Frederick O. Stephens
University of Sydney
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Featured researches published by Frederick O. Stephens.
Cancer | 1990
Frederick O. Stephens
Five‐year results are reported on 27 patients with locally advanced breast cancer treated by intraarterial induction chemotherapy followed by radiotherapy and/or surgery with subsequent adjuvant chemotherapy. The cyclic infusion chemotherapy regimen was given over 3 to 6 weeks using Adriamycin (doxorubicin), 5‐fluorouracil (S‐FU), vincristine, and methotrexate in daily rotation, Regional and systemic side effects were minimal and temporary except in two patients in whom some skin discoloration has remained. Local tumor control and 5‐year cures depended on two important factors: whether follow‐up mastectomy was used after initial local tumor regression; and whether the carcinoma was classified as “inflammatory” with pathologic evidence of tumor invasion of dermal lymphatics. Of 16 patients with noninflammatory carcinoma treated by chemotherapy, radiotherapy, and mastectomy local tumor eradication was achieved in 15 and 5‐year apparent cure in 11. Of six patients with noninflammatory carcinoma treated with chemotherapy and radiotherapy but no mastectomy 5‐year local control was achieved in only three and 5‐year apparent cure in three. Of five patients with pathologic inflammatory carcinoma local tumor control was achieved in only one and only this one patient has been a 5‐year survivor apparently tumor‐free.
Cancer | 1987
Frederick O. Stephens; Martin H. N. Tattersall; William Marsden; Richard Waugh; David Green; Stanley W. McCarthy
Eight patients who had large sarcomas in the hip, thigh, or shoulder girdle have been described. Three had osteogenic sarcomas, and one each had Ewings sarcoma, biphasic synovial sarcoma, pleomorphic liposarcoma, undifferentiated spindling sarcoma, and malignant fibrous histiocytoma. All eight tumors showed evidence of regression after intraarterial infusion of cisplatin and Adriamycin (doxorubicin) given over 48 hours at 3‐week intervals, for a total of between three and seven courses. Tru‐cut needle biopsy specimens of five of the lesions were normal after chemotherapy. However, after resection of the regressed fibrotic tumor in seven of the patients, four contained foci of probably viable malignant cells. These cell foci were intraosseous in three cases and in the wall of a cyst in one case. In the remaining case, tumor in the distribution of the infused artery regressed, but tumor in a region supplied by an artery that was not infused continued to enlarge. In one patient with osteogenic sarcoma in the pelvis, despite a good response to intraarterial chemotherapy that was followed by surgical resection and radiotherapy, tumor recurred in an adjacent area in tissues supplied by an artery not infused. A hindquarter amputation subsequently was required. With the exception of the two cases in which adequate tumor arterial infusion was not achieved, local primary tumor control was accomplished by intraarterial infusion chemotherapy followed by local resection or radiotherapy and local resection in all patients. Four patients are well without evidence of residual or metastatic sarcoma 3.5 years after presentation in the case of an osteogenic sarcoma of shoulder, 2.5 years after presentation in the case of a large pleomorphic liposarcoma of thigh and groin, 20 months after presentation in the case of a large, lower‐thigh malignant fibrous histiocytoma, and 1 year after presentation in a child with an osteogenic sarcoma of lower femur.
American Journal of Surgery | 1971
Frederick O. Stephens; Thomas K. Hunt; Ernest Jawetz; Minetta Sonne; J.Englebert Dunphy
Abstract Systemic cortisone administration in rabbits reduced resistance to light bacterial contamination. Systemic vitamin A did not prevent this sensitivity to infection. Two actions of cortisone are known to be inhibited by vitamin A. These are the interference with fibroplasia and delayed epithelization of open wounds. Three actions of cortisone have not been found to be inhibited by vitamin A. These are the interference with wound contraction, weight loss, and increased susceptibility to wound infection.
BMJ | 1968
Peter R. Hunter; Peter Endrey-Walder; Gaston E. Bauer; Frederick O. Stephens
One hundred and forty-one randomly selected surgical patients, aged 35 years or over, were studied preoperatively, followed through their operative procedures, and reassessed during the first post-operative week for evidence of myocardial ischaemia associated with surgical operations under general anaesthesia. Of these patients 38% were found to have preoperative clinical evidence of heart disease, hypertension, or diabetes; 45% had abnormal preoperative E.C.G. patterns. Three patients experienced myocardial infarction during or within 36 hours of operation, all of the occult type; all were in the preoperative abnormal groups. Non-specific postoperative E.C.G. changes were equally common in the groups of patients with normal or abnormal preoperative electrocardiograms. A relationship existed between a rise in serum lactic dehydrogenase (L.D.H.) concentration and the field of the operation, but the diagnosis of infarction was not confused provided serum L.D.H. isoenzyme patterns and a rise in serum aspartate aminotransferase (S.G.O.T.) levels were consistent with the diagnosis.
American Journal of Surgery | 1971
Frederick O. Stephens; Thomas K. Hunt; J.Englebert Dunphy
Abstract An experimental study in rats indicates that sutures, dressings, and immobilization impair tensile strength in primarily closed skin wounds. Some practical implications of these observations, in the care of wounds in man, are discussed.
Cancer | 1981
Frederick O. Stephens; Garry J. S. Harker; Colin K. Hambly
Since the linear acelerator was installed in Sydney Hospital in 1964, 27 patients who presented with previously untreated but advanced deep carcinoma of the lower lip have been treated with initial megavoltage or orthovoltage radiotherapy with or without follow‐up surgery. In 17 of these, the tumor appears to have been eradicated, but in the other ten (approximately one‐third), the tumor was not controlled. These results are similar to those reported from other major centers. Since January, 1974, six patients with the most advanced lesions have been treated with “basal” chemotherapy (in four cases given intra‐arterially and in two cases given intravenously) prior to radiotherapy. Follow‐up surgery in the form of block dissection was required in one patient, and wedge resection of a residual focus of tumor was required in a second patient, but all six patients remain well and free of disease, with from three to six years follow‐up to date. A further seven patients with advanced recurrent lesions were also treated using “basal” chemotherapy as the initial treatment. In three of these the carcinoma remained uncontrolled, but in four the tumor appears to have been controlled with subsequent follow‐up radiotherapy being used in two cases, surgery in a third, and intermittent chemotherapy in the fourth. The numbers of patients treated in this series are insufficient to allow conclusions to be drawn concerning present management methods. However, the trend of the results to date suggests that for advanced lesions, improved survival may well result from the combination of basal chemotherapy with subsequent radiotherapy and/or surgery.
European Journal of Cancer | 1992
Garry J. S. Harker; Frederick O. Stephens
Clinical evidence that intra-arterial chemotherapy is more effective in regressing head and neck cancers than equivalent intravenous doses is lacking. Intra-arterial versus intravenous 5-fluorouracil infusion was compared in a naturally occurring, auricular epidermal squamous cell cancer in sheep. Of 18 lesions infused intra-arterially and of 18 infused intravenously with the same dose, 39 and 11%, respectively responded objectively (over 50% regression); mean (S.E.) tumour volume reduction was 37(23) and 18(22)%, respectively. There was a statistically significant difference in the mean tumour response and in numbers of tumours regressing by at least 40% of tumour volume (50% of intra-arterial treated tumours compared with 11% of intravenous treated lesions) after the 16 day total infusion time in favour of intra-arterial treatment. Technically, the intra-arterial route in this model was an improvement on previous small animal models. These findings lend support to the need for continuing clinical study of intra-arterial infusion.
American Journal of Surgery | 1978
Frederick O. Stephens
A selection of patients with a variety of tumors treated effectively by chemotherapy followed by radiotherapy or surgery or both is presented. The best success has been achieved with lesions not previously treated by radiotherapy or surgery and which have no fixed lymph node masses. Where possible, we prefer to administer chemotherapeutic agents by direct infusion into the regional artery supplying the tumor mass.
Australasian Journal of Dermatology | 1979
Frederick O. Stephens; Garry J. S. Harker
Various modalities have been used extensively in the treatment of malignant skin neoplasms, usually with considerable success. Clinical situations arise, however, when lesions are so advanced on presentation that standard therapeutic measures are unlikely to achieve tumour eradication. This paper documents the use of intra‐arterial infusion chemotherapy as basal treatment in eleven such patients–five with advanced squamous carcinoma of skin of face; four with extensive peripheral limb lesions (including two patients with Marjolins ulcers): one patient with lymphoma of skin; and another with locally extensive malignant melanoma. In all cases, except the patient with melanoma, there was a major regression of the tumours sufficient to allow local tumour eradication with subsequent radiotherapy and/or surgery.
Archive | 1990
Frederick O. Stephens; W. Marsden; Martin H. N. Tattersall
In treating large and histologically aggressive sarcomas mutilating surgery, often requiring radical amputation became standard practice because of a high risk of local recurrence after less radical surgery. However, in spite of radical local surgery, many patients with sarcomas still developed distant metastatic disease, so that less radical approaches have been investigated for control of local tumour, at least until the period of greatest risk of metastatic disease becoming manifest has passed. Cade [1] used radical local radiotherapy for this purpose, and if after 6 months there was no evidence of metastatic disease, he then proceeded to amputation. In this way, amputation was only carried out in those patients most likely to be cured by the procedure.