Showing papers by "Barbara Fisher published in 1993"

Radiation therapy of pituitary adenoma: delayed sequelae.

Abstract: Clinical records and follow-up computed tomographic (CT) scans were reviewed for 134 pituitary adenoma patients who underwent radiation therapy between 1970 and 1988, to determine the long-term clinical and radiologic complication rates for patients treated in a fairly standard manner for nonmalignant disease. The group consisted of 82 males and 52 females aged 16-85 years (median, 46 years). Fifty-nine (44%) of the 134 tumors were secretory. One hundred eighteen patients underwent surgical resection and radiation therapy, and 16 underwent only primary radiation therapy. Ninety-seven percent (130 of 132) of the patients received doses within the range of 45-50 Gy over 25 fractions. Mean clinical follow-up was 101 months, and mean radiologic follow-up (CT) was 8 years. Clinical complications occurred in 7% (nine of 134) of patients. There were two secondary malignancies, three visual complications, and two cases of auditory deterioration, and there were two posttreatment cerebrovascular accidents that may ...

Giant pituitary adenomas : role of radiotherapy

Abstract: Between 1970 and 1989, 31 patients with a diagnosis of giant pituitary adenoma were referred to the London Regional Cancer Center. Giant pituitary adenoma was defined in terms of extension in excess of 40 mm from the midpoint of the jugum sphenoidale. The diagnosis was made surgically in 30 patients and clinically in one. Tumor extent and dimensions were obtained from operative reports and/or radiological scans computed tomography or magnetic resonance imaging. Mean follow-up was 8 years. Initial treatment consisted of surgery alone (4 patients), radiotherapy alone (2 patients) and combined surgery-radiotherapy (25 patients). One patient underwent a needle biopsy for histological confirmation and was grouped with the radiotherapy alone subset. Four of the six patients who received single modality treatment failed initial treatment (three surgery and one radiation). In contrast only 3 of the 25 patients treated with combined surgery-post-operative radiotherapy progressed despite the fact that all patients had gross residual disease post-operatively and that 43% of these patients received radiotherapy based on the post-operative rather than the pre-operative tumor extent. With subsequent salvage, overall tumor control amongst the 31 patients was 93.5%. Complications in general were minimal although one acromegalic patient sustained a unilateral internal capsular cerebrovascular accident year post treatment. In summary, combined modality treatment with initial surgical debulking followed by radiotherapy in the dose range of 4500–5000 cGy over 25 fractions yields tumor control rates in giant pituitary adenomas similar to those of smaller pituitary adenomas without undue morbidity.

Malignant glioma-timing of response to radiation therapy

Abstract: Purpose: The response of malignant gliomas to radiation was examined retrospectively in 71 patients with newly diagnosed supratentorial malignant gliomas. Questions asked included frequency, timing and clinical significance of response. Methods and Materials: After surgery, all were treated with whole brain plus boost radiotherapy followed 8 weeks later by chemotherapy. The rate, degree, and timing of response to radiation were determined by comparing postoperative, end of radiation, and prechemotherapy CT scans on each patient. Results: Postoperative residual tumor was evident on 6371 postoperative scans. Twenty-two of 63 tumors (35%) had a partial or complete response to radiation. Twenty (32%) had responded by the end of radiation; 17 maximally. Six to 8 weeks later, three responding tumors had responded further and two previously stable ones had begun to respond. Only three tumors (5%) responded completely. A greater proportion of anaplastic gliomas than glioblastomas responded to radiation (52% vs. 26%). Protracted or delayed responses were only observed in patients with anaplastic glioma. Patients who responded to radiation did not live significantly longer than non-responders. However, tumor progression prior to chemotherapy was associated with significantly shorter survival. Conclusion: This CT scan-based analysis demonstrates that malignant gliomas are only moderately radioresponsive tumors and also demonstrates that response to radiation, if it is going to occur, is usually evident by the end of treatment.