ISSN:0378-584X    

DOI:10.1159/000218836

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218837

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Breast cancer has the well-known propensity to metastasize to almost any organ, giving rise to an almost unlimited variability of clinical syndromes. Ophthalmic metastases may become a part of such a pattern. Orbital and ocular metastases are not a rare event within the clinical evolution of a breast cancer, accounting for about 2-10%. Their diagnosis is usually simple and involves only clinical and noninvasive methods. Radiotherapy is the treatment of choice in most of these situations and should obviate the need for exenteration. Radiotherapy is always rewarding, enhances the comfort of the patient by preventing further loss of vision and even promotes his recuperation. Radiotherapy plays an important role in the relief of the symptoms and for the patient’s well-being. Local curability is high, but probably has no influence on the course of the metastatic diseas

ISSN:0378-584X    

DOI:10.1159/000218838

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Improved understanding of the biological features and advances in diagnostic and surgical procedures have been the basis for increased applications of sphincter-preserving operations in lower rectal tumors. The relevant treatment strategies along with their indications will be presented and analyzed. New operative procedures comprise transanal excision of early rectal cancer or trans-sphincteric resection or ultralow anterior resection with colon-pouch creation to improve continence. Recently, for cases in which the removal of the rectal sphincter is indispensible for oncological reasons, a continent perineal colostomy has been developed. Reconstruction of the sphincter function is achieved using a seromuscular cuff. This procedure avoids an abdominal colostomy. The neosphincter can also be formed secondarily, after a prior abdominoperineal excision with a transabdominal colostomy.

ISSN:0378-584X    

DOI:10.1159/000218839

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Head and neck cancer represents 3.6 to 5% of all malignancies in the United States. However, the potential functional, cosmetic and psychological repercussions, resulting from treatment of this disease significantly impacts the patient’s quality of life. A coordinated multidisciplinary team approach for the treatment and follow-up of head and neck cancer patients is crucial for optimal patient management. Standard therapy of early (stage I or II) head and neck cancers consists of radiation alone or surgical resection. Five-year survival statistic for these patients range from 60 to 95%. For advanced cancers (stage III or IV), standard therapy is comprised of surgery plus radiation therapy. The surgical defects are often difficult to rehabilitate. The 5-year survival statistics range from 10 to 60%, depending on the site, but are usually less than 30%. In an effort to improve survival and reduce the need for extensive surgical resections, researchers have utilized induction chemotherapy in several randomized trials for patients with advanced head and neck cancer. Although not been shown to improve survival, induction chemotherapy has played a role in organ preservation as a part of combined modality program for patients with advanced disease. Conservation surgical techniques involve mandible-sparing procedures, laryngeal preservation surgeries and selective or ‘functional’ neck dissections. Free-tissue transfer using microvascular techniques has dramatically increased the surgeon’s reconstructive armamentarium. Patients are experiencing more functional and cosmetic outcomes despite extensive cancer resections. Finally, concomitant chemoradiotherapy has emerged as one of the most promising treatment approaches for patients with advanced stage head and neck cancer. Studies show trends toward improved survival with preservation of organ and function in patients with this devastating

ISSN:0378-584X    

DOI:10.1159/000218840

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Clinical phase I studies in Hematology and Oncology are characterized by specific ethical and methodological considerations. Among these, the determination of a safe starting dose, the definition of dose escalation schemes and the strategies of cohort size expansion per dose level and toxicities observed are of crucial importance. This review will focus on the continual reassessment method, a novel Bayesian-based approach to the conceptual design of clinical phase I studies in Hematology and Oncology. The original method as described by O’Quigley et al. [Biometrics 1990;46:33-48] will be reviewed as well as modifications which are intended to increase patient safety. Finally, clinical applications of the modified Continual Reassessment Method will be discusse

ISSN:0378-584X    

DOI:10.1159/000218841

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Background: Weekly high-dose 5-fluorouracil (5-FU; 24-hour infusion of 2.6 g/m2) and folinic acid (FA; 500 mg/m2as 1- or 2-hour infusion) proved to be effective in patients with metastatic colorectal cancer. The minimum effective dosages of the drugs required in this schedule, however, remain unclear. The aim of this phase II study was to assess, whether a reduction of the dose of 5-FU (2.0 g/m2) combined with an intermediate-dose of FA (200 mg/m2) is still active in this patient population. Material and Methods: From January 1991 to December 1995 a total of 69 patients with metastatic colorectal cancer, 44 untreated and 25 pretreated patients, were treated with 3 courses of 6 weekly infusions of an intermediate-dose 5-FU (2.0 g/m2/24 h) and FA (200 mg/m2 as a bolus). In 12 untreated patients, 5-FU pharmacokinetics were studied by high-performance liquid chromato-graphy (HPLC). Results: 3/44 untreated patients (7%) achieved a complete response, 13/44 (30%) a partial response, 20/44 (45%) a stable disease and in 8/44 patients (18%) the disease was progressive. The probability of median survival in the untreated group was 20 months. Response rates in the pretreated group were inferior with no partial remissions but stable diseases in about 50% of the patients. Sumarizing more than 1000 treatment days, toxicity consisted mainly of mild nausea (n = 24 patients), diarrhea (n = 7) and hand-foot syndrome (n = 10). These side effects were well manageable on an outpatient basis. The mean 5-FU serum steady state level of 0.58 µg/ml (± 0.26) was relatively low compared to the values noted by other authors; individual levels did not correlate with the experienced grades of toxicity in these patients assessed by WHO-defined criteria. Conclusion: Weekly 24-hour infusion of an intermediate-dose 5-FU preceeded by an intermediate-dose FA-bolus is an active regimen with possibly reduced side effects and costs of therapy when compared to the treatment schedule introduced by Ardala

ISSN:0378-584X    

DOI:10.1159/000218842

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Background: Based on promising data with weekly high-dose (HD) continuous 5-fluorouracil (5-FU) and folinic acid (FA) in patients with gastric carcinoma (GC) refractory to 5-FU bolus application, we investigated a weekly combination of HD-5-FU/FA with cisplatin (C) and epirubicin (E) as first-line treatment in patients with advanced GC. Methods: 27 patients with locally advanced or metastatic GC were treated with up to three 6-week courses of FUFACE (5-FU, FA, CE). Chemotherapy was planned preoperatively in localized tumors. Results: Toxicity was usually moderate, but response-independent weight loss and lethargy caused protocol deviations in 30% of the patients. Response rates were 50% and 91% in metastatic and locally advanced tumors, respectively. All patients with localized disease had complete tumor resection at subsequent surgery. Median survival was 20+ months in this patient group. Conclusions: This weekly chemotherapy regimen seems to be very effective in advanced GC. The high response rate and resection rate in locally advanced tumors favours this regimen particularly in the preoperative setting.

ISSN:0378-584X    

DOI:10.1159/000218843

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Background: After conventionally fractionated radical radiotherapy for advanced unresectable squamous cell carcinoma of the tongue, the floor of mouth and the supraglottic larynx, oro- and hypopharynx loco-regional tumor control rates rarely exceed 30%. Therefore, cytotoxic chemotherapy has been added in an attempt to improve loco-regional tumor control rates and reduce the incidence of distant spread and ultimately long-term survival. Still, in these patients comorbidity may often compromise possible improvements achieved by treatment intensification. Patients and Methods: In a prospective phase II study from 1984 to 1989, patients with loco-regionally advanced head and neck carcinoma were treated with 3 courses of simultaneous radio-chemotherapy. Radiotherapy was administered in two fractions per day 1.8 Gy each. During one course from day 3 to day 11 23.4 Gy were delivered in 13 fractions. Chemotherapy consisted of cis-Platin 60 mg/m2, leucovorin 50 mg/m2 intravenous bolus and 5-FU 350 mg/m2 intravenous bolus on day 2 and leucovorin 100 mg/m2/24-hour continuous infusion and 5-FU 350 mg/m2/24 h from day 2 to 5. Treatment was repeated on days 22 and 44, total radiation dose was 70.2 Gy. From day 12 to 21 and 34 to 43 treatment breaks were scheduled. Results: 105 patients are evaluable with a follow-up from 36 to 105 months in surviving patients. The crude overall survival rate at 5 years is 29% the probability of progression-free survival is 39% (Kaplan-Meier estimations). Loco-regional recurrences were observed in 52 patients after a median interval of 11 (2-81) months. 16 patients developed distant metastases after a median interval of 21 (6-81) months. Conclusions: Compared with data from the literature the pattern of relapse is very similar to that observed after radical radiotherapy alone. Median interval to distant spread appears to be prolonged by simultaneous chemotherapy but this may be due to prolonged follow up. Three-year figures of loco-regional control and survival are valid parameters to apreciate long-term data. Since nearly a third of patients are long-term survivors chronic toxicity deserves special attention in future trials.

ISSN:0378-584X    

DOI:10.1159/000218844

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Background: Reports about the influence of curative and palliative tumor resection on metabolism and resting energy expenditure (REE) in colorectal carcinoma are controversial. This study deals with a group of patients with colorectal cancer of all tumor stages undergoing surgery for the primary. Special attention was attributed to the question whether perioperative changes of REE and body composition depend on tumor stage. Patients and Methods: In a prospective study 32 colorectal cancer patients undergoing surgery were investigated in order to compare nutritional status, body composition and metabolism according to tumor stage. In 18 patients with UICC tumor stages I-III the tumors could be completely removed and in 14 patients with stage IV there was persisting tumor mass as liver metastases after resection of the primary. 10 days pre- and post-operatively bioelectrical body impedance analysis (B.I.A.), indirect calori-metry as well as serum and urine analysis were performed. Results: According to tumor stages no significant inter-group difference was observed in body mass index and preoperative weight loss. Significant increase of extracellular/body cell mass ratio indicating an increase of extracellular mass and decrease of body cell mass was preoperatively found in patients with metastatic colorectal cancer. Correlation between the percentage of preoperative weight loss and extracellular/body cell mass ratio was found in patients with tumor stages I-III. Preoperatively, resting energy expenditure, substrate oxidation rates, serum albumin and trans-ferrin as well as urine 3-methylhistidine excretion were without significant differences between the two groups. After resection of the primary no shift towards hypermetabolism was found in patients with unresected metastases compared to those with complete tumor removal. Taking into account the effects of the surgical trauma itself, postoperatively a further increase of extracellular mass and decrease of body cell mass was observed. These changes led to significantly higher ratios of extracellular/body cell mass and resting energy expenditure/body cell mass in patients with metastatic disease. Resting energy expenditure, substrate oxidation rates, serum albumin and transferrin and urine 3-methylhistidine excretion did not reveal significant inter-group differences postoperatively. Conclusion: No difference in body mass index, resting energy expenditure, protein oxidation and 3-methylhistidine urinary excretion can be found in patients with colorectal cancer without and with liver metastases before and after resection of the primary. However, there are indicators for a perioperative higher decrease of body cell mass in patients with liver metastases and palliative resection of the primary. This might be partially attributed to peripheral protein mobilization and protein retention and synthesis by the tumor itself.

ISSN:0378-584X    

DOI:10.1159/000218845

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger