Lee Manchul - Academia.edu (original) (raw)
Papers by Lee Manchul
International Journal of Radiation Oncology*Biology*Physics, 1995
Radiotherapy and Oncology, 2009
Discovery medicine, 2005
Extract: Women who present with early breast cancer are initially treated with surgical lumpectom... more Extract: Women who present with early breast cancer are initially treated with surgical lumpectomy (removal of the tumor mass) followed by radiation therapy. Breast radiation therapy is well established as the "standard of care" for women with early breast cancer as it has consistently been shown, in randomized clinical trials, to reduce the risk of a relapse in the breast by 60-75%. Excellent control rates and survival following lumpectomy and post-operative breast radiation demonstrate that mastectomies (removal of the entire breast, including the tumor) are normally not necessary for early disease. This is consistent with the consensus of multiple experts in the field following their assessment of multiple clinical trials comparing lumpectomy and mastectomy. The increasing use of mammographic screening for breast cancer has resulted in earlier diagnosis of the disease when the tumors are smaller and so they have not yet spread to the axillary lymph nodes (under the armp...
Radiotherapy and Oncology, 2012
Radiotherapy and Oncology, 2009
Radiotherapy and Oncology, 2009
International Journal of Radiation Oncology*Biology*Physics, 2004
Journal of Continuing Education in the Health Professions, 2005
Journal of Continuing Education in the Health Professions, 2003
International Journal of Radiation Oncology Biology Physics, Jan 7, 1998
Purpose: To evaluate the safety and effectiveness of filgrastim (granulocyte colony-stimulating f... more Purpose: To evaluate the safety and effectiveness of filgrastim (granulocyte colony-stimulating factor, G-CSF) in reducing neutropenia and treatment interruptions during whole abdominal radiotherapy for ovarian cancer. Methods and Materials: Sixteen patients with ovarian cancer treated with 2 to 6 courses of cisplatin-containing chemotherapy and abdomino-pelvic radiation therapy received filgrastim for neutrophil counts <2 ؋ 10 9 /L. Endpoints for analysis included the ability to maintain the neutrophil count in the target range, number of treatment interruptions due to neutropenia, and toxicity attributed to filgrastim. Results: Fourteen patients received a mean of 2.9 courses of filgrastim (each with a mean duration of 4.1 days), with no treatment interruptions due to neutropenia. The majority of neutrophil counts were maintained above the target range of 2 ؋ 10 9 /L during treatment. Thrombocytopenia requiring treatment interruption was seen in six patients and necessitated platelet transfusions in one. Thrombocytopenia occurred at a mean abdominal radiation dose of 2207 cGy and in all but one patient was preceded by one or more episodes of neutropenia. In comparison with a control group of 31 patients treated without filgrastim there was no reduction in treatment interruptions. Four patients did not complete treatment because of persistent thrombocytopenia yet received a mean of 94% of the planned abdominal radiation dose and 69% of the planned pelvic dose. Filgrastim toxicity was limited to mild skeletal pains in six patients and a Grade 1 skin rash in two patients. Conclusions: Filgrastim is safe and effective in preventing neutropenia and reducing neutropenic treatment interruptions during abdominal radiotherapy in patients with ovarian cancer. However, there was no clear benefit to the use of filgrastim as thrombocytopenia became the dose-limiting toxicity resulting in a risk of treatment interruptions and early termination of radiotherapy.
Cancer Research, Sep 1, 2001
The purpose of this study was to determine the independent prognostic significance of interstitia... more The purpose of this study was to determine the independent prognostic significance of interstitial fluid pressure (IFP) measurements in cervix cancer. A total of 102 patients with newly diagnosed cervix cancer were accrued to this prospective study. There were 31 International Federation of Gynecology and Obstetrics stage IB or IIA tumors, 40 IIB tumors, and 31 IIIB tumors. The median size was 5 cm (range, 2-10 cm). Pelvic lymphadenopathy was identified radiographically in 20 patients. IFP was measured at examination under anesthesia using a wick-in-needle technique. Multiple measurements were made in each tumor. The mean IFP in individual tumors ranged from ؊3 to 48 mm Hg, and the median for the entire cohort was 19 mm Hg. Treatment consisted of external beam and intracavitary radiation without chemotherapy. Median follow-up was 2.5 years. The 3-year disease-free survival of all of the patients was 53%. Disease-free survival was 34% in patients with IFP >19 mm Hg, and 68% in those with lower IFP (P ؍ 0.002). To evaluate rigorously the independent prognostic significance of IFP measurements relative to established clinical factors, a multivariate model was first developed using stepwise selection of clinical covariates. Tumor size (P ؍ 0.0003) and pelvic lymph node status (P ؍ 0.0016) comprised the clinical model. IFP, when added to this model, provided additional independent prognostic information (P ؍ 0.0013). IFP was also significant (P ؍ 0.0027) when the clinical factors and hypoxic proportion as determined with the Eppendorf electrode were analyzed together. Patients with high IFP were more likely to recur both locally and at distant sites. This study is the first to document a strong, independent prognostic importance of pretreatment IFP measurements in cervix cancer. Patients with high IFP are significantly more likely than those with low IFP to recur after radiotherapy and die of progressive disease, independent of clinical prognostic factors and the results of tumor oxygen measurements.
Cancer, Jun 1, 1998
Interstitial fluid pressure (IFP) is elevated in many animal and human tumors. The authors assess... more Interstitial fluid pressure (IFP) is elevated in many animal and human tumors. The authors assessed tumor IFP and its relation to tumor oxygenation in a prospective clinical study of patients with cervical carcinoma. Measurements were made in 77 patients with cervical carcinoma prior to treatment. IFP was measured in normal paravaginal submucosal tissue and at one to five positions in the visible tumor with the patients anesthetized and in the lithotomy position. Tumor oxygen tension was measured immediately prior to IFP using a polarographic needle electrode. Patients were treated with radiotherapy only. Response was evaluated 3 months after the completion of radiotherapy. There was substantial variation in IFP from region to region in some tumors. The mean IFP in individual tumors ranged from 3 to 48 millimeters of mercury (mmHg). The overall mean and median values for the entire patient group were 19 mmHg and 17 mmHg, respectively. IFP was significantly higher in tumor tissue than in normal tissue (P < 0.0001). Tumors with high IFP were more likely to be hypoxic (P < 0.007) and less likely to regress completely with radiotherapy (P < 0.04). IFP in cervical carcinoma is elevated above normal tissue values. Multiple measurements are needed to evaluate IFP in these tumors. High IFP is associated with hypoxia and may provide information about the mechanism of hypoxia on which treatment can be based.
Discovery medicine, 2005
Extract: Women who present with early breast cancer are initially treated with surgical lumpectom... more Extract: Women who present with early breast cancer are initially treated with surgical lumpectomy (removal of the tumor mass) followed by radiation therapy. Breast radiation therapy is well established as the "standard of care" for women with early breast cancer as it has consistently been shown, in randomized clinical trials, to reduce the risk of a relapse in the breast by 60-75%. Excellent control rates and survival following lumpectomy and post-operative breast radiation demonstrate that mastectomies (removal of the entire breast, including the tumor) are normally not necessary for early disease. This is consistent with the consensus of multiple experts in the field following their assessment of multiple clinical trials comparing lumpectomy and mastectomy. The increasing use of mammographic screening for breast cancer has resulted in earlier diagnosis of the disease when the tumors are smaller and so they have not yet spread to the axillary lymph nodes (under the armp...
Journal of Radiotherapy in Practice, 2000
The purpose of this Phase 2 Breast Skin Care Pilot Study was to compare the acute skin reaction i... more The purpose of this Phase 2 Breast Skin Care Pilot Study was to compare the acute skin reaction in patients undergoing radiation therapy for early breast cancer who use Aloe vera gel on the irradiated skin, with the acute skin reaction in patients from our earlier study who followed a normal skin care routine. Two secondary objectives were to assess patient compliance with the use of Aloe vera gel and the ease of using two skin toxicity scoring tools.A total of 109 patients undergoing radiotherapy following surgery for breast cancer between October 1997 and February 1998 consented to participate in this study. Each patient applied the Aloe vera gel three times daily to the irradiated area during radiation treatment. Skin reactions were assessed objectively on a weekly basis during radiation using the Radiation Therapy Oncology Group (RTOG) and the Acute Skin Reaction Index (ASRI) skin scoring tools and subjectively by patients. All patients were followed for up to 3 weeks following ...
Gynecologic Oncology, 1998
Objective. Earlier studies have demonstrated that the uterine papillary serous carcinoma (UPSC) v... more Objective. Earlier studies have demonstrated that the uterine papillary serous carcinoma (UPSC) variant of endometrial carcinoma has a high recurrence rate, even when disease is apparently confined to the uterus. The current study evaluated survival in patients with surgically staged UPSC. Methods. Patients with UPSC were identified from surgical pathology files and charts were retrospectively reviewed. Only patients who had undergone a TAH-BSO, lymph node dissection, and peritoneal cytology were included. Results. The FIGO stages of the 36 patients were 12 Stage I (4 IA, 4 IB, 4 IC), 2 Stage IIB, 13 Stage III (5 IIIA, 8 IIIC), and 9 Stage IV. Of the 14 Stage I/II patients, 6 did not receive adjuvant therapy, 5 received whole pelvic radiation (WPXRT), and 3 received whole abdominal radiation therapy (WART); after a median follow-up interval of 50 months only 2 (14%) of these Stage I/II patients have developed a recurrence. Both of the recurrences were in Stage IC patients who received radiation; 1 recurred in the radiation field. Of the 5 Stage IIIA patients, 3 patients declined therapy and 2 were treated with WART; 3 patients, including the 2 who received radiation therapy, are alive without disease. Of the 8 Stage IIIC patients, 2 declined postoperative therapy, 2 received WART, and 4 received WPXRT with an extended field to include paraaortic nodes. Four of the 6 Stage IIIC patients treated with curative intent are without evidence of disease and 1 died of unrelated causes after a median follow-up interval of 48 months. Both of the Stage IIIC patients who declined treatment recurred. Of the 9 patients with Stage IV disease, 8 have died of disease. Conclusion. Women with UPSC have a good prognosis when surgical staging confirms that disease is confined to the uterus (Stage I/II). Surgical findings can also be used to tailor adjuvant radiation treatments. Further study is required to define the optimal treatment for women with metastatic UPSC.
Gynecologic Oncology, 2000
Objectives. The aims of this study were to determine the overall survival (OS) and local control ... more Objectives. The aims of this study were to determine the overall survival (OS) and local control (LC) achieved in patients developing a locoregional recurrence of endometrial carcinoma and to define those prognostic factors that predict for improved LC and OS. Methods. Between 1984 and 1988, 958 women were referred to Princess Margaret Hospital (PMH) with a diagnosis of endometrial carcinoma. Of these, 58 were treated for recurrent disease with radical radiotherapy (RT). Forty-two were referred with recurrence and 16 relapsed during follow-up at PMH for their primary tumor. None had received prior RT. The majority (n ؍ 49) were treated with combined external beam RT followed by an intracavitary cesium insertion. Results. The median time to relapse from original diagnosis was 1.3 years (range 0.2-13.4 years). The actuarial 5-and 10-year OS was 53 and 41%, respectively. The respective results for LC were 65 and 62%. All end-points were measured from the time of relapse. The median total dose received was 81.5 Gy. Univariate analysis showed that favorable histological features at original diagnosis (<50% myometrial involvement, grade 1-2, P ؍ 0.007) and Perez modified staging (P ؍ 0.02) were significant predictors for OS. The Perez staging (P ؍ 0.02) and size of recurrence (<2 cm versus >2 cm, P ؍ 0.04) were predictors for LC. Conclusion. Patients with localized relapse of endometrial carcinoma in whom radical radiotherapy can be administered should be treated aggressively and may be cured in over half the cases treated. Pathological findings in the original surgical specimen, size of recurrent disease, and a modified vaginal carcinoma staging system are significant predictors of local pelvic control and survival.
International Journal of Radiation Oncology*Biology*Physics, 1995
Radiotherapy and Oncology, 2009
Discovery medicine, 2005
Extract: Women who present with early breast cancer are initially treated with surgical lumpectom... more Extract: Women who present with early breast cancer are initially treated with surgical lumpectomy (removal of the tumor mass) followed by radiation therapy. Breast radiation therapy is well established as the "standard of care" for women with early breast cancer as it has consistently been shown, in randomized clinical trials, to reduce the risk of a relapse in the breast by 60-75%. Excellent control rates and survival following lumpectomy and post-operative breast radiation demonstrate that mastectomies (removal of the entire breast, including the tumor) are normally not necessary for early disease. This is consistent with the consensus of multiple experts in the field following their assessment of multiple clinical trials comparing lumpectomy and mastectomy. The increasing use of mammographic screening for breast cancer has resulted in earlier diagnosis of the disease when the tumors are smaller and so they have not yet spread to the axillary lymph nodes (under the armp...
Radiotherapy and Oncology, 2012
Radiotherapy and Oncology, 2009
Radiotherapy and Oncology, 2009
International Journal of Radiation Oncology*Biology*Physics, 2004
Journal of Continuing Education in the Health Professions, 2005
Journal of Continuing Education in the Health Professions, 2003
International Journal of Radiation Oncology Biology Physics, Jan 7, 1998
Purpose: To evaluate the safety and effectiveness of filgrastim (granulocyte colony-stimulating f... more Purpose: To evaluate the safety and effectiveness of filgrastim (granulocyte colony-stimulating factor, G-CSF) in reducing neutropenia and treatment interruptions during whole abdominal radiotherapy for ovarian cancer. Methods and Materials: Sixteen patients with ovarian cancer treated with 2 to 6 courses of cisplatin-containing chemotherapy and abdomino-pelvic radiation therapy received filgrastim for neutrophil counts <2 ؋ 10 9 /L. Endpoints for analysis included the ability to maintain the neutrophil count in the target range, number of treatment interruptions due to neutropenia, and toxicity attributed to filgrastim. Results: Fourteen patients received a mean of 2.9 courses of filgrastim (each with a mean duration of 4.1 days), with no treatment interruptions due to neutropenia. The majority of neutrophil counts were maintained above the target range of 2 ؋ 10 9 /L during treatment. Thrombocytopenia requiring treatment interruption was seen in six patients and necessitated platelet transfusions in one. Thrombocytopenia occurred at a mean abdominal radiation dose of 2207 cGy and in all but one patient was preceded by one or more episodes of neutropenia. In comparison with a control group of 31 patients treated without filgrastim there was no reduction in treatment interruptions. Four patients did not complete treatment because of persistent thrombocytopenia yet received a mean of 94% of the planned abdominal radiation dose and 69% of the planned pelvic dose. Filgrastim toxicity was limited to mild skeletal pains in six patients and a Grade 1 skin rash in two patients. Conclusions: Filgrastim is safe and effective in preventing neutropenia and reducing neutropenic treatment interruptions during abdominal radiotherapy in patients with ovarian cancer. However, there was no clear benefit to the use of filgrastim as thrombocytopenia became the dose-limiting toxicity resulting in a risk of treatment interruptions and early termination of radiotherapy.
Cancer Research, Sep 1, 2001
The purpose of this study was to determine the independent prognostic significance of interstitia... more The purpose of this study was to determine the independent prognostic significance of interstitial fluid pressure (IFP) measurements in cervix cancer. A total of 102 patients with newly diagnosed cervix cancer were accrued to this prospective study. There were 31 International Federation of Gynecology and Obstetrics stage IB or IIA tumors, 40 IIB tumors, and 31 IIIB tumors. The median size was 5 cm (range, 2-10 cm). Pelvic lymphadenopathy was identified radiographically in 20 patients. IFP was measured at examination under anesthesia using a wick-in-needle technique. Multiple measurements were made in each tumor. The mean IFP in individual tumors ranged from ؊3 to 48 mm Hg, and the median for the entire cohort was 19 mm Hg. Treatment consisted of external beam and intracavitary radiation without chemotherapy. Median follow-up was 2.5 years. The 3-year disease-free survival of all of the patients was 53%. Disease-free survival was 34% in patients with IFP >19 mm Hg, and 68% in those with lower IFP (P ؍ 0.002). To evaluate rigorously the independent prognostic significance of IFP measurements relative to established clinical factors, a multivariate model was first developed using stepwise selection of clinical covariates. Tumor size (P ؍ 0.0003) and pelvic lymph node status (P ؍ 0.0016) comprised the clinical model. IFP, when added to this model, provided additional independent prognostic information (P ؍ 0.0013). IFP was also significant (P ؍ 0.0027) when the clinical factors and hypoxic proportion as determined with the Eppendorf electrode were analyzed together. Patients with high IFP were more likely to recur both locally and at distant sites. This study is the first to document a strong, independent prognostic importance of pretreatment IFP measurements in cervix cancer. Patients with high IFP are significantly more likely than those with low IFP to recur after radiotherapy and die of progressive disease, independent of clinical prognostic factors and the results of tumor oxygen measurements.
Cancer, Jun 1, 1998
Interstitial fluid pressure (IFP) is elevated in many animal and human tumors. The authors assess... more Interstitial fluid pressure (IFP) is elevated in many animal and human tumors. The authors assessed tumor IFP and its relation to tumor oxygenation in a prospective clinical study of patients with cervical carcinoma. Measurements were made in 77 patients with cervical carcinoma prior to treatment. IFP was measured in normal paravaginal submucosal tissue and at one to five positions in the visible tumor with the patients anesthetized and in the lithotomy position. Tumor oxygen tension was measured immediately prior to IFP using a polarographic needle electrode. Patients were treated with radiotherapy only. Response was evaluated 3 months after the completion of radiotherapy. There was substantial variation in IFP from region to region in some tumors. The mean IFP in individual tumors ranged from 3 to 48 millimeters of mercury (mmHg). The overall mean and median values for the entire patient group were 19 mmHg and 17 mmHg, respectively. IFP was significantly higher in tumor tissue than in normal tissue (P < 0.0001). Tumors with high IFP were more likely to be hypoxic (P < 0.007) and less likely to regress completely with radiotherapy (P < 0.04). IFP in cervical carcinoma is elevated above normal tissue values. Multiple measurements are needed to evaluate IFP in these tumors. High IFP is associated with hypoxia and may provide information about the mechanism of hypoxia on which treatment can be based.
Discovery medicine, 2005
Extract: Women who present with early breast cancer are initially treated with surgical lumpectom... more Extract: Women who present with early breast cancer are initially treated with surgical lumpectomy (removal of the tumor mass) followed by radiation therapy. Breast radiation therapy is well established as the "standard of care" for women with early breast cancer as it has consistently been shown, in randomized clinical trials, to reduce the risk of a relapse in the breast by 60-75%. Excellent control rates and survival following lumpectomy and post-operative breast radiation demonstrate that mastectomies (removal of the entire breast, including the tumor) are normally not necessary for early disease. This is consistent with the consensus of multiple experts in the field following their assessment of multiple clinical trials comparing lumpectomy and mastectomy. The increasing use of mammographic screening for breast cancer has resulted in earlier diagnosis of the disease when the tumors are smaller and so they have not yet spread to the axillary lymph nodes (under the armp...
Journal of Radiotherapy in Practice, 2000
The purpose of this Phase 2 Breast Skin Care Pilot Study was to compare the acute skin reaction i... more The purpose of this Phase 2 Breast Skin Care Pilot Study was to compare the acute skin reaction in patients undergoing radiation therapy for early breast cancer who use Aloe vera gel on the irradiated skin, with the acute skin reaction in patients from our earlier study who followed a normal skin care routine. Two secondary objectives were to assess patient compliance with the use of Aloe vera gel and the ease of using two skin toxicity scoring tools.A total of 109 patients undergoing radiotherapy following surgery for breast cancer between October 1997 and February 1998 consented to participate in this study. Each patient applied the Aloe vera gel three times daily to the irradiated area during radiation treatment. Skin reactions were assessed objectively on a weekly basis during radiation using the Radiation Therapy Oncology Group (RTOG) and the Acute Skin Reaction Index (ASRI) skin scoring tools and subjectively by patients. All patients were followed for up to 3 weeks following ...
Gynecologic Oncology, 1998
Objective. Earlier studies have demonstrated that the uterine papillary serous carcinoma (UPSC) v... more Objective. Earlier studies have demonstrated that the uterine papillary serous carcinoma (UPSC) variant of endometrial carcinoma has a high recurrence rate, even when disease is apparently confined to the uterus. The current study evaluated survival in patients with surgically staged UPSC. Methods. Patients with UPSC were identified from surgical pathology files and charts were retrospectively reviewed. Only patients who had undergone a TAH-BSO, lymph node dissection, and peritoneal cytology were included. Results. The FIGO stages of the 36 patients were 12 Stage I (4 IA, 4 IB, 4 IC), 2 Stage IIB, 13 Stage III (5 IIIA, 8 IIIC), and 9 Stage IV. Of the 14 Stage I/II patients, 6 did not receive adjuvant therapy, 5 received whole pelvic radiation (WPXRT), and 3 received whole abdominal radiation therapy (WART); after a median follow-up interval of 50 months only 2 (14%) of these Stage I/II patients have developed a recurrence. Both of the recurrences were in Stage IC patients who received radiation; 1 recurred in the radiation field. Of the 5 Stage IIIA patients, 3 patients declined therapy and 2 were treated with WART; 3 patients, including the 2 who received radiation therapy, are alive without disease. Of the 8 Stage IIIC patients, 2 declined postoperative therapy, 2 received WART, and 4 received WPXRT with an extended field to include paraaortic nodes. Four of the 6 Stage IIIC patients treated with curative intent are without evidence of disease and 1 died of unrelated causes after a median follow-up interval of 48 months. Both of the Stage IIIC patients who declined treatment recurred. Of the 9 patients with Stage IV disease, 8 have died of disease. Conclusion. Women with UPSC have a good prognosis when surgical staging confirms that disease is confined to the uterus (Stage I/II). Surgical findings can also be used to tailor adjuvant radiation treatments. Further study is required to define the optimal treatment for women with metastatic UPSC.
Gynecologic Oncology, 2000
Objectives. The aims of this study were to determine the overall survival (OS) and local control ... more Objectives. The aims of this study were to determine the overall survival (OS) and local control (LC) achieved in patients developing a locoregional recurrence of endometrial carcinoma and to define those prognostic factors that predict for improved LC and OS. Methods. Between 1984 and 1988, 958 women were referred to Princess Margaret Hospital (PMH) with a diagnosis of endometrial carcinoma. Of these, 58 were treated for recurrent disease with radical radiotherapy (RT). Forty-two were referred with recurrence and 16 relapsed during follow-up at PMH for their primary tumor. None had received prior RT. The majority (n ؍ 49) were treated with combined external beam RT followed by an intracavitary cesium insertion. Results. The median time to relapse from original diagnosis was 1.3 years (range 0.2-13.4 years). The actuarial 5-and 10-year OS was 53 and 41%, respectively. The respective results for LC were 65 and 62%. All end-points were measured from the time of relapse. The median total dose received was 81.5 Gy. Univariate analysis showed that favorable histological features at original diagnosis (<50% myometrial involvement, grade 1-2, P ؍ 0.007) and Perez modified staging (P ؍ 0.02) were significant predictors for OS. The Perez staging (P ؍ 0.02) and size of recurrence (<2 cm versus >2 cm, P ؍ 0.04) were predictors for LC. Conclusion. Patients with localized relapse of endometrial carcinoma in whom radical radiotherapy can be administered should be treated aggressively and may be cured in over half the cases treated. Pathological findings in the original surgical specimen, size of recurrent disease, and a modified vaginal carcinoma staging system are significant predictors of local pelvic control and survival.