1
|
Ramadan KM, Connors JM, Al-Tourah AJ, Song KW, Gascoyne RD, Barnett MJ, Nevill TJ, Shepherd JD, Nantel SH, Sutherland HJ, Forrest DL, Hogge DE, Lavoie JC, Abou-Mourad YR, Chhanabhai M, Voss NJ, Brinkman RR, Smith CA, Toze CL. Allogeneic SCT for relapsed composite and transformed lymphoma using related and unrelated donors: long-term results. Bone Marrow Transplant 2008; 42:601-8. [DOI: 10.1038/bmt.2008.220] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
2
|
Song KW, Barnett MJ, Gascoyne RD, Chhanabhai M, Forrest DL, Hogge DE, Lavoie JC, Nantel SH, Nevill TJ, Shepherd JD, Smith CA, Sutherland HJ, Toze CL, Voss NJ, Connors JM. Primary therapy for adults with T-cell lymphoblastic lymphoma with hematopoietic stem-cell transplantation results in favorable outcomes. Ann Oncol 2006; 18:535-40. [PMID: 17158775 DOI: 10.1093/annonc/mdl426] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Controversy exists regarding the role of high-dose therapy followed by stem-cell transplant (SCT) in the treatment of T-cell lymphoblastic lymphoma (T-LBL). We conducted an intention-to-treat analysis of the strategy of SCT as definitive treatment of T-LBL. PATIENTS AND METHODS From July 1987 to March 2005, 34 adults with T-LBL were diagnosed and treated in British Columbia. Treatment, before planned SCT, consisted of a non-Hodgkin's lymphoma (NHL)/acute lymphoblastic leukemia hybrid chemotherapy protocol (28 patients) or a standard NHL chemotherapy regimen (six patients). RESULTS Median follow-up of the 23 surviving patients is 51 months (range 13-142 months). Twenty-nine proceeded to SCT (four allogeneic, 25 autologous). For all 34 patients, 4-year overall survival (OS) and event-free survival (EFS) are 72% and 68%, respectively. For patients proceeding to SCT, the 4-year OS and EFS are 79% and 73%, respectively. All patients who received allografts are alive without disease at 38-141 months since diagnosis. For patients who received autografts, the 4-year EFS is 69%. Bone marrow involvement was a significant prognostic factor predicting for a worse survival (P = 0.02). CONCLUSION A treatment strategy for adults with chemosensitive T-LBL that includes planned consolidation with SCT in first response produces favorable long-term outcome.
Collapse
Affiliation(s)
- K W Song
- The Leukemia/Bone Marrow Transplant Program of British Columbia, The Vancouver Hospital and Health Science Center, Division of Medical Oncology, British Columbia Cancer Agency and University of British Columbia, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Al-Tourah AJ, Gill KK, Hoskins PJ, Klasa RJ, Savage KJ, Sehn LH, Shenkier TN, Gascoyne RD, Voss NJ, Connors JM. The impact of initial treatment of advanced stage indolent lymphoma on the risk of transformation. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7510 Background: The impact of initial treatment of indolent non-Hodgkin’s lymphoma (NHL) on the risk of transformation (TR) to aggressive NHL is unknown. High LDH and advanced stage at diagnosis have been shown to be predictive for TR; however, the effect of initial treatment is difficult to estimate as most series included heterogenous patient (pts) populations. Methods: As part of a large retrospective analysis examining TR (n = 698), we identified pts from 2 consecutive phase II studies conducted at the British Columbia Cancer Agency. Both studies had identical inclusion criteria: diagnosis of indolent NHL, no prior treatment, age16–60 y and advanced stage disease (III/ IV or I/ II with B symptoms or bulky disease ≥10cm). The first study included use of BPVACOP (bleomycin, cisplatin, etoposide, doxorubicin, cyclophosphamide,vincristine and prednisone, followed by involved field irradiation (RT) to original nodal sites of lymphoma. The second used combination alkylator-purine analogue (cyclophosphamide- cladrabine or fludaribine and prednisone). The definition of TR was based on either histological confirmation (HIST) or clinical features (CLIN), defined as one or more of the following: rapid discordant nodal or extranodal growth; sudden rise in LDH to > 2 x previous baseline; involvement of unusual extranodal sites; or hypercalcemia. Results: 260 pts were identified. BPVACOP+RT (n = 140), alkylator-purine analogue (n = 120). Median age 46 y (19–60). Follicular histology in 133 (94%) and 105 (87%), respectively. The majority were stage III/IV (89%) with equal proportions in each cohort. With a median follow-up (FU) for living pts of 90 months (1–225), 26 (18%) pts treated with BPVACOP+RT developed TR, 16 of which were confirmed with biopsy, versus 32 (27%) in the alkylator-purine group, of which 18 had biopsy confirmation. The 5 y risk of TR for BPVACOP+RT was 9% compared to 24% for the alkylator-purine analogue group (p < 0.0095). The annual risk of TR through 10 y of FU was 1.5% and 3.0%, respectively. The post-TR 5 y OS of all 58 pts with TR was 19%. Pts with TR based on CLIN vs HIST criteria did not differ in their outcome. Conclusions: The use of an anthracycline-based regimen as initial treatment for advanced stage indolent NHL is associated with a marked reduction in the risk of future TR. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- A. J. Al-Tourah
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - K. K. Gill
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - P. J. Hoskins
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - R. J. Klasa
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - K. J. Savage
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - L. H. Sehn
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - T. N. Shenkier
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - R. D. Gascoyne
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - N. J. Voss
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| | - J. M. Connors
- BC Cancer Agency Fraser Valley Centre, Surrey, BC, Canada; BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada
| |
Collapse
|
4
|
Toze CL, Galal A, Barnett MJ, Shepherd JD, Conneally EA, Hogge DE, Nantel SH, Nevill TJ, Sutherland HJ, Connors JM, Voss NJ, Kiss TL, Messner HA, Lavoie JC, Forrest DL, Song KW, Smith CA, Lipton J. Myeloablative allografting for chronic lymphocytic leukemia: evidence for a potent graft-versus-leukemia effect associated with graft-versus-host disease. Bone Marrow Transplant 2005; 36:825-30. [PMID: 16151430 DOI: 10.1038/sj.bmt.1705130] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In all, 30 patients with CLL proceeded to myeloablative allogeneic BMT using related (n=20, 67%) or unrelated (n=10) donors, at the Princess Margaret Hospital (Toronto) (n=20) or the Leukemia/BMT Program of BC (Vancouver) (n=10), from 1989 to 2001. Median (range) interval from diagnosis to BMT was 4.8 (0.3-13) years, median number of prior therapies was three and median age 48 years. The preparative regimen included total body irradiation in 15 (50%). In all, 14 of 30 patients (47%) are alive, with median (range) follow up of 4.3 (2.4-10.5) years. All are in complete remission, two following therapy for post-BMT progression. Actuarial overall (OS) and event-free survival (EFS) at 5 years is 39% (OS 48% for related donor and 20% for unrelated donor BMT); cumulative incidence of nonrelapse mortality (NRM) and relapse is 47 and 19%, respectively. Both acute (RR=0.008, P=0.01) and chronic (RR=0.006, P=0.02) Graft-versus-host disease (GVHD) were associated with markedly decreased risk of relapse. Patients receiving grafts from unrelated donors had increased NRM (RR=3.6, P=0.02) and decreased OS (RR of death=3.4, P=0.002). Allogeneic BMT has resulted in long-term EFS in approximately 40% of patients with CLL. There is evidence for a strong graft-versus-leukemia effect associated with acute and chronic GVHD, resulting in near complete protection from relapse.
Collapse
MESH Headings
- Adult
- Bone Marrow Transplantation/methods
- Disease-Free Survival
- Female
- Graft vs Host Disease/etiology
- Graft vs Host Disease/mortality
- Graft vs Leukemia Effect/radiation effects
- Histocompatibility Testing/methods
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Middle Aged
- Recurrence
- Remission Induction/methods
- Retrospective Studies
- Tissue Donors
- Transplantation Conditioning/methods
- Transplantation, Homologous
- Whole-Body Irradiation/methods
Collapse
Affiliation(s)
- C L Toze
- Division of Hematology, Leukemia/BMT Program of British Columbia, Vancouver Hospital & Health Sciences Centre, BC Cancer Agency and University of BC, Vancouver, British Columbia, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Al-Tourah AJ, Connors JM, Gascoyne RD, Hoskins PJ, O'Reilly SE, Shenkier TN, Voss NJ, Klasa RJ. Long-term follow up of limited stage primary testicular lymphoma: Outcome and patterns of relapse after combined-modality treatment. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - J. M. Connors
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - P. J. Hoskins
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | | | - N. J. Voss
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - R. J. Klasa
- British Columbia Cancer Agency, Vancouver, BC, Canada
| |
Collapse
|
6
|
Abstract
BACKGROUND Mantle-cell lymphoma (MCL) is known to have a poor outcome, however, most patients present with advanced-stage disease. Little information is available on limited-stage MCL. PATIENTS AND METHODS We retrospectively reviewed clinicopathological information on all patients with limited-stage MCL seen at the British Columbia Cancer Agency since 1984. RESULTS Twenty-six patients had low bulk (<10 cm) stage IA (12 patients) or IIA (14 patients) MCL. Initial therapy was involved-field radiation therapy (RT) with or without chemotherapy (CT), 17 patients; CT alone or observation, nine patients. Fifteen patients are alive at a median follow-up of 72 months (range 14-194). Progression-free survival (PFS) at 2 and 5 years was 65% and 46%, and overall survival (OS) 86% and 70%, respectively. Five patients surviving beyond 8 years. Only age and initial use of RT significantly affected PFS. Five-year PFS for patients <60 years of age was 83%, compared with 39% for those aged >/= 60 years, P = 0.04. Patients receiving RT with or without CT (n = 17), had a 5-year PFS of 68%, compared with 11% for those not receiving RT (n = 9, P = 0.002). Receiving RT eliminated the impact of age on PFS (with RT the 5-year PFS was 83% for those aged <60 years and 57% for those >/= 60 years, P = 0.17). Although OS for the whole group was 53% at 6 years, it was 71% for those initially treated with RT, but only 25% for those not given RT (P = 0.13). CONCLUSION In our experience, patients with limited-stage MCL had an improved PFS when treated with regimens including RT, with a trend towards improved OS. These results suggest a potentially important role for RT in limited-stage MCL.
Collapse
Affiliation(s)
- H A Leitch
- Division of Medical Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | |
Collapse
|
7
|
Toze CL, Shepherd JD, Connors JM, Voss NJ, Gascoyne RD, Hogge DE, Klingemann HG, Nantel SH, Nevill TJ, Phillips GL, Reece DE, Sutherland HJ, Conneally EA, Barnett MJ. Allografting for indolent lymphoid neoplasms. Ann Oncol 2000; 11 Suppl 1:59-61. [PMID: 10707781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Allogeneic bone marrow transplantation (BMT) has been used in patients with low-grade lymphoma (LGL) and chronic lymphocytic leukemia (CLL) with the goal of achieving long-term disease-free survival. PATIENTS AND METHODS Twenty-nine patients with these diagnoses (LGL = 19, CLL = 10) received allogeneic BMT between September 1995 and January 1999. Median age was 42 (range 20-52) years. Twenty-three of twenty-nine patients (79%) were Ann Arbor or Rai stage IV at the time of transplant; twenty-four (83%) had never achieved complete remission (CR). Donor source was HLA-matched sibling (20), unrelated (8) and syngeneic (1). RESULTS Seventeen patients are currently alive, a median of 29 months (range 1-85) post-BMT with a median KPS of 90%. Twenty-three of twenty-seven evaluable patients (85%) achieved CR post-BMT. Six patients had refractory/recurrent disease. Death occurred related to transplant complications in eight patients and underlying disease in four. Overall and event-free survival for the whole group is 51% and 44%, respectively. CONCLUSIONS Allogeneic BMT for young patients with advanced stage LGL or CLL is a feasible strategy that can result in achievement of long-term disease-free survival.
Collapse
Affiliation(s)
- C L Toze
- Division of Hematology, Vancouver Hospital & Health Sciences Centre, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Toze CL, Shepherd JD, Connors JM, Voss NJ, Gascoyne RD, Hogge DE, Klingemann HG, Nantel SH, Nevill TJ, Phillips GL, Reece DE, Sutherland HJ, Barnett MJ. Allogeneic bone marrow transplantation for low-grade lymphoma and chronic lymphocytic leukemia. Bone Marrow Transplant 2000; 25:605-12. [PMID: 10734294 DOI: 10.1038/sj.bmt.1702191] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Twenty-six patients with low-grade lymphoma (LGL) (n = 18) or chronic lymphocytic leukemia (CLL) (n = 8) received allogeneic BMTs between 1985 and 1998. Median age was 42 years, median interval from diagnosis to transplant 22 months and median number of prior treatments three. Twenty (77%) had stage IV disease; 22 (85%) had never achieved CR. Donor source was HLA matched sibling (n = 19, 73%), matched unrelated (n = 6, 23%) or syngeneic (n = 1). Conditioning therapy included total body irradiation in 23 patients and busulphan in three. Twenty-five received GVHD prophylaxis with cyclosporine A; + methotrexate (n = 19), + methylprednisolone (n = 2) or + T cell depletion of allograft +/- methotrexate (n = 4). Sixteen patients are alive, a median of 2.4 years post BMT. Death occurred due to transplant complications (n = 7) or underlying disease (n = 3). Eighteen (12 LGL, six CLL) of 22 evaluable patients (82%) achieved CR post BMT. Cumulative incidence of refractory/recurrent disease was 18% (95% confidence interval (CI) 7-42%). Overall and event-free survivals were 58% (95% CI 35-75%) and 54% (95% CI 32-72%), respectively. Allogeneic BMT for young patients with advanced LGL or CLL is feasible and can result in long-term disease-free survival.
Collapse
MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/toxicity
- Bone Marrow Transplantation/mortality
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/toxicity
- Disease-Free Survival
- Etoposide/administration & dosage
- Etoposide/toxicity
- Female
- Graft Survival
- Graft vs Host Disease/epidemiology
- Hemorrhage
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukocyte Transfusion/mortality
- Lung/pathology
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/therapy
- Male
- Middle Aged
- Platelet Transfusion/mortality
- Recurrence
- Survival Rate
- Transplantation Conditioning
- Transplantation, Homologous/mortality
- Treatment Outcome
- Whole-Body Irradiation
Collapse
Affiliation(s)
- C L Toze
- Leukemia/Bone Marrow Transplantation Program of British Columbia: Division of Hematology, British Columbia Cancer Agency, Vancouver Hospital and Health Sciences Centre and University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Toze CL, Shepherd JD, Connors JM, Voss NJ, Gascoyne RD, Hogge DE, Klingemann HG, Nantel SH, Nevill TJ, Phillips GL, Reece DE, Sutherland HJ, Conneally EA, Barnett MJ. Ann Oncol 2000; 11:59-61. [DOI: 10.1023/a:1008379605137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
10
|
Reece DE, Nevill TJ, Sayegh A, Spinelli JJ, Brockington DA, Barnett MJ, Klingemann HG, Connors JM, Nantel SH, Shepherd JD, Sutherland HJ, Voss NJ, Fairey RN, O'Reilly SE, Phillips GL. Regimen-related toxicity and non-relapse mortality with high-dose cyclophosphamide, carmustine (BCNU) and etoposide (VP16-213) (CBV) and CBV plus cisplatin (CBVP) followed by autologous stem cell transplantation in patients with Hodgkin's disease. Bone Marrow Transplant 1999; 23:1131-8. [PMID: 10382952 DOI: 10.1038/sj.bmt.1701790] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This analysis compares the regimen-related toxicity (RRT) and overall non-relapse mortality (NRM) in Hodgkin's disease patients conditioned with either CBV (cyclophosphamide, BCNU (carmustine), and VP16-213 (etoposide)) (26 patients) or CBVP (CBV + cisplatin) (68 patients) followed by autologous stem cell transplantation (ASCT). CBVP included a continuous infusion rather than intermittent doses of etoposide, a lower BCNU dose and the addition of cisplatin. RRT and NRM were determined for each regimen and compared; risk factors for each were examined by multivariate analysis. Grade IV (fatal) RRT occurred in five patients (pulmonary in two, cardiac in two, and central nervous system in one). Eighteen patients experienced grade II-III pulmonary RRT, consistent with BCNU damage in 15. Prior nitrosourea exposure was the main risk factor for pulmonary RRT. Grade II mucosal and hepatic RRT occurred less often after CBVP vs CBV (P = 0.031 and 0.0003, respectively). In addition, three other early and eight late non-relapse deaths were seen. Median follow-up of the entire group is 5.1 (range 2.8-10.2) years. The probability of overall NRM was 26% (95% confidence interval (CI) 13-50%) with CBV vs 23% (95% CI 12-41%) with CBVP (P = 0.40). The progression-free survival and relapse rates were similar. Although the rates of fatal RRT, pulmonary RRT and overall NRM were similar with CBV or CBVP, CBVP produced less mucosal and liver RRT with a comparable antitumor effect. As many autografted patients are cured, future efforts should include measures to decrease NRM.
Collapse
Affiliation(s)
- D E Reece
- Leukemia/Bone Marrow Transplantation Program of British Columbia: Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency and the University of British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
el-Khatib E, Hussein S, Nikolic M, Voss NJ, Parsons C. Variation of electron beam uniformity with beam angulation and scatterer position for total skin irradiation with the Stanford technique. Int J Radiat Oncol Biol Phys 1995; 33:469-74. [PMID: 7673035 DOI: 10.1016/0360-3016(95)00112-c] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE The influence of different scatterer-degraders and beam angulations on beam uniformity for total skin electron irradiation using the six dual beam Stanford technique is investigated. METHODS AND MATERIALS The 6 MeV high dose rate total skin electron irradiation mode on a linear accelerator was used. Beam profiles and percentage depth doses in the patient plane for single, dual, and six dual beams were measured for different dual beam angulations and acrylic scatterer-degraders of different thicknesses mounted on the treatment head or in front of the patient in the treatment plane. RESULTS It is demonstrated that, with the same electron nominal energy, total skin irradiation techniques with different beam penetrations can be obtained by inserting various beam scatterer-degraders into the beam, either mounted on the accelerator head or close to the patient. For our patient treatment, a beam penetration was selected so that the 80% dose lay at 8-9 mm and the 50% dose at 15-16 mm depth. This was achieved by mounting a 0.32-cm thick acrylic beam scatterer-degrader on the accelerator head. A uniform vertical profile was obtained for gantry angulations of +/- 21 degrees. CONCLUSIONS To implement a total skin electron irradiation technique using the Stanford method, the required depth of penetration needs to be selected. Based on this, the appropriate combination of scatterer-degraders and dual beam angulations to produce a uniform beam in the treatment plane needs to be determined. Different techniques with different beam penetrations can be developed using the same high dose rate mode on the linear accelerator by a proper choice of scatterer-degraders and beam angulations.
Collapse
Affiliation(s)
- E el-Khatib
- Division of Medical Physics, British Columbia Cancer Agency, Vancouver, Canada
| | | | | | | | | |
Collapse
|
12
|
Reece DE, Barnett MJ, Shepherd JD, Hogge DE, Klasa RJ, Nantel SH, Sutherland HJ, Klingemann HG, Fairey RN, Voss NJ. High-dose cyclophosphamide, carmustine (BCNU), and etoposide (VP16-213) with or without cisplatin (CBV +/- P) and autologous transplantation for patients with Hodgkin's disease who fail to enter a complete remission after combination chemotherapy. Blood 1995; 86:451-6. [PMID: 7541661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Patients with Hodgkin's disease (HD) who fail to enter a complete remission after an initial course of combination chemotherapy are usually considered to have an induction failure (IF); this subset of patients has an extremely poor outcome with further conventional therapy. Since 1985, we have entered 30 IF patients into protocols using conditioning with high-dose cyclophosphamide, carmustine (BCNU), and etoposide (VP16-213) with or without cisplatin (CBV +/- P) followed by autologous stem cell transplantation (ASCT) with bone marrow (19 patients), peripheral blood stem cells (PBSCs; 8 patients), or both (3 patients). All except 2 patients had previously received chemotherapy regimens for HD that contained at least 7 drugs, and 9 had received prior radiotherapy (RT). After documentation of IF, the majority of patients received some cytoreductive therapy as specified by protocol (local RT in 9, two cycles of conventional chemotherapy in 2, both modalities in 2, or high-dose cyclophosphamide to enhance PBSC collection in 11) before CBV +/- P. Five treatment-related deaths occurred, all before day 150 posttransplant. Eleven patients have had progressive HD at a median of 6 months (range, 0.1 to 45 months) after ASCT. The actuarial progression-free survival (PFS) at a median follow-up of 3.6 years (range, 0.2 to 8.2 years) is 42% (95% confidence intervals, 21% to 61%). The statistical analysis identified only prior clinical bleomycin lung toxicity as an adverse risk factor for PFS, mainly because of the increased nonrelapse mortality seen in these patients. CBV +/- P and ASCT can produce durable remission in a substantial proportion of IF HD patients who otherwise have a poor survival, and we believed ASCT approaches represent the best therapy currently available for these patients. Additional measures are needed to reduce the primary problem of disease progression despite high-dose chemotherapy and stem cell transplantation.
Collapse
Affiliation(s)
- D E Reece
- Leukemia/Bone Marrow Transplantation Program of British Columbia, Division of Hematology, Vancouver Hospital, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
de Smet MD, Buffam FV, Fairey RN, Voss NJ. Prevention of radiation-induced stenosis of the nasolacrimal duct. Can J Ophthalmol 1990; 25:145-7. [PMID: 2361196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Epiphora is a recognized complication of radiotherapy of medial canthal tumours. We reviewed the records of 36 patients who underwent prophylactic nasolacrimal duct intubation with silicone tubing before superficial x-ray beam therapy and 42 patients who did not undergo intubation before radiotherapy. The mean length of follow-up was 3.4 years in the intubated group and 7.2 years in the nonintubated group. A total of 31% of the patients in the nonintubated group reported chronic epiphora during the follow-up period, compared with 6% in the intubated group (p less than 0.003).
Collapse
Affiliation(s)
- M D de Smet
- Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver
| | | | | | | |
Collapse
|
14
|
Epstein JB, Voss NJ, Stevenson-Moore P. Maxillofacial manifestations of multiple myeloma. An unusual case and review of the literature. Oral Surg Oral Med Oral Pathol 1984; 57:267-71. [PMID: 6369219 DOI: 10.1016/0030-4220(84)90182-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Oral symptoms and signs of multiple myeloma are common. An unusual case with pathologic fracture of the pterygoid process and external root resorption is presented. The literature is reviewed with respect to the prevalence of maxillofacial manifestations of multiple myeloma and the presence of such manifestations as the first sign and/or symptom of disease.
Collapse
|