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Biomedical subjects

M J Kirschner

Publications and source records attributed to M J Kirschner.

8 recordsLinked to original sources
PubMed1997

[Therapy pf cervical lymph node metastases of unknown primary tumor].

BACKGROUND: The primary tumor remains unknown in approximately 3 to 9% of patients with lymph node metastases in the neck. Management of these patients is still controversial particularly because of the commonly as poor assessed prognosis. The treatment outcome was surveyed by a retrospective analysis, trying to identify prognostic factors. PATIENTS AND METHODS: From 1979 through 1993, 64 patients with metastatic carcinoma of unknown primary tumor involving neck lymph nodes were treated. Most of them (n = 40) were squamous cell carcinomas. Forty-eight patients underwent surgical resection of the involved nodes by neck dissection or excisional biopsy. Surgery was performed in 41 patients before and in 7 patients after radiotherapy. Additional chemotherapy was administered to 12 patients (simultaneously to 11 patients). The irradiated volume included both sides of the neck, the supraclavicular region and the whole pharynx. The mean radiation dose was 59 Gy. In 32 patients, an additional boost to epipharynx (n = 23) and/or large lymph nodes (n = 11) was given (mean: 12 Gy) by external beam therapy, in 2 cases by interstitial implants (22 Gy). Mean follow-up time was 8 years (range: 7 months to 15 years, median: 9 years). RESULTS: Fifty-two out of 64 (81.2%) patients came into a complete remission and 12 into a partial remission. The cause specific survival after 5 years for the whole group was 51.0 +/- 7%, the overall survival 38.8 +/- 7%. Within the irradiated area the tumor control was 68.3 +/- 7%, the distant metastatic-free survival 70.0 +/- 7%. Best results showed patients after surgery+radiation (n = 48) with 67% overall survival at 5 years versus 0% (median: 9.2 months) without surgery (n = 16), and patients with lymph nodes located above the glottic level (n = 49) 63.2% versus 9.0% (median: 1.2 years, n = 12). The primary tumor appeared in 9 patients (4 times above the clavicles), once in the irradiated volume. CONCLUSION: Patients with cervical metastases of unknown primaries do not fare worse than patients with advanced carcinoma of head and neck and should be treated with a curative intent preferably by surgery and radiotherapy.

Adult↗
PubMed1996

Adjuvant radiotherapy for breast carcinoma in men: a 20-year clinical experience.

Breast cancer in men is a rare malignancy. Current knowledge about its natural history and diagnostic and therapeutic management relies on reviews and few retrospective studies. From 1972 to 1993, 21 men were irradiated for operable primary (n = 17) or recurrent (n = 4) breast cancers at our institution. The mean age at initial diagnosis was 60 years (45-79 years). Tumor distribution by stage was: stage I (two), stage II (seven), stage III (six), stage IV (two), and unknown in four cases. Patients received radiotherapy to the chest-wall and ipsilateral lymph nodes (17) and to the axilla (seven). Additionally hormones (two) and chemotherapy (four) were applied in some cases. Follow-up ranged from 24 to 190 months (median, 53 months). At last follow-up (November 1994), nine patients were alive and eight without disease. The median overall survival of the whole group was 69 months (mean, 106 months). The 3-year (70%), 5-year (59%) and 10-year survival rates (46%) were consistent with literature data. Overall, relapse- and disease-free survival rates were better in patients with stage I/II than in those with stage III/IV disease. Univariate analysis revealed more favorable results for patients with negative axillary nodes, patients younger than 60 years, those with centrally localized tumors, and patients with a diagnostic delay of < 3 months, but the differences were not statistically significant. Six patients relapsed who had not received initial adjuvant radiotherapy to the site of their relapse. At last follow-up, 13 patients had distant metastases, and 12 of them are dead of the metastatic disease, which developed less frequently in stage I/II than in stage III/IV disease. Postoperative adjuvant radiotherapy is an essential part of the overall treatment strategy of advanced node-negative and node-positive cancer of the breast in men.

Age Factors↗
PubMed1996

[Role of percutaneous radiotherapy in male breast carcinoma].

PURPOSE: Breast cancer in men is a very rare malignancy. Current knowledge about its natural history, diagnostic management and overall prognosis is poor and usually relies on reviews and a few retrospective studies. Herein we report about our past 20-year-clinical experience. PATIENTS AND METHODS: From 1972 to 1993, 21 men with histologically verified tumors were irradiated for operable primary (n = 17) or recurrent (n = 4) breast cancers at our institution. Patients received surgery and post-operative radiotherapy to the chest wall and ipsilateral lymph nodes. Additionally hormones and chemotherapy were applied in only a few cases (n = 5). RESULTS: The follow-up ranged from 18 to 184 months (median 46 months). At last follow-up (11/94), 9 patients were alive and 8 without disease. The median overall survival of all patients was 69 (mean: 106) months and the 5-year survival rate 59%. In univariate analysis, a relapse- and disease-free survival advantage was observed for patients with stage I/II disease, with negative lymph nodes, central tumor location, patients younger than 60 years and short interval (less than 3 months) from first symptoms and diagnostic verification of the malignancy. None of these factors, however, was statistically significant due to the low case number. CONCLUSION: Postoperative adjuvant radiotherapy is an essential part of the treatment strategy of advanced node-negative and node-positive cancer of the breast in men. With respect to locoregional tumor control it is a necessary treatment, while it does not influence the rate of distant metastases. The role of adjuvant hormones and chemotherapy management remains unclear from our scarce patient data.

Adenocarcinoma↗
PubMed1993

[The role of radiotherapy in the treatment of desmoid tumors].

Aggressive fibromatoses are benign tumors which derive from connective tissues in muscles, tendons, joints and scars. They are characterized by a low mitotic index and present without major cellular changes. The incidence is low and reaches 0.4 per 100,000. The classification in extra-abdominal, intra-abdominal and abdominal wall tumors has prognostic significance for the therapeutic decision. Extra-abdominal tumors have the highest relapse rate with about two-thirds recurring even after R0 surgical resection. In this meta-analysis, 698 published cases are reviewed and analyzed with respect to the previous surgery and the therapeutic impact of postoperative radiotherapy. After an R1 surgical resection radiotherapy significantly decreases the risk for loco-regional relapse in about 40%. Radiotherapy is also recommended after an R0 surgical resection with safety margins less than 2 cm. A total radiotherapy dose of 50 Gy seems to be sufficient, whereas radiotherapy doses beyond 60 Gy provide no additional control. Following an R2 resection up to 28% of these tumors may not progress or even show a complete remission. A wait-and-see policy is justified for R1-2 resected lesions in the abdominal wall, especially if severe treatment sequelae have to be expected. The role of chemotherapy still remains questionable.

Abdominal Muscles↗
PubMedDate not supplied

Successful physician search process for health care organizations.

Finding a physician is no simple process. Managers need to carefully identify their specific needs, be able to explain the opportunity clearly, use various sources to announce the position and be prepared to act professionally throughout. A 10-step checklist may help.

Employment↗
PubMedDate not supplied

Finding top talent.

Two experts from a health care consulting/physician recruiting company provide a step-by-step approach to recruiting a medical director.

Guidelines as Topic↗