ISSN:0378-584X    

DOI:10.1159/000217338

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000217339

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000217340

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Background: There is still a matter of controversy whether a subtotal gastrectomy has the same therapeutic potential as a total gastrectomy in distal gastric cancer. Whether all or a subgroup of patients can benefit from total gastrectomy can be answered only by a randomized trial. Method: We therefore assembled a prospective randomized multi-institutional trial which has so far randomized 400 patients for total or subtotal gastrectomy and second level lymphadenectomy. Material: Patients with gastric carcinoma of the lower half of the stomach are eligible unless one of the following conditions exists: Age over 75 years, previous malignant neoplasia except skin cancer, previous gastric resection, high surgical risk, tumor located at less than six centimeters from cardia, tumors not radically resectable. Results: The accrual of patients is still in progress. The available results concern the mortality rate that is higher after total gastrectomy but not statistically different from subtotal resection.

ISSN:0378-584X    

DOI:10.1159/000217341

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Considering that the majority of patients with gastric cancer has an advanced stage of disease at diagnosis, the prognosis of gastric cancer continues to be unfavorable in spite of technical advances in early diagnosis and improved surgical management in the western world. The pattern of recurrences has shown a tendency of tumor re-growth in loco-regional structures. Intraoperative radiotherapy is considered as a method to safely deliver higher radiation doses to the tumor while minimizing the dose to the surrounding tissues. Early studies showed an increased five year survival in stage II-IV gastric cancer. The different methodical approaches for intraoperative radiotherapy with or without external beam radiotherapy used in mono- or multi-institutional studies are reviewed and balanced. The impact of these different approaches on the prognosis of this disease must be awaited.

ISSN:0378-584X    

DOI:10.1159/000217342

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Therapeutic control of gastric carcinoma is still unsatisfactory in western countries despite the progress made in surgical techniques and intensive care. Adjuvant therapy aims at improving the results obtained with surgery alone. We present a review of controlled clinical trials on adjuvant chemotherapy and chemoimmunotherapy for gastric cancer and make an appraisal in the light of our experience and of the gastrointestinal group of the EORTC. So far, no statistically significant improvement in survival has been demonstrated in controlled trials conducted in Europe and USA, nor has the efficacy of the FAM regimen in advanced gastric cancer been confirmed in an adjuvant setting. The results of adjuvant therapy appear more satisfactory in Japan than in western countries. This may be partly due to the fact that in Japanese studies chemotherapy is started intraoperatively or during the immediate postoperative period. Other factors may also be the impact of early diagnosis made through mass screening and the standardized surgery in Japan. The new therapeutic trends, using recently available chemotherapeutic compounds tested in Phase II clinical trials or by combining traditional chemotherapy with different types of immunostimulators, are discussed. Their therapeutic efficacy in the adjuvant setting can only be confirmed if large-scale Phase III trials are performed.

ISSN:0378-584X    

DOI:10.1159/000217343

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Photodynamic therapy has been applied predominantly to patients with cutaneous and bronchial malignancies for more than a decade. More recently major interest has been focused on the endoscopic application of photodynamic therapy to tumors in hollow organs. Combining the favorable properties of laser light and a tumor localizing photosensitizer provides effective tumor destruction with a minimum of risk for the patient. Photodynamic therapy in gastrointestinal and genitourinary cancer may be indicated as an alternative to conventional therapy, particularly in superficial malignancies and localized recurrent disease.

ISSN:0378-584X    

DOI:10.1159/000217344

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Ionizing radiation has been known as a carcinogen for a long time. But only about 40 years ago an epidemiological study was started with the survivors after the atomic bombing in Japan. Since then much data has been collected from this life span study (LSS) and from populations after exposures for medical indications. Cancer can be induced more or less in all tissues and organs by radiation. The radiosensitivity is different. High sensitivity is found in female breast, lung, bone marrow, stomach, colon and thyroidea. Leukemia can be observed five to ten years after exposures but other cancers occur only decades later. Infants, children and adolescents have a higher risk than adults. Measurements of risk have been possible after whole body exposures to high radiation doses (in the range > IOO mGy) and high dose rates. Risk estimates for lower doses are obtained by extrapolation under the assumptions of a linear dose response without a threshold. A dose of 10 mGy enhances the ‘spontaneous’ cancer rate by about .5%. The mentioned assumptions have to be proven by a better understanding of the mechanism of radiation-induced carcinogenesis. Around 3% of all cancers and 9% of leukemias are probably caused by exposures from natural sour

ISSN:0378-584X    

DOI:10.1159/000217345

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Despite declining incidence and improved surgical care, gastric cancer remains associated with high mortality. Incidence and survival show remarkable geographic differences. Japanese patients have a much better chance of cure than Western patients. Whether biological differences between Japanese and Western patients are responsible for this remains unclear. Japanese surgeons, however, generally use a different surgical approach. The so-called R2 resection for gastric cancer has been investigated in a number of retrospective trials and, even in the West, evidence is accumulating that a more extensive resection of lymph nodes might positively influence stage dependent survival rates. Whether this approach indeed improves treatment and not just influences staging is currently being studied in a nation-wide, prospective randomized trial in the Netherlands. The design and the first results of this trial are presented here.

ISSN:0378-584X    

DOI:10.1159/000217346

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Background: Lobaplatin (D-19466) is a platinum compound with greater anticancer activity in NSCLC, stomach, breast and ovarian cancer in the human tumor xeno-graft model. Preclinical studies suggested a low or absence of cross resistance to CDDP and CBDCA. Methods: During a clinical phase I trial a pharmacokinetic study was performed. The amount of platinum in plasma, plasma ultrafiltrate and urine samples was measured with atomic absorption spectometry (AAS) during a 48 hour sampling period. In total, 15 patients were studied receiving 17 treatment cycles. Pharmacokinetic parameters were determined by use of a software package TopFIT version 1.1. Toxicity data (reduction of platelets and leucocytes at the nadir) were correlated to either pharmacokinetic parameters as well as to kidney function parameters (ECC). In-vitro binding of D-19466 to plasma proteins was studied. Results: The c(t)-curves of total platinum were best described by a three compartment model. The mean residence time ranged from 5.1 to 37.8 hours in patients treated with 20 respectively 60 mg/m2. The volume of distribution was ranging from 0.64 up to 3.95 L/kg, the total plasma clearance was independent from dose with a mean of 172 ml/min. The area under the curve was increasing by dose from 2490 up to 10,000 μg h/L. The urinary excretion of total platinum during 48 hours was 27.8% of the total dose. The c(t)-curves of free platinum were best described by a two-compartment model. The mean residence time, volume of distribution as well as the total plasma clearance were independent from dose with mean values of MRT – 2.6 hours, Vdss = 0.44 L/kg and Clp = 202 ml/min. The area under the curve was increasing by dose from 2215 to 5200 μg h/L. The part of the free (unbound) platinum was calculated by comparison of the AUCs of c(t)-curves of free and total platinum and was 64% with a wide range (27-95%). In-vitro studies showed an increasing binding to proteins during time. Only a poor correlation was found between the estimated creatinine clearance and the drop of platelets and leucocytes at the nadir whereas a good correlation was found between the AUC of free as well as total platinum and reduction of platelets and leucocytes. Conclusion: In-vitro studies with D-19466 showed a slow binding to plasma proteins. This corresponds with the result that only 64% of the total platinum administered is free (= unbound) platinum. The terminal half-life of the ultrafilterable (free) platinum remains short in comparison to total platinum which includes the plasma bound platinum. There was no good correlation found between estimated creatine clearance and the drop of platelets and leucocytes at the nadir. There is no need to adjust the D-19466 dose to kidney function as far as patients are treated with normal values of creatin

ISSN:0378-584X    

DOI:10.1159/000217347

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger