PubMed Health⌕ Search

Biomedical subjects

R F Pommier

Publications and source records attributed to R F Pommier.

34 records · Page 2Linked to original sources
PubMed1994

Pharmacokinetics and results of dose escalation in cis-platin hyperthermic isolation limb perfusion.

BACKGROUND: We analyzed prospectively collected data on 145 cis-platin hyperthermic isolation limb perfusion (HILPs) for melanoma and soft-tissue sarcoma to determine the pharmacokinetics and maximum tolerable dose of cis-platin. There were 70 melanoma and 75 sarcoma patients. Dosages ranged from 26 to 265 mg/m2. Perfusate and systemic cis-platin levels were measured in patients perfused at doses of 190-200 mg/m2. Tissue levels were measured in patients perfused at 123-209 mg/m2. METHODS: Cis-platin HILP was well tolerated up to doses of 250 mg/m2 for lower extremities. Higher doses produced toxicities of rhabdomyolysis, myoglobinuria, hyponatremia, and neuropathy. Systemic levels of cis-platin were equivalent to those of routine intravenous administration, while perfusate levels were 33 times higher. Tissue levels of cis-platin were five to six times higher than effective intravenous levels. RESULTS: Six melanoma patients have developed local recurrences. All were perfused at doses < 120 mg/m2. However, regional nodal recurrences have occurred in six other patients perfused at doses < or = 200 mg/m2. Four sarcomas have recurred locally, but three of them were present at the time of perfusion. CONCLUSIONS: We conclude that 250 mg/m2 is the maximum tolerable dose of cis-platin for lower-extremity HILPs. Neoadjuvant cis-platin HILP may improve local control rates for sarcomas. However, no tolerable dose of cis-platin provides control of nodal metastases from melanoma.

Adult↗
PubMed1994

Changes in serum sex steroid levels during megestrol acetate therapy.

We hypothesized that megestrol acetate (MA) may work on breast carcinoma by inducing changes in serum sex steroid levels. We prospectively measured levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone (DHEA), estrone (E1), and estradiol (E2) in 18 postmenopausal women before and during megestrol acetate therapy. MA significantly suppressed serum FSH, LH, DHEA and E1 levels. However, this was accompanied by a marked increase in serum E2 levels as measured by radioimmunoassay performed on whole serum. MA did not cross-react with the anti-E2 antibodies used in the assay. Elevated E2 levels also occurred in oophorectomized and/or adrenalectomized patients indicating the ovary and adrenal are not the source of the elevated E2 levels. We conclude that MA may be metabolized to oestrogenic compounds that crossreact with antibodies to E2, explaining the elevated E2 levels observed. The effects of these oestrogenic metabolites on breast carcinoma are unknown.

Adrenalectomy↗
PubMed1994

An improved method of needle localized biopsy of nonpalpable lesions of the breast.

We have created a modified technique of localization biopsy of the breast that more easily identifies the position of the wire tip after placement and before biopsy. After wire placement, metallic skin markers are placed on the nipple and wire entry site. The patient is then positioned on a roentgenography table in the same position to be used during biopsy. A supine roentgenogram of the breast is obtained. At the time of the biopsy, this roentgenogram is aligned with the corresponding markers on the skin of the patient and the position of the wire tip is noted. A curvilinear incision along Langer's lines can then be made at that site. This procedure was used in 53 consecutive biopsies of nonpalpable mammary lesions. In all instances, the biopsy incisions were independent of the wire insertion sites and in each instance, the lesion was excised in a single specimen. Compared with other techniques, our method is simple, inexpensive, requires no special equipment and results in only a minimal increase in radiation dose to the breast (50 millirad). The decrease in the amount of tissue dissection without decreasing accuracy afforded by our technique can improve compliance with the American Cancer Society's recommended surgical guidelines for breast preservation therapy.

Biopsy, Needle↗
PubMed1993

Comparison of adrenal and extraadrenal pheochromocytomas.

BACKGROUND: It is commonly believed that extraadrenal tumors (EAT) of the paraganglion system are more likely to be malignant than adrenal tumors (AT) and carry a poorer prognosis. We analyzed 73 paraganglion tumors (PT) to determine whether EATs are more likely to be malignant or have a poorer prognosis than ATs. METHODS: A review of patients with PTs at three institutions was performed. Malignant tumors were defined as those that metastasized. Comparison of the frequencies of malignant tumors was performed by chi-squared analysis. Survival distributions were determined by Kaplan and Meier analysis. Comparison of survival distributions was performed by log-rank analysis. RESULTS: There were 73 patients. There were 51 ATs, of which 24 were malignant, and 22 EATs, of which 11 were malignant (p = 0.82). The 5-year survival rate was 77% for patients with ATs and 82% for patients with EATs (p = 0.29). The 5-year survival rate for patients with malignant ATs was 57%, and 74% for patients with malignant EATs (p = 0.15). There were no significant differences in disease-free survival rates on the basis of tumor site. CONCLUSIONS: We were unable to demonstrate that EATs are significantly more likely to be malignant than ATs. The survival and disease-free survival rates for malignant ATs and EATs are similar, and among malignant tumors, there may be no prognostic value of the anatomic location.

Adolescent↗
PubMed1992

Synergistic cytotoxicity of combinations of dimethyl sulfoxide and antineoplastic agents against P388 leukemia in CD-F1 mice.

We have reported that dimethyl sulfoxide (DMSO) and antineoplastic agents exhibit synergistic cytotoxicity against human tumors in vitro. This study was undertaken to investigate this effect in vivo. Groups of mice were given intraperitoneal (i.p.) injections of P388 leukemia cells. Groups were treated with i.p. injections of either saline, DMSO alone, mitoxantrone hydrochloride (DHAD) alone, methotrexate alone, DHAD in DMSO or methotrexate in DMSO. Combinations of DMSO and DHAD produced 46-61% increases above expected survival, demonstrating synergistic cytotoxicity in vivo. Following confirmatory animal studies, trials utilizing i.p. delivery of antineoplastics in DMSO as treatment for peritoneal tumors should be undertaken.

Animals↗
PubMed1992

An eleven-year experience with adrenocortical carcinoma.

BACKGROUND: Key issues in the treatment of adrenocortical carcinoma are the value of adjuvant therapy, the value of reoperation, and the search for effective chemotherapeutic agents. The present series was reviewed to evaluate these issues. METHODS: We present a retrospective series of 73 patients with adrenocortical carcinoma treated at a single institution. RESULTS: Twenty patients had carcinomas that were unresectable, and 53 patients underwent complete resections. Ten patients received adjuvant therapy (mitotane, seven patients; radiation, three patients). Forty-five (85%) patients had recurrence, including all who received adjuvant therapy. Mean disease-free intervals for those who did and did not receive adjuvant therapy were equivalent at 2.4 years. Nineteen patients with recurrent disease received chemotherapy, and 26 patients underwent 51 reoperations to resect recurrent and metastatic disease. The overall 5-year survival rate, which was 35%, was 47% for patients with complete resection. Stage and resectability were prognostic factors. Mean survival time for patients with recurrent disease treated medically was 19 months compared with 56 months for patients who underwent reoperation. Mitotane had a 24% partial response rate. Other chemotherapeutic agents were ineffective. CONCLUSIONS: We conclude that an aggressive surgical approach to recurrent and metastatic disease should be adopted and that patients should be resected free of disease whenever possible. Currently no effective chemotherapy exists, and the value of adjuvant therapy remains unproved.

Adrenal Cortex Hormones↗
PubMed1988

Nonanatomic hepatic resection for secondary hepatic tumors with special reference to hemostatic technique.

The techniques for resection of hepatic tumors have traditionally been based on lobar anatomy. The morbidity and mortality associated with hepatic resection have been most closely correlated with intraoperative blood loss. The results of 37 hepatic resections for secondary neoplasms were retrospectively reviewed. This group included 18 patients who underwent anatomic resections and 19 patients who underwent nonanatomic resections. The nonanatomic group experienced significantly less blood loss, shorter operating times, shorter hospital stays, and no significant difference in long-term survival. A positive relationship between blood loss and postoperative complications is demonstrated for the combined groups. These results support the use of nonanatomic resection whenever feasible for secondary hepatic tumors. We describe the technique for nonanatomic hepatic resection for metastatic lesions, with special emphasis on hemostatic techniques.

Adult↗
PubMed1988

Synergistic cytotoxicity between dimethyl sulfoxide and antineoplastic agents against ovarian cancer in vitro.

Dimethyl sulfoxide is a well-known differentiating agent that has been shown to inhibit tumor growth in vitro. We hypothesized that antineoplastic agents might show synergistic cytotoxicity when combined with 10% dimethyl sulfoxide. Twenty-four malignant ovarian tumors were removed and used in tests to determine the cytotoxicities of 10% dimethyl sulfoxide alone, each of six antineoplastic agents alone, and 10% dimethyl sulfoxide plus each antineoplastic agent. Cytotoxicity results for 10% dimethyl sulfoxide alone and each antineoplastic agent alone were used to evaluate each combination of dimethyl sulfoxide and an antineoplastic agent for synergy. There were 14 synergistic responses that were statistically significant at the p less than 0.01 confidence level between 10% dimethyl sulfoxide and an antineoplastic agent against the ovarian tumors. Seven of these responses were significant at the p less than 0.0003 level. This is strong evidence that true synergistic cytotoxicity occurs when an antineoplastic agent is combined with 10% dimethyl sulfoxide. We conclude that intraperitoneal delivery of antineoplastic agents in 10% dimethyl sulfoxide may be useful in the treatment of certain ovarian cancers.

Anthraquinones↗
PubMed1988

Pharmacokinetics, toxicity, and short-term results of cisplatin hyperthermic isolated limb perfusion for soft-tissue sarcoma and melanoma of the extremities.

Fifty-nine patients with melanoma or soft tissue sarcoma of the extremities underwent hyperthermic isolated limb perfusion utilizing cisplatin and wide local excision. Doses of cisplatin ranged from 0.75 to 2 mg/kg. The mortality and morbidity rates were 0 and 6.8 percent, respectively. Pharmacokinetic studies indicate that cisplatin is rapidly bound to perfused tissues and remains bound for 1 month. Maximum tumor response in sarcomas occurs 1 to 2 weeks after perfusion, compared with 1 month after perfusions with l-phenylalanine mustard and actinomycin D. Local and regional recurrence rates were 0 and 3.4 percent, respectively, at 1 year. Further studies of hyperthermic limb perfusions with cisplatin are warranted.

Adult↗
PubMed1988

Cytotoxicity of dimethyl sulfoxide and antineoplastic combinations against human tumors.

Five human tumor reference cell lines were tested in vitro against 0 percent, 5 percent, and 10 percent DMSO; four antineoplastic agents; and combinations of 5 percent or 10 percent DMSO plus each antineoplastic agent. Synergistic cytotoxicity between DMSO and antineoplastic agents against each cell line were demonstrated. We have concluded that delivery of standard doses of antineoplastic agents in 5 percent or 10 percent DMSO may be useful in the treatment of some tumors because of the marked increase in tumoricidal effect seen with some DMSO and drug combinations. Alternatively, lower doses of antineoplastic agents might be delivered in DMSO, producing the same cytotoxic effect as a full dose of drug without DMSO but with less systemic toxicity.

Antineoplastic Agents↗
PubMed1987

The mechanism of hormone-sensitive breast cancer progression on antiestrogen therapy. Implications for treatment and protocol planning.

Fifteen patients whose tumors progressed while they received tamoxifen citrate therapy were studied by serial determinations of serum levels of estrone (E1), estradiol (E2), and dehydroepiandrosterone (DHEA) obtained during progression after withdrawal from tamoxifen therapy and total endocrine ablation or suppression. Discontinuation of tamoxifen therapy resulted in reductions of DHEA, E1, and E2 levels by 44%, 49%, and 42%, respectively. Ablation or suppression reduced sex steroids to minimal levels and produced responses in all patients. Elevations of DHEA, E1, and E2 could be provoked by readministering tamoxifen to hypophysectomized and oophorectomized, but not adrenalectomized, patients, indicating that the adrenal gland is the source of these sex steroids. We conclude that tamoxifen stimulates adrenal production of DHEA, which is aromatized to E1 and E2. Buildup of E1 and E2 overwhelms the competitive binding of tamoxifen to the estrogen receptor, resulting in tumor progression.

Adrenal Glands↗
PubMed1987

Hepatic resection for primary and secondary neoplasms of the liver.

Fifty consecutive major hepatic resections were performed for primary and secondary malignant neoplasms of the liver. There were 7 children and 9 adults with primary neoplasms and 34 patients with secondary neoplasms. The mortality rate was 0 percent and the morbidity rate, 14 percent. Postoperative morbidity correlated with operative blood loss. The 5 year survival rates for children and adults with primary neoplasms were 42 percent and 22 percent, respectively, and the 5 year survival rate for adults with secondary neoplasms was 15 percent. Factors such as disease-free interval, number of metastases, and stage of metastases did not influence the postoperative survival rate. Also, there was no difference in survival rate between patients whose metastases were resected by lobectomy or segmentectomy and those whose metastases were resected by wedge resection.

Adenoma, Bile Duct↗
PubMedDate not supplied

Submandibular gland carcinoma ex pleomorphic adenoma. Report of a case with cytologic features and diagnostic pitfalls.

BACKGROUND: Carcinoma ex pleomorphic adenoma is a rare neoplasm of the salivary gland. This lesion, also known as malignant mixed tumor, occurs when a malignant tumor arises in the epithelial component of a pleomorphic adenoma. Reports of fine needle aspiration biopsy (FNAB) diagnosis of malignant mixed tumors are rare and have been limited to cases arising in the parotid. Cytologic features and diagnostic pitfalls of this uncommon neoplasm are presented. CASE: A 75-year-old male presented with a nontender submandibular mass. The lesion had been present 12 months, with a recent increase in size. FNAB was performed, and the smears revealed a mixture of benign and malignant areas. The benign portion of the smears showed findings typical of pleomorphic adenoma. The malignant area showed large cells occurring singly and in groups. The malignant cells contained pleomorphic nuclei with irregular nuclear membranes and prominent macronucleoli; cytologically, they resembled cells from a poorly differentiated adenocarcinoma. CONCLUSION: We present the first case of carcinoma ex pleomorphic adenoma of the submandibular gland correctly diagnosed by FNAB. This rare salivary gland malignancy can be accurately diagnosed on FNAB if strict criteria are applied.

Adenoma, Pleomorphic↗
PubMedDate not supplied

Tamoxifen in the treatment and chemoprevention of breast cancer.

Synthesized in 1966 and initially tested as a potential contraceptive, the nonsteroidal antiestrogen tamoxifen was subsequently found to have therapeutic benefits in the therapy of breast cancer. Today, tamoxifen is widely used in the treatment of this disease both in an adjuvant setting and for metastatic tumor. This article explores the history, pharmacology, and adverse effects of tamoxifen and summarizes the clinical evidence for its current indications and potential future use as a chemopreventative agent.

Breast Neoplasms↗
PubMedDate not supplied

The current status of somatostatin receptors in malignant melanoma.

On the basis that melanomas are of neural crest origin and might contain somatostatin receptors, the authors utilized 111In Pentetreotide (OctreoScan) to image 16 melanoma patients with known sites of disease. Twelve of 16 patients were positive with 38 percent imaging all sites. No lesion less than 1.5 cm imaged nor did one ocular and one amelanotic melanoma. Of the five described somatostatin receptors, OctreoScan binds only 2 and 5 suggesting that not all melanomas contain those receptors. It is concluded that melanomas contain somatostatin receptors and that this property might be used for imaging, tumor suppression with Octreotide, and/or as a target for Octreotide labelled with therapeutic agents such as immune complexes, chemotherapeutic agents or high energy radioisotopes.

Humans↗