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Biomedical subjects

S S Donaldson

Publications and source records attributed to S S Donaldson.

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

Diffuse small noncleaved cell lymphoma in children, Burkitt's versus non-Burkitt's types. Results from the Pediatric Oncology Group and St. Jude Children's Research Hospital.

The clinical relevance of a morphologic distinction between Burkitt's (B) and non-Burkitt's (NB) types of small non-cleaved cell (SNC) non-Hodgkin's lymphoma (NHL) has been controversial. Numerous attempts to discern an important clinical difference between the subtypes have failed to provide a convincing reason to maintain this distinction for other than descriptive purposes. Because of conflicting reports in the literature, the authors have analyzed 183 cases of SNC NHL in children from the Pediatric Oncology Group and 129 from St. Jude Children's Research Hospital (Memphis, TN). The results from both series, which consist of approximately the same proportions of B and NB subtypes, (i.e., approximately 54%-58% B, 36% NB, and 6%-10% not otherwise specified) show no significant differences in age at presentation, extent of disease, primary site of involvement, or survival. The authors conclude that the morphologic distinction between B and NB types of SNC NHL in children lacks demonstrable clinical importance.

Burkitt Lymphoma↗
PubMed1989

Hypercalcemia and vitamin D metabolism in Hodgkin's disease. Is there an underlying immunoregulatory relationship?

Hypercalcemia is not common in Hodgkin's disease, but in reported cases is often unassociated with bone involvement. A case is presented demonstrating a mechanism involving elevated levels of 1,25-dihydroxy vitamin D3 (calcitriol). Similar cases in the literature are reviewed. Data implicating calcitriol as a hematolymphoid regulatory hormone are discussed as they may relate to lymphomas, leukemias, and paraneoplastic lymphocyte and monocyte/macrophage activity.

Adolescent↗
PubMed1989

Rhabdomyosarcoma: contemporary status and future directions. The Lucy Wortham James Clinical Research Award.

Approximately two thirds of children with rhabdomyosarcoma will be cured of their tumor and become long-term survivors. Multidisciplinary care has brought about improvements in survival. Yet our therapies of today are suboptimal in many situations and demand intense effort toward improving cure rates and quality of life. Rhabdomyosarcoma is a complex childhood malignancy with differing anatomic sites of presentation and varying histologic subtypes, each presenting with unique patterns of growth, making it inappropriate to consider the disease a single entity. Avenues of future research involve cytogenetic and molecular genetic investigations that will aid in diagnosis and screening and, it is hoped, guide clinicians to more specific therapy.

Adolescent↗
PubMed1989

An attempt to use a common staging system in rhabdomyosarcoma: a report of an international workshop initiated by the International Society of Pediatric Oncology (SIOP).

One hundred medical records of children with rhabdomyosarcoma were reviewed independently by ten European and American specialists primarily concerned with pediatric cancer patients. Each specialist assessed the stage of disease using a pre-treatment staging system (International Society of Pediatric Oncology-Union Internationale Contre le Cancer TNM [SIOP-UICC TNM] and a post-surgical staging system (Inter-group Rhabdomyosarcoma [IRS] grouping system). These two prognostic systems are based on different criteria, and there is no simple correspondence between them. The reliability of the two systems, based on patients' characteristics extracted from medical records, was similar and satisfactory (Kappa index: 0.78 and 0.82 with the TNM system and with the IRS system, respectively). Nevertheless, the IRS grouping system, which considers a primary method of treatment: Surgery, is dependent upon the surgeon, the institution, and the current concept of treatment. We believe that the TNM system provides the best description of extent of disease and should be used for determining therapeutic options and comparing therapeutic results.

Child↗
PubMed1989

Minimizing and measuring lens dose when giving cranial irradiation.

Three different techniques of administering cranial irradiation were used to determine the dose to the lens as measured in the Rando phantom. The techniques employed were as follows: (1) the central axis of the radiation beam was placed at the thickest portion of the cranium; (2) the central axis of the radiation beam was placed at the lateral orbital rim (bony canthus); (3) the central axis of the radiation beam was placed at the thickest portion of the cranium but with the beam angled 5 degrees posteriorly away from the eye. Thermal luminescent dosimeters (TLD) were placed in a phantom, at a point determined from a life-sized anatomical section of the plane through the midsection of the eye, to be at the location of the posterior capsule of the lens. In addition, TLDs were placed on the outer surface of the phantom head, directly lateral to the location determined to be where the lens would lie. With equally weighted lateral opposed beams, delivering a midplane dose of 200 cGy, the TLDs at the point of the lens measured 21, 9.9 and 10.6% of the midplane doses from the three techniques respectively. TLDs placed directly lateral to the lens on the surface of the phantom head gave an approximation of the lens dose, particularly when techniques 2 and 3 were used. Isodose curve generated by a General Electric treatment planning computer gave lens doses similar to those of the phantom data for each of the three different radiotherapy techniques. Cranial irradiation should be carried out by either technique 2 or technique 3 to minimize radiation dose to the lens.

Brain Neoplasms↗
PubMed1989

Aggressive management of second primary tumors in survivors of hereditary retinoblastoma.

Survivors of hereditary retinoblastoma are at increased risk for the development of second primary tumors, most commonly osteosarcoma. Recent molecular genetic data demonstrate that a pleiotrophic effect of the retinoblastoma gene may be responsible for the development of these sarcomas. This report describes the incidence of second nonocular malignancies among 53 infants seen at Stanford University Medical Center who have been followed a median of 11.7 years. Of these, 42 initially had bilateral disease and eleven had unilateral disease. Of 53 infants, 50 received irradiation either as part of the initial therapy or as treatment for recurrent disease. The actuarial survival for the entire group is 67% at 30 year follow-up with a median survival of 79% at 11.7 years. Eight patients developed eleven second primary tumors. All occurred in the group having hereditary retinoblastoma. Eight were within the previously irradiated field and three were at distant sites. The second tumors included seven osteosarcomas, one angiosarcoma, one rhabdomyosarcoma, one malignant fibrous histiocytoma, and one unclassifiable round blue cell tumor. The actuarial incidence of the development of a second primary malignancy was 6% at 10 years, 19% at 20 years, and 38% at 30 years. The latent period from treatment of retinoblastoma to the diagnosis of malignancy ranged from 5.2 years to 36.2 years (median 16 years). An aggressive approach with combined modality therapy including radical resection, re-irradiation and/or chemotherapy was used to treat these second primary tumors in five of eight patients. In four of the five, there was no evidence of disease at 22-72 months following treatment. In the three patients who did not receive aggressive combined treatment, there were no survivors. These data confirm the previously reported risk of developing a second primary tumor among survivors with hereditary retinoblastoma. Careful long-term follow-up for this genetically susceptible group is essential for early detection and implementation of curative therapy.

Bone Neoplasms↗
PubMed1989

Treatment results among adults with childhood tumors: a 20-year experience.

Controversy exists regarding the most appropriate treatment for the rare adult patient who develops a so-called pediatric cancer. We have reviewed our 20-year experience with these patients and analyzed their outcome. A total of 299 patients with rhabdomyosarcoma (106), Wilms' tumor (97), and neuroblastoma (96) were evaluated and treated at Stanford University Medical Center between January 1967 and December 1987. Only 26 of these patients (8.7%) were diagnosed during "adulthood"; their age range was 18-67 years, median 23 years. Wilms' tumor; Five patients presented with Wilms' tumor at age greater than or equal to 18 years; four had unfavorable histology. All underwent multimodality therapy; however, only two have survived, one currently disease-free and one with disease. Neuroblastoma: Five patients presented with neuroblastoma at age greater than or equal to 18 years. Four underwent attempted surgical resection, post-operative irradiation (RT), and chemotherapy (CT); the other received no adjuvant CT. Only two of the five patients survive, both with disease. Rhabdomyosarcoma: Of the 16 adults (greater than or equal to 21 years) with rhabdomyosarcoma, 14 (87%) had advanced Intergroup Rhabdomyosarcoma Study-group disease (eight Group III, six Group IV). All 16 underwent aggressive multimodality therapy. At 10 months-16 years follow-up, only five patients survive, four of whom are apparently cured of their tumor. Neither histologic subtype nor site of presentation were of prognostic value. This series demonstrates that adults with Wilms' tumor, neuroblastoma, or rhabdomyosarcoma have a worse prognosis than do children with the same diagnosis. Possible explanations for this disparity in outcome include different tumor biology, less tolerance for treatment, and different natural history among adults relative to children.

Adolescent↗
PubMed1989

Pediatric Hodgkin's disease: pulmonary, cardiac, and thyroid function following combined modality therapy.

Since pediatric Hodgkin's disease is a curable malignancy, it is essential to limit treatment sequelae. This study examines post-treatment pulmonary, cardiac, and thyroid function in 34 children, ages 5 to 17 (23 male and 11 female) with Hodgkin's disease. All received combined modality therapy of 6 cycles of alternating ABVD/MOPP chemotherapy and low dose (1500-2500 cGy) involved field radiotherapy. Mean follow-up period is 27.5 months with actuarial freedom from relapse of 94% and survival of 92%. Twenty asymptomatic patients underwent pulmonary function testing following chemotherapy and supradiaphragmatic radiotherapy. Eleven patients had post-treatment carbon monoxide diffusing capacity (DLCO) performed. Six of 11 children (55%) had abnormal values (mean 66%, range 58-80) showing either a reduced DLCO compared to pretreatment or an low absolute value. Eight of the twenty patients (40%) tested post-treatment for FEV1, FVC, TLC and flow volume loop had abnormal results. Six showed restrictive abnormalities and two had obstructive dysfunction. Fourteen patients underwent cardiac nuclear gated angiogram after completion of chemotherapy. Two asymptomatic patients (14%) had abnormal scans showing either a low resting ejection fraction or a decreased response to exercise. Thyroid function was evaluated post-treatment in twenty-one patients by TSH, T4, free T4 or sensitive TSH analysis. Four (21%) had an elevated TSH with a normal T4 after treatment. Although post-treatment thyroid and cardiac effects were minimal, post-treatment pulmonary dysfunction in asymptomatic patients was substantial with more than 50% of tested children demonstrating an abnormal DLCO and 40% showing restrictive or obstructive pulmonary parameters. These abnormalities were observed following a maximum bleomycin dose of 60 units/m2. Bleomycin and pulmonary radiotherapy have adverse effects on diffusing capacity and the long-term pulmonary sequlae of combined ABVD chemotherapy and radiotherapy are unknown. Our analysis suggests that even in asymptomatic children, pulmonary abnormalities are frequent.

Adolescent↗
PubMed1989

Dynamic probabilistic model for determination of optimal timing of surveillance chest radiography in pediatric Hodgkin disease.

A dynamic probabilistic model based on hazard rate analysis, Monte Carlo modeling, and lead-time estimation techniques was developed to determine the optimal timing and frequency of chest radiography in the monitoring for relapse of children with treated Hodgkin disease. The analysis incorporates the performance characteristics of chest radiography, the natural history of the disease process, and therapeutic efficacy as a function of earliness of detection in the determination of optimal strategy. Examples of the model applied to the experiences of Stanford Medical Center and St. Jude Children's Research Hospital illustrate the utility of such a model in customizing an optimal monitoring strategy for a specific institution and clinical experience. The results suggest that monitoring protocols significantly overutilize chest radiography in the evaluation for recurrent Hodgkin disease in children.

Child↗
PubMed1989

Retinoblastoma: biology, presentation, and current management.

Retinoblastoma is an uncommon ocular tumor of childhood which accounts for 5% of childhood blindness. It serves as a prototype for understanding the genetics of childhood cancer. The identification of the retinoblastoma gene has provided an explanation for the differing features of hereditary and nonhereditary retinoblastoma, as well as the potential for secondary malignancies in the hereditary cases. Management decisions are based upon the potential for useful vision, and the extent of disease including whether one or both eyes are involved. As nearly all patients present with disease confined to the globe, local control is excellent and survival exceeds 85%. Goals of management are cure of the disease, preservation of vision, and early detection and treatment of secondary malignancies in the genetically susceptible group.

Biology↗
PubMed1988

Postirradiation sarcoma in retinoblastoma. Induction or predisposition?

An alarmingly high rate of postirradiation sarcomas following treatment for retinoblastoma has been described in the literature. We present four new cases and report 57 others from the English literature. Osteogenic sarcoma was the predominant histologic type (58%), followed by fibrosarcoma (21%) and various other sarcomas (21%). The average latency period between irradiation and development of the second primary (sarcoma) was 12.4 years. Irrespective of irradiation, a genetic linkage between retinoblastoma and osteogenic sarcoma on the 13q14 chromosome is recognized. Through a pleiotropic effect of this same chromosome, a predisposition for other sarcomas may exist as well. Finally, a strong role for radiation induction is proposed for all of these postirradiation sarcomas. This is based on the increased number of sarcomas arising in the field of prior irradiation (sites uncharacteristic of spontaneously occurring primary sarcomas) and the prolonged latency periods.

Adult↗
PubMed1988

Astrocytoma in children: 14 years' experience at Stanford University Medical Center.

Between January 1, 1971 and December 31, 1984, 50 children (31 males, 19 females) ages 3 1/2 months to 18 years with primary CNS astrocytoma were seen in the Department of Therapeutic Radiology, Stanford University Medical Center. The actuarial survival and freedom from relapse (FFR) for the treated group is 46%, with a median follow-up of 7.2 years and a maximum follow-up of 14 years. The majority of relapses occurred within the first 2 years of diagnosis, and all relapses occurred at or adjacent to the initial site of tumor. Multivariate analysis revealed that factors correlated with poor survival are high histologic grade (including presence of necrosis) and primary tumor in the brain stem, while the only important prognostic factor associated with an adverse FFR is high histologic grade. Age, sex, degree of surgical resection, and total radiation dose to the tumor are not correlated with outcome. Patients with high-grade tumor were selected to receive whole brain irradiation and/or adjuvant chemotherapy; therefore, the findings of apparent poor prognosis associated with whole brain irradiation and adjuvant chemotherapy actually reflect patient selection. Current therapy is adequate for only half of children with astrocytoma. Thus, continued development of innovative therapies is indicated, particularly for those children with adverse prognostic factors.

Adolescent↗
PubMed1987

Combined modality treatment with low-dose radiation and MOPP chemotherapy for children with Hodgkin's disease.

High doses of radiation administered to children with Hodgkin's disease may be associated with long-term alterations in soft tissue and bone growth. In an attempt to minimize this complication, we initiated a protocol using low doses of radiation in conjunction with six cycles of MOPP (nitrogen mustard, vincristine, procarbazine, prednisone) chemotherapy in newly diagnosed, pathologically staged children with Hodgkin's disease. Of 55 children treated in this fashion, the actuarial survival and freedom from relapse rates are 89% and 90%, respectively, with median follow-up of 7 1/2 years and maximum follow-up of 15 1/2 years. The local control rate is 97%. The previously encountered growth alteration did not occur when lower doses of radiation were used. However, three children developed acute leukemia. This study demonstrates that the vast majority of children with Hodgkin's disease can be cured with combined modality therapy. This experience provides long-term follow-up and thus serves as the basis for new ongoing protocols using low-dose involved field radiation with new drug combinations.

Adolescent↗