Marco Sombeck - Academia.edu (original) (raw)

Papers by Marco Sombeck

5117 Background: To determine outcomes of patients (pts) with stage IB-2 cervical carcinoma (CC) ... more 5117 Background: To determine outcomes of patients (pts) with stage IB-2 cervical carcinoma (CC) treated with concurrent chemoradiation (CRT) followed by extrafascial total abdominal hysterectomy (TAH) with common iliac and para-aortic lymphadenectomy (PAL). Methods: We reviewed 69 pts with stage IB-2 CC who were treated with CRT followed by TAH/PAL from 01/99 to 01/09. All pre-treatment CAT scans were negative for para-aortic (PA) lymphadenopathy. Brachytherapy was limited to 1,500-1,800 cGy. Results: Mean age was 46.7 ± 10.7 yr, BMI 29.5 ± 6 kg/m2, tumor size 5.4 ± 1.2 cm, operative time 62 ± 15 min, EBL 187 ± 103 mL, LOS 3.1 ± 1.0 days, and node counts 6.3 ± 2.9. Tumor histologies were: squamous=55, adenocarcinoma = 11, adenosquamous = 3. There were 6 (9%) radiation external beam and 23 (33%) brachytherapy protocol violations. All pts had a complete response to CRT prior to TAH. Complete pathologic responses were confirmed in 34 (49%) pts. At surgery, 11 (16%) pts had (+) PA node...

International journal of radiation oncology, biology, physics, 1994

PURPOSE Review treatment results, complications, and the importance of overall treatment time for... more PURPOSE Review treatment results, complications, and the importance of overall treatment time for carcinoma of the vagina treated with radiotherapy alone. METHODS AND MATERIALS Between October 1964 and October 1990, 65 patients with histologically confirmed carcinoma of the vagina received definitive radiotherapy at the University of Florida. All patients had a minimum 2-year follow-up. Most patients were treated with a combination of external-beam radiotherapy and brachytherapy. The probability of pelvic control, cause-specific survival, and complications was calculated and multivariate analyses were performed. The log-rank test was used to determine significance levels between the curves. RESULTS The 5-year cause-specific survival rates were, Stage 0 (six patients), 100%; Stage I (17 patients), 94%; Stage IIA (six patients), 80%; Stage IIB (ten patients), 39%; Stage III (twn patients), 79%; and Stage IVA (six patients), 62%. The pelvic control rates at 5 years were: Stage 0, 100%;...

This retrospective, nonrandomized review evaluates 125 patients with esophageal carcinoma (adenoc... more This retrospective, nonrandomized review evaluates 125 patients with esophageal carcinoma (adenocarcinoma and squamous cell) who underwent either surgery only or preoperative chemotherapy and/or radiation therapy followed by surgery. Major end points were survival and postchemoradiation downstaging. Methods Forty-four patients underwent radiation therapy of 4500 cGy over 5 weeks. Fluorouracil and cisplatin were administered on the first and fifth week of radiotherapy. Ninety-eight patients underwent "potentially curative" resections-transhiatal esophagectomy (70), Lewis esophagogastrectomy (25), and left esophagogastrectomy (3). All patients with preoperative adjuvant therapy underwent endoscopy and biopsy before surgery. Results There were no differences in overall mortality (5%) or surgical complications in either group. Fourteen of 44 patients (32%) downstaged to complete pathologic response, with 5-year survival of 57%. Fifteen of 44 patients (34%) downstaged to microscopic residual tumor, with 1-and 3year survival of 77% and 31%, respectively. Twenty-eight of 29 patients in the two downstaged groups were lymph node negative. Overall, 5-year survival in the adjuvant therapy plus surgery group versus surgery only was 36% and 1 1% (p = 0.04). Five-year survival in lymph nodenegative adjuvant therapy and surgery patients was 49% (p = 0.005). Positive nodes in the surgery only group was 48% versus 23% in the adjuvant therapy and surgery group (p = 0.02). Conclusion Although retrospective and nonrandomized, these results suggest that preoperative chemoradiation results in significant clinical and pathologic downstaging, increases survival, and may sterilize local and regional lymph nodes, accounting for both downstaging and survival statistics.

Annals of Surgery, 1994

The authors determined the incidence of complications in 133 patients who had undergone staging l... more The authors determined the incidence of complications in 133 patients who had undergone staging laparotomy with splenectomy before treatment for Hodgkin's disease (stages I-IV). Methods and Materials Medical records were reviewed, and the patients or their relatives were interviewed. Median follow-up after laparotomy was 15.7 years (range = 2.5-28 years). Results Ten episodes of overwhelming postsplenectomy infection (OPSI) were documented in nine patients (6.8%). None of 25 patients who received pneumococcal vaccine before splenectomy developed OPSI. Patients with advanced (stages III-IV) or recurrent Hodgkin's disease were at higher risk of OPSI than those with early disease, and those who received combined modality oncologic therapy were at greater risk than those receiving less intensive treatment. Surgical complications included small bowel obstruction in 13 patients (9.8%), necessitating repeat laparotomy in 9 patients (6.8%), atelectasis in 17 patients, abscess in 3 patients, and 1 wound dehiscence. No deaths occurred as a result of surgical complications. Causes of death in the 29 patients who died included Hodgkin's disease (12 patients), acute treatment-related morbidity (1 patient), leukemia (5 patients), bone marrow failure (3 patients), solid malignancy (2 patients), intercurrent disease (4 patients), unknown causes (1 patient), and OPSI (1 patient). Conclusion With presplenectomy pneumococcal vaccination and modern surgical techniques, the long-term risks of laparotomy with splenectomy are acceptable if knowledge of the pathologic extent of abdominal Hodgkin's disease would alter treatment regimens. Recently, there has been interest in reducing the role of staging laparotomy in Hodgkin's disease because of concern over infectious and surgical complications associated with laparotomy. The most serious infectious complication is the development of overwhelming postsplenectomy infection (OPSI), which is heralded by nausea, vomiting, fever, confusion, and unconsciousness, and then rapidly progresses to coma and shock.'-3 Disseminated intravascular coagulation and hypoglycemia can develop, and bilateral adrenal hemorrhage can be found at autopsy.",2'4 Most reported cases occurred before vaccination against pneumococcal organisms was available. The most frequent serious surgical complica-615

Seminars in radiation oncology, 1994

Surgery and radiotherapy yield equivalent results for patients with carcinoma of the cervical eso... more Surgery and radiotherapy yield equivalent results for patients with carcinoma of the cervical esophagus, with long-term survival of less than one in four patients. The advantages of radiotherapy are lower rates of acute morbidity and mortality compared with surgery, and potential for larynx preservation. The advantage of surgery is that the transposed stomach may function better over the long term than an irradiated esophagus, which tends to become stenotic over time. Patients with resectable cancers who are in good general medical condition may be treated with preoperative irradiation and surgery in an effort to improve the likelihood of local control and obtain a good functional result. Patients with relatively early lesions who are not good surgical candidates can be treated with high-dose radiation therapy. Patients with very advanced local disease and those with distant metastases are treated with palliative irradiation. Concurrent chemotherapy and radiotherapy has been shown t...

Southern medical journal, 1993

The majority of patients with adenocarcinoma of the rectum are treated with radical surgical proc... more The majority of patients with adenocarcinoma of the rectum are treated with radical surgical procedures. Lesions located in the distal third of the rectum are usually treated by abdominoperineal resection, and those situated in the proximal portion of the rectum are treated by low-anterior resection. Relatively small, moderately or well differentiated lesions have a low risk of lymph node metastasis, and are therefore amenable to conservative (ie, rectum-sparing) procedures. Conservative management options consist of transrectal excision, transrectal excision and preoperative or postoperative radiotherapy, endocavitary contact radiotherapy, and interstitial therapy. Discussion of these options, the experience at the University of Florida with two of these options, and review of the literature follow.

International journal of radiation oncology, biology, physics, Jan 30, 1995

A retrospective analysis of 74 patients with pure seminoma, treated at the University of Florida ... more A retrospective analysis of 74 patients with pure seminoma, treated at the University of Florida between 1964 and 1989, was undertaken. All patients received megavoltage irradiation, with chemotherapy reserved for salvage. At 10 years, the probability of relapse-free survival was 91% for Stage I, 93% for Stage IIA, 83% for Stage IIB, and 75% for Stage III patients. There were seven recurrences, none of which occurred in irradiated areas. Only two of seven patients (29%) with recurrence were salvaged. A literature review revealed an increasing rate of mediastinal or supraclavicular recurrence, correlating with the size of the subdiaphragmatic disease, in Stage II patients who did not receive elective mediastinal irradiation. Recommendations are made regarding the role of elective mediastinal irradiation for Stage II disease. We conclude that patients with Stage I or II seminoma can have high cure rates when treated with radiotherapy alone. Patients with Stage III seminoma should be t...

$Research paper thumbnail of Stage III ovarian carcinoma: an analysis of treatment results and complications following hyperfractionated abdominopelvic irradiation for salvage$

International Journal of …, 1994

Purpose: We attempted to design a standard pelvic nodal treatment field such that all lymph nodes... more Purpose: We attempted to design a standard pelvic nodal treatment field such that all lymph nodes usually visualized on lymphangiogram would be irradiated with optimal midline blocking of normal tissues. Methods and Materials: Two standard fields for treatment of pelvic lymph nodes were designed, based on bony landmarks. The standard fields were applied to the anterior-posterior view of 35 pretherapy lymphangiograms, and the fields were then assessed for inclusion of visible lymph nodes. Measurements were done on the lymphangiograms to assess lthe amount of additional midline blocking that could be added. Results: All visualized nodes were included in 30 patients (86%) using Standard Field I and in 33 patients (94%)-Standard Field II, but visualized nodes plus a IS-cm minimum margin were included in only two patients (6%) with Field I and 24 patients (69%) with Field II. The most frequent sites of close margins were the lateral and medial borders adjacent to the external iliac nodes. Based on the lymphangiograms, a mean of 1.6 cm in male patients and 3.1 cm in female patients could be added to the width of the midline blocks. Conclusion: Lymphangiography is useful in designing fields for pelvic node irradiation, both to improve coverage of nodes with a 1.5 cm margin and to increase the amount of central shielding of normal tissues.

International Journal of Radiation Oncology*Biology*Physics, 1993

Purpose: To determine the predictive value of lymphangiography and computed tomography of the abd... more Purpose: To determine the predictive value of lymphangiography and computed tomography of the abdomen and pelvis for infradiaphragmatic involvement of Hodgkin's disease. Methods and Methods: We retrospectively reviewed the findings on 125 patients with Hodgkin's disease treated at the University of Florida who underwent lymphangiography and staging laparotomy; 33 patients also underwent computed tomography of the abdomen and pelvis. The positive predictive value and negative predictive value were calculated for both studies. Results: The positive predictive value of lymphangiography for paraaortic or pelvic disease was 352, while the negative predictive value was 95%. The positive predictive value of computed tomography of the abdomen and pelvis for paraaortic or pelvic disease was 20%; the negative predictive value was 93%. There was no advantage in predicting paraaortic or pelvic disease when both studies were obtained as compared to either study alone. For splenic disease, the positive predictive value of computed tomography was 43%; the negative predictive value was 77%. Of the patients with a positive lymphangiography, 57% were found at laparotomy to have either no abdominal disease or upper abdominal disease only, with or without minimal splenic disease, making them reasonable candidates for radiotherapy alone. Of the patients with a negative lymphangiogram, 14% were found at laparotomy to have either lower abdominal disease or extensive splenic disease, and so were not good candidates for radiotherapy alone. Conclusion: We recommend laparotomy for patients who may be candidates for radiotherapy alone or combined modality therapy with limited chemotherapy.