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Biomedical subjects

T Weisenburger

Publications and source records attributed to T Weisenburger.

6 recordsLinked to original sources
PubMed1986

Superior sulcus tumors.

A retrospective analysis of 35 patients treated for superior sulcus tumors of the lung at UCLA was performed for the years 1960-1983. Follow-up ranged from 19 months to 21 years, with all but one patient followed at least 2 years. The 28 patients with localized disease were treated by megavoltage irradiation with or without surgical resection and had a 5-year survival (product-limit) of 21%. However, the 15 patients receiving combined treatment had a 48% 5-year survival (p = 0.009). An effort was made to identify those factors affecting survival. Patients presenting with no radiographic evidence of nodal enlargement appeared to have a survival advantage with a survival of 31% at 3 years, versus no survivors among those with positive nodes (p = 0.059). Bony erosion contiguous with the primary tumor at presentation was found not to affect the prognosis. Patients with local control of the primary tumor showed a survival of 71% vs 0% for those locally recurring. Those patients receiving at least 55 Gy showed a trend toward increased survival though not with statistical significance. The pattern of failure was evaluable in 25 patients. Local recurrence was observed in 18 patients (72%) with seven (39%) of these manifesting as spinal cord compressions. Distant metastases were seen in 35% of recurrences, and as the sole site of disease in only 10%. Three patients developed brain metastases, all of whom had concomitant local failure. Significant pain relief was achieved in 74% of patients. However, it was transient in 60% of these. We conclude that superior sulcus tumors remain primarily a localized problem, and that aggressive treatment is indicated even with apparently local invasive disease.

Combined Modality Therapy↗
PubMed1984

Limb salvage for skeletal and soft tissue sarcomas. Multidisciplinary preoperative therapy.

One hundred eighty-three patients with malignant skeletal (83) or soft tissue sarcoma (100) were entered into the multimodality preoperative limb salvage protocol. Local recurrences were observed in 5 of 183 (2.7%). Six patients required amputation because of complications, and 13 patients died within 1 year from metastatic disease. There was no statistical difference in survival rates between a series of patients who had amputation and adjuvant therapy and patients treated by limb salvage and adjuvant therapy. Overall survival rates for patients with soft tissue sarcoma were 76%. Although the exact reason for the improved local control is not known, it is our belief that it is the result of the multidisciplinary therapy that destroys microscopic disease at the periphery of the primary tumor.

Adolescent↗
PubMed1980

Pelvic lymphadenectomy in the management of carcinoma of the prostate.

Between January 1, 1971 and December 30, 1977, 82 patients underwent bilateral pelvic lymph-adenectomy for carcinoma of the prostate, 65 with associated radical prostatectomy. Lymph node metastases were noted in 27 cases: 1 of 8 with A2, 3 of 16 with B1, 12 of 39 with B2 and 11 of 19 with C tumors. Of the 17 patients undergoing lymphadenectomy only as a staging procedure before definitive radiation therapy 12 had nodal involvement, while 15 of 64 patients with combined lymphadenectomy and prostatectomy had nodal disease. Early complications involved 6 patients with thromboembolic disease, including 1 death while the patient was hospitalized of pulmonary embolism. All 6 thromboembolic complications occurred among 52 patients who had not received anticoagulation, for an incidence of 11.5 per cent compared to no episode of thromboembolism among 30 patients prophylactically anticoagulated with warfarin sodium. Late complications of chronic lymphedema occurred in 15 patients, 10 of whom had postoperative radiation. We recommend lymphadenectomy as an adjunct to radical prostatectomy but its role as a staging procedure before definitive radiation therapy to the pelvis appears to yield increased morbidity in terms of incidence of chronic lymphedema, suggesting that its use be reserved for highly selected patients. We also recommend the prophylactic postoperative administration of anticoagulants and patients awareness of risk factors contributing to chronic lymphedema.

Aged↗
PubMed1980

Is amputation necessary for sarcomas? A seven-year experience with limb salvage.

The rationale for amputation for local tumor control of skeletal and soft tissue sarcomas was based on results obtained from surgical therapy alone. However, our previous results from a pilot trial of multimodality therapy of preoperative chemotherapy and radiation therapy followed by surgical resection indicated that limb salvage (without amputation) could be accomplished in most patients with little morbidity and low recurrence rate. This report summarizes our experience in a prospective trial from January 1972 to December 1979. A total of 105 consecutive patients with soft tissue sarcomas (65 patients) or bone sarcomas (40 patients) were treated with preoperative intraarterial adriamycin, 3500 rads of rapid-fraction radiation and radical en bloc resection of primary tumor. Diseased bones were replaced with cadaver allografts (22 patients), metallic endoprostheses (10 patients) autologous bone (2 patients), or no replacement (ilium or fibula-4 patients). Salvage of a viable, neurologically intact, functional extremity was achieved in 98/105 patients (98%); 97% of limb salvage patients were free of local recurrence after a median follow-up period of 28 months. Major complication rate that required amputation was 3/105 patients (2%). Postoperative adjuvant chemotherapy with cyclical adriamycin and high-dose methotrexate was employed for all patients with osteosarcoma and 35 patients with grade III soft tissue sarcomas. The overall disease-free rate is 50% (18/35) for osteosarcomas and 65% (42/65) for soft tissue sarcomas. These results indicate that local tumor control can be achieved in 91% of patients without amputation. Their functional capabilities are excellent with a low complication rate. Since the advent of adriamycin and methotrexate has significantly improved the overall survival for patients with skeletal and soft tissue sarcomas, the quality of this survival has become even more important. Preoperative multimodality therapy is a major advance in this direction and since results of limb salvage procedures appear to be equal or superior to those achieved by amputation we believe these alternatives should be offered to all patients.

Adolescent↗