Purpose
: To evaluate the patterns of failure and outcome of patients undergoing high-dose chemotherapy and autologous bone marrow transplantation for relapse/refractory Hodgkin's disease with ...emphasis on the impact of involved-field radiotherapy.
Method and Materials
: Fifty-four adult patients with refractory (25) or relapsed (29) Hodgkin's disease underwent high-dose chemotherapy with either autologous bone marrow (32) or peripheral stem cell (23) transplantation. Twenty patients received involved-field radiotherapy either prior to (7) or following (13) high-dose chemotherapy. Patients treated prior to the high-dose chemotherapy received radiation to bulky or symptomatic sites, and those treated following the transplantation were treated to sites of disease persistence (10) or to consolidate to complete response (3). Twenty-six patients had purely nodal disease, 10 had involvement, 7 liver, 5 bone, and 3 bone marrow. A total of 147 sites were present prior to high-dose chemotherapy. Nineteen were bulky (⩾ 5 cm), and 42 arose in a previous radioatherapy field.
Results
: Twenty-five of the 54 patients treated with involved-field radiotherapy had a lower rate of relapse in sites of prior disease involvement (26.3 vs 42.8%) (
p < 0.05) than those not treated with radiotherapy. Twenty-one patients had disease persistence following high-dose chemotherapy, of which 10 received involved-field radiotherapy and were converted to a complete response. Patients with disease persistence who received involved-field radiotherapy had a better progression-free survival (40.0 vs. 12.1%) (
p = 0.04) than those who did not. Moreover, the patients converted to a complete response had similar progression-free and cause-specific survival as those patients achieving a complete response with hight-dose chemotherapy alone. Of the initial 147 sites, 143 (97.3%) were amenable to involved-field radiation therapy. The addition of involved-field radiotherapy improvement the 5-year local control of all sites (
p = 0.008), nodal sites (
p = 0.01), and sites of disease persistence (
p = 0.0009).
Conclusions
: Patients with relapsed/refractory Hodgkin's disease undergoing high-dose chemotherapy and autologous bone marrow rescue have a high rate of relapse in sites of prior disease involvement. Involved-field radiotherapy is capable of improving the control of these sites, the majority of which are amenable to radio therapy. In addition, the use of radiotherapy to sites of disease persistence following high-dose chemotherapy may improve the outcome of these patients.
African-American (AA) men with prostate cancer present with advanced disease, relative to white (W) men. This report summarizes our clinical and biochemical control (bNED) rates after conformal ...radiotherapy (RT). In particular, we aim to characterize any race-based outcome differences seen after comparable treatment.
We reviewed 893 patients (418 AA and 475 W) with clinically localized prostate cancer treated between 1988 and 1997. Neoadjuvant hormonal blockade was used in 22.5% of cases, and all patients received conformal RT to a median dose of 68 Gy (range, 60 to 74.8 Gy). Biochemical failure was defined according to the American Society of Therapeutic Radiology and Oncology consensus definition. Median follow-up was 24 months (range, 1 to 114 months).
The 5-year actuarial survival, disease-free survival, and bNED rates for the entire population were 80.5%, 70.0%, and 57.6%, respectively. When classified by prognostic risk category, the 5-year actuarial bNED rates were 78.7% for favorable, 57.7% for intermediate, and 39.8% for unfavorable category patients. AA men presented at younger ages and with more advanced disease. Controlled for prognostic risk category, AA and W men had similar 5-year actuarial bNED rates in favorable (78% v 79%, P: = .91), intermediate (52% v 62%, P: =.44), and unfavorable categories (36% v 45%, P: = .09). Race was not an independent prognostic factor (P: = .36).
Conformal RT is equally effective for AA and W patients. More research is needed in order to understand and correct the advanced presentations in AA men. These data suggest a need for early screening in AA populations.
The modified Wilson osteotomy for hallux valgus is a double oblique osteotomy through the metatarsal shaft. The distal fragment is displaced laterally and plantarward. The lateral displacement ...corrects the varus position of the metatarsal, while the plantar displacement prevents the distal fragment from tilting dorsally into a metatarsus elevatus deformity that could produce metatarsalgia. Seventy-four cases of hallux valgus treated by this method were reviewed five years postoperatively. Sixty-six cases (89%) were graded as satisfactory and eight (11%) as unsatisfactory. Roentgenographic analysis in 61 cases showed the operation had reduced the hallux valgus angle by an average of 15 degrees and the intermetatarsal angle by an average of 4 degrees. The operation shortened the first metatarsal by an average of 5 mm. Although this caused callosities on the forefoot, it did not produce metatarsalgia. The operation is technically uncomplicated and yields a high percentage of satisfactory results.
A 5‐month‐old girl was born with generalized erythematous skin covered with fine scales. Two days after she was born blisters started appearing over several places on the skin, resulting in multiple ...denudations. Later, over a period of 2–3 weeks, her skin started becoming rough, thickened, and covered with verrucous scales. The patient is the product of a full‐term normal delivery, is born to nonconsanguinous parents, and had normal developmental milestones. None of her family members had had similar episodes, although her father had had verrucous linear epidermal nevus since his childhood.
On examination her entire skin was erythematous, thickened, and covered with rough verrucous scales arranged in a rippled pattern (Fig. 1a), more prominent in the flexural areas. Multiple erosions and a few flaccid vesicles and bullae were seen over the trunk and extremities (Fig, 1b), and islands of normal‐looking skin were seen over the recently healed erosions. Scales were less marked over the face. Mucous membranes, skin appendages, palms, and soles were not affected. The rest of her systemic examination revealed no other abnormality.
Routine laboratory investigations including haemogram, Veneral Disease Research; Laboratory test (VDRL), and radiologic skeletal survey were normal. Histopathologic examination of the lesional skin and also the normal‐looking skin revealed the picture of epidermolytic hyperkeratosis showing features of hyperkeratosis and hypergranulosis with prominent vacuolar degeneration of the upper epidermis extending to the middle of the stratum spinosum (Fig. 2), Dermis was normal but for a mild edema and nonspecific perivascular inflammatory infiltrate.
Dermatologic evaluation of her father revealed bilateral, asymmetric, thick, warty papules, and plaques arranged in a linear pattern following the lines of Blaschko over the trunk and extremities (Fig. 3), The rest of the skin and systemic examination was normal. A skin biopsy of the verrucous plaque over the back showed typical features of epidermolytic hyperkeratosis similar to his daughter (Fig. 4), and normal histology was observed from the skin section obtained from normal‐looking skin.
Iris images acquired from a partially cooperating subject often suffer from blur, occlusion due to eyelids, and specular reflections. The performance of existing iris recognition systems degrade ...significantly on these images. Hence it is essential to select good images from the incoming iris video stream, before they are input to the recognition algorithm. In this paper, we propose a sparsity based algorithm for selection of good iris images and their subsequent recognition. Unlike most existing algorithms for iris image selection, our method can handle segmentation errors and a wider range of acquisition artifacts common in iris image capture. We perform selection and recognition in a single step which is more efficient than devising separate specialized algorithms for the two. Recognition from partially cooperating users is a significant step towards deploying iris systems in a wide variety of applications.
Tetralogy of Fallot with restrictive ventricular septal defect and suprasystemic right ventricular pressure is an uncommon anomaly with high mortality rate. Very few such cases have been reported ...pre-operatively. This report describes echocardiographic features of five patients with restrictive ventricular septal defect due to flap valve in tetralogy of Fallot. In all the five cases, accessory or excessive tricuspid valve tissue obstructed the defect. Recognition of restrictive ventricular septal defect in tetralogy of Fallot is important because it appears to have poor prognosis.
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