ISSN:0378-584X    

DOI:10.1159/000217385

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000217386

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Endocrine tumors of the gastrointestinal tract are relatively rare. They threaten the patient’s life both by their malignant growth and by their hormone production. Surgical strategies for these tumors follow three principles: (1) tumor-directed operations, (2) symptom-directed operations, and (3) repeated operations in recurrent disease. Debulking procedures and repeated operations make sense in order to alleviate the hormonal symptoms and find their further rationale in the slow-growing nature of most of these tumors. Operations on the hormonal target organs are no longer state of the art since improved medical regimens are available for symptom relie

ISSN:0378-584X    

DOI:10.1159/000217387

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

With the availability of all-trans retinoic acid (ATRA), acute promyelocytic leukemia (APL), a subtype of acute myelogenous leukemia (AML), has gained a new and exemplary importance. So far, therapeutic strategies in oncology have been directed against the increased proliferative activity of the neoplastic cell clone. Treatment of APL with ATRA is a good example for successful ‘tumor differentiating therapy’. Under the influence of ATRA, immature leukemic cells differentiate into more mature leukemic cells which lack mitotic activities. Due to the physiological death of these maturing leukocytes, indirect reduction of tumor cell burden is achieved, and the majority of APL patients enter complete remission. It is of particular interest that bone marrow aplasia which is the main side effect of conventional chemotherapy can be avoided. Nevertheless, treatment of APL with ATRA is not devoid of clinical problems. Treatment with ATRA leads to a ‘washout’ of maturing promyelocytic blast cells which may cause hyperleukocytosis. Particularly during the early phases of treatment, this may contribute to the occurrence of severe thromboembolic events. Thus, the clinical picture of APL may change from hemorrhagic complications to leukostasis and thromboembolism. Evaluation of risk factors for the development of hyperleukocytosis is of critical importance for the patient. In order to avoid life-threatening complications, an effective prophylaxis of thromboembolism and in some cases additional chemotherapy may be ne

ISSN:0378-584X    

DOI:10.1159/000217388

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Background: In 1982, a favorable response rate of 63 % in patients with advanced gastric carcinoma treated by sequential high-dose methotrexate and 5-fluorouracil combined with adriamycin (FAMTX) was reported. In order to confirm these data, a prospective randomized comparison with a standard regimen seemed to be necessary.Materials and Methods: 213 patients with advanced measurable or nonmeasurable gastric cancer were randomized for administration of methotrexate (1,500 mg/m2), followed after 1 h by 5-fluorouracil (1,500 mg/m2) on day 1. Leucovorin rescue was started after 24 h (15 mg/m2, orally, every 6 h for 48 h), and adriamycin (30 mg/m2) was given on day 15. The FAM regimen consisted of 5-fluorouracil (600 mg/m2, on days 1, 8, 29 and 36), of adriamycin (30 mg/m2, on days 1 and 29) and of mitomycin C (10 mg/m2, on day 1). The cycles were repeated every 4 and 8 weeks, respectively. Results: The results show a significantly superior response rate, 41 versus 9 % (p < 0.0001), and survival, median 44 weeks versus 29 weeks (p = 0.002) for FAMTX. There was a cumulative thrombocytopenia seen in FAM, but not in FAMTX. Conclusion: The FAMTX protocol should be the reference treatment in future clinical trials which seek to improve the therapeutic outcome in advanced gastric cancer.

ISSN:0378-584X    

DOI:10.1159/000217389

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Background: 3-OH-Tamoxifen (Droloxifene) has become of clinical interest because of its in vitro effect against hormone-dependent tumor growth, its higher affinity to the estrogen receptor and its favorable pharmacokinetic properties as compared with Tamoxifen. Material and Methods: 24 patients with progressive metastatic breast cancer following at least one endocrine therapy including prior Tamoxifen application were treated in a phase II study with 100 mg Droloxifene per os once daily. Results: The drug was very well tolerated; the only clinically relevant side effect was mild nausea, occurring in 6 patients (26%). 21 patients were eligible for response. One patient showed (4.8%) a partial remission for 329 days, and 8 patients (38.1%) achieved stable disease for a median time of 192 (100-404) days. These objective response rates, though limited mostly to stable disease, appeared to be clinically useful, since remission occurred in 5 of 9 patients who were considered to be resistant to any conventional endocrine treatment options. Conclusions: Further comparative trials with Tamoxifen are needed to decide at which step in the sequence of endocrine treatment of disseminated breast cancer Droloxifene will be most preferable for the patients. Based on our results, Droloxifene should be tried even in patients who have become resistant to prior endocrine treatments.

ISSN:0378-584X    

DOI:10.1159/000217390

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Background: Ether lipids could provide new prospects in cancer therapy after successful preclinical investigations. Edelfosine has been the most thoroughly investigated substance in the ether lipid group. So far, no standard therapy has been set up for advanced non-small-cell bronchogenic carcinoma. Therefore, in a phase II study 116 patients with advanced inoperable non-small-cell bronchogenic carcinoma were treated with the alkyl-lysophospholipid edelfosine (EF). Material and Methods: The phenotype modifier EF was initially applied in a daily oral dosage of 300 mg (dissolved in milk) over a period of 4 weeks, then increased to a daily dosage of 900 mg if tolerated well, and continued with the highest tolerable dosage. Therapy was continued until either tumor progression or negative side effects were documented. 35 patients could not be treated for the intended therapy period of at least 8 weeks due to early tumor progression (18 patients), unacceptable gastrointestinal side effects (14 patients), lack of compliance (1 patient), refusal of therapy (1 patient) and change of therapy (1 patient). Results: 81 patients could be evaluated for remission status; of these, 2 showed partial remission, 68 showed ‘no change’, and 11 had unaltered progression of the tumor. Median survival time for these 81 patients was 244 days, for all 116 patients it was 199 days. Retrospectively, in these 81 patients the spontaneous tumor development during the 2 months before EF therapy could be analyzed. Tumor progression during this period could be documented in 1 patient with partial remission, in 46 patients with diagnosis ‘no change’, and in 11 patients with unaltered tumor progression. The survival times of these three groups of patients did not differ significantly. All 116 patients were evaluable for toxicity. Manifestations of gastrointestinal problems were anorexia, nausea, vomiting, diarrhea, obstipation (mostly WHO grades I+Π), but treatment was not required. Toxic effects on organs or late toxicity could not be documented.Conclusions: The high proportion of patients with stationary tumor status was remarkable. Objective tumor remission was extremely rare. On the other hand, the rate of progression was low. This might be explained by the fact that EF is rather a phenotype modifier than a typical cytosta

ISSN:0378-584X    

DOI:10.1159/000217391

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Background: In order to obtain more information on the influence of chemotherapy on erythropoietin (EPO) regulation, the change of serum levels in correlation with the respective hemoglobin value was studied. Material and Methods: Six male patients (age 22-45 years) with testicular cancer were followed over a total of 21 cycles of chemotherapy according to the PEB regimen (Cisplatin 100 mg/m2, Etoposide 500 mg/m2, Bleomycin 60 mg/m2, total intravenous dose administered over 8 days, every 4 weeks). The EPO concentration was measured by radioimmunoassay. Sera from patients with acute blood loss or from healthy individuals served as controls. No impairment of renal or hepatic function was observed during or after PEB chemotherapy. Results: Prior to chemotherapy, EPO levels proved to be adequate when compared with the controls, ranging between 35 and 65 U/l at hemoglobin (Hb) levels above 12 g/dl. In the majority of cases chemotherapy was followed by merely mild anemia (Hb > 10 g/dl). Nevertheless, a 3.4-fold increase in EPO levels was observed during chemotherapy (35-354 U/l EPO, median 150 U/l). EPO levels were highest 6-8 days after the beginning of intravenous chemotherapy and then steadily declined, in most cases to even normal values prior to the next chemotherapy cycle. The elevation of EPO was significantly higher than that found in controls with a similar reduction of Hb levels due to acute blood loss. Conclusion: Chemotherapeutic agents or their combination are able to induce elevated EPO levels due to mechanisms unrelated to the anemia induced.

ISSN:0378-584X    

DOI:10.1159/000217392

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Background: When therapy refusal or contraindication against radical prostatectomy exists, alternatives for the treatment of localized prostatic carcinoma should be considered. In this case, an extensive transurethral resection of the prostate should be performed in order to reduce the tumor mass. This is to be followed by ND:YAG laser coagulation and anti-androgenic therapy. Due to this treatment showing a penetration of 3-4 mm depth the remaining carcinoma cells in the prostate capsule will be destroyed. Patients: From 11/87 to 12/91 follow-up therapy was applied to 13 patients (10/T1, 2/T2,1/T3). Results: One patient died of a local progression, another one without any identifiable advancing tumor growth. The remaining 11 patients are symptom-free. Conclusion: Laser coagulation of the removed prostate is a possible alternative treatment of the localized prostatic carcinoma if therapeutical access is impeded either by therapy refusal or by manifest contraindications.

ISSN:0378-584X    

DOI:10.1159/000217393

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger

摘要:

Background: Bone marrow involvement (BMI) appears to be a rare event in patients (PTS) with germ cell tumors (GCT). Results: Three PTS with GCT and metastatic BMI have been observed. Two PTS were classified as clinical stage (CS) I at initial diagnosis, one PT had advanced disease, constituting a prognostically bad group. All three PTS had LDH levels above 1,000 U/l at detection of BMI. Two of 3 PTS showed severe thrombocyto-penia ( < 20,000/μl) at the time of BMI diagnosis. The increase of the specific tumor markers AFP or ß-HCG was only marginal prior to the detection of BMI. Two PTS reached a complete remission after treatment with aggressive cisplatinum-based chemotherapy (CTX), but ultimately relapsed in the bone marrow and died of progressive disease. One PT died due to thrombocytopenia and hyperfibrinolysis during the primary episode of BMI. Conclusion: The incidence of metastatic BMI in PTS with advanced GCT according to results of different treatment centers was 4 in 329 (1.2%). Clinically, bone marrow biopsies should be considered in PTS with prolonged thrombocytopenia after chemotherapy, especially in cases of elevated LDH level

ISSN:0378-584X    

DOI:10.1159/000217394

出版商:S. Karger GmbH    

年代:1992

数据来源: Karger