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121.
Intensive weekly chemotherapy for good-prognosis patients with small-cell lung cancer. 总被引:1,自引:0,他引:1
D W Miles H M Earl R L Souhami P G Harper R Rudd C M Ash L James C W Trask J S Tobias S G Spiro 《Journal of clinical oncology》1991,9(2):280-285
A weekly, intensive chemotherapy regimen has been used to treat 70 patients with small-cell lung cancer (SCLC). Forty-five patients had limited disease (LD) and 25 extensive disease (ED) with good prognostic features. The regimen consisted of cisplatin 50 mg/m2 intravenously (IV) day 1 and etoposide 75 mg/m2 IV days 1 and 2, alternating weekly with ifosfamide 2 g/m2 IV day 8 and doxorubicin 25 mg/m2 IV day 8, for a total of 12 weeks. Dose modifications were made according to defined hematologic criteria. Responding patients with limited disease subsequently received mediastinal radiotherapy. Overall response to chemotherapy was 91% with a complete response (CR) rate of 50%. Forty-five patients with limited disease (LD) achieved an overall response rate of 91% with a CR rate of 51%, and 25 patients with extensive disease (ED) achieved an overall response rate of 92% with a CR rate of 48%. Median survival for the whole group was 54 weeks (LD, 58 weeks; ED, 42 weeks). Hematologic toxicity was predictable, without the wide fluctuations in WBC count seen in conventional 3-weekly regimens. In all, one quarter of treatment courses were delayed, most frequently because of leukopenia. Dose reductions were required in 63% of cases. The average delivered dose intensity was calculated and shown to be 73% of projected. Nonhematologic toxicity was mild with nausea and vomiting being the most common. This weekly schedule of chemotherapy has proved to be active and well tolerated and is currently being compared with conventional 3-weekly chemotherapy in a randomized study. 相似文献
122.
123.
S Naweed Raza Manish D Shah Carsten E Palme Francis T Hall Spiro Eski Jeremy L Freeman 《Otolaryngology--head and neck surgery》2008,139(1):21-26
OBJECTIVES: Evaluate current accepted risk factors for well-differentiated thyroid carcinoma, and develop a predictive model to determine one's risk of malignancy given a thyroid nodule. STUDY DESIGN: Retrospective analysis of 600 patients. SUBJECTS AND METHODS: Patients with benign thyroid nodular disease and with well-differentiated thyroid cancer were randomly selected. Patient, clinical, and investigational data were compared by means of univariate and multivariate regression analyses. RESULTS: Age, regional lymphadenopathy, ipsilateral vocal cord palsy, solid and/or calcified nodules, and an aspiration biopsy being malignant or suspicious predicted for cancer (P < 0.05). Regional lymphadenopathy and vocal cord palsy are perfect predictors of malignancy. Multivariate analysis indicated age, solid and/or calcified nodules, and all fine-needle aspiration biopsy results to be significant in assessing risk (P < 0.05). CONCLUSION: Taking individual risk factors in isolation is not always reliable. Using a predictive model, one can anticipate a patient's risk of malignancy when the diagnosis is unclear. 相似文献
124.
125.
Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth 总被引:8,自引:0,他引:8
R H Spiro A G Huvos G Y Wong J D Spiro C A Gnecco E W Strong 《American journal of surgery》1986,152(4):345-350
In this review of 105 consecutive patients who underwent operation for previously untreated, N0 squamous carcinomas arising in the oral tongue or the floor of the mouth, 86 percent of the determinate patients remained alive and well 2 years after treatment. Included were 48 patients, 49 patients, and 8 patients who had T1, T2, and T3 tumors respectively. Elective cervical lymphadenectomy was performed in about a third, but tumor staging did not facilitate selection of those who were most likely to have occult metastases. For this reason, we retrospectively assessed the impact of tumor thickness using an optical micrometer to measure the thickness in millimeters of the excised tumors in routinely prepared paraffin sections. Disease-related death appears to be unusual when oral tumors are thin (2 mm or less), regardless of the tumor stage. Multivariate analysis confirms that increasing tumor thickness, rather than tumor stage, had the best correlation with treatment failure and survival. These findings need to be verified in prospective studies involving a larger patient population and other head and neck sites, but they strongly suggest that measurement of tumor thickness may be a better way to select those oral cancer patients who are most likely to benefit from elective treatment of the N0 neck. 相似文献
126.
Observations on the natural history and treatment of recurrent major salivary gland cancer 总被引:1,自引:0,他引:1
J G Armstrong L B Harrison R H Spiro D E Fass E W Strong Z Y Fuks 《Journal of surgical oncology》1990,44(3):138-141
In an attempt to define the natural history and the indications for postoperative radiotherapy (RT) in locally recurrent major salivary gland cancers, we reviewed 78 patients treated between 1965 and 1982. All patients underwent resection of the tumor. Group 1 (N = 38) had complete resection of tumors, with low or intermediate grade histology and without lymph node spread. Group 2 consisted of the remaining 40 patients who had high-risk features (HR) (high grade histology, lymph node metastases, and close or positive margins of resection). Half of the Group 2 patients received radiation therapy. Overall survival was 63% at 5 years, and 35% at 15 years. Survival of Group 1 was 83% at 5 years and 58% at 15 years. Local control for Group 1 was 69% at 5 years, 54% at 15 years, and was size-dependent. Group 2 survival was 40% at 5 years and 29% at 10 years. Local control at 5 and 10 years was 49% and 35%. Our data indicate that surgery alone yielded good local control in patients with small tumors (less than or equal to 3 cm) and no HR features, suggesting that postoperative RT may be unnecessary for these patients. Other patients have suboptimal local control, and although there is a rationale for the use of postoperative radiotherapy, we cannot assess its impact in this retrospective study. 相似文献
127.
Jeffrey K. Lange Yuo-Yu Lee Sara K. Spiro Steven B. Haas 《The Journal of arthroplasty》2018,33(5):1373-1378
Background
Comparisons of satisfaction rates following total knee arthroplasty (TKA) among large, age-differentiated, rigorously matched cohorts are lacking. Therefore, we compared satisfaction rates following TKA in large, age-differentiated, propensity score-matched cohorts.Methods
We identified primary TKAs performed for non-inflammatory arthritis in patients of ages 18-55 or 65-75, yielding 529 younger and 2001 older patients. Patient-reported outcomes were recorded pre-operatively and 2 years post-operatively. 1:1 propensity score matching between groups yielded 529 patient pairs. Matching was based on gender, body mass index, American Society of Anesthesiologists grade, Charlson Comorbidity Index, and Short Form 12 Mental Health Component score. Outcomes were compared between matched groups using t-test and Wilcoxon rank-sum test.Results
Satisfaction with knee surgery was 86% among younger patients and 91% among older patients. Distribution of satisfaction responses was shifted toward greater satisfaction in older patients (P < .001). Overall quality of life (QOL) improvement was 91% among younger patients and 96% among older patients. Pre-operative and post-operative knee-related QOL was better among older patients (P < .0001). Post-operative global health-related QOL was equivalent between groups based on Short Form 12 Physical Component Score and Mental Health Component score (P = .6646 and P = .5705, respectively) and QOL improvement questionnaires (P = .181). Younger patients reported greater knee-related dysfunction and higher activity levels pre-operatively and post-operatively (P ≤ .0002).Conclusion
Satisfaction with knee surgery was over 85% regardless of age. Younger patients perceived more knee-related dysfunction and dissatisfaction after surgery despite higher levels of self-reported activity pre-operatively and post-operatively. 相似文献128.
Background
Dislocation following total hip arthroplasty (THA) remains a significant clinical problem. Few studies have focused on the use of dual mobility (DM) components in the setting of first-time revision for instability following THA. Here, we investigate patient outcomes following first-time revision THA with DM components for a diagnosis of instability.Methods
Institution-wide revision THAs using DM components performed between 2010 and 2013 were identified. Chart review identified 40 patients with average 3-year follow-up who had undergone first-time revision for instability, defined as instability after primary THA. Etiology of instability was classified by Wera type. Patient demographics, medical co-morbidities, re-dislocations, and re-revisions were recorded. Component position and leg-length discrepancy were measured on pre-operative and post-operative radiographs when available. Utilizing Student's t-test or Fisher's exact test, we analyzed differences between those who endured recurrent dislocation and those who did not.Results
Recurrent dislocation occurred in 2 patients (5%). Both patients underwent re-revision for recurrent instability and carried diagnoses of instability of unresolved etiology. Two patients underwent re-revision for reasons unrelated to the DM construct. All-cause re-revision rate at final follow-up was therefore 10% (4 patients). No medical, demographic, or radiographic factors were significantly associated with risk of recurrent instability (P > .05).Conclusion
The use of DM components for first-time revision THA for a diagnosis of instability carried a re-dislocation rate of 5% and an all-cause re-revision rate of 10% at average 3-year follow-up. Instability of unresolved etiology was associated with re-dislocation following revision surgery. 相似文献129.
Amyloidosis and the gut 总被引:6,自引:0,他引:6
130.
Transcriptional determinants of individualized inflammatory responses at anatomically separate sites