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Biomedical subjects

M I Saunders

Publications and source records attributed to M I Saunders.

At least 73 records · Page 4Linked to original sources
PubMed1994

Fractionation and dose in thoracic radiotherapy.

The results of radiotherapy in non-small cell lung cancer confined to the mediastinum are disappointing. Conventional radiotherapy giving 60 Gy in 6 weeks gives primary tumour control of up to 23% with a 1 and 2-year survival of the order of 35% and 12%, respectively. Hyperfractionation--the giving of many small doses, and acceleration--the shortening of the overall duration of treatment, are two of the strategies now being tested. The CHART regime (Continuous, Hyperfractionated, Accelerated Radiotherapy) where 36 fractions are given over 12 consecutive days combines both features. In a pilot study this regime gave 40% local tumour control and a 1- and 2-year survival of 60% and 40%, respectively. Randomized controlled trials have commenced in the United Kingdom comparing CHART with conventional radiotherapy (60 Gy in 6 weeks). Over 300 patients have been entered in the first 2.5 years by 11 participating centres. It is hoped to accrue over 500 patients to this study in a period of 4 years.

Bronchial Neoplasms↗
PubMed1994

ARCON.

Explore the source record for details and available documents.

Animals↗
PubMed1994

A computerized data collection system for a cancer centre.

A data system has been designed for a cancer centre and, with the close collaboration of staff, has been brought into use. Data are continuously gathered by doctors, nurses, radiographers and cancer registration staff for the contracting process, cancer registration, audit, research and development.

Cancer Care Facilities↗
PubMed1993

Precision in reporting the dose given in a course of radiotherapy.

A knowledge of the precise dose given in a course of radiotherapy is vital to the interpretation of the result. Despite this, an acceptable level of reporting was found in only 72 (36%) of 200 papers published in the two leading journals of radiation oncology. Analysis of the treatment data of the cases with head and neck tumours in the pilot study of CHART showed that the mean of the minimum tumour doses given was 5.1% lower than the mean of those at the intersection points. Had the same total dose been prescribed to the intersection point instead of the minimum there would have been a similar lowering of dose. There is evidence from published clinical data and a suggestion from an analysis of the CHART pilot study data that a dose difference as small as 5% may lead to real impairment or enhancement of tumour response, as well as altering the risk of morbidity. Inadequate reporting may lead to a false interpretation of a study and to its wrongful application. It is strongly recommended that it should be editorial policy to publish only those papers where the radiation dose is fully described.

Absorption↗
PubMed1993

The long-term outcome after radical radiotherapy for advanced head and neck cancer.

The patterns of local failure, salvage treatment, metastasis, second primary tumour and intercurrent disease are observed in 99 patients with advanced head and neck tumours, who were entered into a pilot study of CHART. The patients were treated between January 1985 and March 1990 and have a median follow-up of 59 months. All patients presented with squamous cell carcinoma of one of the major sites in the head and neck region, with 85% having T3-4 and/or N3 stage disease. Complete regression of locoregional disease was achieved in 89% of patients, but this fell to 49% at 5 years, 95% of those relapsing did so in the first 24 months. Using univariant analysis, N-stage influenced local tumour control, with N0 disease having a 5-year local tumour control rate of 62% compared with 33% for N+ disease. Local tumour control was not influenced by T-stage due to the disproportionate number of patients with T1-2 tumours who had nodal disease. Three of the 11 patients with residual disease underwent salvage therapy with surgery or further radiation; but failed to obtain local tumour control. Of the 39 patients judged to have recurrent disease two had no histological evidence of tumour when surgery was performed. Of the 21 who had salvage surgery 13 maintained local tumour control to last follow-up or death. Distant metastases occurred in 11 patients, all of whom also showed local failure. Thirteen of the 99 patients developed second primary tumours; these occurred most frequently after treatment for oral cavity tumours.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

The long-term outcome after radical radiotherapy for advanced localized non-small cell carcinoma of the lung.

The incidence of locoregional failure, distant metastases and intercurrent disease was observed in 76 patients with advanced localized non-small cell lung cancer (NSCLC) entered into a pilot study of CHART. Patients were treated between January 1985 and March 1990 and have a median follow-up of 62 months. All patients had advanced, apparently localized, NSCLC and 76% were considered to show mediastinal involvement. Serial computed tomographic (CT) scans were used to assess patients' response to treatment, allowing us to determine the contribution of locoregional disease to death. Locoregional control was achieved in 32 (42%) of the 76 patients, with the figure falling to 23% at 2 years. Metastatic disease was demonstrated in 44 patients and, once detected, the median survival time was 3.8 months. Overall median survival for the group was 12.8 months, with patients attaining locoregional control faring better, with a median survival of 27.9 months compared with 9.9 months for those who did not achieve locoregional control. The life-tables show a 52% survival probability at 1 year for the whole group, but those attaining locoregional control showed a 75% survival probability compared with 39% for patients failing to achieve complete regression; these figures fell to 62% and 6% respectively at 2 years. To date, six patients remain alive and without evidence of disease at any site, and death has occurred in 12 without evidence of locoregional disease. The remaining 58 patients died with locoregional disease, with 35 also showing evidence of distant metastases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Tumor cell kinetics, local tumor control, and accelerated radiotherapy: a preliminary report.

The local tumor control achieved in patients treated in a pilot study of continuous, hyperfractionated, accelerated radiotherapy has been related to the tumor cell kinetics evaluated by in vivo administration of bromodeoxyuridine and flow cytometry. In 42 of 50 patients with advanced squamous cell carcinomas in the head and neck region it was possible to sample the primary tumor prior to treatment. In three further cases, involved regional nodes were studied: in the remaining five, tissue was obtained subsequently either from a local recurrence or from a distant metastasis. Successful cell kinetic measurements were made in 38 (90%) of the 42 primary tumors. The median values of the labelling index, the duration of the DNA synthetic phase and, thus, the potential doubling time for all primaries were 7.1%, 9.8 hr, and 3.9 days, respectively. Complete regression was achieved in 28 (74%) of the primary tumors and in 23 (61%) this was maintained to the time of observation for this report. There was no significant influence of any of the cell kinetic parameters upon the immediate or longer term local tumor control. This result is compatible with the overcoming of cellular repopulation by the acceleration of radiotherapy.

Aneuploidy↗
PubMed1992

The role of radiotherapy in carcinoma of the thoracic oesophagus: an audit of the Mount Vernon experience 1980-1989.

All 244 patients with carcinoma of the thoracic oesophagus registered at the Mount Vernon Centre for Cancer Treatment during the decade from 1 January 1980 to 31 December 1989 have been audited. We have made a detailed analysis of 110 (45%) with localized disease considered unsuitable for surgery, who completed treatment solely by radiotherapy. The median survival of this group of patients was 8.2 months (range 0.2-54 months). Dysphagia was improved by radiotherapy in 77.3% of cases, the median duration of relief was 24 weeks (range 0-208 weeks) and was maintained until death in 40%. Life table analysis showed that radical compared with less than radical regimens of radiotherapy gave significantly superior relief of dysphagia. This result is unlikely to be due to case selection.

Age Factors↗
PubMed1992

The problem of cigarette smoking in radiotherapy for cancer in the head and neck.

Smoking cigarettes during radiotherapy prolongs the period of reaction and may reduce the chance of cure. Of a group of 48 patients with advanced head and neck cancer 35 were smoking at the time of diagnosis, but 17 were persuaded to stop, although 7 relapsed later. Interviews conducted in 35 of the 48 patients revealed the problems which must be overcome if such patients are to cease smoking.

Adult↗
PubMed1992

Chest radiography or computed tomography in the assessment of lung cancer prior to radiography.

A series of 93 patients with lung cancer were considered for intensive radiotherapy, and investigated by chest radiography and computed tomographic (CT) scan. Spread of tumour was detected radiologically to lymph nodes, pleura or chest wall on 98 occasions. Of these, 16 were shown by both investigations, but in 82 the spread was revealed only by CT examination. Clear visualization of the tumour prior to radiotherapy is important to select those patients who would benefit from radical radiotherapy, to allow accurate treatment planning, and to allow, in subsequent follow-up, monitoring of the response to radiotherapy. In this study tumour was clearly visualized in 59 patients treated, but in 31 (53%) of these only by the use of computed tomography.

Aged↗
PubMed1992

Chest radiography or computed tomography to assess the response of lung cancer to radiotherapy.

In 58 patients with lung cancer the response of the primary tumour to treatment with CHART was followed by both chest radiograph and computed tomographic (CT) scan. Clear evidence of complete response was seen by chest radiograph in 11 patients and by CT scan in 20. If all studies showing no definite tumour, regardless of the quality of the study, were included then complete response was considered to have occurred in 25 as indicated by chest radiograph and in 22 by CT scan. The validity of the observations was tested by life table analysis comparing the survival of those showing complete regression with those whose response was incomplete. Comparison based on the CT scan findings showed the greatest significance (P = 0.0001), while that based on the chest radiograph findings showed the least (P = 0.044).

Aged↗
PubMed1992

A case of lung carcinoma induced by radioactive iodine given for disseminated thyroid carcinoma.

We report a case of a patient who at the age of 32 developed a squamous carcinoma arising in the thorax. At 7 years of age he had received aggressive treatment with 131I for a thyroid carcinoma with multiple pulmonary metastases. Radiation induced malignancy, in sites such as the bone marrow or bladder, after 131I therapy is recognized; however, tumours arising in the thorax after such treatment have not been described.

Adult↗
PubMed1992

Tumour proliferation assessed by combined histological and flow cytometric analysis: implications for therapy in squamous cell carcinoma in the head and neck.

The two techniques of flow cytometry analysis (FCM) and immunohistochemical localisation of bromodeoxyuridine (BrdUrd) incorporation after in vivo administration, were combined to study proliferation in squamous cell carcinoma of the head and neck region. Care was taken in this study to ensure that similar material was processed using both techniques such that comparisons could be made. FCM underestimated the labelling index (LI) in tumours classified as diploid compared to the histological evaluation of the tumour cells within those tumours (4.6% vs 17.1%). However, in aneuploid tumours, the FCM LI (10.7%) was similar to that obtained from histology (13.5%). Indeed, proliferation assessed by the combination of histology LI and FCM duration of S-phase (Ts) indicated that diploid tumours had a shorter median potential doubling time (Tpot) of 2.1 days compared to aneuploid (2.8 days). Despite the heterogeneity of proliferation evident histologically within the specimens, there was not a wide variation in the results of FCM analysis when multiple samples from resections were studied. Using FCM data alone, 46% of the tumours showed a Tpot of less than 5 days. When the Ts from the FCM data was combined with the average histological LI, 84% were less than 5 days and with the maximum LI, 99% were within this time interval. Compared with previous estimates, the proportion of tumours possessing proliferative characteristics which may indicate the need for acceleration of treatment seems to be much larger.

Aneuploidy↗
PubMed1991

A comparison of the late radiation changes after three schedules of radiotherapy.

The late radiation change observed in 15 patients treated for carcinoma of oral cavity or oropharynx using continuous hyperfractionated accelerated radiotherapy (CHART) was compared to that seen in 15 similar patients treated with conventional radiotherapy. The average follow up was, 31 and 33 months, respectively. A new dictionary for the recording of radiation morbidity, developed in our centre, was employed and proved highly satisfactory in the recording of the changes observed in these patients and also in a third group treated by a combination of chemotherapy and hypofractionated radiotherapy in hyperbaric oxygen. The dictionary was able to record all the morbidity clinically seen with these three treatment schemes. The late changes observed in skin and mucosa with CHART were similar to those observed with conventional radiotherapy, but hair regrowth was observed in six out of 10 men treated with CHART compared with persistent, partial or complete hair loss in all nine men treated with the conventional scheme; after CHART there was also a trend towards less taste impairment and less severe dryness of mouth.

Adult↗
PubMed1991

The morbidity of salvage surgery following conventional radiotherapy and continuous, hyperfractionated accelerated radiotherapy (CHART).

A comparison was made of the morbidity of surgery for loco-regional recurrence in patients with advanced cancer of the head and neck region following continuous hyperfractionated accelerated radiotherapy (CHART), after conventional radiotherapy, and also in a group following surgery only as the primary treatment. Post-surgical morbidity occurred in 14 (77%) of the 18 patients treated with CHART, of whom 11 (78%) required a further surgical procedure. In the conventional group, morbidity occurred in 14 (58%) of the 24 patients, of whom 9 (64%) required further surgery. Finally, in the surgical group morbidity occurred in 13 (48%) of the 27 patients, of whom 7 (54%) required further surgery. Because of the many factors that may influence the chance of morbidity and of the small number of cases, considered statistical analysis is not meaningful and there must be caution in the interpretation of results. When allowance is made for the greater frequency of more advanced tumors and for sites in the oropharynx and oral cavity, where procedures associated with greater risk of complication were performed, the morbidity seen after surgery was performed upon CHART patients appeared to be no greater than when conventional radiotherapy had been given. As expected, the surgery only group showed less morbidity than either of the radiotherapy groups.

Adult↗
PubMed1991

Experience with CHART.

Continuous, hyperfractionated, accelerated radiotherapy (CHART) has been used at the Mount Vernon Cancer Treatment Center since January 1985. Patients with head and neck tumors and those with locally advanced non-oat cell carcinoma of the bronchus have formed the large majority of the 263 patients treated. Early reactions in the mucosae of the mouth and pharynx have been pronounced, but all have healed, while those in the skin have been less severe than with conventional radiotherapy. An unexpected late morbidity was radiation myelitis in four patients, but in other tissues including the skin, mucosae, the connective tissues, and the salivary glands, late changes appear reduced compared to those after conventional radiotherapy. In 92 patients with squamous cell carcinoma of the major sites in the head and neck region, of whom 71 were in Stages T3 and T4, a complete regression at the primary site and nodes was achieved in 90%. This can be compared with 62% in similar patients previously treated with curative intent at Mount Vernon between 1980 and 1985; the difference was maintained in follow-up (p = 0.003). Of 76 assessable patients with non-oat cell carcinoma of the bronchus, a complete radiological response has been achieved in 40%, compared to 12% in a retrospective group; again the difference has been maintained in follow up (p = 0.0001). A 1-year survival of 60% can be compared to 40% in the retrospective group and a 2-year survival of 29% compared to 12% (p = 0.01). With a reduction of permitted dose to the spinal cord, CHART gives promise for improvement in tumor control and a reduction in late morbidity. These promising results have led to multi-center randomized controlled clinical trials in carcinoma at the head and neck and in non-oat cell carcinoma of the bronchus. In these studies, CHART is being compared with conventional fractionated radiotherapy.

Aged↗