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Biomedical subjects

R D Lindberg

Publications and source records attributed to R D Lindberg.

At least 19 recordsLinked to original sources
PubMed1992

Phase II trial of combination chemotherapy and irradiation in non-small-cell lung cancer, Radiation Therapy Oncology Group 88-04.

Encouraging results of several clinical trials utilizing combination chemotherapy and irradiation in unresectable non-small-cell lung cancer have been reported. A recent report from a cooperative group study suggested that preirradiation vinblastine and cisplatin improved survival over irradiation alone. In an attempt to enhance the possible effectiveness of combination chemotherapy and irradiation, the Radiation Therapy Oncology Group embarked on a Phase II trial utilizing preirradiation vinblastine (5 mg/m2 weekly x 5) and cisplatin (100 mg/m2) on days 1 and 29 prior to irradiation and on days 50, 71, and 92 during irradiation. The irradiation began on day 50 and consisted of 6300 cGy in 7 weeks. Between May 20, 1988 and May 1, 1989, 30 patients were entered on study. Seventy-two percent of patients had Karnofsky status greater than 90, and 76% had weight loss less than 5%. Forty-eight percent of the patients were younger than 60 years of age. Forty-five percent of the patients had Stage IIIA disease. Eighty-three percent of the patients received at least four courses of vinblastine, and 59% received at least four courses of cisplatin. Seventy-eight percent of the patients received at least 95% of the prescribed irradiation. The major toxicity was hematologic, and there were two fatal complications in the study group. The preliminary survival figures are encouraging. This combination of chemotherapy and irradiation appears to be tolerable and may merit further investigation.

Aged↗
PubMed1991

Incidence of complications with mini vaginal culpostats in carcinoma of the uterine cervix.

Between 1980 and 1987, 298 patients with carcinoma of the uterine cervix were treated at the University of Louisville Department of Radiation Oncology. Of these, 197 (66.1%) were treated for cure by radiotherapy alone: 36 by external beam alone and 161 by external beam and tandem and ovoid applications. The F.I.G.O. staging of the 161 patients was 82 (50.1%) Stage IB, 9 (5.6%) Stage IIA, 40 (24.9%) Stage IIB, and 30 (18.6%) Stage III. The usual treatment was whole pelvis irradiation followed by two intracavitary applications using the Fletcher Suit Applicators of tandem and ovoids in 79/161 patients (49%), a 3-M Mini Applicator (Fletcher Suit Delcos Applicator) in 52/161 patients (32.3%), and a 3-M Mini Applicator with Caps in 30/161 patients (18.6%). The incidence of grade 3-4 gastrointestinal or genitourinary complications as defined by the RTOG was 19.3% (31/161). Various treatment parameters were analyzed to define possible contributing factors. Grade 3-4 complications were seen in 7.6% (6/79) of patients treated with the standard ovoid Fletcher system, 26.9% (14/52) treated with the mini-ovoid system, and 36.6% (11/30) treated with the mini-ovoid system with caps (p = .0006). Although trends were noted, neither the vaginal surface dose (VSD) from the ovoids nor the addition of the external beam dose to the VSD (total vaginal surface dose = TVSD) were significant independent variables (p = 0.19 and = 0.133, respectively). The TVSD was significant when comparisons were made between different ovoid systems (p = 0.05 for less than 12,000 cGy and p = 0.004 for greater than 12,000 cGy). In this study, the 3-M mini applicator was associated with a significant increase in grade 3-4 complications as compared to the Standard Fletcher Suit Applicator.

Adult↗
PubMed1990

GYN implant orthogonal film holder.

An orthogonal film holder has been developed for the use of implants in the O.R. This film holder provides both AP and lateral films that are truly 90 degrees apart from each other. Placement of the GYN applicators must be checked before completion of the procedure. Traditionally, orthogonal films have been used for positioning and for the dose calculations. Therefore it is critical to have good quality radiographs. The AP film holder is placed beneath the patient and the lateral film holder slides into the side of the AP film holder, providing accurate placement and reproducibility in relation to each other. After the films have been approved, the lateral film holder bolts on top of the AP film holder. The system then looks like a briefcase and has a carrying handle for easy transportation and storage. This newly designed system has been used successfully and has proved its ease of use and accuracy.

Brachytherapy↗
PubMed1990

Glioblastoma multiforme in adults: results of treatment.

One hundred and thirty adult patients with brain tumors were treated in the Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine from 1973 to 1980. Forty-one patients (39%) were diagnosed with glioblastoma multiforme. Forty-two percent of the patients were in the age group of 51-60 years. There were 24 males and 27 females. Forty-seven percent of the patients had partial resection, 27% had total excision and 26% had biopsy only. The radiation dose ranged from 4400 to 6600 rad with a median dose of 5500 rad. The median survival was 8.5 months, (range 3 to 120 months), 38% of patients survived one year or more and 10% survived 2 years or more. A detailed review of the current policy of treatment and of the ongoing clinical trials is done in this paper.

Adult↗
PubMed1989

Medulloblastoma: results of treatment.

Fourteen patients with a diagnosis of medulloblastoma were treated in the Department of Radiation Oncology, University of Louisville School of Medicine from 1973 to 1979. The age of these patients ranged from 2 to 47 years with a median of 9 years. Twelve of them were 15 years or younger. All patients received craniospinal radiation after surgery, with a boost to the primary site by reduced field. The median dose to the primary was 4736 rads (range 3600 to 5600 rad). The median follow-up was 29.5 months. Six patients have died, and four of those six patients lived more than two years. Eight patients are alive to the last follow-up with a median survival of 29 months. Eight of 14 patients had local control and one patient developed distant metastasis. A brief review of the literature is done in this paper.

Adolescent↗
PubMed1989

Biteblock-head immobilizer system.

To accurately deliver high doses of radiation to the head and neck region one must be able to achieve three primary goals: reproduce the patient set-up or position, immobilize the patient, and most importantly, position the treatment field on the patient in the same exact location on a daily basis. Many patient positioning devices are available commercially but none address the concept of positioning the treatment field on the patient. The system presented in this paper accomplishes all 3 goals. Using a biteblock and a coordinate system, it has decreased the daily set-up time and improved the accuracy of the treatment field placement on the patient. Five hundred port films were reviewed retrospectively from previously treated patients who were treated without this new system (66% of those films were approved, and 34% needed some sort of adjustment). Using the new system the accuracy of 107 port films was determined (91% were approved, while only 9% needed any type of adjustment). This newly developed system provides the extra step, treatment accuracy, that no other device has done.

Dental Impression Technique↗
PubMed1988

Evaluation of unplanned interruptions in radiotherapy treatment schedules.

One of the major radiobiological interests has been to maximize the effectiveness of the time-dose relationship in the clinical setting. Current explorations include altered fractionation schedules, multiple daily fractions and hypofractionation. Patient compliance to standard radiotherapy treatment schedules is taken for granted. To evaluate the true rate of compliance, the charts of all new patients treated from July 1, 1984 through June 30, 1985 were reviewed. The overall incidence of unplanned interruptions was 54% (361/668). The frequency of interruptions is significantly higher in patients treated to the primary site as compared to those treated for metastasis (59.8% and 35.6% respectively). The duration of the interruptions varied: 12.7% of the patients missed only 1 day, 25% missed 2 to 5 days, 38% had interruptions totalling 6-15 days, and in 24% the total exceeded 15 days. The most frequent cause of the unplanned interruptions was a rest resulting from unusually adverse tissue reactions (46.8%-169/361). Although this study has documented that unplanned interruptions are a major problem, the impact on local control and survival cannot be determined from our data. A retrospective review of multi-institutional studies such as those conducted by the Patterns of Care or RTOG might show that one of the major causes of failure is unplanned interruptions.

Humans↗
PubMed1988

Primary gastric lymphoma and pseudolymphoma.

Eighteen patients with primary gastric lymphomas and two with pseudolymphomas treated at the University of Louisville affiliated hospitals were analyzed in order to develop a more precise understanding of these rare diseases. Abdominal pain and weight loss were the most common initial symptoms. Only one patient presented with an abdominal mass. Upper GI series were helpful but failed to show a definite abnormality in two of 18 cases. Endoscopic examinations in all 18 were compatible with malignancy on gross finding, but six out of 15 endoscopic biopsies were not conclusive. All four cases, which proved fatal in less than two years, showed serosal invasion and diffuse histological pattern. On the basis of our analysis, we suggest that in patients with abdominal pain and weight loss of more than two months duration an aggressive course of evaluation should include upper gastrointestinal x ray and repeated endoscopic biopsy. If symptoms persist, laparotomy and biopsy may be warranted even if endoscopic biopsy shows no neoplasm. Curative surgery is the treatment of choice, but radiation therapy should be added in patients with serosal involvement. Very careful histological assessment of pseudolymphomas is necessary, because they may contain malignant lymphoma.

Adult↗
PubMed1985

Rhabdomyosarcoma of the biliary tree in childhood. A report from the Intergroup Rhabdomyosarcoma Study.

Ten cases of rhabdomyosarcoma of the biliary tree (RMS/BT) in children are reported in this review of the Intergroup Rhabdomyosarcoma Study (IRS) I and II. RMS/BT constitutes 0.8% of evaluable tumors on IRS I and II. Intermittent obstructive jaundice with or without abdominal distention, fever, and loss of appetite is the typical presentation. Attribution of these symptoms to hepatitis commonly delayed definitive treatment. Demonstration of a mass in the porta hepatitis by ultrasound led quickly to surgical consultation and an exploratory laparotomy. Intraoperative cholangiography was a valuable technique in establishing the level of biliary tree obstruction and verifying a functioning drainage procedure. Resection of the mass with only microscopic or minimal gross residual disease was possible at the initial surgery in six of the ten patients. Included in this group are all four of the surviving patients. The continuity of bile flow was usually maintained by variations of a Roux-en-Y jejunostomy. Histology was embryonal RMS with some botryoid elements. Consultation with a surgical pathologist during the course of the surgery was of invaluable assistance. Multi-drug chemotherapy and radiotherapy consistent with the IRS protocols were given postoperatively. A second-look surgery was useful in evaluating residual or recurrent disease. Four patients are surviving free of disease at 6 months, 3, 6 1/4, and 6 1/2 years from diagnosis, respectively. This review demonstrates that a multidisciplinary approach in RMS/BT can lead to long-term survival.

Bile Duct Neoplasms↗
PubMed1979

Management and results of localized Ewing's sarcoma.

Seventy-six patients with localized Ewing's sarcoma who received primary treatment at M.D. Anderson Hospital from 1948 through December 1975 were reviewed. Patients have been divided into four groups according to the different treatment regimens they received: Group I, moderate dose radiotherapy alone; Group II, high dose radiotherapy alone; Group III, radiotherapy plus vincristine and cytoxan; and Group IV, radiotherapy plus vincristine, Adriamycin, cytoxan and actinomycin. The problem of local recurrence appears to be solved with combined chemotherapy and radiation therapy with only one of 36 patients having a recurrence at the primary site in Groups III and IV. Multimodal therapy is the preferred treatment to obtain control of the primary lesion by radiation therapy while preserving good function. However, the major cause of failure remains distant metastases, 19 of 36 (53%) in Groups III and IV. In addition, 4 of 10 patients who have survived over 5 years have developed osteogenic sarcoma.

Antineoplastic Agents↗
PubMed1979

Solitary plasmacytoma of bone vs. extramedullary plasmacytoma and their relationship to multiple myeloma.

Solitary plasmacytoma of bone (SPB) and extramedullary plasmacytoma (EMPC) are unusual solitary tumors of plasma cell origin. The clinical differences between these tumors and multiple myeloma are the subject of continued study. This review examines the radiotherapy experience at M. D. Anderson Hospital. Between 1948 and 1977, 12 patients with SPB and 12 patients with EMPC were treated with radiotherapy. Radiotherapeutic doses were most often (22/24) greater than 4,000 rads, at 200 rads per day. In order to qualify as solitary plasmacytoma a disease-free interval of 3 years was required. In the group of SPB, 5 patients of 9 were alive with no evidence of disease (NED) at 3 years, 4 of 5 at 5 years, and none of 4 at 10 years. In the EMPC group, 8 patients of 11 were NED at 3 and 5 years, and 6 of 9 at 10 years. Six patients with SPB developed multiple myeloma compared with only two with EMPC. The results confirm the better prognosis of EMPC and support the theory that SPB and EMPC are two different entities.

Adolescent↗
PubMed1979

Parameningeal rhabdomyosarcoma.

The records of 27 patients with rhabdomyosarcoma involving the parameningeal area (nasopharynx, paranasal sinus, and middle ear) treated from 1961 to 1976 were reviewed. Due to the location of the primary tumor, radiation and chemotherapy were used but surgery was limited to simple biopsy. In the literature, spread of tumor from these primary sites to the meninges has been as high as 26-35%. In this series, meningeal disease developed in only 2 of the 27 patients (7%).

Adolescent↗
PubMed1978

The role of irradiation in the management of head and neck cancer: analysis of results and causes of failure.

The records of patients with squamous cell carcinoma of the oral cavity, oropharynx, supraglottic and glottic larynx, whose primary lesion was treated with radiation therapy from 1964 through 1973, were reviewed. End points of the study are local control rate at the primary site, ultimate control with surgical salvage, and causes of failure. The local control rate at the primary site was 90% for T1 lesions, 80% for T2 lesions, and approximately 70% for selected T3 lesions. The control rates for the advanced T3 and T4 lesions are unsatisfactory; therefore, preoperative or postoperative irradiation is combined with appropriate surgical procedures to improve the local control rates and in some instances survival rates. Analysis of cervical node metastases treatment shows that the incidence of local recurrence in the radically dissected neck can be significantly reduced with either pre- or postoperative irradiation. Elective irradiation of initially clinically uninvolved areas of the neck (both ipsilateral and contralateral) has almost eliminated subsequent nodal metastases.

Carcinoma, Squamous Cell↗
PubMed1977

Soft-tissue sarcoma of the head and neck after puberty.

The most frequent soft-tissue sarcomas in the head and neck are are embryonal rhabdomyosarcomas and neurofibrosarcomas. Histological grading and the staging of the lesions bear on the prognosis of the disease. The use of sequential surgical resection plus postoperative radiation therapy has considerably improved the local control of these sarcomas. The use of multiple-drug systemic chemotherapy as an adjuvant to radiation therapy is fraught with considerate complications in this seris of patients. Studies are ongoing for a better understanding of the immunologic changes that occur in patients with sarcoma.

Adult↗
PubMed1977

Hyperbaric oxygen as a radiotherapeutic adjuvant in advanced cancer of the uterine cervix: preliminary results of a randomized trial.

From September 1968 to March 1974, a randomized clinical trial was carried out, using conventional fractionation, i.e., five treatments per week, in 233 patients with advanced cancers of the uterine cervix--Stages IIB, IIA, IIIB and IVA. The age limit was 70 years and all patients had medical clearance. Lymphangiography and, in some patients, an exploratory laparotomy with selective lymphadenectomy, were done prior to treatment to determine the extent of nodal disease. The staging has not been changed either by lymphangiogram or lymphadenectomy findings. A few patients with bulky Stage I and IIA lesions were entered into the trial because of extensive nodal disease demonstrated either by lymphangiogram and/or lymphadenectomy. First, the patients were grouped according to the clinical stage. The secondary stratification was according to the lymphangiogram and/or selective lymphadenectomy findings. The patients were then randomized to air or hyperbaric oxygen within each group. The patients were pressurized in a Vickers chamber at 3 atmosphere absolute, using a 20-minute soak time prior to the irradition. The size of the external beam portal was determined by the status of the nodes. The difference in absolute NED (no evidence of disease) survival rates for both groups as a whole and by stages is not statistically significant. There is no difference in the incidence of failures in the irradiated area between the HPO and air patients. There is no increase in distant metastases in the HP group. It does not seem that the HPO has had an effect on the major complications. However, there was an increase in the incidence of complications with extended fields. The addition of lymphadenectomy had increased the incidence of fatal complications, even with routine pelvic portals. The negative results of this trial with conventional fractioantion should not lead to the conclusion that HPO could not be useful with schemes using a few high dose fractions.

Adult↗