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Biomedical subjects

M Rotman

Publications and source records attributed to M Rotman.

At least 109 records · Page 6Linked to original sources
PubMed1985

Metastatic melanoma in brain. Rapid treatment or large dose fractions.

A subgroup of 59 patients selected on the basis of favorable prognostic factors from a larger group of 194 patients treated for intracranial metastases of melanoma was analyzed with a view to assessing the relative efficacy of different accelerated fractionation regimens. The most effective modification of the previously standard therapy was a shortening of the overall treatment time, although this was also associated with the use of larger doses per fraction. Patients who had brain metastases only at the time of treatment showed a longer survival time than those with coexistent metastases in other organs and survived longer if treated with 10 fractions within 1 week rather than 20 fractions in 2 weeks. The same was found in patients who underwent complete resection of intracranial tumor before irradiation. A complete surgical resection also increased the probability of eliminating intracranial disease, but overall the median survival increased by less than 2 months. It is concluded that a short overall treatment time is more important than large fraction sizes in attempts to improve the treatment of metastatic intracranial melanomas with favorable prognosis.

Brain Neoplasms↗
PubMed1985

Intracranial metastases from melanoma. Clinical features and treatment by accelerated fractionation.

One hundred ninety-four patients with intracranial metastatic melanoma were treated at the M. D. Anderson Hospital between January 1972 and September 1977, using seven different accelerated irradiation regimens. The total tumor dose varied from 3000 to 4800 rad, and the overall treatment time from 1 to 2 weeks. In these patients, whose disease had progressed to brain metastases, freedom from such metastases had decreased logarithmically with time from initial presentation. This suggests a random distribution of progression rates with a mean time of 2.5 years between diagnosis and development of intracranial metastases. Overall, there was no significant improvement in the results from accelerated fractionation in the treatment of intracranial metastases. The result of treatment did not depend on the site of the primary, the number of intracranial metastases, the total dose, or the dose per fraction. There were, however, two subgroups not mutually exclusive, that benefited significantly from the accelerated fractionation: patients having had a complete resection of brain metastases, and those having no detectable extracranial metastases at the time of their treatment for intracranial metastases.

Adolescent↗
PubMed1985

Complications of combined surgery and radiation therapy for carcinoma of the endometrium.

Long-term gastrointestinal (GI) and urinary tract (UT) complications were evaluated in 133 women with carcinoma of the endometrium who were treated by both radiotherapy and hysterectomy. Major complications developed in 8% of patients who received external pelvic radiation but in none with intracavitary radiation. GI complications were more frequent and more severe in patients receiving external pelvic radiation than in those who received only intracavitary radiotherapy, irrespective of the sequence of treatment. UT complications were more frequent with prehysterectomy external radiotherapy (N = 39) than with posthysterectomy external radiotherapy (N = 21).

Brachytherapy↗
PubMed1984

Vascular invasion in Stage I carcinoma of the cervix.

Vascular invasion was identified as an important prognostic variable for all lesion sizes in 138 patients with Stage I cervical carcinoma. A matched pairs analysis, controlling for lesion size and extracervical spread, showed that vascular invasion was significantly associated with poor outcome. Regression analysis also indicated that vascular invasion contributed prognostic information beyond that available from lesion size and extracervical spread. Studies of adjunctive therapy based on the prognostic variables are recommended.

Carcinoma↗
PubMed1984

Iodine-125 irradiation of choroidal melanoma. Clinical experience.

Twenty-nine patients with choroidal melanomas were treated with iodine-125 seeds in gold scleral plaques. Iodine-125 emits low energy 25 KeV photons which are attenuated by the side and back of the plaques so that the radiation is "directed" towards the choroidal tumor. The anticipated therapeutic benefits of using a low energy isotope and directional applicators have been realized. There has been a marked reduction in ocular complications in the nine medium and 20 large melanomas so treated. Our complication rate was 34% with a mean follow-up of 38 months. This is a lower complication rate, with longer follow-up, and in larger tumors than that reported with the use of cobalt-60, ruthenium-106 or ion beam. Three patients with large tumors and two patients with medium tumors died of metastasis. This compares favorably to results of similarly sized melanomas treated by enucleation.

Adult↗
PubMed1983

Split-course versus continuous pelvis irradiation in carcinoma of the uterine cervix: a prospective randomized clinical trial of the Radiation Therapy Oncology Group.

In August 1980, the Radiation Therapy Oncology Group (RTOG) completed a prospective randomized clinical trial for the comparison of a split-course versus a standard continuous course of pelvic irradiation for carcinoma of the uterine cervix Stages II-B, III-A, III-B, and IV-A. The split-course consisted of 10 fractions of 250 rad each, 5 times a week, up to 2500 rad followed by a rest period of approximately 2 weeks and then another 2500 rad was given (250 X 10). The continuous course consisted of 30 fractions of 170 rad each, 5 times per week, for a total of 5100 rad. In both groups the external pelvis irradiation was followed by intracavitary brachytherapy in the uterus and vagina, with tandem-colpostat or tandem only, for a dose of 3000 rad at point A for the former, or at 2 cm from the center of the linear source for the latter. In cases where brachytherapy was not possible, a boost of external irradiation with reduced field, with a dose of 1600 rad (200 X 8) was advised. Three hundred and one patients were registered, of which 287 are currently evaluable. No differences between the treatments were detected for the following study end-points: treatment tolerance in terms of acute normal tissue reactions and completion of therapy, tumor control in the pelvis, severe late normal tissue reactions, and survival. In the entire study population the estimated tumor control in the pelvis at two years after initiation of therapy was: 81% for Stage II-B, 67% for III-A, 53% for Stage III-B, and 32% for Stage IV-A. The estimated two-year survival was: 70% for Stage II-B, 58% for III-A, 46% for III-B, and 23% for IV-A.

Adult↗
PubMed1981

Prognostic factors in cervical carcinoma: implications in staging and management.

Individualization of treatment using judicious combinations of external and intracavitary irradiation remains the cornerstone of the radiation management of carcinoma of the cervix. The inherent propensity of this cancer to either confine itself to the pelvis or else spread in a systematic and predictable manner through lymphatic channels has facilitated its therapeutic control. The treatment of most early invasive cervical carcinomas is equally advantageous using either intracavitary radium or surgery. However, certain Stage I patients have morphologic and histologic characteristics that militate against tumor control. Factors such as tumor size, depth of invasion, vascular infiltration, uterine extension, and barrel-shaped presentation affect the course of the disease and survival. A clinical-pathologic staging for cervical carcinoma incorporating the above mentioned factors into the current clinical FIGO staging system has been suggested. It aims to facilitate the recognition of those early tumors that require additional external radiotherapy. A description of the role of surgery, intracavitary and external radiation, and their combinations is included. In advanced carcinoma of the cervix, failure can be attributed to either large tumors containing cores of hypoxic cells resistant to conventional radiation therapy or to uncontrolled subclinical disease in the lymphatics at or near the border of the irradiated area. Radiotherapy combined with surgery, oxygen enhancers, infusion chemotherapy, and large particle high LET radiation has been implemented to increase local control; for distal failures, extended field irradiation of paraaortic nodes has been found to be technically feasible and well tolerated and is being studied for its effects on increased survival. The rationale for newer treatment procedures, including preliminary results and their complications, is discussed.

Antineoplastic Agents↗
PubMed1980

Irradiation of choroidal melanoma with iodine 125 ophthalmic plaque.

Radioactive iodine 125 is a low-energy gamma isotope with physical characteristics suitable for irradiation of intraocular tumors. Metal ophthalmic applicators have been designed to shield vital ocular structures while allowing irradiation of the tumor. We compared the radiation effects of iodine 125 and cobalt 60. The Greene melanoma was transplanted into the suprachoroidal space of rabbits. The tumor then grew as an intraocular mass, was irradiated, and was followed up for two months before enucleation. Histopathologic examination defined the extent of the radiation damage to the tumor and other ocular structures from the iodine 125 and from the cobalt 60. The eye irradiated with iodine 125 suffered minimal radiation damage, whereas the tumor was sterilized. The eye irradiated with cobalt 60 showed substantial radiation damage, and the melanoma was incompletely treated. Our results support the use of iodine 125 in treating intraocular tumors. More research is needed as to optimum total dose and dose rate.

Animals↗
PubMed1980

Radiotherapy of choroidal melanoma with iodine-125.

The low-energy radioactive source iodine-125 is ideal for the irradiation of an intraocular tumor tumor such as a choroidal melanoma. The energy (28 kev) of iodine-125 should be sufficient to allow sterilization of tumors as high as 10 mm. However, shielding of 18-kev photons can be achieved with thin metal (eg, gold) plaques. Thse eye plaques can be individually designed for each eye tumor, depending on its size, shape, and location. This paper deals with the basic considerations and preliminary observations that have lead us to the adoption of iodine-125 as the sole source for the radiation treatment of all intraocular tumors.

Choroid Neoplasms↗
PubMed1980

Radiotherapy of choroidal melanoma with iodine 125.

Although specific data on patients will be useful only after a 5- to 10-year follow up, radiotherapy of choroidal malignant melanoma with 125iodine has several advantages over the other radioactive sources that are presently being used. The low gamma energy of 125iodine allows for construction of metal eye plaques that can attenuate the radiation preferentially so that the tumor is treated while the rest of the eye receives minimal irradiation. This ability to direct the radiation is not possible with high energy sources such as 60cobalt. The ability to control the dose rate as well as the total dose is yet another advantage. Exact positioning of the 125iodine seeds in a plaque allows for an even distribution of the radiation throughout the tumor. Six patients have been treated. We are enthusiastic, but consider this an experimental procedure until our follow-up is complete.

Aged↗