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Nancy Price Mendenhall

Publications and source records attributed to Nancy Price Mendenhall.

10 recordsLinked to original sources
PubMed2003

Postmastectomy radiotherapy: patterns of recurrence and long-term disease control using electrons.

PURPOSE: To determine the patterns of failure and prognostic factors for locoregional recurrence after postmastectomy radiotherapy (RT), using a specific electron beam technique. METHODS AND MATERIALS: A uniform electron beam was used in 323 patients with invasive breast cancer at the University of Florida Health Science Center. The patterns of disease recurrence, prognostic factors, and overall outcome were studied. RESULTS: At 10 years, the freedom from locoregional recurrence, disease-free survival, and absolute survival rate was 90%, 62%, and 55%, respectively. The 10-year disease-free survival rate for patients with 0, 1-3, and >3 positive lymph nodes was 73%, 75%, and 47%, respectively. On multivariate analysis, the three factors significantly associated with locoregional recurrence were T stage, number of involved nodes, and RT fields. Full axillary fields appeared to be beneficial (p = 0.02). Patients with positive surgical margins appeared to benefit from a mastectomy incision boost to >/=65 Gy. Finally, patients with T2N0 disease had a substantial risk of chest wall recurrence without chest wall RT. CONCLUSION: Findings include a low rate of clinically detectable locoregional recurrence. The data suggest benefits for the addition of full axillary RT in node-positive patients and chest wall RT in patients with T2N0 disease.

Adult↗
PubMed2003

Angiosarcoma after breast-conserving therapy.

BACKGROUND: Angiosarcoma arising in the irradiated breast after breast-conserving therapy is being reported with increasing frequency. As more women undergo breast-conserving therapy, the incidence can be expected to increase. Surgeons, medical oncologists, and radiation oncologists will be faced with difficult management decisions for this aggressive disease. METHODS: A comprehensive review of all English-language reports of angiosarcomas after breast-conserving therapy was performed. Approximately 100 cases were reviewed for treatment details and outcome analysis was performed. RESULTS: Surgical excision is associated with very high rates of disease recurrence (55 of 75 patients with at least 1 year of follow-up; 73%). Local disease recurrences in the tumor bed or along the mastectomy scar are a component of almost all recurrences (96%). Distant metastases develop simultaneously or shortly after local recurrences. Hyperfractionated radiotherapy has successfully prevented local disease recurrences in a limited number of patients. CONCLUSIONS: Angiosarcoma after breast-conserving therapy is increasingly diagnosed in a small but significant portion of breast carcinoma survivors. The aggressive nature of this disease demands further investigation of adjuvant therapy to prevent recurrence of disease after surgery.

Aged↗
PubMed2003

Breast boost: are we missing the target?

BACKGROUND: Randomized trials have shown improved local control with the use of a breast boost for patients given breast-conserving treatment for breast carcinoma. Although the use of a breast boost is routine practice, no standard technique has been established. The authors compared the commonly used clinical technique with a technique based on computed tomography (CT) imaging of surgical clips in the tumor bed. METHODS: Thirty patients underwent CT simulation for postoperative radiation treatment planning as part of breast conservation therapy. During simulation, a CT-compatible wire was placed on the patient's skin, outlining the intended electron boost field; an electron boost volume (EBV) was generated by contouring the tissue underlying the wire. Also contoured was a CT-based clinical target volume (CTV) using surgical clips and postsurgical changes in the tumor bed as a guide. A planning target volume (PTV) was generated using a 1 cm margin around the CTV. An electron beam treatment plan was generated for each technique using the FOCUS three-dimensional treatment planning system. Dose-volume histograms (DVH) were generated to determine the fraction of the PTV receiving 90% of the prescribed dose if treatment was delivered using the EBV. In addition, DVH analysis was done to determine the volume of normal tissue unnecessarily irradiated when using the EBV. RESULTS: Although the electron cone size remained unchanged in most patients for both EBV and PTV, the isocenter differed more than 1 cm in the medial-lateral direction in 5 patients and in the cephalocaudal direction in 12 patients. The en face gantry angle differed for most patients. On average, only 51% (range, 27-79%) of the PTV received 90% or more of the prescribed dose when the electron plan was generated using the EBV (P < 0.0001). Ten patients received the prescription dose to less than 50% of the PTV. Mean volume of normal tissue receiving more than 50% of prescribed dose was 64.5 cm(3) (range, 24-119 cm(3)). CONCLUSIONS: Clinical delineation of the tumor bed not only carries a significant risk of missing the target, but unnecessarily treats breast tissue that may otherwise be spared. Better delineation of the tumor bed, which optimizes coverage of the target volume and spares normal breast tissue, has the potential to improve both local control and cosmetic outcome. The authors recommend the use of surgical clips to delineate the target volume, followed by CT-based treatment planning, accounting for not only microscopic disease, but also organ motion and daily setup error.

Breast Neoplasms↗
PubMed2003

Radiation therapy for angiosarcoma.

BACKGROUND: Between 1964 and 1998, 19 patients with histologically proven angiosarcoma were treated with curative intent with radiation therapy. METHODS: Median follow-up was 37 months (range, 8-234 months). RESULTS: The actuarial 5-year absolute survival and local control rates were 51% and 50%, respectively. Of 12 patients who relapsed, 8 had isolated local recurrence as the first site of treatment failure, 2 had local (1 patient) or regional recurrence in conjunction with distant metastases, and 2 had distant metastases alone. Two of four patients who underwent further therapy for recurrent disease were successfully salvaged. CONCLUSIONS: Only the location of the primary tumor was a predictor of local control and absolute survival at 5 years. Angiosarcomas located on the scalp imply a dismal prognosis compared with those in other locations with the predominant pattern of failure being local recurrence. Patients should be treated aggressively with surgical resection and preoperative or postoperative radiation therapy.

Adult↗
PubMed2002

Angiosarcoma after breast-conserving therapy: experience with hyperfractionated radiotherapy.

PURPOSE: To report our promising results of hyperfractionated radiotherapy (RT) in conjunction with surgery for angiosarcoma occurring after breast-conserving therapy for early-stage breast cancer. METHODS AND MATERIALS: Since 1997, 3 cases of angiosarcoma after breast-conserving therapy have been managed at the University of Florida. The histologic specimens in each case were reviewed and graded by one of us (J.D.R.). RESULTS: Explosive growth of discolored skin lesions coincident with histologic evidence of angiosarcoma characterized all 3 cases but was preceded by a fairly indolent period (almost 2 years) of atypical vascular hyperplasia in 2 patients. All 3 patients were treated initially with radical surgery for the angiosarcoma, but extensive recurrences were noted within 1 to 2 months of surgery. Because of the extremely rapid growth noted before and after surgery, hyperfractionated RT was used. Two of the patients underwent planned resection after RT, and neither specimen demonstrated any evidence of high-grade angiosarcoma. All 3 patients were alive without any recurrent disease 22, 38, and 39 months after treatment. CONCLUSIONS: Hyperfractionated irradiation appears to be effective treatment for rapidly proliferating angiosarcoma. For previously untreated angiosarcoma, we now recommend hyperfractionated RT followed by surgery to enhance disease control and remove as much reirradiated tissue as possible.

Aged↗
PubMed2002

Subdiaphragmatic Hodgkin's disease: the University of Florida experience.

PURPOSE: To assess the long-term outcomes and late effects of patients with subdiaphragmatic Hodgkin's disease. METHODS AND MATERIALS: Twenty-one patients with Stage I and II subdiaphragmatic Hodgkin's disease were treated with curative intent between February 1966 and February 1998 at the University of Florida. Patient characteristics were as follows: mean age, 38.7 years (range, 3-75 years); 20 males and 1 female; 33% lymphocyte predominant, 43% nodular sclerosing, 14% mixed cellularity, 5% lymphocyte depletion, and 5% unclassified Hodgkin's disease. Treatment included inverted Y irradiation (InY) (8 patients), total nodal irradiation (TNI) (7 patients), and combined modality irradiation and chemotherapy (CMT) (6 patients). Median follow-up was 12.3 years (range, 3.1-33.6 years). RESULTS: Progression-free survival and overall survival were 80% and 70%, respectively, at 10 years. There were no deaths from Hodgkin's disease. Treatment failures occurred in 1 of 8 patients after InY, 1 of 7 after TNI, and 1 of 6 after CMT. Two of 3 recurrences were in patients with 3 or more sites of involvement and/or splenic involvement; 1 was in-field. There were 5 second malignant neoplasms and 3 cardiac events, including 4 second malignant neoplasms and 2 cardiac events in the 9 patients > or =40 years old at diagnosis and 1 second malignant neoplasm and 1 cardiac event in the 12 patients <40 years old. All 3 second solid malignancies in this study occurred 7-14 years after treatment in areas receiving 10-20 Gy. CONCLUSIONS: Subdiaphragmatic Hodgkin's disease is an uncommon manifestation with excellent disease control achieved with InY, TNI, and CMT. This subgroup of patients with Hodgkin's disease is predominantly male and older than subgroups with other presentations, which may predispose the group to a higher risk for serious adverse events after treatment. We recommend InY with spleen for clinical Stages IA and nodular sclerosis or lymphocyte-predominant clinical Stage IIA, InY alone for pathologic Stages IA and IIA, and CMT for all Stage I/II patients with greater than three involved sites, B symptoms, bulky disease (>6 cm), central (para-aortic) presentation, or splenic involvement.

Adolescent↗
PubMed2002

Carcinoma of the skin of the head and neck with perineural invasion.

BACKGROUND: Perineural invasion is observed in a small subset of patients with carcinomas of the skin of the head and neck. METHODS: Review of the patient literature highlighting the University of Florida experience. RESULTS: Patients with early perineural invasion are asymptomatic, and the phenomenon is discovered only on pathologic examination of the excised lesion. These patients are defined as having "incidental" perineural invasion, and treatment with surgery followed by postoperative irradiation results in a cure rate of approximately 80%. Undiagnosed, the perineural carcinoma slowly progresses and eventually results in symptoms, usually facial weakness or numbness. The disease eventually extends to the skull base and becomes incompletely resectable. Symptomatic patients are defined as having "clinical" perineural invasion, and aggressive treatment results in a cure rate of approximately 45%. CONCLUSIONS: Perineural invasion is an uncommon spread pattern observed in patients with skin cancer and is associated with a relatively poor prognosis. The likelihood of cure is inversely related to the proximal extent of the cancer and is lower for symptomatic compared with asymptomatic patients.

Carcinoma, Squamous Cell↗
PubMed2002

The treatment of Ewing's sarcoma of bone at the University of Florida: 1969 to 1998.

Since 1969, 144 patients with previously untreated Ewing's sarcoma of bone were entered in prospective protocols at the University of Florida. From 1969 through 1981, three institutional protocols were used, and some patients were entered into the First Intergroup Ewing's Sarcoma Study. Starting in 1982, an attempt was made to intensify treatment, with patients divided according to their primary tumor size into standard-risk (< or = 8 cm in maximum diameter) and high-risk groups. Patients with metastases at diagnosis also were considered high risk. The standard-risk protocols (Number 1 and Number 2 specified treatment with chemotherapy considered to be standard for the era; the patients who were high risk had standard chemotherapy followed by end-intensification. Treatment for patients with metastases at diagnosis was intensified additionally in 1993 with a protocol (high-risk protocol Number 5) specifically designed just for these patients. The absolute survival rate of all patients treated before 1982 was 50% at 5 years for patients without metastases at diagnosis and 18% for patients with metastases. Patients with small primary lesions had a better survival rate than patients with large primary lesions. After 1982, the 5-year survival rate for patients treated on the standard-risk protocols was 53% (1985-1998), whereas for high-risk protocols the 5-year survival rate was 63%. Survival rates were better for younger patients at diagnosis and for patients who responded well to induction chemotherapy, indicating that future trials may need to tailor therapy based on the response to induction chemotherapy.

Adolescent↗
PubMed2002

Stage IE primary non-Hodgkin's lymphoma of bone.

The results of treatment of 28 patients with Stage IE primary lymphoma of bone were evaluated. Nine patients were treated with curative intent with irradiation alone and 19 patients received radiotherapy combined with adjuvant chemotherapy. Local control was 100%. The 10-year freedom-from-relapse rate was 53%; all relapses were distant metastases, and the median time to failure was 1 year. All patients with relapses succumbed to their disease. The 10-year cause-specific survival rate was 48%. The 10-year survival rate was 53%. Multivariate analysis of survival suggested that pathologic fracture before treatment, age greater than 60 years, no aggressive chemotherapy, and lesions that were not in long bones may influence these end points. Two patients (7%) sustained moderate or severe late toxicity. Although the likelihood of local control after treatment of Stage IE primary lymphoma of bone is very high with radiotherapy, more effective systemic regimens are needed. A significant proportion of patients with this disease die of distant metastases, despite the use of what are considered standard doxorubicin-based chemotherapy regimens.

Adolescent↗