Biomedical subjects

Robert B Marcus

Publications and source records attributed to Robert B Marcus.

5 recordsLinked to original sources

PubMed2003

Radiation therapy for angiosarcoma.

BACKGROUND: Between 1964 and 1998, 19 patients with histologically proven angiosarcoma were treated with curative intent with radiation therapy. METHODS: Median follow-up was 37 months (range, 8-234 months). RESULTS: The actuarial 5-year absolute survival and local control rates were 51% and 50%, respectively. Of 12 patients who relapsed, 8 had isolated local recurrence as the first site of treatment failure, 2 had local (1 patient) or regional recurrence in conjunction with distant metastases, and 2 had distant metastases alone. Two of four patients who underwent further therapy for recurrent disease were successfully salvaged. CONCLUSIONS: Only the location of the primary tumor was a predictor of local control and absolute survival at 5 years. Angiosarcomas located on the scalp imply a dismal prognosis compared with those in other locations with the predominant pattern of failure being local recurrence. Patients should be treated aggressively with surgical resection and preoperative or postoperative radiation therapy.

Adult↗

PubMed2003

Oligodendroglioma: does deferring treatment compromise outcome?

This study reports the University of Florida experience treating oligodendrogliomas with the goal of identifying the factors that predict favorable outcome. Between 1958 and June 1998, 51 patients (aged 5-75 years) were diagnosed with pure oligodendroglioma at the University of Florida. Histologic grade was anaplastic in 19 patients, low-grade in 30 patients, and unknown in one patient. Twelve patients were treated with surgery alone (10 with low-grade tumors). Thirty-nine patients underwent postoperative radiotherapy after surgery (plus chemotherapy in four patients). A biopsy was performed in 10 patients, 40 underwent subtotal or gross total resection, and one had surgery of unknown extent. Thirteen patients with a radiographic abnormality consistent with a low-grade glioma had the initiation of definitive treatment (i.e., surgery with or without radiotherapy) deferred for a median of 4.5 years before undergoing treatment for worsening symptoms or radiographic progression. Absolute survival for the entire group (51 patients) at 5, 10, and 20 years from the date of initial treatment was 61%, 37%, and 31%, respectively, and at 5, 10, and 20 years from the date of initial diagnosis was 65%, 43%, and 34%, respectively. No patient died of intercurrent disease. Multivariate analysis for absolute survival from the time of initial treatment demonstrated young age (young patients fared better than older patients) and size (<5 cm better than > or =5 cm) to be significant variables. No patient under the age of 21 years (n = 8) at the time of diagnosis has died in this series. Deferring aggressive treatment did not alter survival. Multivariate analysis for favorable absolute survival based on the time from initial diagnosis demonstrated young age and presentation with seizures alone to be statistically significant for favorable outcomes. Approximately one third of patients with oligodendroglioma appear to be cured with aggressive treatment. Age is the most important predictor of long-term progression-free and absolute survival with young patients (especially aged <21 years) doing much better than older patients. Deferring aggressive treatment (surgery and/or radiation) until symptoms clearly indicate tumor progression does not compromise outcome for a select group of patients who are diagnosed at a young age with a nonenhancing mass on MR and seizures as the lone presenting symptom.

Adolescent↗

PubMed2003

Role of radiotherapy in the treatment of neurosarcoidosis.

Neurosarcoidosis is usually managed with steroids, immunosuppressives, and other medications. Several small series suggest that radiotherapy might be useful in patients whose disease is refractory to conventional treatment. The purpose of this article is to report the outcome of 4 patients with neurosarcoidosis who were treated at the University of Florida. With long-term follow up, partial regression of disease was observed in 2 patients, stabilization of disease in 1 patient, and disease progression in 1 patient. Our experience and review of the related literature suggest the following conclusions: (1) radiotherapy is often effective in preventing the progression of local symptoms from neurosarcoidosis, but has limited application in reversing established neurologic deficits; (2) sarcoid meningitis is responsive to radiotherapy; and (3) radiation dose for the palliation of symptoms related to neurosarcoidosis is 20 to 25 Gy.

Adult↗

PubMed2002

External beam radiotherapy for primary and adjuvant management of aggressive fibromatosis.

PURPOSE: To review a large single-institution experience in the management of aggressive fibromatosis to determine the effectiveness of external beam radiotherapy (EBRT) and identify the presentation and treatment variables predictive of locoregional control. METHODS AND MATERIALS: Between 1975 and 2000, 72 patients were treated with EBRT for a pathologically confirmed diagnosis of aggressive fibromatosis. Thirty patients were treated at the primary presentation and 42 at the time of a locoregional recurrence. Minimal 2-year follow-up data were available for 65 patients (median 6 years). Megavoltage irradiation with 60Co to 20 MV photons or electron therapy was used for all patients. Most patients were treated after attempted complete surgical resection; 16 patients underwent pretreatment biopsy alone. The prescribed treatment was standard (1.8 Gy) daily fractions in 42 cases and 1.2 Gy fractions b.i.d. in 23 cases. The median prescribed dose was 54 Gy. The prognostic variables and treatment results were evaluated by Kaplan-Meier actuarial analysis. RESULTS: Locoregional control was achieved in 52 of 65 patients. The 5-year actuarial locoregional control was 83%. Locoregional failure occurred in 13 patients (11 in patients with recurrent tumors). Only two failures occurred within the irradiation fields; nine failures occurred at the field margins. Eleven patients were salvaged by surgery: wide excision in nine and amputation in two. The only prognostic factor significant for locoregional control was primary vs. recurrent presentation (p = 0.0193). The 5-year locoregional control rates for irradiation at initial presentation and at recurrence were 96% and 75%, respectively. The variables without significance for locoregional control included primary tumor location, surgical procedures performed, resection margins, and gross vs. microscopic residual tumor at irradiation. Lymphedema was the most common late effect, occurring in 7 patients, 5 with prior treatment. Bone fracture occurred in 3 patients; all 3 had fibromatosis involving the bone at presentation but without recurrence at the time of fracture. CONCLUSION: EBRT is effective treatment for aggressive fibromatosis. The probability of locoregional control decreases with multiple prior recurrences.

Adolescent↗

PubMed2002

Whole-lung radiotherapy for giant cell tumors of bone with pulmonary metastases.

Three patients initially diagnosed with benign giant cell tumors of bone who had lung metastases develop were treated with whole-lung radiotherapy as part of the therapeutic treatment of their distant disease. External beam therapy to 16 Gy in 10 fractions was delivered to the whole lung, with a boost of 35 to 45 Gy to sites of gross metastatic disease. One patient's lung metastases progressed after treatment, and the patient soon died. The two other patients were long-term survivors (7.5 years and 13 years) with complete resolution of detectable disease. One of the two patients required two additional courses of local radiation to metastatic sites. The authors therefore recommend whole lung radiotherapy to 16 Gy with an additional boost to 35 to 45 Gy to gross disease as an option for patients with pulmonary metastases who are poor surgical candidates, who refuse thoracic surgery, whose disease is technically unresectable, or whose disease recurs or progresses after surgery or chemotherapy.

Adult↗