ISSN:0378-584X    

DOI:10.1159/000218296

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218297

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

No definite objective guidelines for selecting patients for pelvic nodal or seminal-vesicle irradiation exist in radical radiotherapy for prostate cancer. Developing such guidelines will aid in decreasing unnecessary irradiation of normal tissues in patients in whom involvement of pelvic nodes and seminal vesicles is unlikely. The development of objective criteria will also be of help in successful planning of dose-escalation studies with 3D conformal radiotherapy. Some recent advances are useful in the development of such guidelines. Based on whole-mount, morphometric studies from radical prostatectomy specimens, a new understanding of the zonal anatomy of the prostate has emerged. The three glandular zones are the transitional, central, and peripheral zones; the fourth zone is a nonglandular, fibromuscular one situated anteriorly. The majority of stage A tumors arise in the transitional zone, whereas stage B tumors arise from the peripheral zone. A tumor arising from the transitional or nontransitional zone usually does not cross the boundary between zones unless the tumor volume exceeds about 4 cm3. The tumor volume influences the following: (a) formation of pelvic nodal me-tastases; (b) seminal-vesicle involvement; (c) capsular extension, and (d) the extent of the Gleason pattern 4-5 component. In general, tumors smaller than 4 cm3 tend not to involve regional nodes or seminal vesicles; they have a negligible Gleason pattern 4-5 component, and this is a favorable prognostic factor. Tumor volume estimates can be obtained from transrectal ultrasound. In addition, transrectal ultrasound has significant potential in the identification of patients with gross seminal-vesicle involvement. Transrectal ultrasound slightly underestimates tumor volumes, and about 20% of tumors may not be visible sonographically, but these shortcomings can be remedied by measurement of the prostate specific antigen level. The level of this antigen, a very useful tumor marker in prostate cancer, depends on the tumor cell burden. Studies show that nodal and seminal-vesicle involvement is unlikely if the prostate specific antigen level (determined by a monoclonal antibody method) is less than 10 ng/ml, and that it is highly likely with levels above 20 ng/ml. In patients with prostate specific antigen levels between 10 and 20 ng/ml, ultrasonographic findings as well as the stage and grade of the tumor can help the radiotherapist to determine the extent of the target volume. For treatment planning, decision trees are developed based on stage, grade, tumor volume determination, and prostate specific antigen levels. A significant difference in the volumes of irradiation to the rectum and bladder with or without pelvic nodal/seminal vesicle irradiation is illustrated with dose-volume histograms. The margin around the target in the definition of the planning target (i.e., the margin from prostate to block) due to day-to-day set-up variations and physiologic movement must be about 1-2 cm. Prospective use of the objective criteria developed here can help in the selection of patients for pelvic nodal and/or seminal-vesicle irradiation. Such selection can bε helpful in customizing of target volume definition in the radical radiotherapy of prostate cancer. These objective criteria should form an integral part of 3D confor-mal dose escalation studies

ISSN:0378-584X    

DOI:10.1159/000218298

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Hodgkin’s disease is curable by radio- and/or chemotherapy. In limited stages most patients are treated with radiotherapy alone, which results in a high cure rate. In intermediate stages a combination of chemotherapy and radiotherapy is usually applied. Advanced stages are treated with polychemotherapy. MOPP/ABVD or related regimes (such as COPP/ABVD by the German Hodgkin’s Study Group -GHSG) are standard regimens for these patients. However, about 50% of patients of this group will not be cured and attempts are made to improve treatment results by high-dose chemotherapy. Salvage therapy for relapsed patients including high-dose chemotherapy with autologous stem cell support frequently results in remission although duration is generally short. New strategies including immunotherapy to improve the results are highly warran

ISSN:0378-584X    

DOI:10.1159/000218299

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

In this review new approaches to adjuvant therapy of colon and rectum carcinomas are reported. Early trials in the 70s using 5-fluorouracil and other monotherapies did not show any advantage for prognosis. The use of combination chemotherapy (e.g. 5-fluorouracil + methyl-CCNU) in several prospective trials suggested a considerable increase of late neoplasia. A statistically significant prolongation of recurrence-free survival and overall survival for patients with high-risk colon carcinoma (Dukes C) was first seen by combination of 5-fluorouracil with levamisole. Data of a first multicenter trial were recently confirmed by a larger series. For rectum carcinoma postoperative radiation therapy, effective for reduction of local recurrences, was included in adjuvant chemotherapy in several studies suggesting a statistically significant advantage of recurrence and overall survival. Recent data and analyses indicate that the combination of 5-fluorouracil and folinic acid, which shows high efficacy in advanced stages of colorectal carcinoma, is effective in the adjuvant setting too. During 1992/1993 in Germany five multicenter, prospective randomized trials were activated to clarify further details of this new prophylactic treatmenl possibility for colorectal carcinoma.

ISSN:0378-584X    

DOI:10.1159/000218300

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

In this review we will present the technical requirements, possibilities and limitations of endoluminal and intraoperative ultrasound scanning. With endoluminal ultrasound (ES) it is possible to visualise submucosal, transmural and extraluminal tumours of the gastrointestinal system. Main areas of the use of ES are preoperative staging and postoperative follow-up. With ES it is possible to predict the correct histopathological tumour infiltration in oesophageal carcinoma in 73-92%, in gastric cancer in 67-86%, in pancreatic cancer and carcinoma of the papilla in 82-94% and in carcinoma of the rectum in 80-91% of all cases. Regional lymph node involvement can be assessed correctly in 50-84% of all patients. Intraoperative ultrasound (IOUS) increases the possibilities of intraoperative exploration of the liver and the pancreatic gland. If applied it influences the operative strategy in 20-50% of all pancreatic or hepatic resections.

ISSN:0378-584X    

DOI:10.1159/000218301

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Background: Prognostic factors significantly influence further therapeutic measures: ‘low-risk’ patients should be spared large-scale therapy, whereas ‘high-risk’ patients might probably benefit from more intensive therapy. The parameter ‘vessel invasion’ was to be compared with other prognostic factors and tested with regard to its clinical applicability. Patients and Methods: Breast cancer tissue sections were examined with regard to their prognostic importance for disease-free survival in 64 patients with primary breast cancer. Immunocytochemical staining for factor-VIII-related antigen was used to outline vascular endothelium. Results: In 19 cases (29.6%) vessel invasion could be detected. The 5-year disease-free survival rate was 13.8% in the cases with vessel invasion and 75.1% in those cases without vessel invasion (p = 0.0001). A Cox proportional hazards model identified vessel invasion as independent prognostic factor for recurrence-free survival in breast cancer (relative risk = 3.74; p = 0.0023). The recurrence rate within the first 24 months after surgery was 57% for the cases with and 9% for the cases without vessel invasion, respectively. Out of 32 lymph node negative patients we found vessel invasion in 5 patients, out of whom 4 developed recurrence. Conclusion: We therefore conclude that vessel invasion in primary tumours of breast cancer patients might possibly identify a high-risk group for early tumour

ISSN:0378-584X    

DOI:10.1159/000218302

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Background: Elderly patients with non-Hodgkin’s lymphoma (NHL) are often excluded from or underrepresented in clinical trials of combination chemotherapy regimens because of toxicity of the treatment. Materials and Methods: We report our results in a cohort of 32 patients aged over 60 years who received mitoxantrone, etoposide and prednisolone as first-line therapy and of another 14 patients with relapsed NHL as salvage therapy. 26 patients had high-grade NHL and 20 had low-grade NHL. Advanced stage was defined as Ann Arbor stages 3 and 4 and was seen in 38 patients. Results: Patients with NOVEP as first-line therapy achieved 41% complete remissions (CR) and 34% partial remissions (PR), leading to an overall response rate of 75%. Event-free 3-year survival was 29% in this subgroup. Pretreated patients achieved only 7% CR and 14% PR. Two patients died of treatment-related side effects. Conclusions: The combination of mitoxantrone, etoposide and prednisolone is successful in non-pretreated elderly patients with NHL and shows only low toxicity especially for this subgroup, even in advanced stages. It is of minor success as salvage therapy for older patients with relapsed NH

ISSN:0378-584X    

DOI:10.1159/000218303

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Background: On the basis of preclinical data and phase I trials, a disease-orientated phase II trial was conducted with 4’-iodo-4’-deoxydoxorubicin (I-DOXO) in advanced and measurable non-small cell lung cancer (NSCLC). Patients and Methods: Twenty-three patients with advanced and measurable NSCLC were treated with 80 mg/m2 I-DOXO every 3 weeks. Results: Three partial remissions (13%, 95% confidence interval: 2.8-33.6%) lasting 3.5, 5, and 6.5 months, were observed. Nine patients (39%) demonstrated no change of short duration and 11 (48%) patients had progressive disease. Hematologic side effects were mild to moderate without any WHO grade 2 leuko- or thrombocyto-penia. No severe nonhematologic toxicities occurred. Conclusions: I-DOXO has only minimal efficacy in NS

ISSN:0378-584X    

DOI:10.1159/000218304

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Background: Because MDRl RNA is frequently encountered in advanced breast cancer, we have initiated a phase I/II study with pirarubicin in combination with the multidrug resistance modifier quinidine. Patients and Methods: Fourteen patients with metastatic breast cancer refractory to conventional anticancer chemotherapy with anthracyclines and/or vinca alkaloids were entered into this trial. All patients were given 250 mg quinidinebisulfate twice daily for a total of 5 days, and the anthracycline derivative pirarubicin was administered on the 4th day of the cycle. The pirarubicin starting dose was 50 mg/m2 body surface and was escalated during the study in cohorts of 3 patients each. Cycles were repeated every 3-4 weeks. Results: All patients were evaluable for toxicity and response assessment. The maximum tolerated dose of pirarubicin was 70 mg/m2. Overall treatment-associated toxicity was mild and comparable with conventional pirarubicin monotherapy. The median leukocyte nadir was 2000/mm3, partial alopecia (70%) and nausea/emesis (20%) were the most frequently encountered nonhematologic side effects. Quini-dine-associated side effects were not reported. There was no objective response. Six patients had stable disease, while the tumor progressed in eight. Conclusions: Quinidine in combination with pirarubicin is not active in advanced refractory breast cancer.

ISSN:0378-584X    

DOI:10.1159/000218305

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger