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Biomedical subjects

S Kramer

Publications and source records attributed to S Kramer.

At least 163 records · Page 9Linked to original sources
PubMed1982

Patterns of care outcome studies in Hodgkin's disease: results of the national practice and implications for management.

In a statistically valid random sample of 387 patients selected from the national practice and treated with radiation therapy in 1973 for Hodgkin's disease, the 4-year recurrence-free survival was: stage IA, 82%; stage IIA, 75%; stage IIIA. 60%; and combined stages IB-IIIB, 50%. Observations of in-field recurrence in 996 separate lymph node areas show no dose-response relationship between 3000 and 5000 rad. The use of chemotherapy in stage IIIA Hodgkin's disease in the national practice is associated with a significant improvement in recurrence-free survival (P = 0.01). A group of 51 patients with stages IA-IIIA Hodgkin's disease, aged 5-15, treated with radiation therapy alone, has a 92% recurrence-free rate at 3 years with no major complications.

Hodgkin Disease↗
PubMed1982

Preliminary results of RTOG phase I/II study of misonidazole and radiation for bladder cancer.

Eleven patients were entered in a phase I/II study to evaluate the toxicity and effectiveness of the use of misonidazole with radiation in cancer of the bladder. The radiation fractionization used is shown in Figure 1. Misonidazole was administered in a dose of 1.5 g/m2, 4-6 hours before the radiation dose. The large radiation dose (400 rad) used with misonidazole was designed to obtain maximum enhancement of radiation sensitizer effect. Only minor misonidazole toxicity was observed. Tumor regression was dramatic, with 7/9 patients achieving complete regression of disease. Three patients however, developed severe small bowel complications, probably from the unconventional radiation fractionation used. In view of this high complication rate, this study was terminated.

Aged↗
PubMed1981

Acute intermittent porphyria. A case report.

A case of acute intermittent porphyria is presented. This case emphasizes the clinical, biochemical and endocrinological changes, and their possible aetiology is discussed. Treatment, especially the use of intravenous haematin, is also described.

Acute Disease↗
PubMed1981

Equivalence of radiation schedules for the palliative treatment of brain metastases in patients with favorable prognosis.

Five whole-brain irradiation schedules ranging from 2000 rad in one week to 4000 rad in four weeks were evaluated in 1830 patients with cerebral metastases treated in two randomized studies by the Radiation Therapy Oncology Group. The duration of palliative effectiveness among those patients with favorable survival prognosis was investigated. Favorable subgroups were identified consisting of 123 ambulatory breast cancer patients with no soft tissue metastases, 373 ambulatory lung cancer patients with primary absent or no extracerebral metastases, and 65 ambulatory patients with other primaries and no extracerebral metastases. This group of 561 patients had a median survival of 28 weeks compared with 11 weeks for the remaining patients. Analyses of neurologic function control rates failed to show a significant benefit of higher doses. No advantage was demonstrated for treating brain metastases patients with favorable prognoses with more than one week of whole-brain irradiation.

Brain Neoplasms↗
PubMed1981

Variation in work-up and treatment procedures among types of radiation therapy facilities: the patterns of care process survey for three head and neck sites.

The PCS Process Survey analyzed radiation therapy facilities to evaluate procedures in work-up and treatment of patients with cancer of the larynx, tongue, and nasopharynx. Types of facilities are compared to establish bench marks in performance of work-up and treatment procedures that can be used as a foundation for upgrading care and for adjusting studies to follow this paper. A statistical method is demonstrated that provides a "signature" of relative performance over a standardized set of procedural criteria. Facilities with resident training programs perform nearly all of these procedures much more consistently than do nontraining facilities. Facilities with full-time head therapists perform most procedures more consistently than do facilities with part-time heads. A third comparison of large versus small facilities shows that among training facilities size has no effect and that among full-time facilities size has a slight effect. Among part-time facilities, however, smaller ones fail to perform most procedures more often than larger facilities. The size difference is confounded with the full-time/part-time difference because part-time facilities are on the average smaller than facilities with full-time head therapists.

Follow-Up Studies↗
PubMed1981

Combined pre- and postoperative adjuvant radiotherapy for bladder cancer: results of RTOG/Jefferson Study.

This paper presents the results of adjuvant "sandwich" radiotherapy for bladder cancer in 65 patients treated in a Radiation Therapy Oncology Group (RTOG) phase II study and at Thomas Jefferson University Hospital. In this approach of adjuvant therapy, patients with clinical stages B or C bladder cancer were given low dose preoperative irradiation (500 rads) to the whole pelvis on the day before or on the day of surgery. Following cystectomy, patients were pathologically staged. Those with high grade (III or IV) stage B1 tumors or stages B2 or C were given 4500 rads in five weeks postoperative radiation. Thirty-four of these 65 patients were entered in the RTOG protocol and 31 in the Jefferson Study. TWenty patients had early lesions (stage 0, A or B1, grade I-II) and did not receive postoperative irradiation. Six patients had stage D cancer and were given palliative therapy. Of 39 patients eligible for postoperative irradiation, 29 received the full course of pre- and postoperative irradiation. Ten patients did not receive treatment. Follow-up ranged from six months to three years with a median of 18 months. Treatment was extremely well tolerated. Incidence of major complications was 6% (4/65). Local control of disease was excellent, with no failures in pelvis response. Actuarial survival at three years is 78%. At this preliminary analysis, these survival results appear to be better than those obtained with other approaches using preoperative irradiation and surgery.

Clinical Trials as Topic↗
PubMed1981

Neurotoxicity of folates: implications for vitamin B12 deficiency and Huntington's chorea.

Recent work has shown that several folates interact with excitatory kainic acid receptors in the mammalian brain and appear to have agonist activity at these receptors. Since kainic acid is a potent neurotoxin it is possible that folates share this toxicity and that high levels of folates result in neuronal damage. Levels of methyltetrahydrofolate are markedly elevated in vitamin B12 deficiency, a disease associated with neuronal destruction. We propose that this destruction occurs as a result of a neurotoxic action of methyltetrahydrofolate. Injection of kainic acid into the basal ganglia of experimental animals produces a pattern of damage similar to that found in patients dying of Huntington's chorea. It is possible that the underlying defect in this disease resides in the pathways of folate metabolism such that a neurotoxic excess of folates accumulates in the central nervous system. Such a disease process might be arrested by antifolate drugs.

Animals↗
PubMed1980

Postirradiation sarcoma of the head and neck: a report of three late sarcomas following therapeutic irradiation for primary malignancies of the paranasal sinus, nasal cavity, and larynx.

Sarcoma of the head and neck region following irradiation for primary malignancy other than retinoblastoma has rarely been reported. Three cases of postirradiation sarcoma arising in the head and neck region following definitive radiotherapy for primary malignancies of the nasal cavity, paranasal sinuses, and larynx are presented. The intervals from initial radiation to diagnosis of sarcoma were 10 years, 10 1/2 years, and 12 1/2 years, respectively. The dosage ranged from 6000--6400 rads using conventional fractionation (1750--1811 ret) on a 60Cobalt teletherapy unit. Methotrexate (25 mg I. V. every three days for seven doses) was utilized during the initial course of radiation in two of the three patients. The cases conform well to established criteria for the diagnosis of radiation-induced sarcoma. Postirradiation sarcoma of the head and neck region is a remote hazard that must be weighed against the benefits of curative radiation therapy, particularly when treating in the presence of bone disease or when treating retinoblastoma or benign lesions.

Adult↗