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Biomedical subjects

R E Peschel

Publications and source records attributed to R E Peschel.

At least 19 recordsLinked to original sources
PubMed2000

Father-son testicular tumors: evidence for genetic anticipation? A case report and review of the literature.

BACKGROUND: The etiology of testicular carcinomas is unknown. Father-son testicular tumors represent an important subset of patients because the sons have a 6- to 10-fold increase in the risk of developing a testicular tumor compared with the general population, suggesting a possible genetic component in the etiology of the disease. Genetic anticipation has been established for several diseases and manifests itself clinically with earlier age of onset (AO) of disease or with increased severity of disease in children compared with their parents. METHODS: We report only the 13th case of pure seminoma occurring in both a father and a son. The most striking feature of our case study was a 27-year difference in the AO between father and son. A review of the literature from 1972 through 1999 provided 47 cases of father-son testicular tumors in which sufficient information was available to compare the AO and the severity of the disease in the fathers (G1) and the sons (G2). RESULTS: The mean AO for G1 was 43.3 (+/- 1.6) years compared with a mean AO for G2 of 27.0 (+/- 1.0) years for all 47 cases (P < 0.01). For fathers presenting with a pure seminoma, the mean AO was 45.9 (+/- 1.8) years for G1 compared with 27.0 (+/- 1.1) years for G2 (P < 0.01). For fathers presenting with a nonseminomatous tumor, the mean AO in G1 was 37.9 (+/- 2.6) years and 26.9 (+/- 1.8) years for G2 (P < 0.01). For the entire group of 47 cases, disease was more severe in G2 compared with G1 in 43% of cases, of equal severity in 47% of cases, and less severe in G2 compared with G1 in 10% of cases. CONCLUSIONS: Genetic anticipation may be responsible for many father-son testicular tumors.

Adolescent↗
PubMed2000

PSA based review of adjuvant and salvage radiation therapy vs. observation in postoperative prostate cancer patients.

Because of the uncertainties regarding the efficacy of postoperative radiation therapy for early prostate cancer, treatment strategies following radical prostatectomy include: (1) observation alone in high-risk patients, (2) adjuvant radiation therapy (PSA undetectable) in high-risk patients, or (3) salvage radiation therapy for biochemical and clinical recurrence. Fifty-two patients treated with postoperative radiation therapy in either an adjuvant setting (13) or for salvage (39) were retrospectively reviewed. The actuarial biochemical disease-free survival (bNED) rates following radiation therapy were calculated using the life-table method. Univariate and multi variate analyses were used to define the clinical factors that predict biochemical failure following postoperative radiation therapy. In addition, the bNED survival rate for 36 high-risk surgery patients who were simply observed following prostatectomy was determined. The 3-year bNED survival rate for the adjuvant radiation group was 85% compared with 27% for salvage radiation and 43% for the observation group. These results are statistically significant. Factors that predict biochemical failure following postoperative radiation therapy include preoperative PSA level, pre-radiation therapy PSA level, and seminal vesicle involvement. At our institutions, adjuvant radiation therapy was a superior strategy compared with either observation alone or salvage radiation therapy for high-risk postoperative prostate cancer patients. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 29-36 (2000).

Aged↗
PubMed1999

Long-term complications with prostate implants: iodine-125 vs. palladium-103.

The linear quadratic model predicts that the normal tissue biologically effective dose (BED) will be lower with palladium-103 (Pd-103) vs. iodine-125 (I-125) for the currently prescribed minimum tumor doses (MTD) used for I-125 (160 Gy) and Pd-103 (115 Gy) prostate cancer brachytherapy. The predicted BEDs for I-125 and Pd-103 suggest that the long-term complication rates should be lower with Pd-103 vs. I-125 in clinical practice. A review of 123 early stage T1c and T2 prostate cancer patients implanted at Yale University with I-125 (82 patients) or Pd-103 (41 patients) reveals a significantly lower overall complication rate with Pd-103 (0%) vs. I-125 (13%). Most important, the grade III-IV complication rate for Pd-103 was 0% vs. 6% for I-125. The 3-year actuarial probability of remaining free of a long-term complication was 100% for Pd-103 vs. 82% for I-125 (P<0.01). A review of the literature for 992 patients implanted with I-125 vs. 540 patients implanted with Pd-103 shows a consistently higher complication rate for I-125 vs. Pd-103. Assuming that the MTD for Pd-103 may be increased to produce an equivalent late-reacting normal tissue BED to that for I-125, then the radiobiology model predicts the log10 cell kill for Pd-103 implant will be greater than that of an I-125 implant for all tumor doubling times (high-grade tumors and low-grade tumors). The implications of these findings are discussed in terms of future research directions for prostate implants.

Actuarial Analysis↗
PubMed1998

Effective treatment of stage I uterine papillary serous carcinoma with high dose-rate vaginal apex radiation (192Ir) and chemotherapy.

PURPOSE: Uterine papillary serous carcinoma (UPSC) is a morphologically distinct variant of endometrial carcinoma that is associated with a poor prognosis, high recurrence rate, frequent clinical understaging, and poor response to salvage treatment. We retrospectively analyzed local control, actuarial overall survival (OS), actuarial disease-free survival (DFS), salvage rate, and complications for patients with Federation International of Gynecology and Obstetrics (FIGO) (1988) Stage I UPSC. METHODS AND MATERIALS: This retrospective analysis describes 38 patients with FIGO Stage I UPSC who were treated with the combinations of radiation therapy, chemotherapy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy (TAH/BSO), with or without a surgical staging procedure. Twenty of 38 patients were treated with a combination of low dose-rate (LDR) uterine/vaginal brachytherapy using 226Ra or 137Cs and conventional whole-abdomen radiation therapy (WART) or whole-pelvic radiation therapy (WPRT). Of 20 patients (10%) in this treatment group, 2 received cisplatin chemotherapy. Eighteen patients were treated with high dose-rate (HDR) vaginal apex brachytherapy using 192Ir with an afterloading device and cisplatin, doxorubicin, and cyclophosphamide (CAP) chemotherapy (5 of 18 patients). Only 6 of 20 UPSC patients treated with combination LDR uterine/vaginal brachytherapy and conventional external beam radiotherapy underwent complete surgical staging, consisting of TAH/BSO, pelvic/para-aortic lymph node sampling, omentectomy, and peritoneal fluid analysis, compared to 15 of 18 patients treated with HDR vaginal apex brachytherapy. RESULTS: The 5-year actuarial OS for patients with complete surgical staging and adjuvant radiation/chemotherapy treatment was 100% vs. 61% for patients without complete staging (p = 0.002). The 5-year actuarial OS for all Stage I UPSC patients treated with postoperative HDR vaginal apex brachytherapy and systemic chemotherapy was 94% (18 patients). The 5-year actuarial OS for Stage I UPSC patients treated with HDR vaginal apex brachytherapy and chemotherapy who underwent complete surgical staging was 100% (15 patients). The 5-year actuarial OS for the 20 Stage I UPSC patients treated with combinations of pre- and postoperative LDR brachytherapy and postop WART was 65%. None of the 6 surgically staged UPSC patients treated with LDR radiation and WART/WPRT developed recurrent disease. For patients with FIGO Stage IA, IB, and IC UPSC who underwent complete surgical staging, the 5-year actuarial DFS by depth of myometrial invasion was 100, 71, and 40%, respectively (p = 0.006). The overall salvage rate for local and distant recurrence was 0%. Complications following HDR vaginal apex brachytherapy included only Radiation Therapy Oncology Group (RTOG) grade 1 and 2 toxicity in 16% of patients. However, complications from patients treated with WART/WPRT, and/or LDR brachytherapy, included RTOG grade 3 and 4 toxicity in 15% of patients. CONCLUSION: Patients with UPSC should undergo complete surgical staging, and completely surgically staged FIGO Stage I UPSC patients can be effectively and safely treated with HDR vaginal apex brachytherapy and chemotherapy. Both OS and DFS of patients with UPSC are dependent on depth of myometrial invasion. The salvage rate for both local and distant UPSC recurrences is extremely poor. Complications from HDR vaginal apex brachytherapy were minimal.

Adult↗
PubMed1997

Treatment of recurrent pelvic and selected primary gynecologic malignancies with 241Am.

The purpose of this study was to update the experience and demonstrate the effectiveness and limitations of 241Am applicators for previously irradiated patients and for selected patients with primary gynecologic malignancies. Between October 1986 and May 1994, 30 patients were treated with 241Am. The median patient age was 68 years, ranging from 41 to 91 years. Patients were retrospectively categorized by treatment intent, i.e., palliative vs. curative. Patients undergoing curative therapy were further classified as to whether 241Am brachytherapy was directed at microscopic residua after surgery or to gross primary tumor. Of the 30 patients, 18 had recurrent pelvic malignancies from various primary sites and were reirradiated with 241Am for palliation. Six patients had microscopic disease after surgical resection and were managed with postoperative radiotherapy (RT) that included 241Am. Six patients had gynecologic cancers managed with primary RT that included treatment with 241Am. Overall, 50% (9/18) of the patients with recurrent pelvic malignancies were locally controlled after reirradiation with 241Am. Including surgical salvage, the ultimate local control rate was 61% (11/18). Postoperative 241Am with or without external beam radiation therapy (XRT) was effective in 83% (5/6) of the patients with microscopic disease. Including surgical salvage, 100% (6/6) of the patients were ultimately free of disease. Fifty percent (3/6) of the patients treated with primary RT that included 241Am brachytherapy experienced local control. Including surgical salvage, 67% (4/6) of the patients were ultimately controlled with 241Am. In conclusion, reirradiation utilizing 241Am was effective in palliating patients with recurrent pelvic malignancies. 241Am was effective in 83% (5/6) of the patients with microscopic disease managed with postoperative RT. 241Am was of marginal benefit in patients with gynecologic tumors managed with primary RT.

Aged↗
PubMed1996

Consumerism for neurobiological disorders. An assessment.

Consumerism is a growing phenomenon in U.S. health care, yet its exercise is still inhibited by powerful forces within the medical community. Despite the neuroscientific framework that stresses the commonalities between mental and physical illness, consumerism is even more problematic and difficult in mental health care than in other areas of health care. People with severe mental illness and their advocates must contend with limited public understanding of neurobiological disorders, poor definitions of effective treatment, and a paucity of outcome data, especially from prospective randomized and long-term studies. The only clear way for consumerism to grow in mental health care is for its advocates to align themselves with the neuroscientific revolution and to demand that effective and equitable treatment programs be created based on the documented evidence of the physical nature of neurobiological disorders.

Consumer Advocacy↗
PubMed1995

Hodgkin's disease with spinal cord compression. A case report and a review of the literature.

BACKGROUND: Spinal cord compression is a rare complication of Hodgkin's disease, occurring in only 5% of cases, usually in the setting of progressive, advanced disease. As the initial symptom of Hodgkin's disease, it is extremely rare, with only a few cases reported in the literature. METHODS: A case report of a 46-year-old man who presented with signs and symptoms of spinal cord compression and was found to have an extradural mass in the cervical and thoracic spine is described. Biopsy revealed Hodgkin's disease. This case report represents a unique case of a patient with Hodgkin's disease presenting with epidural disease, with spinal cord compression as the only apparent site of initial clinical involvement. A review of the literature of patients with Hodgkin's disease presenting with spinal cord compression from 1970 to the present is presented. RESULTS: The patient, whom we report, received chemotherapy followed by external beam radiation therapy and achieved complete resolution of symptoms and a complete response by radiologic criteria. Based on a review of the literature, Hodgkin's disease involving the spinal epidural space is very responsive to radiation therapy and chemotherapy with a good prognosis for both functional recovery (86%), complete response (61%), and long term survival. CONCLUSIONS: Chemotherapy and/or radiation therapy is successful treatment for Hodgkin's disease presenting with spinal cord compression. For the rare patient who presents with spinal cord compression as the initial symptom of Hodgkin's disease, the therapeutic options include chemotherapy alone, radiation therapy alone, or combined modality therapy.

Hodgkin Disease↗
PubMed1995

Prostate specific antigen following radiotherapy for local prostate cancer.

The clinical recurrence-free survival rates were compared to the combined clinical and biochemical recurrence-free survival rates in 285 patients with stages A2 (T1b), B (T2) and C (T3) prostate cancer treated with radiation therapy. For stages A2 (T1b) and B (T2) disease the 10-year clinical recurrence-free survival rate was 48% and the corresponding 10-year clinical and biochemical recurrence-free survival rate was 33%. For stage C (T3) disease these rates were 33% and 22%, respectively. These results demonstrate that approximately a third of the patients who are considered recurrence-free by standard clinical criteria at 10 years after radiation therapy have elevated prostate specific antigen values and are at significant risk for later clinical failure.

Actuarial Analysis↗
PubMed1994

Preoperative serum prostate-specific antigen and Gleason grade as predictors of pathologic stage in clinically organ confined prostate cancer: implications for the choice of primary treatment.

PURPOSE: Despite careful preoperative staging, approximately 50% of patients who undergo radical prostatectomy for clinical stage A2 (T1b-c) and B (T2) prostate cancer are found to have pathologic stage C (T3-4) or D (N1) disease. This study investigates whether preoperative serum prostate specific antigen (PSA) and Gleason grade predict pathologic stage among patients with clinically organ confined prostate cancer. METHODS: The records of all 63 patients who underwent attempted pelvic lymphadenectomy and radical prostatectomy for adenocarcinoma of the prostate at our institution in 1990-91 were retrospectively reviewed. RESULTS: Patients with a preoperative serum PSA of 12.5 ng/mL or greater had an 81% incidence of pathologic upstaging to stage C (T3-4) or D (N1) compared with 38% for patients with a PSA less than 12.5 (p = 0.0015). The incidence of various pathologic findings for prostate specific antigen > or = 12.5 vs. prostate specific antigen < 12.5 was as follows: seminal vesicle involvement 29% vs. 5% (p = 0.0186), lymph node metastases 24% vs. 0% (p = 0.0029), capsular penetration 71% vs. 38% (p = 0.0424), and positive margins 47% vs. 36% (p = 0.56). None (0/3) of the patients with Gleason grade 4 or less were pathologically upstaged compared with 49% (24/49) of patients with grade 5-7 tumors (p = 0.15) and 82% (9/11) of patients with grade 8 or higher cancers (p = 0.0474, grade 5-7 vs. 8-10). Within the group of patients with Gleason grade 5-7, a prostate specific antigen of 12.5 ng/mL or greater predicted an 79% rate of upstaging compared with 37% for patients with prostate specific antigen less than 12.5 (p = 0.0098). CONCLUSION: Patients with clinical Stage A2 (T1b-c) or B (T2) prostate cancer who have Gleason grade 8-10 tumors and those patients with Gleason grade 5-7 tumors with a preoperative serum prostate specific antigen of 12.5 ng/mL or higher have a high incidence of pathologic upstaging. These patients should be preferentially treated with external beam radiation in most cases.

Adenocarcinoma↗
PubMed1994

Location of the prostatic apex and its relationship to the ischial tuberosities.

PURPOSE: Although modern computerized tomography scans have revolutionized the three-dimensional treatment planning for external beam radiation therapy for prostate cancer, the prostate apex is often difficult to precisely define. Some institutions routinely use the ischial tuberosities to define the lower border of external beam fields for prostate cancer, while others recommend a retrograde urethrogram. This study was undertaken to estimate the accuracy of using the bottom of the ischial tuberosities to define the lower border of the external beam fields for Stages T1, T2, and T3 prostate cancer. METHODS AND MATERIALS: The anatomic location of the apex of the prostate was determined in 153 implant patients either by direct surgical exposure of the prostate (133 patients) or by using transrectal ultrasound (20 patients). The prostate apex position relative to the ischial tuberosities was determined and plotted on a schematic of the bony pelvic structures drawn to scale. RESULTS: There was excellent agreement in the estimate of the location of the prostate apex between the two methods (surgery vs. ultrasound) used. The prostate apex was located above the ischial tuberosities in 152 of the 153 patients studied (99.3%). Seven of the 153 patients (4.6%) had a prostate apex which was less than 1.5 cm above the ischial tuberosities and 3 of the 153 patients (2%) had an apex-tuberosity distance of less than 1 cm. CONCLUSION: This study indicates that locating the inferior border of the external beam fields at the ischial tuberosity adequately treats at least 95.4% of all prostate patients with a margin of 1.5 centimeters or more below the prostate apex. In addition, the external beam policy of locating the inferior border at the ischial tuberosities has produced: (a) excellent 10-year clinical local control rates of 88% for Stage T1 and T2 patients and 82% for Stage T3 patients, and (b) 5-year and 10-year biochemical (normal prostate specific antigen) and clinical disease free survival rates for T1 and T2 patients which are similar to surgery.

Brachytherapy↗
PubMed1993

Radiation therapy for prostate cancer. Long-term results and implications for future advances.

BACKGROUND: There are surprisingly few studies that concurrently report the 10-year overall survival (OS) rate, 10-year adjusted survival (AS) rate, 10-year recurrence free (NED) survival rate, and 10-year local tumor control (LC) rate using external beam radiation therapy (RT) for Stages A2, B, and C prostate cancer. A simultaneous analysis of OS, AS, NED survival, and LC rates is useful in terms of establishing priorities for future research efforts. METHODS: Actuarial LC, NED survival, AS, and OS rates were analyzed for 289 patients with Stages A2, B, and C prostate cancer treated with RT between 1975 and 1990 in the Department of Therapeutic Radiology, Yale University School of Medicine. RESULTS: The 10-year LC, NED survival, AS, and OS rates for 168 patients with Stage A2 and B disease were 88% (standard error [SE], 5%), 50% (SE, 10%), 70% (SE, 7%), and 38% (SE, 7%), respectively. The 10-year LC, NED survival, AS, and OS rates for 121 patients with Stage C disease were 82% (SE, 6%), 41% (SE, 6%), 25% (SE, 7%), and 21% (SE, 6%), respectively. CONCLUSION: External beam radiation provides excellent local clinical tumor control for early prostate cancer. However, 60% of all prostate cancer deaths of patients with Stage A2 and B disease and 76% of all prostate cancer deaths of patients with Stage C disease were attributable to metastatic disease without clinical local failure. The major obstacle in improving the death rate associated with Stages A2, B, and C prostate cancer remains the inability to control metastatic disease; research efforts must concentrate on overcoming this problem.

Follow-Up Studies↗
PubMed1993

The effect of advanced age on the efficacy of radiation therapy for early breast cancer, local prostate cancer and grade III-IV gliomas.

PURPOSE: This study was undertaken to determine the effect of advanced age on radiation therapy outcomes for early breast cancer, local prostate cancer and Grade 3-4 gliomas of the brain. METHODS AND MATERIALS: Radiation therapy outcomes for three malignancies (N = 1,401) were determined for a geriatric cancer population defined as 70 years of age or older and compared to a non-geriatric cancer population defined as less than 70 years of age. The three patient groups studied were: (a) primary breast cancer patients with clinical Stage I or II disease treated with lumpectomy and radiation therapy (N = 994), (b) local prostate cancer patients with Stage A2, B, or C disease treated with radical radiation therapy (N = 294), and (c) patients with Grade 3-4 gliomas of the brain treated with high dose radiation therapy (N = 113). RESULTS: For Stage I and II breast cancer, there was no statistically significant difference in the overall 10-year survival rates (63% vs. 73%), 10-year cause-specific disease-free survival rates (70% vs. 63%), and 10-year local breast recurrence free survival rates (76% vs. 79%) comparing the geriatric cancer population to the non-geriatric cancer population. For local prostate cancer, there was no statistically significant difference in the 10-year survival rates (38% vs. 41%) or in the 10-year cause-specific disease-free survival rates (58% vs. 52%) in the geriatric population compared with the non-geriatric population. On the other hand, the use of high dose radiation therapy for malignant gliomas resulted in statistically significant inferior 1-year (18% vs. 38%) and 2-year (0% vs. 10%) survival rates for the geriatric population versus the non-geriatric population. CONCLUSION: This study strongly supports the use of standard radiation therapy programs for early breast and prostate cancer patients age 70 years or more. However, our study raises questions about the efficacy of radiation therapy in patients over the age of 70 years with Grade 3-4 gliomas.

Age Factors↗
PubMed1993

Effects of prefracture irradiation on the biomechanical parameters of fracture healing.

This study examined the effects on the biomechanical parameters of fracture healing of a single dose of 900 rad (the approximate single-dose equivalent of 2,500 rad in 10 divided doses), given 1 day prior to closed fracture of the femur. The femurs were recovered at 2, 3, 4, 8, and 16 weeks after fracture and were mounted and tested to failure in torsion; the results were compared with those in nonirradiated controls from a previously published study. Prefracture irradiation delayed the progressive increase in biomechanical parameters of fracture healing. The delay was statistically significant up to 8 weeks after fracture. At 4 weeks, the normalized torque was 44% that of intact bone in the treated group compared with 75% for the control group. Sixteen weeks after fracture, the biomechanical and histological parameters of fracture healing of the irradiated femurs were no different from those of the nonirradiated controls. Within the treated group, the irradiated fractures remained significantly weaker than their contralateral intact bone at all time intervals, with a torque of only 79% that of intact bone at 16 weeks. Thus, femoral fractures in rats healed (or regained substantial strength) following palliative doses of radiation delivered 1 day prior to injury, but the repair process was delayed compared with that of nonirradiated controls.

Animals↗
PubMed1993

A phase II trial of mitomycin C, 5-fluorouracil and radiation therapy in the treatment of unresectable non-small cell lung cancer.

We conducted a study evaluating the efficacy of simultaneous administration of 5-fluorouracil, mitomycin C, and X-irradiation in unresectable Stage III non-small cell lung cancer. Radiation was delivered in a split course to a total of 55 Gy. In the first course, radiation was administered daily in 250 cGy fractions for 12 treatments. Following a two week rest, an additional 10 treatments of 200 cGy fractions were delivered. Chemotherapy consisted of 10 mg/M2 of mitomycin C on day 1, and 1000 mg/M2 per day of 5-fluorouracil by continuous infusion on days 1 through 5 and 29 through 33. Twenty-one enrolled patients were evaluable. The overall response rate was 52% (95% confidence intervals 31-73%), with a median duration of response of 42 weeks. There were 5 complete responders (24%) and four of these patients remain disease-free with follow-up between 24-54 months. The median survival time for all patients was 59 weeks. For the complete responders the median survival time has not yet been reached, but is in excess of 42 months. Toxicity consisted of moderate stomatitis and myelosuppression. The sustained remissions obtained by 4 of 21 patients (18%) treated with concurrent mitomycin C, 5-fluorouracil and x-irradiation are encouraging and deserve further study.

Adenocarcinoma↗