ISSN:0378-584X    

DOI:10.1159/000218604

出版商:S. Karger GmbH    

年代:1995

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218605

出版商:S. Karger GmbH    

年代:1995

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218606

出版商:S. Karger GmbH    

年代:1995

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218607

出版商:S. Karger GmbH    

年代:1995

数据来源: Karger

摘要:

In the past decade substantial progress has been made in the treatment of adult ALL (acute lymphoblastic leukemia). With current intensive chemotherapy protocols 30-40% of patients can be cured. The further development of diagnostic facilities and retrospective analysis of outcome of patients have shown that ALL is not a homogenous disease. Diagnosis by morphological, immunological, cytogenetical, and molecular biological methods is a prerequisite for stratification in risk groups. These groups have a different clinical course and prognosis and require specific therapy approaches. Patients with T-ALL and/or mediastinal tumor with CR (complete remission) rates of 80-85% and long-term survival of 40-50% are now a facorable prognostic subgroup. Prognosis of B-ALL patients has been improved substantially by the use of specific therapy concepts. 50-60% of patients can be probably cured. The majority of ALL patients have B-precursor ALL, which can be stratified in high- and low-risk patients by the use of risk factors (time to CR, WBC, Philadelphia (Ph’) chromosome, and bcr-abl rearrangement). Therapy results in this group stagnated in the past years at CR rates of 75-85% and survival rates of about 30%. The main reason is the poor results in the subgroup of Ph’/bcr-abl-positiveALL (20-25% of adult ALL patients) that could not be improved by conventional therapy approaches. Despite an increase in CR rates to 70% long-term survival is still between 10 and 15%. Elderly ALL patients with increased therapy-related toxi-city and mortality are also at high risk of relapse or death. The adult ALL Study Group (GMALL) is currently investigating the possibilities for further improvements by the use of risk-adapted therapy regimens, intensified chemotherapy and BMT in high-risk patients. Further progress might be made by the use of biologic response modifiers, growth factors, better supportive care, and the control of minimal residual disease and multidrug resista

ISSN:0378-584X    

DOI:10.1159/000218608

出版商:S. Karger GmbH    

年代:1995

数据来源: Karger

摘要:

Pentostatin, a structural analogue of the purine adenosine, is acting as a potent inhibitor of adenosine deaminase. It has been studied in the treatment of various lymphoproliferative disorders and proved to be very effective in the treatment of hairy-cell leukemia achieving complete remissions in up to 93%, complete or partial remissions in 63 to 100% of patients. Furthermore, pentostatin has shown activity in treating chronic lymphocytic leukemia, prolymphocytic leukemia, adult T cell leuke-mia/lymphoma and especially cutaneous T cell lymphoma refractory to conventional chemotherapy. Randomized clinical studies show that in the treatment of hairy-cell leukemia pentostatin achieves a faster response, significantly higher response rates and longer duration of remissions than interferon-α. Nevertheless it remains uncertain if patients with complete remission have finally been cured. Since pentostatin does produce a substantial response in a highly practicable therapy with low toxicity it should be applied as standard first-line treatment of hairy-cell leukemia

ISSN:0378-584X    

DOI:10.1159/000218609

出版商:S. Karger GmbH    

年代:1995

数据来源: Karger

摘要:

Wilms’ tumor in adults is rare and preoperative diagnosis may be difficult. Tumor stage and histology are the main determinants of outcome. Adult patients usually present with more advanced disease and the prognosis is poorer than for children. Data concerning therapy are conflicting. A multimodal procedure regardless of the stage with radical nephrectomy, chemotheray with actinomycin D, vincristine and adriamycin, and radiotherapy to the renal bed has often been recommended. However, encouraging treatment results could also be achieved by different and less aggressive treatments depending on tumor stage. Recurrencies are common in advanced disease and usually affect the lungs. Salvage chemotherapy (cisplatin/etoposide) and pulmonary radiation has been effective in some cases. Experimental approaches such as allogenic bone marrow transplantation deserve further consideratio

ISSN:0378-584X    

DOI:10.1159/000218610

出版商:S. Karger GmbH    

年代:1995

数据来源: Karger

摘要:

Recent advances in imaging techniques (e.g. computed tomography, nuclear resonance imaging) have led to the discovery of unexpected adrenal tumors in about 2% of the patients. The incidental discovery of an adrenal tumor presents a complex diagnostic problem since the differentiation of the few endocrine active adrenal tumors (combined less than 6% of incidental adrenal tumors) and extremely rare adrenal carcinomas (less than 0.07%) from the very frequent harmless adrenal lesions requires a careful approach to avoid unnecessary diagnostic procedures and surgery. The initial investigations evaluate endocrine activity by clinical signs of sex steroid and mineralocorticoid overproduction. When neither hypertension in combination with hypokalemia nor virilization/feminization are present, costly hormone determinations can be omitted. The low-dose dexamethasone test and determination of 24-hour urinary free cortisol and catecholamines should always be performed. In case of positive screening results further confirmatory tests are needed. Usually all endocrine active tumors are surgically removed, as well as endocrine inactive masses larger than 5 cm because of suspected malignancy. Endocrine inactive tumors even smaller than 5 cm have a 60% change of being a metastasis if the patient has or has had a malignancy. Image-guided fine-needle biopsy can distinguish metastases from adrenal tissue with high sensitivity and specificity, but is not indicated when primary adrenal carcinoma is suspected, since the differentiation of benign from malignant primary adrenal tumors by cytology is of low accuracy. For tumors smaller than 5 cm exhibiting no criteria of malignancy in the initial image, observation by follow-up CT scanning after 3 and 6 months is justified. If morphological criteria of malignancy are present, functional scintigraphy with I131 norcholesterol may give further support to adrenalectomy by showing reduced tracer uptake. Surgical resection is the therapy of choice for primary adrenal carcinomas. However, at diagnosis 70% of patients present with metastases. Of these, 30% respond to high-dose mitotane therapy with partial remission. Other modalities have hardly been evaluated and so far not proven to be of higher efficacy. Five-year survival rates are between 25 and 43%.

ISSN:0378-584X    

DOI:10.1159/000218611

出版商:S. Karger GmbH    

年代:1995

数据来源: Karger

摘要:

Worldwide, hepatocellular carcinoma (HCC) is responsible for at least 1 million deaths a year. It is almost always associated with chronic underlying liver disease, specifically hepatitis B, C, and in the western industrial nations with alcohol-induced cirrhosis. The definition of these and other less common risk factors presents both an opportunity and a difficulty: the opportunity to prevent and/or screen a high-risk population for the development of HCC, but the difficulty of treating patients with chronic liver dysfunction. The only potential curative therapy is surgery, though it is curative in only a small percentage. Surgical innovations such as cryosurgery and percutaneous alcohol injection have not yet been shown to offer any advantage, and liver transplantation, while curative in some patients, requires an enormous expenditure of resources to achieve cure in few patients. There are numerous palliative treatment options in patients with more advanced disease, however, differences in patient selection and the lack of randomized studies make their impact on median survival difficult to assess. Conventional chemotherapy is clearly ineffective in HCC. Modifications of chemotherapy, including intraarterial infusion and chemoembolization, tamoxifen, other hormonal agents, interferon, as well as radioimmunotherapy, and conformal radiotherapy have not been shown to offer any therapeutic benefit until today. Patients being treated for HCC should thus be enrolled on treatment protocols evaluating multimodality or new strategies.

ISSN:0378-584X    

DOI:10.1159/000218612

出版商:S. Karger GmbH    

年代:1995

数据来源: Karger

摘要:

Carcinoembryonic antigen (CEA) serum level determinations play an important role in monitoring therapy and follow-up of colorectal carcinoma. However, the impact of CEA values in the adjuvant situation after surgery for colorectal carcinoma is not yet generally accepted. This review summarizes evidence for 1. CEA as a pretherapeutic indicator for patients’ prognosis, 2. CEA as an indicator of tumor-biological behavior, 3. CEA as a posttherapeutic indicator of residual tumor following surgery, and 4. CEA as a parameter for disease-free survival after adjuvant treatment. From this we conclude that CEA values should be used to identify high-risk patients preoperatively, to stratify patients to adjuvant therapy protocols postoperatively and that CEA determinations might possibly serve as parameter to evaluate adjuvant therap

ISSN:0378-584X    

DOI:10.1159/000218613

出版商:S. Karger GmbH    

年代:1995

数据来源: Karger