PubMed Health⌕ Search

Biomedical subjects

M K Gospodarowicz

Publications and source records attributed to M K Gospodarowicz.

64 records · Page 4Linked to original sources
PubMed1987

Patterns of disease in localized extranodal lymphomas.

The site of origin of lymphoid tissue is an important determinant of lymphocyte migration patterns. The association of gastrointestinal (GI) and Waldeyer's ring lymphoma and the unique lymphocyte migration pattern of gut-associated lymphoid tissue (GALT) have been previously described. To establish whether predictive clinical patterns of disease occur in localized Non-Hodgkin's lymphoma, survival and relapse patterns for 496 patients with stage I and II non-Hodgkin's lymphoma (NHL) treated with loco-regional irradiation (XRT) alone were examined. We identified 139 patients with GALT lymphoma (defined as arising from primitive gut and including Waldeyers' ring, thyroid, and GI lymphomas) and 87 patients with extranodal non-gut-associated lymphoma (ENL). Survival and relapse data were assessed in multifactorial analysis to correct for previously identified other prognostic variables. GALT lymphomas (GALT-L) have a survival advantage compared with other ENL (P = .017) independent of stage and histology. A difference in distant relapse (DR) rate between GALT-L and other ENL (P = .0002) was also identified. The presentation site of localized extranodal NHL is predictive of clinical behavior and is an independent determinant of outcome. This may be an expression of lymphocytic origin and determinants of migration patterns.

Abdominal Neoplasms↗
PubMed1985

Role of radiation therapy in localized non-Hodgkin's lymphoma.

Relapse occurs in 50% of patients receiving radiation for clinical stage (C.S.) I and II nodal and extranodal non-Hodgkin's lymphoma (N.H.L.). Prior to the introduction of intensive chemotherapy those failing primary control with irradiation and most of those who relapsed died of their disease with a resultant overall mortality of 50%. An analysis of Princess Margaret Hospital results with radiation for C.S. I and II N.H.L. between January 1967 and December 1978 revealed that tumour bulk, age, stage and histology were of independent prognostic significance. It was possible to group patients using combinations of these attributes so that each group encompassed only patients with similar outcomes. Such prognostic groups were identified separately within the low grade and the intermediate plus high grade categories of the Working Formulation. Patients with a high probability of cure with radiation were so defined. Also those patients in whom chemotherapy would be optimal initial therapy were also defined. Such patients were in the intermediate plus high grade histology groups. Thirty percent of all patients with low grade histology lymphoma had an actuarial survival of 83%, and relapse-free rate of 63% at 10 years. By implication, approximately 20% of all patients with these histologies seen at the Princess Margaret Hospital for the same time period achieved prolonged relapse-free survival by localized therapy. This is at variance with the implications of staging from studies where laparotomy and multiple bone marrow biopsies have been used. Such aggressive staging procedures suggest truly localised disease in only 5-6% of patients with low grade lymphoma. A significant relationship between radiation dose and disease control was demonstrated only for patients with intermediate and high grade lymphoma of medium or large bulk. A minimum tumour dose of 30 Gy was required for optimal local control with radiation.

Adult↗
PubMed1985

Prognostic groups for management of localized Hodgkin's disease.

Two hundred fifty-two patients receiving radical irradiation for clinical stages I and II Hodgkin's disease between 1968 to 1977 had an actuarial ten-year survival rate of 78% and a relapse-free rate of 61%. Sixty-seven patients receiving chemotherapy followed by radiation had a 78% survival rate and a 63% relapse-free rate. Independent prognostic factors for survival and relapse were age, stage, and histology. Disease bulk was predictive only of relapse. Neither site of presentation above or below the diaphragm nor presence of mediastinal involvement was predictive for survival or relapse; however, patients with large mediastinal masses (greater than or equal to 10 cm absolute diameter) had a significantly higher intrathoracic failure rate with conventional mantle irradiation. Analysis of failure, according to age, clinical stage, and histologic type, showed three groups of patients defined according to the risk of relapse with radiation therapy: those with isolated upper cervical stage IA disease (group 1, relapse rate 8%), younger patients with localized stages I and II disease of favorable histologic type (group 2, relapse rate 35%), and older patients with extensive or symptomatic stages I and II disease of less favorable histologic type (group 3, relapse rate 70%). Subsequent analysis of radiation treatment volume indicates that the use of upper abdominal irradiation for patients in group No. 2 could yield results equivalent to those achieved with radiation therapy for surgically staged patients.

Adolescent↗
PubMed1984

Prognostic factors in nodular lymphomas: a multivariate analysis based on the Princess Margaret Hospital experience.

A total of 1,394 patients with non-Hodgkin's lymphoma were treated at the Princess Margaret Hospital between January 1, 1967 and December 31, 1978. Overall actuarial survival of 525 patients with nodular lymphomas was 40% at 12 years; survival of patients with localized (Stage I & III) nodular lymphomas treated with radical radiation therapy was 58%. Significant prognostic factors defined by multivariate analysis included patient's age, stage, histology, tumor bulk, and presence of B symptoms. By combining prognostic factors we have identified distinct prognostic groups within the overall population. Patients with Stage I & II disease, small or medium bulk, less than 70 years of age achieved 92% 12 year actuarial survival and a 73% relapse-free rate in 12 years of follow-up. These patients represent groups highly curable with irradiation.

Adolescent↗
PubMed1984

Radical external beam radiation therapy for prostate carcinoma.

Between 1970 and 1978, 202 patients with carcinoma of the prostate were treated with radical external beam radiation with curative intent. Intracapsular disease was present in 38% and the remaining 62% had disease extending through the prostatic capsule. The overall survival is 72% at five years, and despite the large number of patients with advanced disease the five-year disease-free survival is 46%. Significant prognostic factors include: i) tumor, grade, ii) extent of primary disease, iii) procedure done to determine diagnosis (TURP vs. needle biopsy) and iv) tumor dose. There was a significant improvement in survival at a minimum dose of 5000 Gy. Prostate carcinoma is radiosensitive and a dose-response relationship in treatment has been demonstrated by this review.

Acid Phosphatase↗
PubMed1983

Extranodal malignant lymphomas of the head and neck.

The management of primary extranodal lymphomas of the head and neck at The Princess Margaret Hospital is reviewed. This manner of presentation is uncommon and particularly rare in Hodgkin's disease. As with lymphomas at any other site, detailed investigation is necessary to determine the stage of the disease before definitive treatment is attempted. Surgery is normally restricted to biopsy. Radiation therapy and chemotherapy, alone or combined are the principal treatment modalities. Early disease (stages IA and IIA) may be treated by radiation alone with a cause specific survival of approximately 70% at five years and 60% at 10 years. Survival is better for histiocytic, nodular, and less bulky disease. Primary thyroid disease is uncommon but highly curable with local radiation. Similarly, orbital disease is usually locally curable with negligible sequelae. The addition of combination chemotherapy has significantly improved the prognosis with more advanced and bulky disease.

Adolescent↗
PubMed1982

Non-Hodgkin lymphoma of the testis.

Sixteen patients (median age 67 yrs.) with non-Hodgkin lymphoma of the testis were studied. Twelve of these patients had disease that was classified as local (Stages IE and IIE). Eight patients had diffuse histiocytic lymphoma, 6 had diffuse poorly differentiated lymphocytic lymphoma, 1 had both lymphoma and seminoma, and 1 had nodular poorly differentiated lymphocytic lymphoma. The overall median survival was 9.5 months. Para-aortic nodal involvement was the factor that had the strongest prognostic influence with the management methods used. Median survival without para-aortic nodal involvement was 57+ months, but with such involvement it was 6 months (p = 0.002). There is a high probability of generalized disease if lymphoma can be detected in the para-aortic nodes. For patients with Stages IE and IIE disease, radical radiation therapy is the preferred treatment. For those with disseminated disease, chemotherapy, with irradiation reserved for symptomatic and bulky localized deposits, is the recommended method of management.

Adult↗
PubMedDate not supplied

Staging of bladder cancer.

The definitive diagnosis of bladder cancer is established at cystoscopic examination and confirmed by means of a transurethral biopsy. A careful bimanual palpation of the bladder under anesthesia is an integral part of the initial assessment of each patient. The most important part of the assessment of patients with bladder cancer is a thorough pathologic examination of the biopsy material establishing the histologic type of tumor, histologic grade, tumor configuration, depth of invasion of the bladder wall, and depth of the bladder wall available for assessment. If possible, the size of the tumor and the presence of associated carcinoma in situ should also be reported. Imaging studies play a smaller role in the clinical staging of bladder cancer. However, when initial staging procedures point to invasion of the muscularis propria, chest X-ray, bone scan, and computed tomography scan of the abdomen and pelvis may provide valuable information about possible metastases. Whereas the clinical staging is essential to select and evaluate therapy, the pathologic stage (pTNM) provides the most precise data with which to estimate prognosis and calculate end results. The pathologic assessment entails resection of the primary tumor or a biopsy adequate to evaluate the highest pT category, removal of lymph nodes adequate to validate the absence of regional lymph node metastasis, as well as biopsy and microscopic examination for assessment of distant metastases. Although numerous factors have an impact on the behaviour of the malignancy, in bladder cancer the anatomic extent of disease reflected in the current staging classification remains the most powerful indicator of outcome.

Carcinoma in Situ↗