ISSN:0378-584X    

DOI:10.1159/000218815

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218816

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Resections in benign and malign lung diseases have to be carried out sparing parenchyma maximally, in order to preserve the patient’s respiratory functional reserves as much as possible. In malignancies, complete surgical remission, however, must be guaranteed in the first place. Remarkedly, local recurrence of bronchial carcinoma occurs in 19% of cases after segmental resections, both anatomic and atypical, versus 4% after lobectomy in stage I, the 30-day lethality being 1% versus 5%. Where pneumonectomy can be avoided, bronchial sleeve resections are typically required. They are classically indicated on tumor involvement of the origin of the upper lobe bronchus, both with and without lymph node metastasis (stages II–IIIA at the right, I–II at the left). In 30% of the cases, bronchial sleeve resections are performed in combination with segmental resection of the associated pulmonary artery. There is a wide variety of standardized techniques both at the bronchi and the vessels. 5-Year survival rates after sleeve resections are 52% in stage I, 42% in stage II, 18% in stage IIIA, which corresponds with the survival rates after standard surgery. 30-day lethality is 7.6% after all sleeve procedures. The typical early complications resulting from bronchial insufficiency occur in 9.4% of cases, which might be reduced by the use of modern absorbable monofilament. Vascular complications, on the other hand, are very rare. Cicatricial stenoses occur as late complications. In the surgery of pulmonary metastases from various primaries, atypical segmental or wedge resections are the procedures used most frequently (69%). For parenchyma-sparing resections of metastatic lesions, too, sleeve resections both at the bronchial and the vascular tree are carried out, with the same techniques, variations and early/late complications as in bronchial carcinoma. The frequently used median approach is not adequate for bronchoplasty procedures on the left

ISSN:0378-584X    

DOI:10.1159/000218817

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Muscle invasive, but still locally confined bladder cancer is treated by radical cystectomy in most of the patients. New forms of bladder substitution and operative techniques provide good quality of life; however, any kind of bladder substitution is suboptimal to a well-functioning and disease-free bladder. Bladder preservation in muscle invasive cancer is only possible in a selected group of patients by transurethral resection, partial cystectomy or definitive radiotherapy. The introduction of effective systemic chemotherapy made integrated therapy strategies attractive. The results in terms of complete remission are significantly improved over monotherapeutic approaches, but recurrent tumors within the bladder still occur in a similar percentage. This fact indicates that only appropriate selection of patients with a low risk of recurrence, and additional local adjuvant therapy may lead organ-preserving therapy modalities to the point where it is a true alternative to radical cystectomy.

ISSN:0378-584X    

DOI:10.1159/000218818

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Maximal androgen blockade (MAB) using leuprorelin or goserelin plus flutamide provides a significant survival advantage in patients with D2 prostate cancer. It is noteworthy that in a nonconcurrent comparison leuprorelin plus flutamide was more effective than leuprorelin plus nilutamide. The benefits of leuprorelin plus flutamide outweigh the side effects and costs of patients with bone metastases limited to the axial skeleton have a significantly prolonged time to progression and survival. Novel indications of MAB are neoadjuvant and adjuvant therapies. However, a final benefit assessment is not possible at the present time. The side effects of MAB can be minimized when given intermittently. Studies to test its effectiveness have been initiated.

ISSN:0378-584X    

DOI:10.1159/000218819

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Until recently, 5-Fluorouracil (5-FU) monochemotherapy had to be considered the standard in advanced pancreatic carcinoma although neither remission rates nor increases in median survival time have been convincing. Various efforts have been taken to improve the efficacy of 5-FU Polychemotherapeutic regimens with 5-FU as well as biomodulation of 5-FU could not ameliorate the results. In recent years, new drugs like the taxanes. topoisomerase inhibitors, and gemcitabine focused attention in chemo-therapeutic regimens. However, in a purely palliative situation as it is the case for pancreatic carcinoma a shift between drug toxicity and therapeutic symptom relief to the latter side is warranted. This gave way to the development of a new measure for therapy efficacy which aims at analyzing the patients’ well-being. This so-called ‘clinical benefit response’ (CBR) comprises quality of life parameters as pain intensity and analgesic consumption, Karnofsky’s performance index and weight changes. In a pro-spectively randomised study, gemcitabine showed a significantly better CBR than 5-FU and a good response rate, too. However, further trials are necessary to confirm these results. A definite statement of the relative roles of either chemotherapy or radiation in combined modality regimens cannot be given as yet. There are no convincing data that the combination of these two strategies will result in any additive or synergistic profit for the patient concerning symptom relief or even survival time. On the other hand, hormonal therapy modalities as for instance tamoxifen and/or somatostatin may be useful tools with the advantage of only minor toxicity. Nevertheless, even as new drugs have entered the treatment of pancreatic carcinoma, survival figures have not very much improved. Palliation strategies should be stressed further in clinical trials especially since the advent of CBR as a new ob

ISSN:0378-584X    

DOI:10.1159/000218820

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Amifostine (WR-2721, Ethyol), a phosphorylated aminothiol, was originally developed as a radioprotective agent. Since numerous preclinical studies showed that, following dephos-phorylation to the active thiol WR-1065, amifostine selectively protected normal tissues from the damaging effects of irradiation and of several cytotoxic agents without reducing the anti-tumor activity, an intensive clinical development in chemo- and radiotherapy studies was performed. In clinical trials, amifostine proved to be an effective cytoprotector in patients receiving treatment with antineoplastic agents or irradiation. It significantly reduced the incidence and severity of acute, cumulative and delayed toxicities associated with antineoplastic therapy, allowing better patient tolerance of current regimens and possible dose escalation. This protection is achieved without any reduction in the antitumor efficacy. Thus, the integration of amifostine into oncological regimens represents a new ‘preventive’ strategy for a more tolerable and selective ther

ISSN:0378-584X    

DOI:10.1159/000218821

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

The population kinetics of cells within tumors determine both the rates of growth of tumors and their responses to therapy. Of the kinetic parameters that can be measured at present, pre-treatment potential doubling time (Tpot) is thought to be of the greatest value in predicting treatment outcome. Tpot, defined as the time required for a proliferating population to double in number in the absence of spontaneous cell loss, may be measured using flow cytometric techniques following in vivo per-fusion of halogenated pyrimidine analogues of thymidine such as bromodeoxyuridine (BrdUrd). Short Tpot values may identify patients who would be expected to benefit from acceler-ated-fractionation radiotherapy regimens. This paper reviews the literature to date on Tpot. It shows large variations in values even for tumors of similar histologies, indicating a rapid proliferation rate in some tumors. Technical problems in data production are described and ongoing studies discussed.

ISSN:0378-584X    

DOI:10.1159/000218822

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Background: Laboplatin, D-19466, 1,2-diaminomethylcyclobutaneplatinum(II) lactate, is a novel, water-soluble platinum complex which showed a better therapeutic index than Cisplatin or Carboplatin in murine and human tumor models. In a preceding Phase I study myelosuppression with predominant thrombocytopenia was the dose-limiting toxicity. Besides nausea and vomiting no further side effects were observed. Patients and Methods: The phase II study group of the AIO performed a phase II study in pretreated patients with advanced small-cell lung cancer (SCLC). 19 patients received Lobaplatin without hydration from which 18 were evaluable for toxicity and 17 for antitumor activity. The dose of 40 mg/m2 was given by intravenous bolus injection repeated every 4 weeks. Results: No objective complete or partial remissions were observed. 2 Patients showed a short-lasting no change. Thrombocytopenia was the dose-limiting toxicity: 11/18 (61%) patients presented WHO grades 1-4 and 5 WHO grades 3-4 (28%). The nadir occurred after 2 weeks with recovery within a week. Anemia WHO grades 1-3 were seen in 11 patients (61%), leukopenia grades 1-3 in 10 patients (56%). The nadir of leukopenia occurred after 3 weeks. Nausea and vomiting occurred in two thirds of the patients; however, were well controlled by antiemetics. No renal, CNS or ototoxi-city was observed. Conclusions: In patients heavily pretreated with chemotherapy, Lobaplatin did not show therapeutic activity at the dose of 40 mg/m2, although 33% of the patients experienced a grade 3 or 4 thrombocytopenia as the dose-limiting toxicity. Secondary resistance to chemotherapy and compromised bone marrow reserve due to intensive prior treatment may have contributed to this study outcome since Lobaplatin was clearly active in SCLC patients with no or one prior chemotherapy only, allowing administration of Lobaplatin at a dose of 50 mg/m2 and a repeat interval of 3 weeks.

ISSN:0378-584X    

DOI:10.1159/000218823

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

We studied the effect of fotemustine (FM) on the expression of several melanoma-associated antigens (MAA) and HLA antigens defined by a panel of seven monoclonal antibodies (mabs). We also looked for the effect of the culture conditions on the antigen expression. We used eight established melanoma cell lines, grown as monolayers in (a) modified Leibowitz L15 medium for 0, 48, 96 h; (b) with 12.8 μg/ml fotemustine for 48 h; (c) with 12.8 μg/ml fotemustine for 48 h followed by incubation with modified Leibowitz L15 medium for another 48 h. Incubation of melanoma cell lines for 48 or 96 h in growth medium (a) resulted in a modest upregulation of the trans-ferrin receptor (TFR), the very late antigen 2 (VLA-2), and the intercellular adhesion molecule 1 (ICAM-1) in the majority of our cell lines. Following the addition of FM (b) no relevant change in the antigen expression was observed during continuous incubation for 48 h. However, an additional incubation of the FM-treated melanoma cells for another 48 h in FM-free medium (c) showed a striking upregulation of TFR, VLA-2 andICAM-1. Furthermore, the nuclear proliferation-associated antigen detected by Ki67 was upregulated markedly only in the presence of at least 80% HLA-DR-positive cell

ISSN:0378-584X    

DOI:10.1159/000218824

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger