PubMed Health⌕ Search

Biomedical subjects

R E Cupps

Publications and source records attributed to R E Cupps.

At least 19 recordsLinked to original sources
PubMed1995

Extramedullary hematopoiesis manifesting as a symptomatic pleural effusion.

The occurrence of extramedullary hematopoiesis in the pleura is rare and is usually asymptomatic. It is generally diagnosed on postmortem examination. Herein we describe a 61-year-old woman with agnogenic myeloid metaplasia who sought medical assessment because of progressive dyspnea. Thoracentesis yielded sanguineous fluid with 10% myeloblasts. A 99mTc bone marrow scan demonstrated increased tracer activity throughout both lungs, an outcome consistent with extramedullary hematopoiesis. Fine-needle aspiration and video-assisted thoracoscopy were considered but deferred because of the potential risk of profuse bleeding. Treatment with low-dose external beam irradiation to the left posterior pleura was successful. To date, no hemothorax has recurred.

Female↗
PubMed1994

Definitive therapy for prostate carcinoma: Mayo Clinic results at 15 years after treatment.

Data on long-term follow-up for definitive therapy of prostate cancer are limited, especially for radiation therapy. Either surgery or radiation was used in 322 patients for treatment with curative intent, and follow-up was for a minimum of 15 years. Overall survival was nearly identical to that in age-matched cohort. 5-, 10-, and 15-year recurrence-free survival rates were 77%, 63% and 53%, respectively. Grade and stage were significant prognostic factors for both recurrence and survival. More than 60% of the initial failures were local, and more than 25% of the failures occurred after 10 years. Radiation therapy was used in 137 patients with clinically staged disease. Radical retropubic prostatectomy and perineal prostatectomy were performed in 133 and 44 patients, respectively. In this group, pathological staging was used. Survival rates for surgically treated patients were better than those in the cohort population. In conclusion, overall long-term follow-up demonstrates that definitive treatment does not have an adverse effect on survival from prostate cancer. Local recurrence is a frequent cause of failure. Caution must be used in interpreting any prostate study with less than 10 years of follow-up, because 25% to 50% of the failures occur after that time.

Aged↗
PubMed1992

Nuclear deoxyribonucleic acid content measured by static cytometry: important prognostic association for patients with clinically localized prostate carcinoma treated by external beam radiotherapy.

To determine if relative nuclear deoxyribonucleic acid (DNA) content is an important prognostic parameter for patients with clinically localized prostate carcinoma treated by external beam radiotherapy, we performed static DNA cytometry on archival paraffin embedded prostate needle biopsy specimens obtained before treatment. DNA content was measured with the Zeiss IBAS 2000 Image Analyzer and the Feulgen staining method. Tumor samples from 65 patients with clinically localized carcinoma of the prostate treated with at least 6,000 cGy. from 1974 to 1980 were studied. Patients and tumors were divided into 2 groups: group 1 - 31 patients with relative DNA content less than 1.5 times normal and group 2 - 34 patients with relative DNA content greater than 1.5 times normal. The prostate cancer nonprogression rate at 10 years was 64% for group 1 and 11% for group 2. Prostate cancer cause specific survival at 10 years was 73% for group 1 and 20% for group 2. These differences are highly significant (p less than 0.0001). By contrast, stratification and analysis according to tumor clinical stage, Mayo histological nuclear grade or Gleason score proved not to be as significant. Cox multivariate analysis also identified DNA content as the most important independent variable for cancer specific survival and progression. Nuclear DNA content measured by static cytometry appears useful in identifying those patients with clinically localized prostate carcinoma who may have a favorable probability of long-term disease control by external beam radiotherapy.

Aged↗
PubMed1992

Results of radiotherapy for chemodectomas.

Between 1974 and 1988, 10 Mayo Clinic patients had unresectable, locally recurrent, or partially resected chemodectomas. Of these 10 tumors, 9 were confirmed pathologically, and 1 was diagnosed clinically. The chemodectoma was located in the jugular bulb in five patients, the middle ear in three, and the carotid body in two. The following symptoms were noted: tinnitus (in eight patients), loss of hearing (in six), hoarseness (in six), dysphagia (in four), pain (in three), and alteration of mental status (in one). Many patients had more than one symptom. Treatment was delivered with megavoltage photons and electrons; total doses ranged from 16.2 to 52 Gy (median, 46 Gy), and the daily doses ranged from 1.6 to 2.4 Gy. Follow-up among the nine survivors ranged from 3 1/2 to 16 years (median, 7 1/2 years). In one patient, the response could not be assessed because the patient died of renal failure 4 months after treatment. All nine assessable patients had decreased symptoms and objective control of the tumor (no evidence of progression of disease). Of the nine assessable patients, four had complete responses, one had a partial response, and four had stable disease. No patient experienced progression of disease after radiotherapy. We conclude that radiotherapy for chemodectomas yields successful results--namely, decreased symptoms and objective control of the tumor.

Adult↗
PubMed1992

Effect of external beam radiotherapy on prostatic carcinoma DNA content as measured by static image cytometry.

Static image cytometry was used to study the effect of radiotherapy on the DNA content of prostatic carcinoma. Feulgen-stained specimens from 50 patients before and after radiotherapy were examined. The DNA index increased significantly after treatment (p less than 0.03), and it occurred equally in those with low (less than 1.5) and high (greater than or equal to 1.5) indices. The level of the initial DNA index was significantly related to the rate of symptomatic progression (p less than 0.05). The initial change in and final DNA indices were not related to survival however. There was a significant increase in Gleason score (p = 0.001) and histological grade (p = 0.01) after irradiation and, when taken individually, the degree of change was related to survival in both, p = 0.05 and 0.004, respectively. As Gleason score, Mayo grade and clinical stage were not independent variables; none of them was related to survival when corrected for the other factors. Thus, DNA content or ploidy, as well as Mayo grade and Gleason score, increases in recurrent tumor after radiotherapy. This may be of importance when considering what treatment to use and how intensively the patients should be followed up.

Actuarial Analysis↗
PubMed1991

Radiotherapy for large symptomatic hemangiomas.

Between 1974 and 1988, 13 patients presented with large (3 to greater than 20 cm) symptomatic unresectable or partially resected hemangiomas. Tumor sites were extremities (five cases), vertebral bodies (three cases), face (two cases), pituitary fossa (one case), pelvic bones (one case), and bladder (one case). Symptoms included severe pain in eight patients, inability to use an extremity in five, vision problems in three, weakness in two, and hematuria with decreased urinary stream in one. Many patients had more than one symptom. Two of the cases were associated with life-threatening consumptive coagulopathies (Kasabach-Merritt syndrome). Therapy was delivered with both orthovoltage and megavoltage photons. Doses ranged from 6.25 to 40.0 Gy in 1.6- to 2.5-Gy fractions. Follow-up ranged from 2 to 15 years (median, 13 years). Tumor shrinkage was noted in 9 (82%) of the 11 cases in which tumor size data were collected before and after therapy. Complete response of tumor mass occurred in 4 (36%) of 11, partial response occurred in 5 (45%), and no response occurred in 2 (18%). No tumor grew after radiotherapy. Some relief in symptoms occurred in all 13 patients; 10 (77%) had complete resolution of symptoms. In both patients with life-threatening cytopenias, hematologic values returned to normal after treatment. Because the majority of the patients responded to all dose levels administered, no firm dose-response relationship was evident. However, objective (measurable) complete responses occurred in two (50%) of the four patients receiving doses of 30 Gy or greater compared with only two (29%) of the seven patients who received lesser doses. No long-term morbidity occurred. Radiotherapy of large unresectable and partially resected hemangiomas yields long-term relief of symptoms and tumor shrinkage in the majority of patients treated.

Adolescent↗
PubMed1990

Life-threatening bleomycin pulmonary toxicity with ultimate reversibility.

A 60-year-old man with advanced seminoma was treated with four cycles of a cisplatin, etoposide and bleomycin. He then developed severe pulmonary toxicity with diffuse infiltrates as evidenced on a chest x-ray film. The room air PaO2 value was 32 mm Hg. The patient was treated with steroids and oxygen supplementation, including a high FIo2 for several days, and survived and eventually experienced marked improvement in his pulmonary status. Aggressive management of severe bleomycin-induced pneumonitis appears justified.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Polymorphic reticulosis limited to the upper aerodigestive tract--natural history and radiotherapeutic considerations.

Polymorphic reticulosis (PMR) is a specific clinicopathological entity which commonly presents as an aggressive, necrotizing lesion of the upper airway. It is a separate nosologic entity from Wegener's granulomatosis, though its site and aggressive nature has lead to confusion in the distinction between these two different processes. Although radiotherapy has been acknowledged as the treatment of choice for limited upper airway PMR, little data exist to guide the radiation oncologist in the practical management of this disorder. We review our single institutional experience with PMR limited to the upper airway. Thirty-four patients (24 males, 10 females) with a median age of 44 years (range 19-80 years) are presented. Symptoms of nasal obstruction were present in 94%. Systemic symptoms such as fever, night sweats, and weight loss were noted in 62% and were often striking clinically. The nasal mucosa was most frequently involved (91%), although involvement of the paranasal sinuses (47%), palate (32%), as well as, other upper airway sites was not uncommon. Perforation of involved structures was recorded in 37%. All but 1 patient were treated with primary radiotherapy. Twelve relapsed with PMR and 3 additional patients manifested diffuse histiocytic lymphoma either within or adjacent to the original treatment field. The median survival relapse in these 15 patients was only 4 months, although 25% were salvaged at 5 years post-relapse. The overwhelming majority of relapses were noted within the first 3 years following treatment. An evaluation of radiotherapy parameters indicated that a minimum dose of 42 Gy or a TDF of 70 is necessary to achieve long-term local control. Pattern of failure analysis demonstrated in-field failure as the predominant failure site, and this problem should become much less significant with implementation of proper time-dose-fractionation schemes. Marginal failure was noted in 20% as a component of eventual failure sites suggesting the need for generous treatment volumes including clinically uninvolved adjacent structures at risk, such as palate, sinuses, and nasopharynx for nasal lesions. Finally, systemic failure occurred in 25%. Although this rate may be reduced by improved local treatment measures, ultimately effective systemic chemotherapy will be required to substantially impact on these patients' survival.

Adult↗
PubMed1982

Invasive bladder carcinoma managed by irradiation and surgery.

Four hundred forty-four patients with invasive vesical carcinoma were entered in a nonrandomized treatment program of preoperative irradiation and surgical extirpation of the primary lesion. Fifteen of the patients did not undergo surgery, and an additional 13 were found at operation to have an inoperable lesion. Thus, 416 patients, at risk for more than two years, were available for statistical study. Pathologic findings constitute the basis for the calculation of crude survival rates. Five-year survival for 107 patients without residual carcinoma was 66 per cent, approximating the 71 per cent for the 160 patients with low-stage carcinoma. By contrast, 149 patients with high-stage carcinoma had a five-year survival of 31 per cent. The need for a yet undefined adjuvant modality is evident.

Carcinoma↗
PubMed1980

Management of stages I to III Hodgkin disease in children.

Thirty-seven children, ages 4 through 16 years, presented with clinical stages I, II, or III Hodgkin disease. In nine (24%) patients, laparotomy and splenectomy resulted in a pathologic stage that varied from the clinical stage. Of 36 patients with pathologic stages I, II, and III, 26 have been followed for more than two years from diagnosis. Pathologic stages I and IIA disease were found in 21 patients, and 19 received radiation therapy alone (usually mantle-field), with 90% disease-free survival and 95% overall survival (median follow-up 46 months). Five patients had stage IIB disease; two had progression of disease while received combined modality therapy. Of ten patients with stage III disease, five have had relapses and five have remained in complete remission. All relapses occurred in patients receiving either irradiation or chemotherapy but not both. This experience supports extended-field irradiation alone as adequate treatment for stages 1 and IIA Hodgkin disease in children, but suggests that for stages IIB and III, single modality treatment is not adequate.

Adolescent↗
PubMed1980

Radical prostatectomy after radiotherapy for prostatic cancer.

We report on 18 patients with clinical stages B and C carcinoma of the prostate who underwent radiotherapy to the prostate, followed by radical retropubic prostatectomy and pelvic lymphadenectomy. Of the 18 patients only 2 (1 with grade 1 and 1 with grade 4 disease) had no residual local cancer at operation. Surgical morbidity was minimal in the 18 patients and only 3 patients had spread of the disease after the combined treatment. Radical retropubic prostatectomy after radiation therapy appears to be safe and effective treatment.

Adenocarcinoma↗
PubMed1980

Definitive radiation therapy for prostatic carcinoma: Mayo clinic experience.

Primary radiation therapy for clinically localized prostatic cancer is effective and safe. Of our 147 patients treated between 1964 and 1973, 144 were evaluated 5 years after the initial date of radiation therapy. At 5 years the over-all survival rate was 80 per cent and the rate of survival free of disease was 63 per cent. More than 70 per cent of the patients were free of progression 5 years after the date of the first radiation treatment. Analysis revealed a highly significant association between tumor grade and patient survival (p less than 0.001), and between tumor grade and the interval free of disease (p less than 0.002). The relationship between tumor stage and time to progression of disease also was significant (p approximately equal to 0.01) but there was no relationship between lower stage and longer survival. Of the 142 patients who completed treatment only 20 (14 per cent) had local recurrence of the prostatic cancer after radiation therapy, representing a local control rate of 86 per cent 5 years after treatment. A few of the patients underwent post-treatment prostatic biopsy after radiation therapy. If a biopsy is done for increased prostatic induration and the results are positive adjuvant treatment is recommended. In the absence of urologic symptoms of progressive induration of the prostate gland biopsy is not instrumental in predicting the course of the cancer.

Adenocarcinoma↗
PubMed1979

Radiation therapy for malignant melanoma of the head and neck.

Thirty-one patients with melanoma of the head and neck received split-course radiation therapy (5,000 to 6,000 rads/30 fractions) for loco-regional disease. There was no difference in survival in patients with gross tumors versus patients with no clinical evidence of disease at the start of radiation therapy. The prognosis was notably worse in patients with recurrence in the irradiated field.

Adolescent↗
PubMed1978

Adjuvant radiation therapy for regional nodal metastases from malignant melanoma: a randomized, prospective study.

After nodal metastasis from malignant melanoma, approximately 80% of patients die from disseminated disease. To clarify the role of radiation therapy (XRT) following node dissection. 56 patients with biopsy-proven nodal metastasis participated in a randomized, prospective clinical trial which compares radiation therapy to the regional lymph node area following lymphadenectomy (27 patients) with lymphadenectomy alone (29 patients). Interesting differences in the survival curves (p = 0.09) and in the disease-free interval curves (p = 0.08) for the two treatment groups proved to be attributable to imbalances in the age and nodal distributions in the treatment groups. Covariate analysis identified age and sex as the factors having the most significant (p less than 0.04) effect on survival and identified the number of positive nodes as the covariate having the most significant (p less than 0.02) effect on disease-free interval. Treatment did not have a significant effect upon survival or disease-free interval.

Clinical Trials as Topic↗
PubMed1978

Testicular relapse in childhood leukemia.

Five patients in bone marrow remission from childhood leukemia who subsequently had relapse in the testicle are reviewed. Clinically, recurrence of disease is often limited to this site. In spite of satisfactory local control with radiotherapy, further systemic progression generally occurs within 1 year. Previous studies suggest that patients who are in clinical remission harbor tumor in multiple occult "sanctuaries." Testicular leukemia reflects this uncontrolled extramedullary disease, and studies in optimal management of the generalized process are needed.

Child↗
PubMed1976

Elective whole lung irradiation in the treatment of osteogenic sarcoma.

Fifty-three patients with histologically confirmed osteogenic sarcoma of bone and no clinical evidence of pulmonary metastases were divided into two equivalent groups: one received elective pulmonary irradiation of 1500 rads administered to both lung fields, and the other acted as a control group. There were no significant differences in either survival probabilities or the interval between treatment and the development of pulmonary metastases. Therefore, elective whole lung irradiation so administered was not found to be of value as a prophylactic measure in the treatment of osteogenic sarcoma. There were no recognized untoward reactions to the pulmonary irradiation.

Adolescent↗