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R J Babaian

Publications and source records attributed to R J Babaian.

At least 91 records · Page 5Linked to original sources
PubMed1989

Identifying patients with low-risk clinical stage I nonseminomatous testicular tumors who should be treated by surveillance.

We examined the records of 82 patients with clinical Stage I nonseminomatous germ cell tumors of the testis who, after radical orchiectomy, were treated by surveillance at M.D. Anderson Cancer Center between October, 1981, and March, 1987. Our purpose was to determine whether or not patients with a low risk of relapse can be identified at the time of the initial staging evaluation. In 30 of 82 patients (Group 1), embryonal carcinoma constituted less than 80 percent of the tumor, no vessel invasion was present, and the preorchiectomy serum AFP level was less than 80 ng/dL. No relapses occurred in this group. Fifty-two patients (Group 2) had more than 80 percent embryonal carcinoma or vessel invasion or a serum AFP level higher than 80 ng/dL. Relapse occurred in 24 (46%) of these patients. The difference in the rate of relapse between patients in Group 1 and Group 2 was statistically significant (P less than 0.00001). A separate analysis of teratoma as a predictor of nonrelapse showed that the orchiectomy specimens of 30 of the 82 patients contained more than 50 percent teratoma. Only 1 relapse occurred among 25 patients with more than 50 percent teratoma and no vessel invasion. Our data show that there is a subgroup of patients with clinical Stage I nonseminomatous germ cell tumor who have a very low rate of relapse. We believe these patients can be effectively treated by surveillance and should be spared the morbidity of an unnecessary retroperitoneal lymph node dissection.

Humans↗
PubMed1989

Radioimmunoscintigraphy of prostate cancer.

The development of hybridoma technology has increased research efforts and clinical applications in the area of radioimmunodetection. Despite the many investigative antibodies directed against prostatic tissue or prostate cancer cell lines, only two have been tested in clinical trials. A 111In-labeled antibody directed against prostate-specific antigen, the best available serum tumor marker for prostate cancer, has shown poor sensitivity in limited clinical radioimmunoimaging trials. Monoclonal antibodies against prostatic acid phosphatase have shown better imaging results, particularly at higher antibody doses (greater than or equal to 40 mg). The limitations of this antibody include the poor results in detecting soft tissue lesions, including the primary lesion; the development of human antimouse antibodies in 50% of the patients at doses greater than or equal to 40 mg; the expense of the antibody; and the fact that better results are currently attainable by other less expensive imaging modalities. If and when a more suitable antibody or fragment is developed, the prospect of improved staging and new treatments using immunologic conjugates carrying therapeutic agents may become realities. Until such time, prostatic cancer will be staged with other currently available imaging modalities and conventional therapies with their limitations will remain state of the art.

Acid Phosphatase↗
PubMed1989

[Diagnosis of early prostatic cancer. Correlation of in vitro echography and histopathologic mapping].

Sonographic detection of early prostatic carcinoma is based on the depiction of a hypoechoic focus. Thirty-seven correlations between in vitro sonographic patterns and pathologic mapping of prostatectomy specimens could be obtained in 26 patients. It was assumed that carcinomas smaller than 5 mm in diameter could not be visualized on sonography. Sonography identified 4 to 8 carcinomas greater than 5 mm in size (sensitivity, 50%). Of 18 hypoechoic foci, only 4 were carcinomas (positive predictive value, 22%). Among false positive results, 79% corresponded to normal prostatic tissue at pathology. The specificity of the hypoechoic focus as an indicator of cancer was 52% in this series. 36% of the carcinomas were located in the anterior half of the prostate. The carcinomas that were detected on sonography were all hypoechoic.

Adult↗
PubMed1988

Ketoconazole therapy for hormonally refractive metastatic prostate cancer.

Twenty-two patients who had progressive metastatic prostatic carcinoma (Stage D2) despite androgen-deprivation therapy (bilateral orchiectomy, 10 cases; bilateral orchiectomy followed by diethylstilbestrol, 7 cases; diethylstilbestrol, 3 cases; combined megestrol acetate and low-dose estrogen, 2 cases) were treated with ketoconazole. Of 19 evaluable patients, 2 (11%) achieved a partial response (for 6 and 8 months) and 7 others (37%) achieved stabilization of disease (for periods of 3-8 months). Of 16 patients in whom pain was a prominent clinical feature, 13 (81%) noted improvement in pain for periods of one to eight months (median 3 months). We conclude that ketoconazole is a useful addition to our current armory for management of patients with metastatic prostatic cancer resistant to prior hormonal therapy.

Aged↗
PubMed1988

Effective outpatient use of polyethylene glycol-electrolyte bowel preparation for radical cystectomy and ileal conduit urinary diversion.

In this prospective study we examined the oral electrolyte-overload method of bowel preparation for patients who were to undergo radical cystectomy and ileal conduit urinary diversion. We found it to be a safe and effective mechanical bowel preparation that can be used by outpatients. It was well tolerated and resulted in adequate bowel cleansing and a low incidence of postoperative wound infections and pyelonephritis. A major advantage of this method is that it reduced the period of preoperative hospitalization.

Ambulatory Care↗
PubMed1988

Dissemination of disease following transurethral resection for locally advanced prostate cancer.

Between 1974 and 1978, 258 patients with clinical Stage C adenocarcinoma of the prostate were treated at the U.T. M.D. Anderson Hospital in Houston. Of these, 208 were considered evaluable for a review of the impact of transurethral resection (TUR) on the dissemination of disease. After TUR, the incidence of disease progression was 38.9 per cent, compared with 36.4 per cent for patients who did not undergo TUR. There were significant differences in both incidence of progression (31.2% versus 55.6%, p = 0.002) and time to progression (p less than 0.001) when patients were divided into Stages C1 and C2 (presence or absence of pelvic side wall fixation) irrespective of their TUR status. Therefore, it appears that for patients with locally advanced prostate cancer, the degree of tumor burden and not the TUR status has a significant influence on disease progression.

Actuarial Analysis↗
PubMed1988

Medical castration using megestrol acetate and minidose estrogen.

Sixty-two men who presented with previously untreated metastatic carcinoma of the prostate (D0: 10 patients; D1: 29 patients; D2: 23 patients) received oral megestrol acetate (80 mg twice daily) and minidose estrogen (diethylstibestrol 0.1 mg or ethinyl estradiol 0.05 mg once daily) as a means of achieving total androgen ablation (testicular and adrenal). A high incidence of feminizing side effects (70-74%), a higher than expected rate of cardiovascular complications (18%), an unexpected need for cortisone replacement (13%), and failure of patients with Stage D2 disease to obtain results better than those of standard therapy during the first year of observation suggest this regimen offers no advantage over other more conventional therapy.

Adenocarcinoma↗
PubMed1988

Testicular seminoma: the M. D. Anderson experience. An analysis of pathological and patient characteristics, and treatment recommendations.

We treated 240 patients with testicular seminoma at our institution between January 1960 and December 1982. The over-all 5-year survival free of disease for these patients regardless of stage was 93.6 per cent. The 165 patients (69 per cent) with stage I disease had a 95.5 per cent 5-year survival free of disease that remained constant at 20 years. Stage II cancer was diagnosed clinically in 62 patients (26 per cent), while 13 (5 per cent) presented with more advanced (stages III and IV) disease. The 5-year survival rate free of disease for all patients with stage II cancer was 85 per cent. There were 14 pathological and patient characteristics analyzed, 4 of which were statistically significant. All but 1 of these factors (spermatic cord invasion) was related to tumor volume (stage, palpable mass and hydronephrosis). Based on the data of this retrospective review, the Canadian experience without prophylactic mediastinal irradiation and the development of effective chemotherapy, we recommend radiation therapy without prophylactic mediastinal irradiation for patients with stage I or IIA disease and chemotherapy for patients with stage IIB, III or IV disease. In an attempt to improve our results in the latter patients we recently instituted adjunctive radiotherapy for those with a persistent radiographic mass. Our current guidelines for the staging evaluation and followup of patients with this neoplasm also are discussed.

Combined Modality Therapy↗
PubMed1988

Adjuvant cyclophosphamide, doxorubicin, and cisplatin chemotherapy for bladder cancer: an update.

Seventy-one patients received adjuvant Cytoxan (cyclophosphamide; Bristol-Myers Co, Evansville, IN), Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and cisplatin (CISCA) chemotherapy between March 1981 and March 1986. Patients received adjuvant CISCA chemotherapy if they had pathological findings that were thought to predict for high likelihood of relapse. These included the presence of resected nodal metastases, extravesicular involvement of tumor, lymphatic/vascular permeation of the primary tumor, or pelvic visceral invasion. Sixty-two patients at a similar high risk for recurrence did not receive adjuvant CISCA chemotherapy because they refused, had medical contraindications to therapy, or were not referred for chemotherapy. Two-hundred six patients had a cystectomy performed during the same study period but had none of the poor prognostic features suggesting a high risk for relapse. Sixty-two percent of the patients receiving adjuvant chemotherapy are alive and disease-free for a mean follow-up of 118 weeks (range, 28 to 310 weeks). A survival advantage exists for the adjuvant-treated patients when compared with those with unfavorable pathological findings who did not receive adjuvant chemotherapy (70% v 37%) (P = .00012): no difference exists in long-term disease-free survival for those with favorable pathological findings (long-term disease-free survival 76%) v those who received adjuvant chemotherapy (70%) (P = .33). Adjuvant CISCA chemotherapy prolongs the disease-free survival of some patients following a cystectomy. Patients who benefitted from adjuvant CISCA chemotherapy included those with resected nodal metastases, extra-vesicular involvement of tumor, and direct invasion of the pelvic viscera. Patients not benefitting from adjuvant CISCA chemotherapy in this analysis included those with lymphatic/vascular invasion in their primary tumor as the sole manifestation of high risk for relapse.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Radiation after pelvic lymphadenectomy: effect on morbidity.

The role of a staging pelvic lymph node dissection has been questioned because of its associated morbidity, especially when followed by definitive radiation therapy. Forty-nine patients with clinically localized adenocarcinoma of the prostate underwent a staging pelvic lymphadenectomy. Clinically suspected lymph nodes were submitted for frozen section analysis. A unilateral dissection was performed on 7 patients (14%), none of whom developed intraoperative or postoperative complications. The remaining 42 patients underwent bilateral pelvic lymphadenectomy, after which 26 were treated with definitive radiation therapy using the four-field box technique, and 16 received other forms of therapy (delayed androgen deprivation or hormonal manipulation). The complication rate of 19% was identical for both groups of patients. Complications consisted of 3 seromas, 1 atelectasis, 1 prolonged ileus, 1 wound infection, and 2 transient penile or scrotal edemas. Radiation therapy, therefore, did not increase postoperative morbidity.

Acid Phosphatase↗
PubMed1987

Stage I testicular seminoma: rationale for postorchiectomy radiation therapy.

The cases of 163 patients with Stage I seminoma of the testis treated by orchiectomy and adjuvant radiation therapy (XRT) were retrospectively evaluated to document outcome and to determine the prognostic significance of age side or primary, cryptorchidism, prior ipsilateral herniorrhaphy, status of the contralateral testis, history of prior testicular cancer, scrotal incision, postorchiectomy beta- human chorionic gonadotropin (BHCG) level, invasion of the epididymis, spermatic cord involvement, vascular invasion in the primary and mediastinal XRT. Of the prognostic factors evaluated, only spermatic cord involvement proved to be a significantly adverse factor. However, the true significance of cord involvement is unclear because the para-aortic regions were not irradiated in 2 of the patients in whom there was this finding, and in 1 of these there was failure in the retroperitoneum. Spermatic cord involvement was not a prognostically significant finding in patients whose para-aortic region was treated. For all 163 patients who underwent XRT, disease-free survival was 95% at 5, 10, and 15 years. Total survival corrected for intercurrent death was 97% from 5 through 20 years. Seven patients relapsed (4%) and 4 died of seminoma (2%). The XRT technique described is simple to implement and is extremely effective. Of 161 patients whose para-aortic region was irradiated, none developed subdiaphragmatic nodal recurrence. Only 1 patient developed acute leukemia. No patient developed any of the recognized delayed XRT-induced complications involving small bowel, large bowel, bladder, kidney, liver or spinal cord. The virtues and limitations of surveillance in Stage I testicular seminoma are discussed, and it is concluded that routine postorchiectomy XRT is the treatment of choice.

Adolescent↗
PubMed1987

The role of radiation in stage II testicular seminoma.

This is a retrospective review of 62 patients with Stage II testicular seminoma treated either by initial radiation therapy (48 patients) or by platinum-containing chemotherapy (14 patients). For all 62 cases, disease-free survival from 2 to 20 years was 86%, uncorrected survival was 86% at 5 years and 83% at 15 years, and survival corrected for deaths from intercurrent disease was 90% from 2 to 20 years. There were no significant differences in outcome between the two treatment groups. An analysis of potential prognostic factors for the initial radiation therapy group and for the whole group revealed that age, site of primary, cryptorchidism, ipsilateral hernia repair, contralateral testicular atrophy, scrotal incision, elevated postorchiectomy beta-human chorionic gonadotropin level, epididymal invasion, spermatic cord involvement, and vascular invasion in the primary were not significant. However, bulk of abdominal disease was a prognostic factor. Patients with small-volume abdominal disease defined as nonpalpable disease or as a mass less than 10 cm in largest diameter accounted for two-thirds of the series and had a disease-free survival of 95% when treated with initial radiation therapy. Patients with bulky disease, either palpable or greater than or equal to 10 cm in diameter, had a disease-free survival of 64%. The relative roles of the two treatments in bulky abdominal disease are discussed, but in the absence of a prospective study it is not possible to definitively answer the question of which modality is best in this setting. In our series, the patients treated with platinum-containing chemotherapy fared as well as the primarily irradiated patients, but 71% of the former had palpable masses, compared with 22% of the latter. The chemotherapy-treated patients who relapsed were treated with radiation therapy for salvage, leading to a 100% survival corrected for intercurrent death. We have therefore elected to continue the policy of initial radiation therapy for small-volume (less than 10 cm) disease and platinum-containing chemotherapy for bulky disease (greater than or equal to 10 cm), with irradiation used for residual masses.

Adult↗
PubMed1987

Incidence, extent and location of unsuspected pelvic lymph node metastasis in patients undergoing radical cystectomy for bladder cancer.

Between March 1, 1983 and December 31, 1985, 18 of 130 patients (14 per cent) undergoing radical cystectomy had unsuspected metastasis. In 17 patients (94 per cent) only 1 or 2 nodes were involved. The mean size of the involved nodes was 0.81 cm. and the mean size of metastasis was 0.39 cm. In patients with 1 or 2 positive nodes metastasis was not observed above the bifurcation of the common iliac arteries or lateral to the external iliac arteries. In patients in whom the primary bladder tumor was localized clearly to 1 side of the bladder unsuspected metastasis was observed only in ipsilateral lymph nodes. In accordance with these findings, we advocate a restricted pelvic lymphadenectomy in patients in whom gross examination reveals no evidence of nodal metastasis at radical cystectomy.

Humans↗
PubMed1987

Radioimmunological imaging of metastatic prostatic cancer with 111indium-labeled monoclonal antibody PAY 276.

A total of 25 patients with histologically proved adenocarcinoma of the prostate, whose disease was staged clinically as D2 by appropriate radiographic and nuclear medicine studies, received increasing doses of PAY 276, an antiprostatic acid phosphatase monoclonal antibody for radioimmunological imaging. The patients were divided into 5 groups of 5. Groups 1 through 5 received an infusion of 5, 10, 20, 40 or 80 mg. monoclonal antibody, respectively, 1 mg. of which was labeled to 5 mCi. of 111indium, while stable monoclonal antibody was added to achieve the desired antibody concentration. No patient had an allergic reaction, and no significant change in serial hemoglobin levels, platelet count, chemistry profile or results of urinalyses was noted. The monoclonal antibody scan visualized at least 1 lesion in 19 of 25 patients (76 per cent): 4 in groups 1 and 2, and all 15 in groups 3 to 5. With results of conventional radiography and bone scintigraphy considered definitive for metastases, monoclonal antibody scans detected 7 of 32 metastases (21.8 per cent) in group 3 (20 mg.), 31 of 58 (53.4 per cent) in group 4 (40 mg.) and 101 of 134 (75.4 per cent) in group 5 (80 mg). In group 5 the incidence of false positive and false negative scans was 2.3 per cent (3 of 132) and 24.6 per cent (33 of 134), respectively. The detection of metastatic lesions increased as the concentration of unlabeled monoclonal antibody increased. Radioimmunological imaging of prostatic cancer with antiprostatic acid phosphatase monoclonal antibody seems to be feasible.

Acid Phosphatase↗
PubMed1987

Hyperdense parapelvic cyst confused with renal tumor.

We have reported a case of a hyperdense parapelvic renal cyst that could not be easily differentiated from a solid tumor by multiple diagnostic studies. However, the typical findings of a hyperdense parapelvic cyst may allow less aggressive surgery.

Diagnostic Errors↗
PubMed1986

Elevated prostatic acid phosphatase: a prognostic factor for stage C adenocarcinoma of the prostate.

The clinical course of 25 patients with clinical stage C adenocarcinoma of the prostate who had pre-treatment elevations of the prostatic acid phosphatase (Roy test) was analyzed retrospectively. All patients were treated with definitive external beam radiation therapy at our hospital between 1974 and 1980. Of the 25 patients 17 (68 per cent) have had disease progression. The median time to treatment failure for this group was 27 months (range 10 to 101 months), and the over-all median survival for these patients has not been reached (range 16 to 120 months). Local control of disease was achieved in 84 per cent (21 of 25) of the patients. The control group consisted of 75 consecutive age-matched patients with normal pre-treatment prostatic acid phosphatase levels whose disease was identically staged and treated at our hospital from July 1977 to January 1979. The median time to disease progression in this group has not yet been reached. Of these 75 patients 24 (32 per cent) have had disease progression within a median time of 38 months. Therefore, an elevated pre-treatment prostatic acid phosphatase value is a harbinger of systemic disease and indicates that radiotherapy will be significantly (p equals 0.002) less effective as a definitive local therapeutic modality.

Acid Phosphatase↗