GCC appears to be improved when doxorubicin is added to etoposide, cisplatin, and bleomycin.

Adolescent↗
PubMed1986

CT evaluation of advanced seminoma treated with chemotherapy.

The serial CT characteristics of nodal metastases from pure seminoma treated with chemotherapy were evaluated in 18 patients. Fifty percent of masses at presentation contained areas of low attenuation; none had calcification. After chemotherapy, masses completely resolved in four patients, partially resolved in 12 patients, and remained unchanged in one patient. The remaining patient developed progressive liver metastases during therapy and died. Pathologic evaluation of residual masses in four patients demonstrated only fibrosis. Residual masses in nine other patients demonstrated further partial resolution or remained stable over the following year; two developed calcification. These patients exhibited no clinical evidence of disease for a median follow-up of 22 or more months. Persistent but stable or resolving masses are common after chemotherapy for advanced seminoma. Unlike their nonseminomatous counterparts, they most often represent fibrosis in patients with no other clinical evidence of disease and do not warrant surgical excision.

Adult↗
PubMed1986

Leuprolide versus diethylstilbestrol for previously untreated stage D2 prostate cancer. Results of a prospectively randomized trial.

In a randomized, prospective trial, 199 previously untreated patients with Stage D2 prostatic cancer were treated with 3 mg/day diethylstilbestrol (DES) or 1 mg/day leuprolide acetate, a luteinizing hormone releasing hormone analog. Both DES and leuprolide suppressed testosterone to the desired castrate levels. Objective measures of disease, such as acid phosphatase levels, and subjective measures, such as bone pain, performance status, and mobility, showed similar decreases in both groups. No progression of disease was seen in 86 per cent of the leuprolide-treated group, compared with 85 per cent of the DES-treated group. The time to disease progression, development of adverse reaction requiring discontinuation of treatment, or death was identical for the two groups. Hot flashes were more common with leuprolide than with DES. Gynecomastia and breast tenderness, nausea and vomiting, and peripheral edema occurred more often in the DES group. Of those taking DES, 13 per cent discontinued treatment because of side effects, compared with 3 per cent of those taking leuprolide.

Acid Phosphatase↗
PubMed1985

Unusual behavior of low-grade, low-stage transitional cell carcinoma of bladder.

A case report of low-grade, low-stage transitional cell cancer of the bladder with isolated metastases to the uterus, fallopian tube, and ovary is presented. The pathogenesis of such unusual behavior for a local bladder malignancy is discussed along with a review of similar cases from the literature.

Carcinoma, Transitional Cell↗
PubMed1985

Therapeutic guidelines and results in advanced seminoma.

Twenty patients with advanced seminoma were treated with chemotherapy. Fourteen patients were previously untreated (group 1) and received vinblastine, bleomycin, and cisplatin (VPB) at presentation. Six patients had received prior radiation therapy (group 2), and at relapse received either VPB or VP-16-213 (etoposide)-cisplatin. Within group 1, five patients received no further therapy after VPB (group 1A), six patients received radiation to residual radiographic abnormalities (group 1B), and three patients underwent surgery to remove residual radiographic areas following VPB (group 1C). The complete response rate in group 1 was 14/14 (100%). At present within group 1A, 5/5 patients (100%) are alive and disease-free (NED) for a median follow-up of 32 + months. In group 1B, 6/6 patients (100%) are alive and NED for a median follow-up of 17+ months. In group 1C, 3/3 patients (100%) had residual fibrosis at the time of surgical resection. Two of these patients died of postoperative complications with no evidence of disease and the third is alive and NED at 19+ months. In group 2, 4/6 patients (67%) achieved a complete remission, including two patients who are NED at 22+ and 85+ months, respectively. Two have died and two are alive with progressive disease. Doses of chemotherapy to group 2 patients were substantially lower than the doses given to group 1 patients. We conclude that chemotherapy is acceptable initial therapy for advanced seminoma, and prior extensive radiation therapy may impair the ability to give adequate doses of chemotherapy in patients who relapse. Residual masses after chemotherapy are often fibrotic and the role of postchemotherapy radiation therapy in these patients is uncertain.

Adult↗
PubMed1985

Curative testis cancer therapy: psychosocial sequelae.

We examined the long-term impact of advanced testis cancer and its curative therapies on emotional states and outlook on life, employment, intimate relationships, and sexual function. The sample consisted of 74 nonseminomatous and seminomatous tumor patients who had completed treatment two to ten years ago. The majority of men felt that surviving the debilitating treatment(s) was both an accomplishment and worthwhile trade-off. Neither the rate of unemployment (7%) nor divorce (10%) was remarkable. The most critical outcome was in the area of sexual functioning. One fourth to one half of the men reported some type of sexual impairment. Multiple regression results indicate that ejaculatory dysfunction, a side effect of the retroperitoneal lymph node dissection, is significantly associated with distress about both infertility and sexual impairment. Men with sexual impairment report more psychological symptoms, strained intimate relationships, and negative changes in other areas of life functioning. These data, while not definitive, suggest that there are delayed effects and that the subgroup of men, who are least likely to disclose these problems to physicians, are at greater risk for the deleterious outcomes.

Adolescent↗
PubMed1985

Residual abdominal masses after chemotherapy for nonseminomatous testicular cancer: correlation of CT and histology.

Computed tomographic (CT) characteristics of 45 residual masses in 30 patients with disseminated nonseminomatous testicular cancer treated with chemotherapy were correlated with histologic findings at surgery. Thirty-one masses were studied serially on pre- and postchemotherapy scans. At the time of tumor-reductive surgery, all patients had normal serum tumor markers (alpha-fetoprotein and human chorionic gonadotropin). Residual malignancy was found in 27% of patients, teratoma in 33%, and fibrosis or necrosis in 40%. The CT appearance of the masses--size, qualitative density, and change noted during the course of treatment--was insufficient to exclude the presence of residual malignancy or teratoma. An enlarging mass of psoas density occurred only once in this series; it contained malignancy. Other CT characteristics of residual masses had no greater than 50% correlation with the presence of malignancy. Histologic evaluation of residual masses remains necessary to guide further patient management.

Abdominal Neoplasms↗
PubMed1985

Hematologic malignancies associated with primary mediastinal germ-cell tumors.

Three men with primary mediastinal germ-cell tumors subsequently developed a malignant hematologic disorder characterized by pancytopenia and marrow infiltration with hematopoietic blast cells. Two of these patients were classified as having acute megakaryocytic leukemia and the third was believed to have a myelodysplastic syndrome with a prominent megakaryocytic component. Analysis of clinical characteristics of these patients and review of the literature suggest that the proximate association of mediastinal germ-cell tumors with malignant hematologic disorders is neither a coincidence nor a consequence of chemotherapy given for the germ-cell tumor. We believe this association represents the evolution of a neoplastic disorder that initially involves a totipotent germ cell. These germ cells, when located in the mediastinum, apparently acquire hematologic phenotypes and are manifested clinically as a hematologic malignancy.

Acute Disease↗
PubMed1984

The efficacy of routine whole lung tomography in germ cell tumors.

A prospective analysis was undertaken to evaluate the efficacy of performing routine whole lung tomography in addition to conventional chest radiography in the initial staging and subsequent management of 120 patients with seminomatous and nonseminomatous germ cell tumors. Two hundred fifty whole lung tomographs were performed on these patients. At presentation, only one patient (0.8%) had positive tomography with simultaneously normal posteroanterior and lateral chest films. On follow-up tomographic examinations, three patients had metastases when chest roentgenographs were normal. In only one patient was therapy altered by tomographic findings. The results indicate that routine whole lung tomography is not useful or cost-effective in the initial staging and subsequent management of patients with germ cell tumors.

Evaluation Studies as Topic↗
PubMed1984

Intravesical doxorubicin for prophylaxis in the management of recurrent superficial bladder carcinoma.

Intermittent intravesical doxorubicin chemotherapy was given to 27 patients with multiple recurrent superficial transitional cell carcinoma of the bladder, including 12 who had become refractory to intravesical thiotepa. The starting dose was 60 mg. doxorubicin diluted in 40 to 50 ml. normal saline solution and doses were increased to 90 mg. The duration of instillation was 60 minutes. Treatments were administered every 3 weeks for a total of 8 doses, then every 6 weeks for 2 doses and then every 12 weeks for 2 doses. Therapy then ended for patients who were rendered free of disease. Cystoscopy and urinary cytology studies were performed every 3 months throughout the study. Of the patients 30 per cent had intermittent episodes of dysuria, 26 per cent had urinary frequency, 41 per cent had hematuria and 15 per cent had bladder spasms. None of these toxicities required discontinuation of the drug. Analysis of plasma samples for doxorubicin and metabolites revealed no systemic absorption and there was no myelosuppression. Of the 27 patients 15 (56 per cent) have maintained complete eradication of bladder cancer without any evidence of residual carcinoma detected endoscopically or with urinary cytology. Recurrent disease developed in 9 patients (33 per cent) while on therapy, including 3 with muscle invasion. Cystoscopy has remained grossly negative in 3 patients who have had positive class 5 cytology studies. The median duration of followup in all patients has been 12 months, with a range of 6 to 24 months. We conclude that intravesical doxorubicin is tolerated well and is effective in the management of multiple recurrent superficial transitional cell carcinoma of the bladder.

Administration, Topical↗