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Biomedical subjects

M T Selch

Publications and source records attributed to M T Selch.

34 records · Page 2Linked to original sources
PubMed1992

Conservation therapy for invasive lobular carcinoma of the breast.

Earlier literature suggests a high incidence of multicentricity and bilaterality, with an overall poor prognosis, in patients with invasive lobular carcinoma of the breast. Consequently, there is considerable disagreement regarding appropriate local management of this disease. To determine the influence of invasive lobular histologic findings on local tumor control, disease-free survival, and overall survival, the authors reviewed 60 patients with Stage I and II invasive lobular breast carcinoma treated with local tumor excision and radiation therapy between 1981 and 1987 (mean follow-up, 5.5 years; range, 2.5 to 10 years). The 5-year actuarial risk of locoregional recurrence was 5%, with two of three failures occurring in the regional lymphatics. The mean time to locoregional failure was 28 months. The 5-year actuarial disease-free survival (84%) and overall survival (91%) were comparable to those seen in several large series of similarly treated patients with invasive ductal carcinoma. Contralateral breast cancer occurred at a rate of approximately 0.6% per year. This study and a review of the literature suggest that breast conservation, with local resection and radiation therapy, is appropriate therapy for invasive lobular breast cancer.

Adult↗
PubMed1992

Stages 1 and 2 epidermoid carcinoma of the glottic larynx: involvement of the anterior commissure.

Data on 55 patients with stages 1 and 2 epidermoid carcinoma of the glottic larynx treated from 1978 to 1988 were retrospectively reviewed. Twenty-six patients had involvement of the anterior commissure (AC). Local and ultimate local control rates achieved, respectively, with mean follow-up of 41 months (range, 6-120 months), were as follows: 92% and 100% for patients without AC involvement and stage T1a lesions, 60% and 80% for patients without AC involvement and stage T2 lesions, 100% and 100% for patients with AC involvement and stage T1a lesions, 100% and 100% for patients with AC involvement and stage T1b lesions, and 75% and 100% for patients with AC involvement and stage T2 lesions. There was no correlation between the degree of response at completion of treatment and local control. There was no difference in the local control rate of patients with and without involvement of the AC. Factors associated with a decreased local control rate include extensive subglottic extension and use of a single lateral field technique. Surgical salvage after failure of radiation therapy is effective and can be performed with acceptable morbidity.

Carcinoma, Squamous Cell↗
PubMed1992

Technical considerations in the use of prophylactic radiation therapy to prevent heterotopic bone formation.

The UCLA Department of Radiation Oncology radiated 97 hips at high risk for heterotopic bone (HTB) formation from 1980 through 1988. Adequate follow-up (minimum of 2 months, median, 10 months) is available in 92 hips (82 patients). These hips were treated with a variety of doses, fractionation schedules, and shielding techniques as treatment evolved over time. There was a total of 49 hips with porous coated ingrowth prostheses. These were all shielded with custom blocks. There were no untoward complications in this subgroup. Only 6 of the 92 hips evaluable developed clinically significant HTB. Five of these 6 failures can be attributed to initiating treatment after postoperative day (POD) 5 or block malposition. Of the 78 hips that initiated radiation therapy before POD 6 (with proper shielding), only 1 (1.3%) developed clinically significant HTB. Radiation therapy is very effective at preventing HTB formation following hip surgery when treatment is initiated within 4 days of surgery. To assure an optimal outcome, close attention to the technical aspects treatment is critical.

Equipment Design↗
PubMed1990

Radiation therapy in the management of Langerhans cell histiocytosis.

Twenty-two patients with Langerhans cell histiocytosis (LCH) were managed in the UCLA Department of Radiation Oncology from 1974 to 1987. Their median age was 17 years (range 1-42 years) and median followup 4.5 years (range 1-13 years). Fourteen patients had disease localized to a bone (13) or a soft tissue (one). Eight patients had LCH involving multiple bones (3) or soft tissues plus bones (5). Nine of 10 patients less than 19 years old had disease confined to bone(s) compared to 7 of 12 older patients. Fifty-six sites of LCH (40 bone, 16 soft tissue) were irradiated. Pediatric patients received therapy to 15 sites (14 bone, 1 soft tissue) and adults 41 sites (26 bone, 15 soft tissue). Median dose for bone lesions was 900 cGy (range 600-1,500) and for soft tissue 1,500 cGy (range 600-2,600). Local control was achieved in 46 of 56 sites (82%). Control rates for bone and soft tissue lesions were 35 of 40 (88%) and 11 of 16 (69%), respectively. Fifteen of 15 sites in pediatric patients were controlled compared to 29 of 41 (72%) in adults. Ten sites (18%) recurred 10 months to 4 years after irradiation. Recurrences were in-field and noted only in adults with involvement of multiple soft tissues plus bones. All recurrent soft tissue lesions had been treated with orthovoltage. Five patients developed new foci of LCH subsequent to irradiation. Four of these patients had disease involving soft tissues and bones. One patient with progressive LCH initially presented with a single bone lesion. The acute and chronic effects of radiation therapy were minimal. One patient suffered transient enlargement of adenopathy. An elevated serum TSH level was detected 9 years after irradiation of a cervical vertebra in another patient.

Adolescent↗
PubMed1990

Limb salvage therapy for soft tissue sarcomas of the foot.

From 1974 to 1988, 20 patients with soft tissue sarcomas of the foot underwent attempted limb preservation at UCLA. Eighteen patients had localized tumor and two had metastases. Sixteen patients had previously untreated tumors and four patients had experienced 2-4 local recurrences before definitive management. Eleven patients had grade 3 sarcomas and nine had grade 2 sarcomas. Fourteen patients had an excisional biopsy and six had an incisional biopsy. At the time of definitive local treatment, nine patients had palpable tumor ranging from 2-10 cm (median 5 cm). Sixteen patients received sequential preoperative chemotherapy and irradiation followed by attempted conservative resection. Four patients underwent immediate conservative resection followed by postoperative irradiation. Preoperative chemotherapy was administered over 3 days intraarterially, intravenously or by a combination of routes. Fifteen patients received 60-90 mg doxorubicin and one received 120 mg doxorubicin plus 220 mg cisplatinum. Preoperative irradiation was delivered in 350 cGy fractions to total doses of 3500 cGy (one patient), 2800 cGy (8) or 1750 cGy (7). Postoperative irradiation doses were 4140-6480 delivered in 180-200 cGy fractions. Fifteen of 16 preoperatively treated patients had limb salvage surgery. Four of these 15 had positive histopathologic margins and none received postoperative irradiation. One patient required a primary amputation due to gross involvement of the os calcis. Three of four patients undergoing immediate conservative excision had positive margins and one had gross residual disease. Five patients received chemotherapy following local treatment: 3 adjuvantly and 2 for metastatic disease. Follow-up for salvage patients ranged from 6 to 99 months (median 36). Local control was achieved in 17 of 19 (90%). Two patients recurred in-field at 24 and 30 months. Fourteen of 15 preoperatively treated and salvaged patients maintained local control. Three of four managed with excision and postoperative irradiation were controlled. The actuarial local control at 3 years was 83%. One patient recurred in the inguinal lymph nodes and three patients died of metastatic disease. The actuarial survival and relapse-free survival at 3 years were 83% and 63%. Eleven patients developed acute complications and four had late complications. Of 14 patients surviving with local control, function was good or excellent in 86%. No patient has required an amputation for complications or a dysfunctional foot. Limb salvage therapy for a selected patient with a soft tissue sarcoma of the foot can reasonably be expected to result in a high probability of local control and useful function without compromising survival.

Adolescent↗
PubMed1990

Postoperative irradiation for the prevention of heterotopic bone: analysis of different dose schedules and shielding considerations.

Ninety-seven high risk hips were irradiated postoperatively for prevention of heterotopic bone (HTB) in the UCLA Department of Radiation Oncology from 1980 to 1988. Ninety-two hips in 82 patients were eligible for analysis with a minimum follow-up of 2 months and a median follow-up of 10 months. Forty-nine of the hips had porous coated ingrowth prostheses. From 1980 to 1986, 2 Gy fractions were used to deliver 20 Gy (8 hips), 12 Gy (1 hip), and 10 Gy (27 hips). Since December of 1986, 38 hips received 8 Gy in two increments and 18 hips received a single 7 Gy fraction. All porous ingrowth components were shielded with custom blocks. Six out of 92 hips developed clinically significant (Brooker grade 3 or 4 heterotopic bone). There was one clinically significant failure in 78 hips (1.3%) when irradiation was initiated before post-operative day (POD) #6 and shielding was properly placed. One clinical failure occurred in 38 hips which received 8 Gy in two increments. One clinical failure occurred out of the 18 hips treated with 7 Gy in one fraction. This failure could be related to block malposition. There were four clinical failures in the 36 hips treated with 2 Gy fractions to total doses of 10 Gy, 12 Gy, or 20 Gy. Three of these failures were associated with initiation of treatment after POD #5, and the fourth was related to block malposition. Unshielded trochanteric osteotomies resulted in five migrations and seven fibrous unions for a total non-osseous union rate of 12/36 (33%). Shielding of the remaining 28 trochanteric osteotomies resulted in a non-osseous union rate of 7% (0 migrations and 2 fibrous unions). There were no failures of union of components, and the only side effects noted in the series were the five trochanteric migrations. In conclusion, the use of 8 Gy in two increments or 7 Gy in one fraction was found to be as efficacious as conventional 2 Gy fractionation schemes with no increase in side effects. For optimal results, treatment should be implemented prior to POD #5 with shielding of the trochanteric osteotomy. Postoperative irradiation to prevent HTB can be used in hips with porous components using properly placed blocks to shield the porous region.

Adolescent↗
PubMed1989

Primary radiation therapy in the treatment of squamous cell carcinoma of the soft palate.

From 1970 to 1986, 45 patients received primary radiation therapy for squamous cell carcinoma of the soft palate at the University of California Los Angeles (UCLA) Center for the Health Sciences and Wadsworth Veteran's Administration Hospital. Seven patients were lost to follow-up or had prior irradiation, and were excluded. Thirty-eight patients received a median dose of 70 Gy (62.5 to 80 Gy) to the primary site. After a median follow-up of 48 months, initial control of disease at the primary site was accomplished in 74% of the patients. The initial control by stage was as follows: TI, 83%, T2, 67%; and T3, 63%. After surgical salvage, local control increased to 92%, 80% and 75% for stages T1, T2, and T3, respectively. Twenty-nine percent (11 of 38) of the patients had cervical node metastases at presentation. Radiation provided regional control in 96% (26 of 27) with N0 disease and 86% (six of seven) with N1 disease at diagnosis. Sixteen patients (42%) had an additional malignancy of the upper aerodigestive tract. Because the incidence of second malignancies after treatment is high and surgical salvage of treatment failures is possible, close follow-up is essential in the management of this tumor. We conclude that radiation therapy is an effective modality for the treatment of squamous cell carcinoma of the soft palate. Primary radiation therapy may offer many patients the chance to avoid surgical procedures that are both cosmetically and functionally debilitating without compromosing treatment outcome.

Adult↗
PubMed1988

The use of postoperative irradiation for the prevention of heterotopic bone formation after total hip replacement.

Formation of heterotopic bone (HTB) following total hip replacement may partially or completely ankylose the joint space, causing pain and/or limiting the range of motion. Patients at high risk for formation of HTB postoperatively include those with previous HTB formation, heterotopic osteoarthritis, and active rheumatoid spondylitis. Patients in these high risk groups have a 63-69% incidence of post-operative HTB formation, usually seen radiographically by 2 months post-operation. From 1980-1986 twenty-nine hips in 28 consecutively treated patients were irradiated post-operatively at the UCLA Center for the Health Sciences. The indication for irradiation was documented HTB formation previously in 26 of the 27 hips presented below. From 1980-1982 patients received 20 Gray (Gy) in 2 Gy fractions; from 1982-1986 the dose was reduced to 10 Gy in 2 Gy fractions. Twenty-seven hips in 26 patients completed therapy and were available for evaluation, with a minimum of 2 month follow-up, and a median follow-up of 12 months. Three of 27 hips developed significant HTB (Brooker grade III or IV) post-operatively, whereas 5 of 27 hips developed minor, nonsymptomatic HTB (Brooker grade I). When irradiation was begun by postoperative day 4, 0 of 17 hips formed significant HTB. If irradiation began after post-operative day 4, 3 of 10 hips formed significant HTB (Brooker grade III or IV). These 3 hips received doses of 10 Gy in one hip and 20 Gy in the other 2 hips. There were no differences in the incidence or severity of side effects in the 10 Gy vs. the 20 Gy treatment groups. Eighteen hips received 10 Gy, 8 hips 20 Gy and, 1 hip 12 Gy. In conclusion, 10 Gy in 5 fractions appears as effective as 20 Gy in 10 fractions at preventing post-operative formation of HTB. For optimal results, treatment should begin as early as possible prior to post-operative day 4.

Adult↗
PubMed1988

Testicular seminoma. A study of 103 cases treated at UCLA.

The records of all patients treated at UCLA with stage I through stage III testicular seminoma, diagnosed in 1956-1983, were reviewed. Histologic subtype, therapeutic protocol, survival, and the incidence of subsequent primary malignancies are examined in this presentation. The 10 year cause-specific survival is 93% for stage I and 70% for stage II patients. Of the four patients initially seen with stage III disease, three have achieved long-term disease-free survival after combined irradiation and chemotherapy. Irradiation of the whole pelvis was not associated with improved control for those patients with previous pelvic surgery. Four patients complained of gynecomastia after therapy, and since none of these patients had elevated human chorionic gonadotropin levels, the gynecomastia was attributed to gonadal failure.

Adult↗
PubMed1987

Regressing atypical histiocytosis: a case report of control following low dose radiation therapy.

A case of regressing atypical histiocytosis with a 10-year local course is reported. Long term control of a large fungating mass was achieved with low dose electron beam irradiation to 1500 cGy. Whereas spontaneous resolution of regressing atypical histiocytosis has been noted in the literature, this case demonstrates that certain lesions may be more aggressive than commonly assumed. In these particularly destructive lesions radiation therapy may have a role.

Adult↗
PubMed1986

Results in the management of locally unresectable pancreatic carcinoma.

Between 1973 and 1983, 43 patients with histologically proven unresectable pancreatic carcinoma were irradiated in the UCLA Department of Radiation Oncology. Ten patients received irradiation alone and 33 were nonrandomly assigned to receive chemotherapy in addition to irradiation. Of those patients receiving chemotherapy, 30 were given 5-fluorouracil and three were given a combination of agents. Forty-one of the 43 patients have died with a median survival of 7 months. Actuarial survival at 1 and 2 years was 24% and 3%. Local control was achieved in three of 43 patients. Two patients are alive with no evidence of disease at 11 and 30 months. The median survivals with and without chemotherapy were 9.5 and 4 months, respectively (p = 0.06). Survival dependent on nodal status, surgical bypass, primary site, and dose are also reported. No significant differences were found. Acute complications were noted in 23 patients but were a reason for discontinuing therapy in none. Late complications were noted in nine patients. Six patients with an upper gastrointestinal hemorrhage or a small bowel obstruction all had local recurrence. There were two patients with posttreatment diabetes mellitus and one with pancreatitis. The limits of conventional therapy for unresectable pancreatic cancer have been reached. Creative sequencing of induction combination chemotherapy, newer radiation modalities, and maintenance chemotherapy are required if systemic and local progression of this lethal disease is to be eliminated.

Adult↗
PubMed1986

Orbital lymphomas and pseudolymphomas: treatment with radiation therapy.

A retrospective analysis of 16 patients with orbital lymphoma or pseudolymphoma from 1961-1984 was undertaken to evaluate the use of radiation therapy. Pathologic assessment confirmed that four patients had benign pseudolymphoma, and 12 patients had true malignant lymphoma, including two with advanced disease at presentation. With a median follow-up of 4 years, the local control rate with radiation therapy was 100%, although the two patients with advanced disease died of lymphoma 26-33 months after irradiation. While doses of 1,600-2,000 cGy appear adequate for pseudolymphoma, for lymphoma a dose of 3,000-4,000 cGy is necessary. Subconjunctival lesions can be treated in a single anteroposterior field; retroorbital lesions require an additional lateral field.

Aged↗
PubMed1984

Rhabdomyosarcoma of the head and neck in children.

Seventeen children with rhabdomyosarcoma arising in the head and neck are presented. With a median follow-up of 2 years 3 months, 11 patients are currently living, seven patients are alive free of disease, and local control was achieved in 11 patients. Of 13 group III patients managed with irradiation and chemotherapy following biopsy, seven patients are alive, with four patients free of disease, and local control achieved in eight patients. In a subgroup of nine group III patients with tumor involving multiple head and neck sites, four patients are alive, with two patients free of disease, and local control achieved in six patients. In four groups I-II patients, local control was achieved in three, and all patients are currently living. Long-term complications include facial bone hypoplasia in three patients and cataracts in three patients. Primary irradiation and chemotherapy can locally control rhabdomyosarcoma of the head and neck, while avoiding the functional and cosmetic sequelae associated with surgical ablation.

Adolescent↗