Biomedical subjects

R Dodge

Publications and source records attributed to R Dodge.

At least 19 recordsLinked to original sources

PubMed2005

Effects of HZE particle on the nigrostriatal dopaminergic system in a future Mars mission.

Because of long duration travel outside the Earth's magnetic field, the effect of iron-rich high charge and energy (HZE) particles in Galactic Cosmic Rays on human body is the major concern in radiation protection. Recently attention has been directed to effects on the central nervous system in addition to mutagenic effects. In particular, a reduction in striatal dopamine content on nigrostriatal dopaminergic system has been reported by investigators using accelerated iron ions in ground-based mammalian studies. In addition, studies of the pathophysiology of Parkinson's disease demonstrated that excess iron cause a reduction in the dopamine content in the substantia nigra. This suggests an intriguing possibility to explain the selective detrimental effects of HZE particles on the dopaminergic system. Should these particles have biochemical effects, possible options for countermeasures are: (1) nutritional prevention, (2) medication, and (3) surgical placement of a stimulator electrode at a specific anatomic site in the basal ganglia.

Animals↗

PubMed2001

Pneumatic compression versus low molecular weight heparin in gynecologic oncology surgery: a randomized trial.

OBJECTIVE: To compare the efficacy and treatment-related complications of low molecular weight heparin and external pneumatic compression in the prevention of venous thromboembolism of postoperative gynecologic oncology patients. METHODS: A total of 211 patients over age 40 years, undergoing a major operative procedure for gynecologic malignancy, were randomized to receive perioperative thromboembolism prophylaxis with either low molecular weight heparin (n = 105) or external pneumatic compression (n = 106). Demographic data and clinical outcome were recorded for each patient. All patients underwent bilateral Doppler ultrasound of the lower extremities on postoperative days 3-5 to evaluate for the presence of occult deep vein thrombosis. A follow-up interview 30 days after surgery sought to detect patients who developed deep vein thrombosis or pulmonary embolism after hospital discharge. RESULTS: Venous thrombosis was diagnosed in two patients receiving low molecular weight heparin and in one patient receiving external pneumatic compression. The frequency of bleeding complications, measured by the number of required perioperative transfusions, and estimated intraoperative blood loss was similar between the two groups. CONCLUSION: Low molecular weight heparin and external pneumatic compression are similarly effective in the postoperative prophylaxis of thromboembolism. The use of low molecular weight heparin is not associated with an increased risk of bleeding complications when compared with external pneumatic compression. We believe that both modalities are reasonable choices for prophylaxis in this high-risk group of patients.

Adult↗

PubMed2000

Radiotherapy for a rising prostate-specific antigen after radical prostatectomy: the first 10 years.

PURPOSE: To determine the results of radiotherapy (RT) to the prostate bed for a presumed local recurrence heralded by a rising prostate-specific antigen (PSA) after radical prostatectomy (RP) for adenocarcinoma of the prostate. METHODS AND MATERIALS: From 1987 to 1997, 89 patients were treated by the senior author (M.S.A.) with RT to the prostate bed for a rising PSA after RP. No patients had clinical or radiographic evidence of local or distant disease. The RT technique was usually a 4-field box with fields shaped to protect normal tissues. Of the 89 patients, 36 (40%) were treated using three-dimensional conformal RT (3DRT) using beam's eye view technique; the remaining 53 patients (60%) were irradiated using a standard two-dimensional approach. The median dose was 66 Gy. Patients were followed at 3- to 6-month intervals after completing RT with a history, physical examination, and PSA. Late normal tissue toxicity was scored using Radiation Therapy Oncology Group (RTOG) criteria. An undetectable PSA was required to be considered free of prostate cancer (NED). RESULTS: Eighty-seven percent of patients had pathologic stage III/IV disease. Three patients had lymph node involvement. The median PSA prior to RT was 1.4 ng/mL. The median Gleason score was 7. Of the 89 patients, 64 (72%) became NED. Of these 64 patients, 47 (73%) remain NED at last follow-up (median follow-up = 48 months). The estimated 4-year disease-free survival (DFS) for all patients is 50%. The DFS at 4 years was 61% for the 3DRT patients vs. 41% for those treated without 3DRT (p = 0.006). Late complications (Grade 1/2 only), however, were significantly more common in the 3DRT group. On multivariate analysis, only dose > 65 Gy predicted for better DFS. CONCLUSIONS: Pelvic RT may achieve sustained remission of prostate cancer for about half of patients with a rising PSA after RP, at least in the intermediate term. Doses > 65 Gy are recommended. 3DRT may offer improved disease-free survival over non-3D approaches, however, this issue requires further study.

Adenocarcinoma↗

PubMed2000

Uterine smooth muscle tumors: utility of classification by proliferation, ploidy, and prognostic markers versus traditional histopathology.

CONTEXT: Accurate categorization of uterine smooth muscle neoplasms by light microscopic examination is difficult. Multiple classification schemes have been proposed based on mitotic rate, nuclear atypia, and the presence or absence of necrosis. None of these classification systems has been entirely successful. Multiple ancillary techniques have been tested for their ability to predict behavior of uterine smooth muscle tumors. OBJECTIVE: We assayed 45 smooth muscle neoplasms for a variety of proliferation markers, oncogene protein products, and DNA ploidy level to determine if these markers supplied prognostically useful information over and above that obtained by routine light microscopic assessment. STUDY DESIGN: Forty-five uterine smooth muscle neoplasms were assessed for DNA ploidy; silver-staining nucleolar organizer regions (AgNORs); percent nuclear proliferating cell nuclear antigen (PCNA); expression of p53, Her-2/neu, and MDM-2 protein; mitotic rate; and nuclear grade. These markers were correlated with histologic diagnosis and the occurrence of a clinically adverse event (death, metastasis, or recurrence). RESULTS: Diagnostic category (P <.001), nuclear grade (P <.002), mitotic activity (P <.001), mean AgNORs (P <.001), percent nuclear PCNA (P =.02), and expression of p53 (P =.02) all correlated with clinical outcome. No statistically significant correlation between clinical outcome and the categories MDM-2 expression, Her-2/neu expression, or DNA ploidy was seen. Nuclear grade, p53 expression, mitotic rate, AgNORs, and percent nuclear PCNA correlated with diagnosis. CONCLUSIONS: Diagnostic category, mitotic rate, AgNOR counts, PCNA, and p53 expression dichotomized uterine smooth muscle neoplasms into prognostically favorable and unfavorable groups. Although highly significant, the category AgNORs was no more successful than mitotic rate in dividing uterine smooth muscle neoplasms into prognostically favorable and unfavorable groups. Expression of p53 and percent nuclear PCNA dichotomized uterine smooth muscle neoplasms into prognostic groups, but neither technique reached the level of significance achieved by mitotic rate. Our data indicate that mitotic rate and the classification system of Kempson and Bari are at least as effective as the tested markers in separating uterine smooth muscle neoplasms into prognostic categories.

Aneuploidy↗

PubMed1998

Mucin gene expression in ovarian cancers.

Ovarian cancer is a highly lethal disease with metastases present in the majority of patients at the time of diagnosis. The molecular mechanisms underlying the metastatic process of this cancer are not well understood. One family of cell-associated and secreted glycoproteins, the mucin glycoproteins, has been implicated in events leading to metastasis of several epithelial cancers including gastrointestinal and lung cancers. The purpose of this study was to characterize mucin gene expression in ovarian cancers and relate expression to tumor histology, stage, and patient survival. RNA was isolated from 29 epithelial ovarian cancers, 1 neuroendocrine carcinoma, 3 mixed mesodermal tumors, and two transformed, yet nonmalignant, ovarian epithelial cell lines. The expression of mucin genes, MUC1, 2, 3, 4, 5AC and 5B, was determined by northern analyses. Epithelial ovarian cancers expressed several mucins including MUC1, 2, 4, and 5AC; MUC3 and 5B were rarely expressed. In contrast, the transformed nonmalignant ovarian epithelial cell lines expressed only MUC1 and 5AC. Although there was no correlation of mucin expression with tumor histology, there was a significant decrease in expression of MUC3 and MUC4 with increasing cancer stage (P < 0.05). In addition, a trend toward improved patient survival occurred with increased expression of MUC4. These observations suggest a relationship between mucin gene expression and the metastatic process in epithelial ovarian cancers. Additional investigation of MUC3 and MUC4 in ovarian cancers may lead to new approaches for early detection and therapy.

Blotting, Northern↗

PubMed1998

Fine-needle aspiration: comparison of smear, cytospin, and cell block preparations in diagnostic and cost effectiveness.

We compared the results of smears to those of cytospin and cell block preparations from fine-needle aspirations to determine the cost effectiveness of each and to determine which should be routinely obtained. We reviewed 844 cases, 361 of which had both smears and cytospins, and 483 of which had both smears and cell blocks. Smears alone were diagnostic in 94% of cases (796/844 cases), cytospins alone diagnostic in 43% of cases (154/361 cases), and cell blocks alone diagnostic in 57% of cases (277/483 cases). Cytospins contributed additional information beyond that obtained from smears in 2% (7/361) and cell blocks in 12% (57/483) of cases. When smears were nondiagnostic, cytospins contributed additional information in 10% (2/21) of cases and cell blocks contributed additional information in 44% (12/27) of cases. The cost of providing a diagnosis from smear alone is $212, from cytospin alone is $352, and from cell block alone is $392. The cost for additional information established by cytospin is $7,736 and by cell block the cost is $1,906. Smears are superior to either cytospins or cell blocks in providing a diagnosis. It is not cost-effective to obtain either cytospins or cell blocks in addition to smears on all cases. However, it is cost-effective to obtain cell blocks when the immediate smear evaluation is nondiagnostic.

Biopsy, Needle↗

PubMed1997

Long-term follow-up of Cancer and Leukemia Group B studies in acute myeloid leukemia.

BACKGROUND: During the past 3 decades, the Cancer and Leukemia Group B (CALGB) has conducted numerous large clinical trials in adult patients with acute myeloid leukemia. METHODS: Updated data were obtained for 9 trials initiated by the CALGB between 1974 and 1992. The updated data were compared with the original published results. RESULTS: It was apparent from all the studies that hazard rates for death and relapse are greatest in the first year, decrease substantially between Years 1 and 2, then decrease further between Years 2 and 3. Rates of death and relapse are quite low after 3-4 years. Large numbers of patients are long-term disease free survivors. Overall, these patients have excellent function and a normal quality of life. CONCLUSIONS: Patients with AML who are in complete remission for 3-4 years can be assured that late relapse and death are relatively uncommon events. It is inadvisable to publish results of large studies until this minimal level of follow-up has been reached.

Acute Disease↗

PubMed1997

Replication-defective canarypox (ALVAC) vectors effectively activate anti-human immunodeficiency virus-1 cytotoxic T lymphocytes present in infected patients: implications for antigen-specific immunotherapy.

In the attempt to develop immunotherapeutic strategies for acquired immunodeficiency syndrome capable of activating effector cells in an antigen-specific manner while maintaining the broadest possible T-cell repertoire, we evaluated two canarypox (ALVAC)-based vectors for their capacity to induce ex vivo activation/expansion of human immunodeficiency virus (HIV)-specific CD8+ cytotoxic lymphocyte precursors (CTLp) obtained from HIV-1-infected donors. These two vectors, vCP205 encoding HIV-1 gp120 + TM (28 amino acid transmembrane anchor sequence) in addition to Gag/protease and vCP300 encoding gp120 + Gag/protease as well as Nef and Pol CTL determinants, are pancytotropic but replication incompetent in mammalian cells. Bulk peripheral blood mononuclear cells (PBMCs) or enriched CD8+ T cells were stimulated for 10 days with autologous ALVAC-infected PBMCs in the presence of different cytokine combinations (interleukin-2 [IL-2], IL-4, IL-7, and IL-12). Activation by ALVAC constructs was highly antigen-specific, because vCP205 elicited only Env and Gag CTL, whereas vCP300 elicited broader reactivities against Env, Gag, Pol, and Nef determinants. The ALVAC activation of CTLp was IL-2 dependent and enhanced by the addition of IL-7, whereas IL-4 and IL-12 failed to augment cytotoxic reactivities elicited by these constructs. The expansion of enriched CD8+ T cells after activation with vCP300 was higher in patients with CD4 counts greater than 400 cells/microL. Two rounds of in vitro stimulation (IVS) with vCP300 resulted in nearly an eightfold expansion of CD8+ lymphocytes over a 25-day period. After the second IVS, an average 3.2-fold increase among the different antigen-specific CTL frequencies was achieved. These studies clearly show that HIV-recombinant ALVAC vectors represent powerful polyvalent antigenic stimuli for activation and expansion of the CD8 lymphocyte response that occurs as a result of HIV infection.

Adult↗

PubMed1997

Combined external beam irradiation and external regional hyperthermia for locally advanced adenocarcinoma of the prostate.

PURPOSE: To determine the safety and efficacy of combined external beam irradiation and external regional hyperthermia in the treatment of adenocarcinoma of the prostate. METHODS AND MATERIALS: From 1987 to 1994, 30 patients received combined external beam irradiation and external regional hyperthermia for locally advanced prostate cancer. The results of the 21 patients with newly diagnosed (n = 18) or locally recurrent (n = 3) adenocarcinoma are reported herein. No patient had evidence of distant metastases. Total radiotherapy doses of 65-70 Gy to the prostate were planned using a four-field box technique. Hyperthermia treatments were delivered using an annular phased array microwave device. The treatment goal was to achieve temperatures > or = 42 degrees C in all measured points within the prostate. RESULTS: Of the newly diagnosed patients, 16 out of 18 (89%) had T3 or T4 tumors, 11 out of 18 (61%) had Gleason scores of 7-9, and the mean pretreatment Prostate Specific Antigen (PSA) was 69 ng/ml. The median follow-up of all 21 patients was 36 months. None of the patients achieved the treatment goal of all intratumoral temperatures > or = 42 degrees C. The mean CEM 43 T90 was 2.34 min. The disease-free survival at 36 months is 25%; 12 out of 18 (67%) of the patients have relapsed. The only significant predictor of relapse was pretreatment PSA. There were no complications > Grade 3. CONCLUSIONS: In spite of the inability to achieve high tumor temperatures, the relapse-free survival rate in this population of patients with very advanced localized prostate cancer treated with radiation therapy plus hyperthermia compares favorably with most series using radiation therapy alone. Further studies aimed at improving the ability to deliver hyperthermia to the prostate are warranted.

Adenocarcinoma↗

PubMed1997

Racial disparity in overexpression of the p53 tumor suppressor gene in stage I endometrial cancer.

OBJECTIVE: This study was conducted to determine whether overexpression of the p53 tumor suppressor gene is associated with poor outcome in early-stage endometrial cancers and whether a racial difference in the frequency of p53 overexpression contributes to the observed racial disparity in survival rates. STUDY DESIGN: Immunostaining for the p53 gene was performed in 164 women with stage I endometrial adenocarcinomas. RESULTS: Overexpression of mutant p53 protein was seen in 28 out of 164 (17%) cases and was associated with a poor histologic grade (p = 0.003) and a nonendometrioid histologic appearance (p = 0.06). Overexpression also was three times more frequent in blacks (15 out of 44, 34%) than in whites (13 out of 117, 11%) (p = 0.003). Recurrent disease developed in 15 out of 164 (9%) cases and was more than twice as frequent in cases when the p53 gene was overexpressed (5 out of 28, 18%) than in cases with normal expression (10 out of 136, 7%). Recurrent disease was seen in 6 out of 44 (14%) blacks compared to 9 out of 117 (8%) whites. CONCLUSIONS: These data support the hypothesis that differences in the frequency of alteration of the p53 tumor suppressor gene contribute to the racial disparity in endometrial cancer survival.

Adenocarcinoma↗

PubMed1997

Cervical intraepithelial neoplasia in HIV-infected women in a southeastern US population.

The objectives of our study were to determine the prevalence of cervical intraepithelial neoplasia (CIN) in a southeastern human immunodeficiency virus (HIV)-positive population relative to an HIV-negative control group and to compare these findings with published reports from other geographic regions. Demographic, medical, and cytopathologic data were collected on 89 HIV-positive women receiving care at the Duke Adult Infectious Disease Clinic. Comparisons were made with 100 HIV-negative obstetric patients who delivered at Duke and with published reports from other regions of the United States and abroad. Cervical intraepithelial neoplasia was present in 43 (49%) of 87 HIV-positive women compared with 23% of the 100 HIV-negative patients. Two of the HIV-positive patients had invasive cancer. Comparison of these patients with patients from other geographic regions revealed similar odds ratios for the presence of CIN in HIV-positive patients compared with HIV-negative patients. These results suggest a significantly increased risk for cervical dysplasia in HIV-positive women in this southeastern population.

Adult↗

PubMed1996

p53 overexpression in advanced-stage endometrial adenocarcinoma.

OBJECTIVES: Mutation and overexpression of the p53 tumor suppressor gene in endometrial cancers are associated with advanced stage and poor survival. We sought to determine whether p53 overexpression is an independent variable predictive of poor prognosis in advanced endometrial adenocarcinomas. STUDY DESIGN: Immunohistochemical evaluation was used to examine p53 expression in paraffin blocks from 179 endometrial adenocarcinomas. RESULTS: p53 overexpression was seen in 35% of cancers and was associated with higher stage (p = 0.004), black race (p < 0.001), higher grade (p = 0.02), lack of hormone replacement (p = 0.04), and older age (p = 0.05). In addition to a higher frequency of p53 overexpression (57% vs 26%), black women had a lower survival rate than white women (p = 0.001), but overexpression was associated with poor survival in both races. After we corrected for hormone use, multivariate analysis revealed that older age (p < 0.001), higher stage (p < 0.001), higher grade (p = 0.01), and p53 overexpression (p = 0.04) were predictive of poor survival. CONCLUSIONS: Overexpression of p53 in advanced-stage endometrial cancers is an independent variable that is associated with poor survival, occurs more frequently in black women, and may contribute to the racial disparity in survival.

Adenocarcinoma↗

PubMed1996

Preoperative evaluation of macrophage colony-stimulating factor levels in patients with endometrial cancer.

OBJECTIVE: Our purpose was to examine the relationship between preoperative serum levels of macrophage colony-stimulating factor, alone and in combination with CA 125, and the presence of prognostic clinicopathologic factors and subclinical metastases in women with endometrial cancer. STUDY DESIGN: Ninety-two women who underwent primary exploration for endometrial adenocarcinoma had preoperative serum samples evaluated for macrophage colony-stimulating factor and CA 125 levels. Multivariate analysis was used to determine the associations of surgicopathologic findings with macrophage colony-stimulating factor and CA 125 levels. Logistic regression analysis was used to identify factors associated with the risk of extrauterine disease. The association of macrophage colony-stimulating factor and CA 125 levels with stage, grade, and depth of myometrial invasion and histologic characteristics were analyzed with Fisher's two-tailed exact test. RESULTS: Elevated levels of macrophage colony-stimulating factor were not associated with depth of myometrial invasion, histologic grade, or histologic cell type; however, advanced stage (p = 0.02) and the presence of lymph node metastases (p = 0.04) were associated with elevated levels. Sensitivity and specificity of macrophage colony-stimulating factor for predicting extrauterine disease were 42% and 89%, respectively. If either an elevated macrophage colony-stimulating factor or an elevated CA 125 level was used to predict extrauterine disease, the sensitivity was increased to 67% but the specificity was decreased to 78%. Macrophage colony-stimulating factor elevations predicted lymph node metastases with a sensitivity of 50% and a specificity of 86%. A multivariate regression model showed CA 125 to be the most significant predictor of extrauterine disease; macrophage colony-stimulating factor also contributed prognostic information (p = 0.02). The sensitivity and specificity of the multivariate model for predicting extrauterine disease were 75% and 73%, respectively. CONCLUSION: Macrophage colony-stimulating factor and CA 125 are neither sensitive nor specific enough to be used as predictors of the presence or absence of extrauterine disease in patients with endometrial cancer.

Adenocarcinoma↗

PubMed1996

Early childhood respiratory symptoms and the subsequent diagnosis of asthma.

BACKGROUND: Respiratory symptoms are frequent in very young children, and the relation of these symptoms to later asthma in some of these children is unknown. OBJECTIVE: The aim of the study was to describe the natural history of respiratory symptoms in a community-based sample of young children who were prospectively observed for as long as 11 years. METHODS: Subjects were participants in the Tucson Epidemiologic Study of Airways Obstructive Disease. They were under 5 years of age at enrollment and were studied by means of a parent-administered mail survey instrument every 1 to 2 years for 3 to 11 years. RESULTS: Among subjects younger than 1 year of age, no single respiratory symptom, such as cough or wheeze only with colds, significantly increased the risk of a subsequent diagnosis of asthma. Among 1- and 2-year-olds, however, those with wheeze only with colds and those with attacks of shortness of breath with wheeze were more likely to be diagnosed with asthma later when compared with children without those symptoms (odds ration = 2.1; p < 0.05 for wheeze only with colds). At ages 3 to 4 years, symptoms were even more strongly associated with subsequent asthma (odds ratio = 7.2; p < 0.0001 for attacks of shortness of breath with wheeze). CONCLUSION: Although respiratory symptoms reported by parents very early in life are not significantly associated with future asthma, those symptoms that begin at or persist through ages 3 to 4 years are.

Adolescent↗

PubMed1995

Inhibition of radiation-induced up-regulation of leukocyte adhesion to endothelial cells with the platelet-activating factor inhibitor, BN52021.

PURPOSE: The inflammatory process is likely involved in normal tissue damage after radiation exposure, yet few studies have directly evaluated the factors that might be involved in the regulation of inflammation after irradiation in vivo. We tested the hypothesis that platelet-activating factor, a neutrophil agonist synthesized by endothelial cells, is involved in the upregulation of radiation-induced leukocyte-endothelial cell interactions by using an inhibitor of its receptor, BN52021. METHODS AND MATERIALS: Fischer-344 rats with dorsal skin-fold window chambers were randomized to three experimental groups: control (sham irradiation); 6 Gy radiation; and 6 Gy + BN52021. BN52021 (0.5 mg/kg) was administered 5 min prior to 6 Gy radiation. Leukocytes were stained in vivo with i.v. acridine orange for visualization with fluorescent microscopy. Venous vessel diameters were measured and number of rolling leukocytes were counted per 30-s period. The number of adhering leukocytes per unit surface area was also determined. Differences among the three experimental groups for rolling and adhering leukocytes were analyzed using a mixed-effects linear model with vessel shear rate used as a covariate. Results are reported as means +/- standard errors. RESULTS: Irradiation caused upregulation of leukocyte rolling, as compared with sham-treated controls (p = 0.04): the BN compound in addition to radiation did not downregulate this effect. Irradiation also upregulated leukocyte adhesion (p < 0.001), but the addition of BN52021 prior to irradiation blocked this effect. The drug did not affect heart rate or blood pressure. CONCLUSIONS: These results support the hypothesis that radiation-induced upregulation of leukocyte adhesion is mediated by platelet-activating factor. These results are consistent with prior reports that platelet-activating factor is not involved in leukocyte rolling, which involves separate families of adhesion molecules from those that regulate adhesion. BN52021, a ginkolide, or other related drugs might provide a useful pharmacological means to prevent or ameliorate inflammatory pathways that are invoked after radiation exposure.

Animals↗

PubMed1995

The natural history of insomnia and its relationship to respiratory symptoms.

BACKGROUND: Although insomnia is a frequent complaint among patients, epidemiologic study has been limited. Researchers have reported a wide range in the prevalence of this complaint in a variety of selected populations. Other parameters, such as incidence and remission rates, have not been reported. METHODS: Subjects of the Tucson (Ariz) Epidemiologic Study of Obstructive Lung Disease were asked questions about trouble sleeping in the 1984-1985 (survey I) and 1990-1992 (survey II) surveys. Answers were analyzed along with responses to questions about age, sex, respiratory symptoms, and drug and alcohol use for sleep. RESULTS: The prevalence of insomnia was similar in both surveys, 34.4% in survey I and 34.1% in survey II. Women had a higher prevalence of insomnia than men in both surveys, and insomnia was more common among older subjects (50.6% of the women aged 65 years or older had insomnia in survey II). In addition, the incidence of new insomnia in survey II was higher in the same groups. Grouping subjects by respiratory symptoms, we found that the prevalence of insomnia was significantly related to cough, dyspnea, or wheeze. Furthermore, subjects with persistent or new respiratory symptoms at survey II were less likely to have remission of insomnia by that survey (31.6% vs 51.5%; P < .05; odds ratio, 0.43) and more likely to develop new insomnia (28.6% vs 14.5%; P < 05; odds ratio, 2.36) than subjects with either no symptoms or disappearance of their symptoms by survey II. CONCLUSIONS: In our population, insomnia is a common dynamic complaint whose frequency waxes and wanes in association with respiratory symptoms.

Adult↗

PubMed1995

Postsurgical surveillance of patients with FIGO stage I/II endometrial adenocarcinoma.

OBJECTIVE: To examine the effect of postsurgical surveillance on survival of patients with FIGO stage I/II endometrial adenocarcinoma. METHODS: We examined the records of 354 patients who underwent primary surgical therapy for FIGO stage I/II endometrial adenocarcinoma. In patients who developed recurrent disease, we determined whether symptoms or signs of disease were present at recurrence and whether there was evidence of disease on Pap smear or chest radiograph. RESULTS: Among the 354 patients in this study, 44 (12%) developed recurrent disease. Sites of recurrence included 12 (27%) isolated vaginal, 12 (27%) pelvic with vagina or abdomen, 4 (10%) isolated lung, 13 (29%) pelvic/abdominal with other distant sites, and 3 (7%) other distant sites. At diagnosis of recurrence 61% of patients had symptoms related to their cancer, 68% had physical exam findings suggestive of recurrence, and 84% had symptoms and/or signs. Findings consistent with recurrent cancer were detected by Pap smear in 25% and on chest radiograph in 20%. Among the 44 patients who developed recurrent disease, 8 (18%) remain alive without evidence of disease, including 6/12 (50%) with isolated vaginal disease and 2/34 (6%) with other patterns of recurrent disease (P = 0.01). Among the 12 patients with isolated vaginal recurrence, 1/3 (33%) in whom recurrent disease was diagnosed by Pap smear alone was salvaged compared to 5/9 (56%) who had symptoms or signs of vaginal recurrence. None of the three patients in whom an abnormal chest radiograph was the only evidence of recurrence survived. CONCLUSIONS: Because of the low recurrence rate of FIGO stage I/II endometrial cancer and the paucity of effective second-line treatment, surveillance Pap smears and chest radiographs appear to have little impact on survival. Although few asymptomatic potentially curable recurrences were detected due to surveillance examinations, the value of psychological reassurance associated with a normal examination is difficult to quantitate.

Adenocarcinoma↗

PubMed1995

Low incidence of TAL1 gene rearrangements in adult acute lymphoblastic leukemia: A cancer and leukemia group B study (8762)

TAL1 gene rearrangements have been described in approximately 25% of children with T cell acute lymphoblastic leukemia (ALL). Three percent of these rearrangements are the result of a reciprocal translocation, t(1;14)(p34;q11). The remainder of these rearrangements are submicroscopic and involve a nearly precise 90-kilobase pair deletion of the TAL1 gene. Detection of these submicroscopic rearrangements can be accomplished easily using Southern blot and PCR technology and may have potential value for monitoring disease during and following treatment. The incidence of TAL1 gene rearrangements in adults with ALL is unknown. In this pilot study, we performed Southern blot and PCR analysis in a group of newly diagnosed adult ALL patients to determine the incidence of TAL1 rearrangements. Thirty-three adults with T cell ALL were studied; of these, one patient had a t(1;14)(p34;q11) and molecular rearrangement of TAL1. No submicroscopic deletions of TAL1 were detected (95% confidence intervals, 0.000 and 0.106). Unlike pediatric T cell ALL, the incidence of TAL1 rearrangements in adult ALL appears to be very low.

Journal Article↗