摘要:

The influence of systemic chemotherapy on advanced bladder carcinoma is limited. Apparently patients do not benefit from cytostatic treatment prior to surgical removal of the bladder (neoadjuvant chemotherapy). Combination chemotherapy subsequent to radical cystectomy is currently being investigated in several clinical trials, at present, however, adjuvant chemotherapy cannot be regarded as standard treatment. In metastatic disease responses following application of cisplatin and methotrexate were observed in approximately 50% of the patients without significantly influencing cure. Regarding the progress in surgical techniques including continent urinary diversion, improvement of chemotherapy through basic research and development of new cytotoxic agents and novel combination regimens is mandatory.

ISSN:0378-584X    

DOI:10.1159/000218755

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218884

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Wilms’ tumour (nephroblastoma) ist the most common malignant kidney tumour in childhood with an incidence of 0.8/100,000 children below the age of 15 years. Boys and girls are affected with equal frequency. Peak incidence is between the 2nd and 4th year of life. This tumour is frequently accompanied by certain malformations. Familial cases occur in about 1% of all cases. A bilateral nephroblastoma is found in 5% of the patients. The pre-operative diagnosis of Wilms’ tumour is based on imaging studies and confirmed by histology. Treatment should be performed according to prospective multicentre studies, like the SIOP studies in Europe or the NWTS studies in North America. The SIOP favours a pre-operative chemo-therapeutic approach, whereas the NWTS starts treatment with primary surgery of the tumour. Post-operative treatment depends always on stage and histological subtype of the tumour. The most important drugs are vincristine and actinomycin D. Adriamycin is restricted to patients with higher stages or those with unfavourable histology. Second-line drugs are carbopla-tinum, VP 16 and cyclophosphamide or ifosfamide. Radiotherapy is only necessary in patients with stage II disease and lymph node involvement or higher stages, or in patients with unfavourable histology with the exception of stage I. Prognosis depends mainly on stage and histology. Today more than 85 % of all children with Wilms’ tumour can be cured. Patients with stage I disease and favourable histology have a more than 90% chance of cure. Treatment of children with unfavourable histology is still not satisfying. Because of the high cure rates attention must be drawn to possible late effects of trea

ISSN:0378-584X    

DOI:10.1159/000218756

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Essential thrombocythemia typically occurs in age groups over 50 years. It is characterized by clonal myeloproliferation with prominent megakaryocytosis. The leading sign is a chronic elevation of abnormal platelets with disturbed function. Diagnosis of essential thrombocythemia is confirmed by the exclusion of other myeloproliferative disorders with a thrombocythemic component and of reactive thrombocytosis. Typical complications are caused by a combined predisposition to thromboembolic complications and hemorrhage. The treatment options fall into two broad categories: antiplatelet agents and platelet-lowering drugs. To date, only subgroups of patients are shown to benefit from these treatment modalities. Survival prognosis is considered close to normal in most patients.

ISSN:0378-584X    

DOI:10.1159/000218757

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Kaposi’s sarcoma (KS) was first described 100 years ago. This tumor of endothelial origin starts in the skin or mucous membranes. The classical form is rare, affects elderly persons of Mediterannean origin and is generally indolent. The African variant develops in children and young men, showing an aggressive and usually fatal course. The third variant of KS affects immunodeficient patients, particularly renal transplant recipients and HIV-infected persons. The epidemic Kaposi’s sarcoma (EKS) is the most common tumor of HIV-infected patients with an incidence of up to 50%. The cause of EKS still remains to be determined. The clinical progression of the disease is closely related to the immunologic defect. This tumor generally appears with multiple skin, oral lesions and/or lymph node involvement. Progressive EKS may infiltrate lungs and the gastrointestinal tract. Treatment of EKS must take into account the extent of the tumor and debilitating symptoms or tumor-associated severe to life-threatening complications. Therapeutic approaches include local treatment with radiotherapy, intralesional injections of dilute chemotherapy, topical application of liquid nitrogen, laser treatment or systemic therapy with interferon or cytostatic agents. The choice of therapy should be based on the specific needs of the individual patient. EKS-associated clinical symptoms, immunological status and other HlV-in-duced diseases, particularly opportunistic infections, influence the therapeutic decis

ISSN:0378-584X    

DOI:10.1159/000218758

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Background: Operative decompression, usually anteriorly, and stabilization are appropriate for patients with spinal metas-tases and intractable pain due to mechanical causes, spinal instability, or neurological impairment. Material and Methods: Sixty-four patients with spinal metastatic disease, treated surgically between 1972 and 1991 at the Department for Orthopedics, University Clinics Innsbruck, were reviewed. 35 cases of surgical stabilization were performed by an anterior, 21 by a posterior approach, and 8 by a combination of both. The most common primary tumors were cancers of the breast, kidney and thyroid gland. Results: Postoperatively, pain was significantly relieved in 59 patients (95%) and neurological deficits could be improved in 17 patients (39%). The median survival time of all patients with metastatic diseases was 3.5 months, of those with cancer of the thyroid gland or cancer of the breast 36.9 or 12.4 months, respectively. Survival time correlated to type of primary tumor, single or multiple involvement of bone, and presence of metastasis other than bone. One case of pulmonary thrombembolism and one case of cardiorespiratory failure due to myocardial infarction amounted to a total of two lethal perioperative events. Conclusions: Operative treatment of spinal metastases in appropriately selected patients leads to significant postoperative pain relief and restoration of impaired neurologic function. Mobility may be restored and a considerable alleviation in caring achieved. Surgery may increase the quality but not the duration of remaining life.

ISSN:0378-584X    

DOI:10.1159/000218759

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Background: Adjuvant chemo- and radiotherapy for colorectal carcinoma has been established during recent years. Currently treatment with 5-fluorouracil (5-FU) and levamisole (LEV) is recommended as standard treatment for Dukes C colon cancer; for rectal cancer (Dukes B2-C) radiation and 5-FU single-agent chemotherapy is considered treatment of choice. Progress for therapy is expected by the introduction of folinic acid (FA) and 5-FU as chemotherapy. However, there has been concern about increased toxicity; therefore the object of this report is to present toxicity data from two ongoing adjuvant treatment trials on colorectal cancer. Method: In the study for colon cancer (Dukes C), 3 treatment groups were compared: arm A (5-FU/LEV, weekly, 12 months), arm B (5-FU/FA, days 1-5, every 4 weeks, 12 cycles) and arm C (like B, 6 cycles). In the rectal cancer study (Dukes B2-C) arm A (5-FU/FA, days 1-5, every 4 weeks, 12 cycles) and arm B (like A, 6 cycles) were compared. During the second cycle radiation up to 50.4 Gy was performed and chemotherapy was applied weekly. Results: From 1993 until December, 1994 a total of 146 patients were recruited in both studies. Data from 92 completely documented patients, who received adjuvant treatment either with 5-FU + FA (n = 76) or 5-FU + LEV (n = 16), could be analysed for toxicity patterns. In the group with 5-FU + LEV one case with WHO grade-IV toxicity (hae-matological, gastrointestinal) and 6 events with grade-III toxicity occurred (CNS, alopecia, fever). In the 5-FU + FA group 15 events with grade-III toxicity were found, most of these gastrointestinal, and one case of cardio-toxicity. All patients recovered, and treatment-related death was not seen. Conclusion: For the majority of patients therapy was tolerable. Preliminary data of our two adjuvant trials in colon and rectum carcinoma using chemotherapy or radio-chemotherapy suggest that treatment with 5-FU + LEV and 5-FU + FA is safe but has to be performed under adequate control and dose adjustment.

ISSN:0378-584X    

DOI:10.1159/000218760

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Background: Unconventional therapy has become increasingly popular in cancer patients. Apart from some factors such as age and education there is little known about patients’ conviction and motivation. Patients and Methods: 206 patients having attended the oncologic after-care out-patient department were asked to complete a questionnaire and return it anonymously by mail. Patients’ self-concept and body image were assessed with the help of the ‘Frankfurter Selbstkonzept-skalen’ (FSKN) and ‘Frankfurter Körperkonzeptskalen’ (FKKS), respectively, by Deusinger (1986). Motivation and conviction were assessed with further questions known from the literature. Results: No statistically significant differences with respect to body image and self-concept have been found, although a trend was observed indicating that users have a higher ability to solve problems and to cope with difficulties. Further investigations revealed that users have a different attitude to conventional therapy and generally wish to play a more active part. Conclusion: Open-minded counselling of patients about unconventional therapy considering patients’ needs is necessary to avoid that patients will reject possibly curative or good palliative conventional therapy in cases

ISSN:0378-584X    

DOI:10.1159/000218761

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218762

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218763

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger