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Biomedical subjects

S C Pendlebury

Publications and source records attributed to S C Pendlebury.

13 recordsLinked to original sources
PubMed2006

Pectoral stretching program for women undergoing radiotherapy for breast cancer.

Surgery and radiotherapy commonly cause adverse musculoskeletal problems, particularly loss of strength and range of motion, in the upper quadrant of breast cancer patients. Few well-designed studies have investigated whether these impairments can be prevented. Stretching is an effective technique for increasing range of motion, hence the aim of this study was to investigate whether a stretching program reduced acute musculoskeletal impairments in patients undergoing radiotherapy for breast cancer. Sixty-four women were recruited prior to commencement of radiotherapy following breast cancer surgery. Participants were randomised to either a control or stretch group. Participants in both groups were reviewed by the physical therapist on a weekly basis for approximately 6 weeks, and were given general information about skin care and lymphedema. The control group received no advice about exercise. The stretch group received instruction on low-load, prolonged pectoral stretches, which were to be performed daily and were checked at weekly visits. Shoulder range of motion, strength, arm circumference, and quality of life measurements were taken prior to, and at completion of radiotherapy, and at 7 months after radiotherapy. There was no difference in any outcome between groups. Breast symptoms increased for both groups during radiotherapy, without loss of strength or range of movement. The incidence of lymphedema during the study was low for both groups and did not differ between groups. The pectoral stretching program did not influence the outcomes measured because the symptoms reported by patients were not a consequence of contracture.

Breast Neoplasms↗
PubMed2001

Implications of extranodal spread in node positive breast cancer: a review of survival and local recurrence.

An evaluation of extra nodal spread (ENS) in predicting overall survival and locoregional relapse rates in 311 node positive breast cancer patients was undertaken: the study group comprised 71 patients with ENS and the control group comprised 240 patients with no ENS. A review of pathology reports that described ENS was performed and a scoring system to categorize focal involvement, extensive axillary fat involvement, and positive axillary surgical margins was devised. Median follow up time was 3.1 years. Overall survival, disease specific survival and disease-free survival rates were significantly worse in the study group in comparison with the control group. Poorer survival with more extensive pathological invasion of ENS was demonstrated. Multivariate analysis of disease specific survival in those patient with 1-3 involved lymph nodes demonstrated that ENS positivity was prognostically significant (P=0.013). Although locoregional relapse was increased in the presence of ENS, axillary relapses were uncommon and do not warrant axillary radiation.

Journal Article↗
PubMed1999

Carcinoma of the male breast: a review of adjuvant therapy.

The purpose of the present paper was to evaluate the characteristics and outcomes of male breast cancer patients seen for adjuvant therapy at a single institution. A retrospective review of computerized records in the Departments of Medical and Radiation Oncology at the Royal Prince Alfred Hospital (RPAH) was undertaken. Between 1983 and 1996, 24 men were referred for treatment of breast cancer. Of these, 19 had localized breast cancer, four had metastatic disease and one had ductal carcinoma in situ (DCIS). The median age was 57.5 years (range: 26-78) and median follow-up was 6.2 years (range: 0.6-36). Pathological staging was performed. Survival was assessed using actuarial life table analysis. Of the 19 patients who presented with localized disease, there were 12 T1, five T2 and two T4 cancers. Eleven patients had axillary lymph node involvement. Ten patients were oestrogen receptor (ER) positive, two patients were ER negative and seven patients had unknown receptor status. All patients underwent surgery. Eleven patients received radiotherapy. The median dose and dose per fraction were 50 Gy and 2 Gy, respectively. Adjuvant systemic therapy was delivered to 10 patients, of whom nine were node-positive. Four patients received chemotherapy alone, three patients received chemotherapy and tamoxifen, and three patients received tamoxifen only. Seven patients relapsed (one local, five distant, one both). Of the two patients with local relapses, one had received radiotherapy. Of the distant failures, four of six patients had no systemic therapy. There were only two node-positive patients who were not given systemic treatment and both relapsed. Median survival in all patients with invasive cancer was 7.5 years, and in those with localized disease it was 7.6 years. The median survival of node-positive patients was 3.8 years. In node-negative patients the median survival had not been reached at a median follow-up of 6.2 years. The majority of patients (12/14) with known receptor status were ER+, a finding that parallels those of other studies. Local control rates were 88% (7/8) in patients who had mastectomy alone and 91% (10/11) in those patients receiving adjuvant radiotherapy. Systemic therapy was found to be beneficial in patients with node-positive disease. Chemotherapy was administered more frequently than hormonal therapy. The median survivals were consistent with those reported in other series.

Adult↗
PubMed1999

Review of internal mammary chain irradiation in breast cancer.

The aim was to assess the effectiveness of and indications for irradiation of the internal mammary chain (IMC) in the treatment of breast cancer based on a review of the literature. A computerized literature search was performed of the MEDLINE database from 1966 to March 1998. The data retrieved were ranked into levels of evidence as per convention. There was no Level I evidence found. Six randomized controlled trials and nine retrospective series were found pertaining to early stage breast cancer. Although some retrospective data suggested that IMC irradiation improved survival in mediocentral and axillary node-positive tumours, this was not supported by the randomized data. Two randomized trials were identified in high risk operable breast cancer. One of these showed a survival advantage to post-mastectomy irradiation, but the contribution of IMC irradiation to this could not be delineated. Based on the best current evidence, there is no advantage to elective IMC irradiation. The only indication is for positive IMC nodes where the management aim is palliative. The ongoing EORTC randomized trial may provide the definitive answer.

Journal Article↗
PubMed1996

Role of a psychiatry liaison clinic in the management of breast cancer.

Psychological factors contribute to morbidity in the management of breast cancer. This study assesses the role of a psychiatric liaison clinic in the management of such problems. Fifty-seven patients with breast cancer seen by the liaison psychiatrist within the radiation oncology clinic from May 1989 to March 1991 were retrospectively reviewed. This population was assessed for pattern of referral, concordance between oncologist and psychiatrist regarding diagnosis, compliance with referral and treatment patterns. The most frequent times of referral were during initial treatment or at the time of metastatic or recurrent disease. Compliance with referral was 90%. There was concordance of psychiatric diagnosis between the oncologist and the psychiatrist in only 23%, with the oncologist failing to diagnose a major depression in a significant number of patients. Antidepressants were prescribed by the psychiatrist in all patients in whom a major depression was diagnosed. Our conclusions are that there is a high incidence of major depression in this outpatient breast cancer population. Oncologists frequently fail to recognize a major depression in this patient population with resultant psychological morbidity. Compliance with referral to a liaison psychiatric clinic located within an oncology department is high. The psychiatric management of these patients is an important part of their overall treatment.

Adult↗
PubMed1995

Sarcomas following radiation therapy for breast cancer: a report of three cases and a review of the literature.

PURPOSE: First to describe clinical and pathologic features of sarcomas arising after radiation therapy for breast cancer and to report three cases of sarcoma arising 7, 15, and 20 years following radiation therapy for breast cancer. Second, to review the literature on this treatment complication. METHODS AND MATERIALS: Medline literature search. RESULTS: The most frequent histology is osteosarcoma and bone is affected more commonly than soft tissue at a median latency of 11 years. The scapula is the most frequently affected bone. The most frequently affected soft tissue site is now the conserved breast with a median latency of 5.5 years. The aetiologic factors relating to these sarcomas are not fully defined with factors of beam energy, radiation dose, chemotherapy and regional edema being inconsistently reported. CONCLUSION: The frequency of radiation-induced sarcoma at 10 years of follow-up is approximately 0.2%. This is an overestimate by an unknown factor because of the description of sarcomas arising metachromously in breast cancer patients, in nonirradiated areas.

Adult↗
PubMed1994

Hodgkins disease: clinical and radiological prognostic factors in a laparotomy series.

From July 1979 to June 1988, 62 patients managed at Westmead Hospital underwent a staging laparotomy (LAP) for Hodgkins disease. Fifty-four patients were clinical stage (CS) I or II and eight were CS III. The sensitivities of the imaging modalities of computed tomography (CT), Gallium and bipedal lymphangiogram (LAG) were assessed for their predictive value for abdominal disease in patients who underwent a LAP. The most sensitive combination for predicting a negative laparotomy (78%) was a negative abdominal CT and a negative Gallium scan. Upstaging occurred in two of 16 Stage I patients (13%) and nine of 38 Stage II patients (24%). Of the 11 patients upstaged, the spleen was involved in 10 (91%). Factors which predicted for upstaging in a univariate analysis were: age greater than 40 years (P = 0.02), mixed cellularity or lymphocyte depleted histology (P = 0.02), and more than three sites involved above the diaphragm (P = 0.008). In a multivariate analysis, the only significant predictor was the number of sites of involvement (P = 0.007). Two subgroups who had a low probability of upstaging were favourable histology patients with up to two sites of involvement (0%) and females with up to two sites of involvement (0%). We conclude that abdominal imaging is associated with a high false-negative rate, particularly for CS II disease.

Abdomen↗
PubMed1993

Role of bipedal lymphangiogram in radiation treatment planning for cervix cancer.

PURPOSE: The role of bipedal lymphangiogram in tailoring radiation portals in radical radiation therapy for Stages II or III cervix cancer is investigated. METHODS AND MATERIALS: The records and simulation films of 87 patients with Stage II or III carcinoma of the cervix treated with radical radiation therapy alone have been retrospectively reviewed. RESULTS: Sixty-two percent of patients who had a bipedal lymphangiogram, subsequently had their radiation fields altered from a "standard portal." The most frequently altered fields were the lateral margin of the postero anterior field and the anterior margin of the lateral fields. In order to cover the lymphatic channels in the pelvis in 90% of cases as outlined by the bipedal lymphangiogram, the lateral margins of the postero anterior fields would need to be 2.5 cm lateral to the pelvic brim and the anterior border of the lateral field, 0.5 cm anterior to the pubic symphysis. CONCLUSION: "Standard" fields adequately cover the median distribution of lymphatics, but may result in a geographic miss in some patients. Bipedal lymphangiograms allow a more accurate tailoring of pelvic lymphatic fields.

Australia↗
PubMed1992

Thymic hyperplasia associated with Hodgkin disease and thyrotoxicosis.

A 19-year-old woman had a residual gallium-sequestering mediastinal mass after treatment for Hodgkin disease. Coincidentally, she also had hyperthyroidism. The initial concern was that the mass was residual Hodgkin disease. Thymic hyperplasia has been described in association with both these conditions. The mass disappeared after treatment of her hyperthyroidism.

Adult↗
PubMed1989

Hyponatraemia during oxcarbazepine therapy.

A clinical and pharmacokinetic study was carried out progressively substituting a new anticonvulsant oxcarbazepine for its congener carbamazepine in a group of patients with refractory epilepsy. Although oxcarbazepine showed possible though not statistically significant advantages of better seizure control and was probably less sedating, its use was associated with a dose-dependent reduction in plasma sodium levels in 12 of 15 patients. The mean plasma sodium level fell from 137.5 +/- 5.2 (s.d.) to 128.5 +/- 6.1 mE/l. Imposed restriction of fluid intake may have minimized the degree of hyponatraemia. This adverse effect may limit the role of the drug as an anticonvulsant or necessitate special precautions when it is used. However, the possibility of employing the drug in diabetes insipidus may be worth exploring.

Adult↗
PubMed1988

Further clinical and pharmacokinetic observations on the new anticonvulsant, oxcarbazepine.

Continuing experience with oxcarbazepine has shown that the drug tends to be less sedative than carbamazepine and at least as potent as an anticonvulsant but much more likely to cause hyponatraemia. The behaviour of the clearance of oxcarbazepine over a period of 3 months raises the possibility that the drug may not be as active an inducer of drug metabolism as is carbamazepine.

Adult↗
PubMed1987

Oxcarbazepine: preliminary clinical and pharmacokinetic studies on a new anticonvulsant.

Oxcarbazepine is a new anticonvulsant, currently undergoing clinical trials. Its spectrum of antiepileptic action, and its chemical structure, resemble those of carbamazepine, though the 2 drugs have no pharmacologically active metabolites in common. In a study of 7 adults with poorly controlled partial epilepsy, progressive substitution of oxcarbazepine for carbamazepine left seizure control unaltered in 4 and improved in 3, whilst 5 became more alert and one was rendered ataxic. Three subjects became hyponatraemic. There were no other adverse effects. Plasma levels of the drug and its pharmacologically active 10-hydroxy derivative were measured sequentially over 4 days after a single drug dose at the outset of therapy in 5 subjects. Calculated pharmacokinetic parameter values for the drug, assuming complete oral bioavailability, were: absorption lag time 2.07 +/- 1.61 h: absorption rate constant 8.328 +/- 8.941 h-1: apparent volume of distribution 3.937 +/- 2.222 L kg-1: oral clearance 2.898 +/- 1.439 L kg-1: elimination rate constant 0.609 +/- 0.261 h-1 (half-life 1.26 +/- 0.37 h), while the metabolite had a formation rate constant of 0.593 +/- 0.233 h-1, and an elimination rate constant of 0.082 +/- 0.014 h-1 (half-life 8.74 +/- 1.79 h). Even with a single dose, peak plasma metabolite levels were substantially higher than those of the parent drug. Oxcarbazepine appears to be a promising alternative to carbamazepine as an anticonvulsant, although in view of its rapid elimination it probably serves mainly as a prodrug for its 10-hydroxy metabolite.

Adult↗