摘要:

Background: The combination of doxorubicin/ifosfamide is an effective chemotherapy regimen in metastatic soft-tissue sarcomas (STS), generally resulting in remission rates between 30 and 40%. A serious disadvantage of the combination are severe side effects, notably hematotoxicity, often leading to potentially life-threatening infectious complications due to leukopenia. Patients and Methods: Between May 1992 and October 1995, 45 previously untreated patients with advanced/ metastatic STS were treated every 3 weeks with a combination of doxorubicin 30 mg/m2 on days 1 and 2 and ifosfamide 3 g/m2 on days 1-3. The first course of chemotherapy was given without G-CSF support. When IV° leukopenia or fever > 38 °C after any course of chemotherapy developed, 5 μg/kg G-CSF was administered s. c. on days 4-12 after all subsequent courses. Results: Treatment resulted in severe hematotoxicity. All patients developed at least once III/IV° leukopenia and 33% developed III/IV° thrombocytopenia. The 167 courses of chemotherapy were followed by 33 (20%) episodes of fever > 38°C. Particularly the first cycle led to 17 (38%) IV° leukopenia and febrile events. In 29/45 patients treatment could only be continued by G-CSF support. Remission rate was 32%. In 15 patients metastasectomy was performed after chemotherapy. In 8/9 thoracotomies and in 2/6 laparotomies complete removal of metastases was possible. Probability of median survival for all patients is 14 months, for those who underwent metastasectomy it is 17 months. Conclusions: The combination of doxorubicin/ifosfamide in the doses used by us is an effective but very hematotoxic regimen in STS and should be administered with G-CSF support. In our opinion, such a toxic chemotherapy should be considered in patients with metastatic STS only when additional therapeutic steps for selected patients are planned, such as metastasectomy or high-dose chemotherapy with peripheral blood stem cell s

ISSN:0378-584X    

DOI:10.1159/000218783

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Background: Cancer cachexia is a common and serve medical problem in the management of patients with cancer, and its treatment remains a therapeutic challenge. Medroxyprogesterone acetate (MPA), which has been used for many years for hormonal therapy of breast cancer, has been noted to produce weight gain and increase appetite unrelated to any antitumour effect. To assess its symptomatic therapeutic value in patients suffering from advanced gastrointestinal malignancies and cachexia, the present double-blind placebo-controlled trial was initiated. Methods: Thirty-one patients with advanced gastrointestinal malignancies suffering from anorexia and weight loss were entered into this study and randomised to receive the anabolic steroid medroxyprogesterone acetate (MPA) 500 mg/day or placebo for 3 months. The primary end-points for comparison were body weight, appetite, Karnofsky performance status and quality of life, all of which were serially evaluated in monthly intervals until death. Results: A beneficial effect of MPA was noted in terms of weight as well as quality of life (measured by the functional living index for cancer). In the treatment arm, median body weight increased from 58 kg at study entry to 61 kg after 3 months, as compared to a decrease in median weight from 57.5 kg to 55 kg in the placebo arm. Partial palliative responses in quality of life were documented in 4/10 (40%) evaluable patients treated with MPA versus 2/14 (14%) in those who received placebo. There was no difference between the two treatment groups with regard to appetite (an improvement was indicated by 6 patients in each arm), Karnofsky performance score or overall survival. Conclusion: In summary, our preliminary data seem to support the potential therapeutic value of MPA for symptomatic treatment of cancer cachexia in patients with advanced gastrointestinal malignancies.

ISSN:0378-584X    

DOI:10.1159/000218784

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Background: Tumor marker determinations are helpful parameters in the control and follow-up of the clinical course of neoplastic diseases. The serum concentrations of the three tumor markers CEA, CA 15-3 and MCA have been evaluated to comparatively investigate their clinical relevance in breast cancer patients. Patients and Methods: Simultaneous determinations of the serum concentrations of the three tumor markers CEA, CA 15-3 and MCA were performed in 419 sequential breast cancer patients. CEA and MCA were determined by means of enzyme immunoassays and CA 15-3 by a radio-immunoassay. Results: The serum concentrations of all three tumor markers correlate with tumor activity and tumor mass. The receiver operating characteristics (ROC) curves show that CA 15-3 has the greatest sensitivity and specificity. All three tumor markers did not reveal any dependence on age, but on the location of metastases; the median serum values decrease in the following sequence: osseous, visceral, and soft-tissue metastases. With a combination of tumor markers, the gain in sensitivity is associated with a loss of specificity, the combination of CEA + CA 15-3 appears to be the most favorable one. The combination of all three tumor markers does not show any advantage over the double combination CEA + CA 15-3. Conclusions: CA 15-3 has the highest sensitivity and specificity. As a combination of tumor markers CA 15-3 + CEA is recommended in breast cancer patients.

ISSN:0378-584X    

DOI:10.1159/000218785

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Background: Tumor size, grading and lymph node involvement as well as the estrogen (ER) and progesterone (PR) receptors are important factors in predicting risk of recurrence and responsiveness to hormone and/or chemotherapy in breast cancer. Measurement of a number of new prognostic factors such as pS2 protein, epidermal growth factor receptor (EGFR) and cathepsin D appears to provide additional information; however, no consensus exists regarding their prognostic significance. The aim of the present study was to investigate the relationship between these parameters and established prognostic factors and their value in defining prognostic subgroups. Material and Methods: The present prospective study comprised 122 patients with untreated breast cancers. pS2 protein and cathepsin D were assayed immunoradiometrically, EGFR was measured by ELISA. Steroid hormone receptors were measured using a radioligand binding assay. Results: Relating the levels of these parameters to lymph node involvement, meno-pausal status as well as tumor size, no significant association could be established. ER and PR are significantly correlated with the expression of pS2 protein but not with cathepsin D. EGFR was shown to be inversely correlated with the content of ER and PR. At a median follow-up of 15-18 months, recurrence was more common in node-negative (without adjuvant therapy) as well as in node-positive (Tamoxifen and/or CMF) tumor patients with negative status for pS2 protein and steroid hormone receptors. Conclusions: A negative status for pS2 protein seems to be associated with an increased frequency of recurrence at early follow-up. EGFR and cathepsin D did not allow prediction of early recurrence in node-negative and node-positive patients, although we cannot exclude these parameters emerging as risk factors with longer follow-up.

ISSN:0378-584X    

DOI:10.1159/000218786

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218787

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218788

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Hintergrund: Dieser Beitrag beschäftigt sich mit der Bedeutung der zivilrechtlichen Arzthaftung für das Fach Strahlentherapie. Insbesondere sollen die zahlenmäßige Entwicklung der strahlentherapeutischen Arzthaftungsprozesse in Deutschland und Österreich dargestellt und die Gründe für eventuelle Veränderungen transparent gemacht werden. Weiters wird untersucht, welcher der beiden möglichen Haftungsgründe (Behandlungsfehler oder mangelhafte Aufklärung) den Verurteilungen zugrunde liegt und ob zwischen Haftungsrisiko und behandelten Krankheiten ein Zusammenhang besteht. Material und Methoden: Gegenstand der Untersuchung sind alle zivilgerichtlichen Arzthaftungsentscheidungen (33), die im Zeitraum zwischen 1955 und 1993 in einschlägigen rechtswissenschaftlichen Fachzeitschriften und Entscheidungssammlungen Deutschlands und Österreichs publiziert wurden und auf eine ärztliche Behandlung zurückgehen, die typischerweise von einem Strahlentherapeuten vorgenommen wird. Ergebnisse: Die Zahl der veröffentlichten Entscheidungen blieb zwischen 1960 und 1980 annähernd konstant (4 und 6 Judikate in je 10 Jahren). Im Zeitraum zwischen 1981 und 1990 stieg die Zahl der publizierten Entscheidungen auf 16 an. Mit diesem zahlenmäßigen Anstieg verringerte sich die Quote der Verurteilungen. Differenziert nach Haftungsgründen ergibt sich, daß die Zahl der Verurteilungen wegen Behandlungsfehlern seit 1961 annähernd gleich geblieben ist (je 3, 2 und 2 Fälle in 10 Jahren), während die Verurteilungen wegen mangelhafter ärztlicher Aufklärung im letzten Jahrzehnt drastisch angestiegen sind (von 2 bzw. 1 auf 8). Schlußfolgerungen: Das mit dem Anstieg der publizierten Arzthaftungsentscheidungen einhergehende Absinken der Quote der Verurteilungen läßt darauf schließen, daß der sprunghafte zahlenmäßige Anstieg primär auf vermehrt unbegründete Prozeßführung durch geschädigte Patienten zurückzuführen ist. Betrachtet man den Rechtsgrund für die ausgesprochenen Verurteilungen, so ergibt sich, daß als haftungsbegründendes ärztliches Fehlverhalten überwiegend mangelnde Aufklärung des Patienten von den Gerichten festgestellt wurde. Zusätzlich kann festge-halten werden, daß das Haftungsrisiko des behandelnden Strahlentherapeuten bei Krankheiten mit guten Heilungs- und Überlebensprognosen ungleich g

ISSN:0378-584X    

DOI:10.1159/000218789

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218790

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218791

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218792

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger