ISSN:0378-584X    

DOI:10.1159/000218796

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218797

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218798

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218799

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Despite constant improvement in surgical techniques and peri-operative management over the past decades, still about 90% of the Western patients with oesophageal cancer (EC) will die from their disease. Additionally, surgery causes significant mortality and morbidity of the patients. These problems raised the interest in nonoperative, organ-preserving treatment procedures. Apart from metastatic disease, it is not clear from the literature, however, if a nonoperative therapy offers the patients a comparable chance of cure with less toxicity. Therefore, surgery is recommended in localized oesophageal cancer, so far. However, as the number of promising data on combined chemoradiotherapy, particularly in locally advanced tumours, increases, efforts get imperative to investigate the role of nonoperative therapies within randomized clinical trials.

ISSN:0378-584X    

DOI:10.1159/000218800

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Neuroendocrine tumors of the gastroenteropancreatic system present not only a diagnostic but also a therapeutic challenge. In case of limited neuroendocrine tumor disease curative surgery is the goal to aim for. But in patients with metastatic disease (palliative) surgery may be indicated, too. (Chemo-) Embolization should to be considered for liver metastases causing severe local symptoms. Recently, biotherapy with somatostatins or interferon-α has revolutionized the treatment of metastatic neuroendocrine tumor disease of the gastroenteropancreatic system. Both somatostatins and interferon-α are mostly effective in controlling the carcinoid syndrome; they lead to significant tumor reductions at least in some cases and thereby improve the quality of life and possibly lengthen survival. For patients with anaplastic neuroendocrine tumors or with advanced neuroendocrine tumor disease of the pancreas, chemotherapy may still be the first-line treatment modality; the response rate is 40-70%. Present clinical trials investigate the efficacies of combinations of different biotherapie

ISSN:0378-584X    

DOI:10.1159/000218801

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Many patients with completely resected non-small-cell lung cancer relapse locally or systemically. Besides better local control, therefore, effective systemic therapies are required in order to improve the outcome. Previous adjuvant chemotherapy did result in improved survival in some trials but not in others. A recent meta-analysis of these trials revealed that postoperative cisplatin-based chemotherapy leads to a 13% reduction in the risk of death as compared to surgery alone, which is equivalent to an absolute survival benefit of 5% at 5 years. The availability of new drugs and improved supportive care have resulted in renewed interest in postoperative adjuvant chemotherapy. Thus adjuvant chemotherapy is currently re-evaluated in clinical trials that include more active protocols and better antiemetics in order to improve patient compliance. Many phase II trials of induction chemotherapy with or without radiation therapy suggested an improved clinical outcome in patients with locally advanced non-small-cell lung cancer. More recently, three small randomized trials demonstrated a survival benefit for induction chemotherapy followed by surgery as compared to surgery alone. Thus induction therapy protocols should be further evaluated in clinical trials in order to determine the optimal chemotherapy protocols and the optimal local control (surgery or radiotherapy or both) in patients with locally advanced disease.

ISSN:0378-584X    

DOI:10.1159/000218802

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Cutaneous T-cell lymphomas (CTCL) comprise a heterogeneous group of rare diseases that are characterized by a clonal accumulation of T lymphocytes (mainly CD4+) in the skin. The diagnosis is established using an adapted Kiel classification. For staging the present TNM system can be applied, although it is certainly not optimized yet. The choice of treatment modalities depends on the extent and the aggressiveness of CTCL (low- or high-grade lymphoma) and on the individual situation of the patient. A stage-adapted therapy is currently recommended. In stage Ia-IIa we suggest PUVA alone or in combination with retinoids as the first-line therapy. If there is disease progression, interferon-α or methotrexate shall be added. CTCL cases in stage lib can be treated with PUVA combined with interferon-α and soft X-ray radiation (6-8 ×200 cGy, 50 kV twice/week). In stage III (Sézary’s syndrome) photo-pheresis is a well-tolerated first-line therapy which can be supported by interferon-a, methotrexate or retinoids. In case of disease progression, systemic chemotherapy is reasonable (prednisone and chlorambucil or, if resistant, CHOP). Alternatives are radiotherapy (total-skin electron beam) or experimental prot

ISSN:0378-584X    

DOI:10.1159/000218803

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Recently, the Ewing family of tumours (ET). previously classified by clinical appearance and histology as Ewing’s sarcoma (ES), Askin tumour, peripheral primitive neuroectodermal tumour (pPNET) or neuroepi-thelioma, has been redefined on a purely molecular basis – the presence of specific gene rearrangements. Here, we describe how the recent genetic findings have influenced our view of ET pathophysiology. The t(ll;22), t(21;22), t(7;22) and t(17;22) chromosomal translocations fuse the EWS gene to members of the ETS oncogene family. We present a new functional model for the generation of ET that might explain variable neural marker expression in an otherwise non-neural crest-derived cell by unscheduled gene activation. Currently, two thirds of patients with non-metastatic disease can be cured by multimodal therapy. Patients presenting with metastases, however, have an adverse prognosis which is increasingly corn-batted by myeloablative therapy. Molecular detectability of ET specific aberrations has stimulated great hopes as to the definition of high-risk patients by PCR screening for tumor cells in blood, bone marrow and stem cell phereses. Positive results have been obtained as a consequence of metastatic tumour spread but also due to a large tumour burden or to traumatic or surgical tumour cell mobilisation. Physiological and sampling parameters influence the outcome of the analysis. Thus, the significance of negative/positive results for minimal residual and metastatic disease detection remains to be established. Dissection of the functional cascade in which the aberrant ETS transcription factor is involved might aid in identifying novel biological treatment modalities for the high-risk group of patients. The scope of this review is to describe the potential input of molecular biology on the clinical management of ET as a model tumour and should separate realistic perspectives from utopic dre

ISSN:0378-584X    

DOI:10.1159/000218804

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Background: Conservation of the breast is one of the major goals of modern breast cancer surgery. Despite several advances in surgical technique and adjuvant multimodahty treatment, very large tumors or those with unfavorable localization remained subject to mastectomy until recently. We wanted to find out if preoperative chemotherapy has an impact on the reduction of tumor size and if subsequently breast-conserving surgery could be offered to these patients. Patients and Methods: We report on 48 patients suffering from biopsy-proven breast cancer, who would have been treated with mastectomy when conventional criteria would have been applied. In an individualized multimodahty treatment approach, these patients were treated using preopertive cytotoxic chemotherapy. Study end points are the clinical and pathological response rates and the surgical method which could be applied at the end of their preoperative treatment. Results: Overall, in 41 out of 48 patients (85%), we observed at least partial response to the treatment, 6 (13%) patients had a complete pathological response at the time of their operation. 33 patients (69%) received a breast-conserving surgical procedure, and only 15 (31%) had to undergo mastectomy. Conclusions: Preoperative chemotherapy is an extremely valuable tool in the treatment of large breast cancers. Reduction of tumor size took place in almost all of the patients and led to breast conservation in a substantial number of patients who would have underwent mastectomy without this treatment. There are several questions regarding preoperative chemotherapy currently under debate, e.g., the optimal duration of treatment or the best agents. In particular, the question whether these initial responses had a favorable impact on long-term results can only be clarified by prospective trials, which are currently under way in many breast cancer centers.

ISSN:0378-584X    

DOI:10.1159/000218805

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger