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Biomedical subjects

M V Pilepich

Publications and source records attributed to M V Pilepich.

At least 73 records · Page 4Linked to original sources
PubMed1986

Prognostic significance of the pattern of tumor regression following definitive radiotherapy for carcinoma of the prostate.

Postirradiation evaluation of 262 patients, treated with curative intent from 1967 to 1981, included systematic recording of the degree of tumor regression (expressed as percentage of the tumor size on presentation) at 90 days after completion of radiotherapy, and the time to complete regression of the palpable tumor. These two parameters were correlated with the tumor extent (stage) and histological grade. Although smaller (lower stage) tumors appeared to regress somewhat faster in the early postirradiation period, this trend was not statistically significant. Similarly, the time to complete regression did not differ significantly among extent (stage) and histological grade categories. The overall complete response rate at 6, 12, and 24 months was approximately 55, 80, and 90%, respectively. In 14 patients, palpable tumor never regressed completely. All of these patients suffered a relapse. Late resolution (second year or later) was not associated with a significant increase in the incidence of locoregional recurrence. The degree of tumor regression at 90 days after completion of treatment correlated well with the locoregional control rate. Regression of 50% or more at 90 days was associated with a significantly lower probability of locoregional failure (25% versus 45%). Assessment of the degrees of tumor regression early in the postirradiation course (at 90 days) is a useful prognostic indicator.

Carcinoma↗
PubMed1984

Surgical staging in carcinoma of the prostate: the RTOG experience. Radiation Therapy Oncology Group.

One hundred thirty-six patients with carcinoma of the prostate entered on phase III RTOG studies (RTOG 75-06 and RTOG 77-06) between 1976 and the end of 1980 underwent staging lymphadenectomy prior to irradiation. The operative reports and histological findings have been reviewed in order to determine the patterns of intrapelvic tumor spread and to correlate the type of surgical procedure and the extent of lymphatic dissection with the incidence and type of postirradiation complications (primarily genital and lower extremity lymphedema). The surgical procedures were classified into three categories according to extent: 1) biopsy only, 2) limited (diagnostic) dissection, and 3) complete (therapeutic) dissection. The incidence of postirradiation lymphedema was found to be strongly dependent upon the extent of dissection. Patients undergoing limited (diagnostic) dissection followed by pelvic irradiation have a 25-30% risk of developing this debilitating complication. In patients undergoing complete (therapeutic) dissection followed by pelvic irradiation lymphedema has been observed in 66% of cases.

Biopsy↗
PubMed1984

Treatment-related morbidity in phase III RTOG studies of extended-field irradiation for carcinoma of the prostate.

The incidence, severity, time of onset, and clinical course of complications of treatment have been reviewed in the RTOG studies of extended field irradiation in carcinoma of the prostate. A total of 526 patients, entered between 1976 and 1980 and followed for a minimum of 18 months, comprised the study population. In most instances of treatment-related morbidity, the symptoms were recorded during the first several months to 1 year following completion of treatment. Late occurrences, however, were not uncommon in certain types of radiation-produced injuries, such as proctitis, hematuria, and urethral strictures. Resolution of symptoms has been observed in a large proportion of patients including those with late occurrences of treatment-related morbidity, although the probability and the pattern of resolution differed considerably from one type of morbidity to another. Symptoms of cystitis are more likely to abate than those of proctitis. In patients who develop symptoms of proctitis the probability of persistence of symptoms beyond the second year following occurrence has been estimated at 20%-30%. Hematuria and symptoms secondary to urethral strictures seem to be even more likely to recur or persist, while genital and leg edema remain chronic in the majority of patients.

Adenocarcinoma↗
PubMed1984

Postoperative irradiation in carcinoma of the prostate.

Twenty-eight patients received postoperative radiotherapy with curative intent following either radical prostatectomy (18 patients) or enucleative prostatectomy (10 patients). In patients undergoing radical prostatectomy, the indications for postoperative radiotherapy included positive margins in 13, "close" margins in 2, and seminal vesicle involvement in 3 patients. The majority of patients (82%) received total dose to the prostatic bed in excess of 6500 rad. In over 80% of the patients, the pelvic lymphatics are also treated (to a total dose of 4000-5000 rad). Minimum follow-up is one year, maximum is 10 years, average 54 months, median 41 months. Local recurrence was observed in only 1 patient, who was treated post-enucleation. All of the patients irradiated after radical prostatectomy clinically remained disease-free locally. Approximately one-half of the patients in both the enucleation and radial prostatectomy groups developed evidence of distant metastases. The complications of treatment have been comparable to those in patients treated with radiotherapy only. The continence status has not been affected significantly. All patients (5 in the radical prostatectomy group and 2 in the enucleation group) with incontinence following completion of radiotherapy had documented impairment of continence prior to radiotherapy. Postoperative radiotherapy administered following either radical or enucleative prostatectomy was tolerated well and resulted in excellent local control.

Aged↗
PubMed1983

Preliminary report on phase III RTOG studies of extended-field irradiation in carcinoma of the prostate.

The radiation therapy oncology group (RTOG) has conducted two studies testing the value of extended-versus limited-fields in carcinoma of the prostate. RTOG protocol 75-06 tests the value of paraaortic irradiation in patients with locally advanced tumors limited to the pelvis. RTOG protocol 77-06 tests the value of pelvic irradiation in patients with tumors limited to the prostate. Two hundred sixty-eight evaluable patients have been entered on RTOG 75-06, and 219 on RTOG 77-06 prior to 1981. This is a preliminary report on treatment-related morbidity in patients followed for a minimum of 1 year. Treatment-related morbidity has been classified according to a five-grade severity classification schema and correlated with the protocol option assignment in order to determine whether the use of extended fields had an effect on the incidence of side effects. Thirty-one percent of 268 patients on RTOG 75-06 and 34% of 219 patients on RTOG 77-06 had some form of treatment side effects. The majority (over 80%) of these were mild (grade 1 and 2) and by definition did not interfere with the patients' performance (life style). Only three patients on RTOG 75-06 and one on RTOG 77-06 had grade 4 complications (by definition requiring a surgical intervention). No fatal (grade 5) complications have been recorded so far. The use of paraaortic fields in RTOG 75-06 and pelvic fields in RTOG 77-06 have not resulted in a significant increase of GI or GU morbidity at this time. The only statistically significant trend was the incidence of postirradiation genital and lower extremity edema which strongly correlated with the extent of staging lymphadenectomy.

Aged↗
PubMed1983

Renal graft irradiation in acute rejection.

To evaluate the effect of graft irradiation in the treatment of acute rejection of renal transplants, a randomized study was conducted from 1978 to 1981. Patients with acute rejection were given standard medical management in the form of intravenous methylprednisolone, and were chosen randomly to receive either graft irradiation (175 rads every other day, to a total of 525 rads) or simulated (sham) irradiation. Eighty-three rejections occurring in 64 grafts were randomized to the protocol. Rejection reversal was recorded in 84.5% of control grafts and 75% of the irradiated grafts. Recurrent rejections were more frequent and graft survival was significantly lower in the irradiated group (22%) than in the control group (54%). Graft irradiation does not appear to be beneficial in the treatment of acute rejection of renal transplants when used in conjunction with high-dose steroids.

Female↗
PubMed1983

Anatomic considerations in radiotherapeutic management of bladder cancer.

From July 1975 to December 1981, a total of 47 patients with intact bladders had pelvic CT scans. All patients had biopsy-proven bladder cancer. Utilizing CT scans, we measured the bladder extensions in three dimensions. Evacuation of the bladder prior to each treatment is, according to our survey of 48 radiotherapy departments, a rarely practiced procedure. Therefore, it was reasonable to assume that the partially distended bladder, as seen on CT scans, is the target volume for definitive radiotherapy of bladder cancer as practiced in most departments. Analysis of our results indicates that routinely recommended booster ports of 8 X 8, 10 X 10, and 12 X 12 cm would result in gross misses in approximately 50%, 26%, and 7% of patients, respectively. It would appear that geographic misses might contribute significantly to the high incidence of local failures usually reported for definitive radiotherapy in carcinoma of the bladder.

Adult↗
PubMed1982

Graft irradiation in the treatment of acute rejection of renal transplants: a randomized study.

A randomized study of graft irradiation in the treatment of acute rejection of renal transplants was conducted from 1978 to 1981. Patients developing clinical signs of an acute graft rejection received customary antirejection treatment in the form of intravenous administration of high-dose (1 gm per day) of methylprednisolone. They were at the same time randomized to either receive therapeutic irradiation (175 rad every other day to a total of 525 rad) or sham irradiation. Neither the patient nor the Transplant Service surgeons knew at any time whether the radiation treatment had been given. Eight-three rejection episodes occurring in 64 grafts were entered into the study. Acute rejection was reversed in 84.5% of grafts in the control and 75% in the treated group. The incidence of recurrent rejection was higher in the treated group (66 vs. 46%) and graft survival was lower (22% vs. 54%). The study failed to demonstrate a beneficial effect of graft irradiation in the treatment of acute renal allograft rejection, when used in conjunction with high dose steroids.

Adolescent↗
PubMed1982

Computed tomography in definitive radiotherapy of prostatic carcinoma, part 2: definition of target volume.

Pretreatment computed tomography (CT) scanning of the pelvis was performed in 100 consecutive patients with carcinoma of the prostate treated with external irradiation (82 patients) or interstitial I125 (18 patients). Treatment plan modifications prompted by CT scan findings were most frequent in patients with (clinical) involvement of the seminal vesicles in whom the conventional treatment planning often resulted in an underestimate of tumor volume. Seventeen of 32 (53%) such patients required an enlargement of treatment fields to adequately encompass the target volume. Using skeletal landmarks as reference, the dimensions of the prostate, seminal vesicles and the detectable tumor and their topographic relationships were systematically tabulated. These measurements provide a basis for the definition of the target volume in patients with carcinoma of the prostate in whom CT scans might not be available.

Brachytherapy↗
PubMed1981

Radiotherapy and combination chemotherapy in advanced Ewing's Sarcoma-Intergroup study.

Forty-four patients with metastatic (36 patients) and advanced regional (eight patients) Ewing's sarcoma were treated on a protocol employing intensive combination chemotherapy and radiotherapy to all sites of overt disease (primary site and metastatic sites). Thirty-one patients achieved a complete remission, eight achieved a partial remission, and five patients did not respond to treatment. Of the 31 patients who achieved a complete remission (12 had metastases and six had regional spread), 18 remained disease-free with a median follow-up of 34 months, while recurrences occurred in nine patients. Four patients died of complications of treatment. Although late relapses can still be expected, it appears that intensive multimodal management in metastatic Ewing's sarcoma can produce prolonged disease-free survival and possibly cure in a significant percentage of patients.

Adolescent↗
PubMed1981

Effect of bladder distension on dosimetry in gynecological implants.

In order to quantitate the impact of bladder distension on implant position and on radiation dosage to various parts of the bladder, 24 patients with gynecological neoplasms underwent computed tomographic scanning of the pelvis following insertion of afterloading intracavitary applicators. Shifting of the applicators due to bladder distension was measured at and two inches above the level of the vaginal ovoids. By maintaining a residual vesical volume of 200-300 ml with contrast material, radiation exposure to a large part of the bladder was reduced significantly while only a minor displacement of the implant system was noted.

Adenocarcinoma↗
PubMed1981

Contribution of CT to quantitative radiation therapy planning.

The contribution of computed tomography (CT) in radiotherapeutic treatment of lung cancer was evaluated. Radiation therapy ports prepared for 50 patients on the basis of routine diagnostic radiographs and without CT scan information were reviewed after CT scanning. Of 50 patients, 13 (26%) required alteration of treatment ports on the basis of the additional CT scan information. In 11 patients (22%) the changes resulted in an increase in field size to cover the tumor adequately, and in two patients (4%-) the field size was reduced to spare normal tissue. A three-phase study was completed to evaluate the impact of CT on quantitative parameters of two-dimensional treatment plans on 25 of the 50 patients. Treatment plans in the absence of CT scan and without lung transmission correction were compared with treatment plans where CT information was used and lung transmission corrections were performed. Numerical results for local efficiency and nonuniformity factor were compared for conventional, CT unoptimized, and CT optimized plans. Of the 25 patients, 14 (56%) had poorer local efficiency and 16 (64%) had nonuniformity factor exceeding 5% when treatment was planned without CT information. CT-optimized plans improved local efficiency in 16 (64%) of 25 patients and reduced nonuniformity to within 5% in 21 (84%). It is suggested that in the treatment planning of patients with lung cancer, CT scan information is essential for accurate determination of dose distribution and optimization of therapy.

Adenocarcinoma↗
PubMed1980

Preoperative irradiation in carcinoma of the pancreas.

Seventeen patients with carcinoma confined to the pancreas and the peripancreatic area received preoperative radiation therapy in an attempt to increase the resectability rate and to reduce the incidence of recurrence. The tumors were considered either unresectable or of borderline resectability. The radiation dose ranged between 4000--5000 rads, the majority of patients (75%) receiving 4400--4600 rads in 4 1/2--5 weeks. After a period averaging six weeks the patients were reevaluated for surgery. Eleven patients were explored and six underwent radical resection. Two patients remained disease free after five years. Pancreatic resection is feasible following a course of preoperative radiotherapy to a moderately high dose. It is suggested that the response of the primary tumor to radiotherapy be used as a criterion for selecting patients for reexploration and resection.

Adenocarcinoma↗
PubMed1980

Prognostic parameters in radiotherapeutic management of localized carcinoma of the prostate.

A series of 215 patients with carcinoma of the prostate localized to the pelvis received radical radiotherapy. Treatment results have been correlated with the tumor stage, tumor size defined independently from stage, doses of radiation and histological grade. The following ranges from 2 to 13 years (median 5 years). Local recurrence was observed in 6.6 percent of stage B, 16.1 per cent of stage C and 20 per cent of stage D1 cases. Eighty per cent of the patients with stage B disease, 56 per cent with stage C and 0 per cent with stage D1 survived 5 years free of disease. Tumors less than 2 cm. in diameter were controlled uniformly, while tumors more than 2 cm. in diameter showed an over-all local control rate of about 85 per cent. Increasing size resulted in a higher incidence of distant metastases. A dose of 6,500 rad (180 to 200 rad per day) appears adequate for tumors less than 2 cm. in diameter and stage B tumors, while higher stage tumors require doses of 7,000 rad (180 to 200 rad per day). Most high grade tumors and massive tumors of any grade fail outside the pelvis.

Adenocarcinoma↗
PubMed1980

Muscle enlargement in lymphoma patients.

Five patients with regional muscle enlargement were identified among 97 lymphoma patients who underwent CT scanning as a part of their work-up. Muscle enlargement occurred in the absence of lymphatic or venous obstruction or direct involvement of the muscle by the tumor. Prompt resolution of the phenomenon was observed following radiotherapy or chemotherapy.

Adult↗