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Biomedical subjects

R A Potish

Publications and source records attributed to R A Potish.

At least 37 records · Page 2Linked to original sources
PubMed1989

Pretreatment surgical staging in cervical carcinoma: therapeutic efficacy of pelvic lymph node resection.

Pretreatment surgical staging in cervical carcinoma has been studied extensively to define a group for extended field radiation or adjuvant chemotherapy. A theoretical, but as yet unproved, benefit from this surgery is the resection of large, presumably radioresistant, pelvic nodal metastases before radiation therapy. One hundred fifty-six patients were divided by pelvic nodal status after surgical staging with excision of pelvic lymph nodes: group A, negative (n = 81); group B, microscopic metastases only (n = 18); group C, macroscopic nodal metastases resected (n = 48); and group D, unresectable nodal metastases (n = 9). The 5-year recurrence-free survival in group C (51%) approached that of group B (57%) and was significantly better than that of group D (0%). The groups are compared by International Federation of Gynecology and Obstetrics stage, grade, histology, and incidence of paraaortic metastases. Patterns of recurrence imply improved pelvic control in patients undergoing resection of pelvic nodal metastases. Surgical removal of pelvic nodal metastases before radiation therapy is recommended.

Carcinoma↗
PubMed1989

Mediastinal involvement by myxoid liposarcoma.

Metastatic involvement of the mediastinum by liposarcoma is uncommon, and clinical experience in its management is limited. A patient with liposarcoma of the lower extremity having a concomitant anterior mediastinal mass as the only manifestation of distant metastatic involvement is described.

Adult↗
PubMed1989

The role of surgical debulking in cancer of the uterine cervix.

From 1978 to 1985, 159 women with advanced cervical cancer received definitive radiation therapy following extraperitoneal surgical staging including pelvic lymph node dissection and periaortic lymph node sampling. Relapse-free survival was a strong function of peritoneal and nodal metastases but was independent of clinical stage. The 5-year relapse-free rate fell from 86% in women without pelvic node metastases to 0% in those with unresectable pelvic node metastases. Women with microscopically positive pelvic node metastases had virtually the same (56%) relapse-free rate as those with grossly positive but completely resected metastases (57%). The overall pelvic failure rate was 16.4% and was significantly higher in women with unresectable pelvic node metastases. Periaortic and peritoneal metastases substantially increased the probability of recurrence. Although histologic grade was prognostically significant, histopathologic category was not. Severe enteric morbidity occurred in 3.6% of patients treated solely to the pelvis and in 7.9% of patients treated to the pelvis and periaortics. Therapeutic implications of debulking pelvic node metastases are discussed.

Female↗
PubMed1989

Abdominal radiotherapy for cancer of the uterine cervix and endometrium.

From 1973 through 1985, 49 women received postoperative open-field whole abdominal radiotherapy as primary management for peritoneal metastases from uterine cancer. The 5-year relapse-free rate was 63% in women with endometrial carcinoma, and two prognostic subsets were identified. Five-year relapse-free rates fell from 77% in women with spread to the adnexa or peritoneal fluid to 36% in women with macroscopic spread of cancer beyond the adnexa. Any peritoneal spread of cervical carcinoma yielded a 3-year relapse-free rate of 31%. Although abdominal spread of cervical cancer was associated with other poor prognostic factors, peritoneal metastases frequently occurred in otherwise early endometrial cancer. Four percent of patients developed small bowel obstruction requiring surgical intervention. The utility and limitations of whole abdominal radiation are discussed.

Adenocarcinoma↗
PubMed1989

An analysis of adjuvant treatment strategies for carcinoma of the cervix.

The majority of women with cancer of the cervix are cured with radiation or surgery, but a sizable fraction of tumors recur. Adjuvant chemotherapy is generally toxic and of limited efficacy. Thus, 49 women with surgical staging and estrogen and progesterone receptors were analyzed with logistic models to identify patients at high and low risk of treatment failure following conventional therapy. This methodology allows the patient and her physician to optimize choice of therapy. The benefits and limitations of such a decision theory analysis are discussed.

Adenocarcinoma↗
PubMed1988

Methylene blue protects intestinal mucosa from free radical-mediated sublethal radiation damage.

Susceptibility of the intestine to radiation damage is a primary reason for the failure of external beam radiation to cure intra-abdominal cancer. High-dose irradiation causes intestinal denudation, fluid loss, and resultant shock. Simple and effective methods for protecting the intestine from irradiation damage are not available. Many biological effects of ionizing irradiation are caused by free radical intermediates. We have previously reported that many of the toxicities of doxorubicin, a classic free radical generating anticancer agent, are blocked by methylene blue pretreatment. We have now found that pretreatment with methylene blue protects rats from intestinal damage, as measured histologically and by quantitative stool blood determinations. Whereas the exact mechanisms of this protection remain elusive, we believe this method of modulating the therapeutic index of ionizing radiation deserves additional preclinical and clinical study.

Animals↗
PubMed1988

The consensus statements on adjuvant chemotherapy in breast cancer. Fact or artifact.

The decision of the National Cancer Institute, in November of 1985, in favor of adjuvant chemotherapy in the treatment of the premenopausal patient was based on the analysis of randomized clinical trials. The authors have carefully evaluated five papers dealing with the trials and found in each of them some problem in the performance or statistics which makes us question the interpretation of the findings of a statistically significant advantage for adjuvant chemotherapy in premenopausal patients. In view of this, we suggest that all the studies being considered need to be checked for their validity and if a significant number have similar flaws to those in the five trials noted, then we suggest that it is not possible to come to conclusions reported by the consensus panel.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Tolerance and preliminary results of simultaneous therapy with radiation and cisplatin for advanced cervical cancer.

From 1982 through 1985, 49 women with advanced cervical cancer were treated with concurrent radiation and cisplatin to assess tolerance to the combined modality regimen and its efficacy in comparison to historical controls at the same institution. Eligibility criteria included clinical stage IV disease; para-aortic lymph node metastases; and bilateral, unresectable, and/or multiple (greater than 3) pelvic node metastases. Nodal status was assessed by extraperitoneal surgical staging in the majority of patients with clinical stage I-IVA disease. There was no increase in acute or chronic toxicity compared to historical controls. No patient required reduction of the planned dose of radiation because of acute toxicity. Comparison with historical controls suggests a modest improvement in relapse-free survival in the cisplatin-treated group with positive para-aortic nodes (59% vs. 54% at 2 yr and 59% vs. 42% at 3 yr). We conclude that adjuvant cisplatin can be given simultaneously with radiation for advanced cervical cancer without excessive toxicity or compromise of the radiation regimen. However, confirmation of the modest improvement in relapse-free survival rates for patients with positive para-aortic nodes and identification of other subsets of patients who may benefit will require a prospective randomized trial.

Adult↗
PubMed1987

Cervical cancer: intracavitary dose specification and prescription.

Dose and volume specifications for reporting intracavitary therapy were analyzed according to criteria recommended by the International Commission on Radiation Units and Measurements (ICRU). Ninety Fletcher-Suit radium applications were studied to examine the validity of the assumptions of the ICRU and the merit of their routine reporting. It was demonstrated that the reporting recommendations were inconsistent with clinical prescription systems and added little to dose specification. The distinction between dose specification and dose prescription was stressed.

Brachytherapy↗
PubMed1987

Radiation therapy of periaortic node metastases in cancer of the uterine cervix and endometrium.

Thirty-eight women with surgically confirmed periaortic lymph node metastases from cervical or endometrial carcinoma received radiation therapy. The 5-year observed actuarial survival and relapse-free rates were 42% and 41%, respectively. Concomitant peritoneal metastases conferred a bleak prognosis. There were no differences in survival as a function of site of origin, histologic characteristics, or bulk of periaortic metastases. Earlier stage disease tended to have a higher probability of cure. Morbidity was acceptable. The results confirmed the importance of radiation therapy in the management of lymph node metastases in uterine cancer.

Adult↗
PubMed1986

Prognostic importance of progesterone and estrogen receptors in cancer of the uterine cervix.

Tissue levels of cytosolic estrogen receptors (ERc) and progesterone receptors (PRc) have been shown to have prognostic meaning in hormonally responsive cancers arising in the breast and endometrium. Although carcinomas of the uterine cervix rarely respond to hormonal manipulation, the normal cervical stroma and epithelia contain ERc and PRc. To study the prognostic value of these receptors, 65 cervical carcinomas for ERc and PRc were assayed before initiation of surgical or radiation therapy. In premenopausal women, logistic models demonstrated that clinical stage, surgical stage, and receptor level independently predict survival. If confirmed in further studies, ERc and PRc may prove to be useful prognostic factors in the management of cervical carcinomas.

Adenocarcinoma↗
PubMed1986

Concurrent weekly cis-platinum and radiotherapy in advanced cervical cancer: a preliminary dose escalating toxicity study.

Concurrent weekly cis-platinum in a dose escalating manner and conventional radiotherapy was evaluated in advanced cervical cancer. The toxicity of weekly cis-platinum given 2 hr before standard fractionation of radiotherapy was assessed using the modified GOG toxicity criteria. Sixteen patients having parameters indicating high risk for conventional therapy failure including positive pelvic and paraaortic nodes and intraperitoneal spread were entered. There was no life-threatening toxicity. The toxicity of the administered chemotherapy was only moderate. Patient compliance was good as at the 20 mg/m2 dose level, 79% of the prescribed doses were administered. The use of adjuvant cis-platinum in poor prognosis advanced cervical cancer merits further study.

Brachytherapy↗
PubMed1986

The effect of definitive irradiation on local control and disease free survival in breast cancer.

The prognostic factors important in determining local regional control or failures can be divided into two groups. The first, the intrinsic factors, relate to the initial inherent condition of the tumor, that is, the tumor labeling index, progesterone receptors, the degree of involvement of the lymph nodes in he area, the size of the tumor, etc. The second, extrinsic factors, relate to type and adequacy of treatment. The presentation demonstrates that the most critical factors in determining failure and patterns of failure are the intrinsic factors, that is, histologic grade tumor labeling index, number of nodes involved, progesterone receptors and size, and that the adequacy of treatment affects failure and patterns of failure in patients treated. This paper shows that adequate radiation reduces local recurrence and, consequently, increases the survival rate; it also demonstrates that inadequate radiation will lead to increased local recurrence and decreased survival. The factors involved in determining the adequacy of irradiation are discussed.

Breast Neoplasms↗
PubMed1986

Effect of cis-platinum on tolerance to radiation therapy in advanced cervical cancer.

Women with advanced carcinoma of the uterine cervix are at high risk for the development of local, regional, and distant metastases. Thus, both effective systemic agents and radiosensitizers could be useful adjuvants. However, because a substantial fraction of women with advanced cervical neoplasms are cured with radiation therapy, such experimental agents must not compromise the administration of conventional therapy. Cis-platinum is particularly appealing as it has both radiosensitizing properties and activity in metastatic cervical cancer. The present study examined the effect of weekly cis-platinum on radiation tolerance in 29 women with advanced cervical cancers. Although toxicity was acceptable, no marked enhancement in survival could be demonstrated.

Adult↗
PubMed1986

Role of point A in the era of computerized dosimetry.

Treatment prescriptions based on milligram-hours and point A doses were examined in light of the recommended dose and volume specification for intracavitary therapy proposed by the International Commission on Radiation Units and Measurements (ICRU). Because neither point A doses nor milligram-hours are to be included in dose reporting, it is necessary to translate the vast empirical experience with prescriptions based on these parameters into the ICRU schema. A total of 90 Fletcher-Suit radium applications were analyzed to explore relationships between point A doses, milligram-hours, and the ICRU guidelines. It was demonstrated that some definitions of point A can have essentially no utility within any dosimetric system, while others can lead to treatment prescriptions with some degree of correspondence to ICRU recommendations. Older dosimetric concepts must be retained while newer ones are being developed.

Brachytherapy↗
PubMed1986

Cytoplasmic estrogen and progesterone receptors as prognostic parameters in primary endometrial carcinoma.

Eighty-six cases of primary endometrial carcinoma were assayed for the presence or absence of cytoplasmic estrogen and progesterone receptors by the saturation point dextran-coated charcoal assay. The levels of cytoplasmic progesterone receptors and estrogen receptors were analyzed according to clinical stage, histologic type and grade of the tumor, presence or absence of lymph node metastases, myometrial invasion, and survival. The cases were divided into positive and negative receptor groups with levels chosen of greater than 10 fmol/mg of cytosol protein for progesterone receptor and 5 fmol/mg of cytosol protein for estrogen receptor as discrimination points. Statistically significant survival differences were found between estrogen receptor positive versus estrogen receptor negative patients, progesterone receptor positive versus progesterone receptor negative patients, and estrogen positive-progesterone receptor positive versus estrogen negative-progesterone receptor negative patients. Mean cytoplasmic estrogen and progesterone receptor levels were inversely proportional to grade. This report suggests that treatment protocols should be devised to reflect the prognostic significance of receptor status.

Adenocarcinoma↗