Life Table Analysis Of Patients Research Articles

Palladium-103 Ophthalmic Plaque Radiation Therapy for Choroidal Melanoma: 400 Treated Patients

To describe 18 years of experience with palladium-103 ((103)Pd) ophthalmic plaque brachytherapy. Retrospective case series. From 1990 to 2007, 400 patients were diagnosed with uveal melanoma, found negative for metastatic disease, and treated. Episcleral (103)Pd radiation was delivered to a mean apical radiation dose of 73.3 Gy over 5 to 7 continuous days. Palladium-103 ophthalmic plaque brachytherapy. Patients were evaluated for local tumor control, visual acuity, radiation damage (retinopathy, optic neuropathy, cataract), and metastatic disease. A total of 272 tumors (68%) were located at or posterior to the equator. There were 186 (46.5%) T1 tumors, 156 (39%) T2 tumors, 50 (12.5%) T3 tumors, and 8 (2%) T4 tumors. Patients were followed for a maximum of 205 months (mean, 51.1 months). Fourteen patients required secondary enucleation (5 for tumor growth and 9 for glaucoma pain control). The local control rate was 96.7%. Life table analysis of patients with 20/200 or better before treatment (n = 357) suggests that 79% and 69% are expected to retain that acuity for 5 and 10 years, respectively. Life table analysis demonstrates a probability that 92.7% and 86.6% of patients will be free of metastatic disease at 5 and 10 years, respectively. In a nonrandomized phase I clinical evaluation, (103)Pd ophthalmic plaque radiotherapy was used to treat 400 patients with uveal melanoma. In this series, results after (103)Pd ophthalmic plaque radiotherapy were superior to those reported for alternative forms of radiation.

Survival of patients with soft tissue sarcoma (STS) correlated to tumor grade, size, site of origin & cell type. Does the high risk group need adjuvant systemic therapy?

19510 Background: The prognosis of patients with STS depends on the tumor stage, which includes tumor size (T) and grade (G). Patients with low-grade tumors (G1) are managed by radical resection only. Patients with moderate (G2) and high-grade (G3) tumors require postoperative adjuvant radiation therapy (RT); this became standard therapy. This study was conducted to determine the efficacy of standard therapy on survival. Methods: This is a retrospective study of patients with primary STS, excluding those with skin, subcutaneous tissue and GIST. All patients underwent radical resections (S). Postoperative RT was requested for G2 and G3 tumors; 6 patients with G3 tumors received chemotherapy (C) prior to RT. Results: 52 patients were studied with a median follow-up of 84 mo. The overall survival ranged from 3 to 264 mo. with a median of 52 mo. The incidence of tumor grade and size were correlated to the survival. 37 patients had STS of the extremities and torso; 24 are alive. 10 patients had intra- and retro-peritoneal STS; 5 are alive. 4 of the 6 patients who received C are alive, 3 are disease-free for a period of 3 to 7 years. Life table analysis of patients with G3T2 tumors comparing the 3 treatment groups (S vs. S+RT vs. S+C+RT) showed no statistical difference in survival, but there was a trend in favor of S+C+RT. Conclusions: 1. Radical resection and postoperative RT may be insufficient for systemic control. 2. Adjuvant systemic chemotherapy may improve the survival, and may be safer than RT in the management of retroperitoneal and visceral sarcomas. [Table: see text] No significant financial relationships to disclose.

Complications of Denver Peritoneovenous Shunting

The records of 49 consecutive patients treated with Denver peritoneovenous shunts were reviewed to determine the incidence of complications and length of patient survival. Thirty-eight complications (16 types) were identified in 22 (45%) of the patients and, in 10 instances, contributed to subsequent death. Ten percent of shunts failed during long-term follow-up. The 54% one-year survival by life-table analysis of patients with cirrhosis treated with the Denver shunt matched results previously reported for similar patients treated with the LeVeen shunt. Patients with intra-abdominal malignant neoplasms had an 11% one-year survival overall. Although it too is associated with significant complications, the Denver peritoneovenous shunt seems to have a lower failure rate and a lower incidence of complications than the LeVeen peritoneovenous shunt. Thus, the Denver shunt offers advantages in the treatment of intractable ascites.

Femoropopliteal bypass in elderly diabetic patients

The records of sixty-nine consecutive elderly diabetic patients over age 70 years who underwent femoropopliteal bypass at the New England Deaconess Hospital from 1966 to 1975 were reviewed and analyzed statistically. Grafts were classified as patent only if the patient had a palpable distal pulse postoperatively. No hospital deaths occurred. The patency rate declined with decreasing runoff below the knee. Patients receiving insulin had a patency rate of 7 per cent, compared with a rate of 35 per cent in patients treated with diet or oral agents ( p < 0.05). Cross analysis disclosed no other significant difference between these two groups. No benefit from Dextran was demonstrable in our series. Graft closure carried a 36 per cent risk of above knee amputation. Life table analysis of patients who underwent autogenous vein graft (fifty-seven patients) showed one and three year patency rates of 72 and 56 per cent, respectively. Conversely, grafts of Dacron had one and three year patency rates of 48 per cent and less than 10 per cent, respectively. In a favorable subset of twenty-six patients who (1) were receiving insulin, (2) had either previously successful bypass or no previous vascular surgery, (3) had arteriographic evidence of one or more vessel runoff, and (4) had autogenous vein grafts, the one and three year patency rates were 91 and 82 per cent, respectively. Our experience shows that femoropopliteal bypass is safe and effective when patients are carefully selected. We strongly discourage the use of Dacron materials in elderly diabetic patients.