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Biomedical subjects

R Jyothirmayi

Publications and source records attributed to R Jyothirmayi.

17 recordsLinked to original sources
PubMed2005

An audit of the indications for and techniques of palliative splenic radiotherapy in the UK.

AIMS: This paper describes a national audit of the indications for, and techniques and toxicity of, palliative splenic radiotherapy in haematological disorders. MATERIALS AND METHODS: A postal questionnaire was sent to consultant clinical oncologists treating haematological malignancies in the UK. RESULTS: The response rate was 76%. The audit shows chronic lymphocytic leukaemia, myelofibrosis and chronic myeloid leukaemia to be the most common underlying conditions in which splenic irradiation is used. Painful splenomegaly and hypersplenism were the most common indications. Dose fractionation schedules vary widely across the UK, and also the level of full blood counts used to interrupt radiotherapy. CONCLUSIONS: Palliative splenic radiotherapy continues to be widely used in the UK in small numbers of patients and seems to be well tolerated. Re-irradiation for further symptomatic progression is also commonly carried out.

Hematologic Diseases↗
PubMed2003

Pseudomyxoma peritonei.

Pseudomyxoma peritonei is a rare form of mucinous ascites associated with peritoneal and omental implants. The origin is controversial, and recent immunohistochemical and molecular genetic evidence suggests the appendix to be the likely site. The condition often presents as an incidental finding at laparotomy. Ultrasonography, computed tomography and magnetic resonance imaging aid in preoperative diagnosis. Treatment remains controversial, surgery being the main stay. The role of intraperitoneal and systemic chemotherapy is poorly defined. We review the literature on the pathology, clinical features and treatment options in pseudomyxoma peritonei.

Appendiceal Neoplasms↗
PubMed2002

Oligodendroglioma: clinical profile and treatment results.

Oligodendrogliomas are rare glial tumors with a long natural history. Radical surgery, postoperative radiotherapy, chemotherapy and observation have been suggested as part of primary management. This series reports the presentation and outcome in 34 patients with histologically verified pure oligodendrogliomas treated between 1983 and 1993. All patients were treated at the time of initial diagnosis with surgery, with or without additional radiotherapy. The overall survival and progression free survival rates at five years were 69.8% and 55% respectively. There was no tumor or treatment related factor influencing survival significantly.

Adolescent↗
PubMed2001

Stereotactic radiotherapy for solitary brain metastases.

PURPOSE: Surgery is considered to be the treatment of choice for patients with solitary brain metastases. We report a single-centre experience of stereotactic radiotherapy (SRT)/radiosurgery as an alternative to surgery and define prognostic parameters that provide for a more rational selection of patients for appropriate treatment. PATIENTS AND METHODS: Between 1990 and 1997, 96 patients with 106 brain metastases received SRT to a dose of 20 Gy in two fractions (range 20-30 Gy in 24 fractions) either alone or in combination with whole brain radiotherapy. RESULTS: After SRT, 51% of patients had improvement in neurological function. The median survival of the 96 patients was 9 months. The Radiation Therapy Oncology Group prognostic grouping for patients with multiple brain metastases (prognostic factors: age, performance status, systemic metastases, status of primary tumour) was applicable to this cohort, with median survivals of 15, 8 and 2 months for favourable, intermediate and poor prognostic groups respectively. CONCLUSION: SRT is a non-invasive method of treatment of solitary brain metastases and the outcome is comparable with the results obtained after surgical excision. Prognosis is determined by factors defined for patients with multiple brain metastases, with performance status being the most important. SRT/radiosurgery should be reserved for patients with favourable prognostic factors, with a Karnofsky performance status >70, who have a reasonable chance of good quality prolonged survival. In future trials, radiosurgery should be compared in terms of survival, quality of life and health economics to whole brain radiotherapy and surgery.

Adult↗
PubMed1999

Radiation therapy in the treatment of giant cell tumor of bone.

PURPOSE: To assess the local control rate and potential complications of radiotherapy, and the factors influencing response to radiotherapy for primary and locally recurrent giant cell tumor of bone. METHODS AND MATERIALS: Twenty patients were irradiated for giant cell tumor of bone between 1983 and 1993. Fourteen patients received radiotherapy at the time of primary diagnosis (10 had biopsy and 4 partial surgery) and 6 patients at the time of local recurrence (following additional surgery in 2). Fourteen patients had tumors of the extremity and six of the vertebral column. The radiotherapy dose ranged from 40-60 Gy in 15-30 fractions over 3-6 weeks. The response to radiotherapy was assessed by clinical and radiological criteria and the probable factors influencing response were analyzed. RESULTS: The median follow-up period was 48 months (range, 4 months to 13 years). Local control was obtained in 18/20 patients. The two local failures were salvaged, one by reirradiation and the other by surgery. Only one patient died of giant cell tumor, following extensive bone marrow infiltration. There was no serious late toxicity or malignant transformation. The response to radiotherapy was not influenced by disease status at presentation, tumor site, radiotherapy schedule, or presence of soft tissue extension. CONCLUSIONS: Radiotherapy is effective in producing local control in primary as well as recurrent giant cell tumor of bone. There are no major complications and no significant risk of malignant transformation. Radiotherapy could be considered as the primary treatment modality in patients where surgery would produce functional deficits.

Adolescent↗
PubMed1998

Extragonadal germ-cell tumors: a ten-year experience.

Extragonadal germ-cell tumors (EGCT) are uncommon and biologically distinct from their gonadal counterparts. Thirty-seven patients who had EGCT were treated over a ten-year period at the Regional Cancer Centre, Trivandrum, India. There were 26 men and boys and 11 women and girls. The sites of primary tumor were mediastinum (n=18), central nervous system (n=5), sacrococcygeal region (n=4), retroperitoneum (n=2), and other sites (n=8). After combined modality therapy, 13 of 18 patients who had mediastinal EGCT--1 of 2 with retroperitoneal, 1 of 4 with sacrococcygeal, 0 of 5 with central nervous system, and 2 of 8 patients with tumor in other sites-were alive with no evidence of disease at a median follow-up of 16 months. The overall 5-year survival rate was 40%. Histologic subtype and elevated marker levels were the significant prognostic factors on univariate analysis.

Adolescent↗
PubMed1997

Radiotherapy in the treatment of verrucous carcinoma of the oral cavity.

Verrucous carcinomas are considered to have poor radioresponsiveness and radiotherapy has been reported to induce anaplastic transformation. Surgery has been considered to be the primary mode of treatment for these tumours. The clinical features, response to radiotherapy, survival and prognostic factors of a group of 53 patients with oral verrucous cancers, were studied and compared to patients with oral well-differentiated, squamous cancers, treated during the same time period. The buccal mucosa was the commonest primary site in both groups. 42 patients with verrucous cancer underwent primary radiotherapy and 11 underwent primary surgery. Complete response to radiotherapy was achieved in 76% of patients with verrucous cancer and partial response in 24%. Patients with verrucous cancer had a five year actuarial disease-free survival of 66% and overall survival of 86%. The corresponding survival figures were 43% and 56% in well-differentiated squamous cancers (P = 0.004). Composite stage of disease was a significant predictor of disease-free survival in both groups. None of the 16 patients with verrucous cancers that recurred after radiotherapy, had features of anaplastic transformation. Oral verrucous carcinoma appears to have similar radioresponsiveness and improved disease-free survival, compared to well-differentiated squamous cancers. The treatment policies for other oral squamous cancers are applicable to these tumours.

Adult↗
PubMed1997

Conservative surgery and radiotherapy in the treatment of spinal cord astrocytoma.

Spinal cord astrocytomas are rare neoplasms, and optimal treatment guidelines are undefined, 23 patients with spinal cord astrocytomas were treated between 1984 and 1993 with conservative surgery and postoperative radiotherapy. The mean age was 31 years. Twelve patients were male and eleven female. All patients presented with neurologic deficit. Cervical cord was involved in five patients, cervicothoracic in four, thoracic in eight and thoracolumbar in six. Five patients had intramedullary cysts. Fifteen patients had low grade tumors and six high grade. Surgery was near total excision in three patients, partial excision in ten and biopsy in ten patients. All patients received postoperative radiotherapy to a median dose of 45 Gy in 25 fractions over 5 weeks. The median followup was 51 months (range 7-143 months). At 6 months post radiotherapy, twelve patients had improvement of neurologic status, nine had stable status, and two deteriorated. The actuarial overall survival was 55% at 5 years and 39% at 10 years. The actuarial progression free survival probability was 75% at 5 years and 55% at 10 years. Five patients had local failure and two failed at distant sites. Twelve patients died, six due to progressive disease, five due to complications of paraplegia and one patient of unrelated causes. Tumor grade was a significant prognostic factor for overall survival. 5 year overall survival was 79% for low grade tumors. No patient with high grade tumor survived more than 2 years and the median survival was 10 months. Low grade, female sex and presence of intramedullary cysts were associated with significantly improved progression free survival. Conservative surgery followed by radiotherapy appears to have a role in achieving tumor control and neurologic recovery in patients with low grade astrocytomas of the spinal cord. Treatment results of high grade tumors remain poor and new therapeutic strategies need to be studied.

Adolescent↗
PubMed1997

Radiotherapy in the treatment of solitary plasmacytoma.

Solitary plasmacytoma of bone (SPB) and extramedullary plasmacytoma (EMP) are rare. High local control rates are reported with radiotherapy, although the optimal dose and extent of radiotherapy portals remains controversial. Between 1983 and 1993, 30 patients with solitary plasmacytoma were seen at the Regional Cancer Centre, Trivandrum, India. 23 patients had SPB and seven EMP. The mean age was 52 years and the male to female ratio 3.2:1. Diagnosis of SPB was confirmed by biopsy in 16 patients and tumour excision in seven. 20 patients received megavoltage radiotherapy to the bone lesion with limited margins, and one received chemotherapy. Two patients who underwent complete tumour excision received no further treatment. All seven patients with EMP received megavoltage radiotherapy, four following biopsy and three after tumour excision. Local control was achieved in all patients with SPB. Nine progressed to multiple myeloma and one developed a solitary plasmacytoma in another bone. Six patients with EMP achieved local control. Three later progressed to multiple myeloma and one had local relapse. Median time to relapse was 28 months in SPB and 30 months in EMP. 5-year overall survival rates were 82% and 57% for patients with SPB and EMP, respectively. The corresponding progression free survival rates were 55% and 50%, respectively. Age, sex, site of tumour, serum M protein and haemoglobin levels did not significantly influence progression free survival. The extent of surgery, radiotherapy dose or time to relapse were not significant prognostic factors. Radiotherapy appears to be an effective modality of treatment of solitary plasmacytoma. No dose-response relationship is observed, and high local control rates are achieved with limited portals. Progression to multiple myeloma is the commonest pattern of failure, although no prognostic factors for progression are identified. The role of chemotherapy in preventing disease progression needs further evaluation.

Adult↗
PubMed1997

Primary malignant germ cell tumours of the mediastinum--results of multimodality treatment.

Primary malignant mediastinal germ cell tumours are rare and considered to have poorer prognosis compared with those arising from gonads. Eighteen patients with primary mediastinal germ cell tumour were treated over an 1-year period; 9 had seminoma and 9 non-seminoma. Eight patients, 4 each with seminoma and non-seminoma underwent initial tumour excision and the rest had biopsy only. All patients received cisplatin-based chemotherapy. All patients with seminoma received consolidation radiotherapy to mediastinum. Three patients with non-seminoma received radiotherapy following partial response. All 9 patients with seminoma achieved complete response at the end of chemotherapy. Two patients with NSGCT had complete response to chemotherapy, 5 partial response and 2 no response. Two patients who underwent resection of the residual tumour mass are surviving free of disease. Addition of radiotherapy or second-line chemotherapy did not bring about any added response in partial and non-responders. Nine out of 9 patients with seminoma and 4/9 with non-seminoma are surviving disease-free at a median follow-up of 48 months (range 16 153 months). Mediastinal seminoma has excellent prognosis with cisplatin combination chemotherapy, whereas non-seminoma carries poor prognosis, and aggressive chemotherapy with resection of residual masses may improve the outcome. The role of additional radiotherapy and initial tumour debulking needs further evaluation.

Adolescent↗
PubMed1996

Efficacy of vitamin A in the prevention of loco-regional recurrence and second primaries in head and neck cancer.

Chemoprevention with retinoids is currently an experimental approach to prevent local relapses and second primaries in treated head and neck cancer patients. We evaluated the effectiveness of vitamin A in preventing the above events in a randomised trial involving 106 head and neck cancer patients who had achieved complete regression of their disease with radiotherapy and/or surgery. They were randomised to receive retinyl palmitate (200,000 IU per week for 1 year) or placebo. 50 subjects on vitamin A and 43 on placebo completed 1 year supplementation; 49 in the former group and 42 in the latter could be evaluated over a 3 year period from the initiation of the study. One fifth (11/56) of patients in the vitamin A group and one tenth (5/50) in the placebo group had loco-regional recurrence. The frequency of recurrences in stage I patients in the vitamin A group was higher compared to the placebo group, although it was not statistically significant. No second primaries were observed in the vitamin A group; 2 patients in the placebo group had second primaries. No clinically obvious side effects were observed with vitamin A. The higher frequency of recurrences in the vitamin A group is of concern although it may be a chance finding given the small size of the trial. The effect on second primaries is consistent with other observations reported in literature.

Anticarcinogenic Agents↗
PubMed1995

Case report: brain metastases from papillary carcinoma thyroid.

Papillary carcinoma, the commonest thyroid malignancy, has a good prognosis and low incidence of distant metastases. Brain metastasis is extremely rare with a frequency of 0.1-5% in reported series. The clinical details of two cases of histologically proven brain metastases from papillary thyroid cancer treated in our centre are presented. In one patient, the lesion was in the cerebellar hemisphere, and in the other, the frontal lobe. Also presented is a review of the literature of this unusual clinical presentation.

Brain Neoplasms↗
PubMed1995

Case report: spinal metastasis from carcinoma of the penis.

Carcinoma of the penis has a well documented metastatic pattern, regional lymph nodes being the predominant site of involvement. Distant metastasis is extremely rare, with a reported incidence of 1-10%. Osseous metastasis is even rarer and no case of metastasis to the spine has been reported previously. We present a case of carcinoma of the penis metastasizing to the spine.

Humans↗
PubMedDate not supplied

Hodgkin's disease in association with Down syndrome: a case report.

The increased incidence of malignancies, especially acute leukemia, in Down syndrome has been clearly established. The association of Hodgkin's disease with Down syndrome has not been extensively documented, and only a few cases have been reported. We present here a case report of Hodgkin's disease in an 11-year-old female child with Down syndrome. The child presented with a stage IVB nodular sclerotic Hodgkin's disease and died of progressive disease. We also present a brief review of the mechanisms of development of malignancy in Down syndrome.

Cell Transformation, Neoplastic↗