ISSN:0378-584X    

DOI:10.1159/000218230

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000218231

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Testicular intraepithelial neoplasia (TIN; so-called carcinoma in situ of the testis) is the uniform precursor of testicular germ-cell tumors. TIN is derived from embryonal gonocytes and is present in the testis of a future testis cancer patient at the time of birth. TIN spreads inside the seminiferous tubules until it progresses to invasive cancer. Diagnosis is best achieved by surgical biopsy of the testis and subsequent im-munohistological staining of placental alkaline phosphatase. This enzyme is present in gonocytes, TIN, and seminoma as well as in several other types of germ-cell tumors but not in normal germ cells. TIN is found in testicular tissue adjacent to testicular germ-cell tumors and is observed in all clinical groups known to be at risk for testicular cancer: cryptorchidism (2-3%), infertility (1%), ambiguous genitalia (25%), in contralateral testis of patients with testis cancer (3-6%). Conversely, TIN is not found in the normal male population.If TIN is left untreated, there is a 50% probability of progressing to frank germ-cell neoplasm within 5 years. Localized radiotherapy to the testis with 18-20 Gy eradicates TIN and germ cells while Leydig cells are preserved. The patient can thus be spared orchiectomy and hormone supplementation. The concept of TIN offers the chance of very early detection of testis cancer and organ-preserving early treatment.

ISSN:0378-584X    

DOI:10.1159/000218232

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Carcinoma of the penis is a relatively rare neoplasm in the western hemisphere. Conventional surgery for the primary tumor is mutilating and many controversies exist concerning the ideal treatment of regional lymph nodes, the role of radiotherapy and that of chemotherapy. Due to the rarity of the condition, conduction of controlled comparative and randomized studies is problematic. The intention of this review is to sum up current opinions on etiology, pathology, diagnosis and treatment according to the available literature. The interpretation of historical and cumulative data will remain problematic as long as several staging systems are being used simultaneously. The uniform use of the revised UlCC-initiated TNM classification of 1987 is strongly recommended. Surgery remains the treatment of choice for locoregional disease. Microscopically controlled chemosurgery and laser surgery are viable options compared to partial penile amputation in noninvasive or stage Tl tumors. Stage T2 and T3 tumors should be submitted to partial or total penectomy. The role of lymphadenectomy remains controversial. Guidelines to indication and extent of regional lymphadenectomy are given in correlation to the stage of the primary tumor. Radiation still has its role in the palliation and treatment of superficial noninvasive tumors. Chemotherapy is still experimental and should be guided by the inidividual situation of the patient and the current state-of-the-art chemotherapy in head and neck squamous cell carcinoma.

ISSN:0378-584X    

DOI:10.1159/000218233

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Blood transfusion has been widely touted as a useful adjunct to radiation therapy. This is based on the premise that higher hemoglobin levels will increase tissue oxygenation thereby improving the efficacy of therapeutic radiation. Consequently, it has become common clinical practice to transfuse patients undergoing radiotherapy to arbitrary hemoglobin levels. There has been extensive research evaluating the use of transfusion with radiotherapy. Animal data are divided regarding the radiobiologic benefits of transfusion. Clinical experience has established that anemia is a poor prognostic indicator in patients receiving radiotherapy. However, clinical trials have not clearly shown that correction of anemia by transfusion improves the outcomes. This may be explained by adverse effects of transfusion on tumor immunobiology. In addition to the well-known risks of infectious disease, alloimmunization, and allergic reactions, homologous blood has been shown to be immunosuppressive. This immunosuppression has been associated with decreased survival as well as increased rates of recurrence in the treatment of a variety of malignancies, thus making homologous transfusion particularly hazardous for the tumor-bearing patient. This suggests that routine use of transfusion to support patients receiving radiotherapy must be reappraised, and alternative methods of increasing hemoglobin, such as recombinant human erythropoietin (r-HuEPO), need to be considered. r-HuEPO represents a unique opportunity to assess the value of increasing hemoglobin mass without the confounding variable of immunosuppression. Consequently, a prospective clinical trial utilizing r-HuEPO in patients undergoing radiotherapy seems warranted.

ISSN:0378-584X    

DOI:10.1159/000218234

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Side effects of cisplatin-based chemotherapy for germ cell tumors include myelosup-pression, nephro-, neuro- and ototoxicity. These side effects as well as the pulmonary toxicity of bleomycin are dose-dependent. On the contrary, chemotherapy-associated vascular complications are unpredictable. Whereas Raynaud’s phenomenon is observed in a considerable proportion of patients, myocardial infarction, stroke, and pulmonary embolism appear to occur infrequently. The fact that some patients have been in complete remission at the time of myocardial infarction or cerebrovascular accident argues against a tumor-induced complication and is an argument in favor of a possible causative role of chemotherapy. An alteration of the clotting system and vascular smooth muscle tone as well as an endothelial cell damage are discussed to be pathogenetic mechanisms. Pulmonary embolism, on the contrary, seems to be more frequently associated with inferior vena caval obstruction by tumor masses. Presently there is a debate whether, apart from rare acute vascular events, chemotherapy for testicular cancer leads to a long-term alteration of lipid profile and thereby eventually increases cardiovascular ris

ISSN:0378-584X    

DOI:10.1159/000218235

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Background: Partial or total penectomy is the first choice of treatment for localized squamous cell carcinoma of the penis. Mutilation, postoperative micturition difficulties as well as loss or limitation of their sex life are reasons why patients refuse treatment, and therefore the possibility of an effective therapeutic method with lower morbidity should be offered them. Results: A 58-year-old patient with cancer pTa, pNO, MO, WHO grade II had no evidence of recurrent cancer 2 years after circumcision, tumor excision and ND:YAG laser coagulation (wavelength 1,064 nm). A staging biopsy of the superficial lymph nodes (sentinel LN) and a postoperative biopsy of the tumor base were uneventful. There were no complications from laser therapy. The postoperative cosmetic result was excellent after 2 years. Up to now, no hematogenic or lymphogenic metastases could be observed (CT, MR, bone scan).Conclusions: The local radical surgery offered by ND:YAG laser coagulation gives the possibility of organ preservation in stage Tis-Tl, NO, MO tumors. So, an effective therapy with low morbidity can be set up. ND:YAG laser coagulation enables preservation of the organ and leads to optimal cosmetic results. The success rate can be compared to results gained by surgical techniques.

ISSN:0378-584X    

DOI:10.1159/000218236

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Background: In a single-center phase II setting the efficacy and toxicity of the combination of 5-fluorouracil, vincristine and mitomycin C were tested in patients with advanced non-small-cell lung cancer (NSCLC) in order to limit side effects and costs. Materials and Methods: Fifty-four patients with inoperable or metastatic NSCLC were treated with 5-fluorouracil 450 mg/m2 i.v. on days 1-3 and days 22-24, vincristine 1.2 mg/m2 i.v. on day 22, and mitomycin C 12.5 mg/m2 i.v. on day 1. ‘FOM’ treatment was repeated every 6 weeks.Results: Three out of 47 evaluable patients demonstrated a complete response of 10+, 15 and 21 months duration. Ten patients experienced partial responses of 3 to 14 months duration. The overall response rate in all 54 patients was 24% (95% confidence interval 13-38%). No change in tumor size was seen in 17 patients after 3-10 months duration (median 4.7 months). Fifty patients with a total of 190 cycles are evaluable for toxicity. Forty-one patients (82%) had worst toxicity grade 0 or 1 only. The regimen was very well tolerated on an outpatient basis.Conclusions: The acceptable activity of ‘FOM’ treatment combined with its very low toxicity makes this regimen attractive to be tested in a randomized trial versus current cisplatin- or anthracycline based combinations for advanced NSCLC, evaluating primarily quality of life and including a control arm with best supporti

ISSN:0378-584X    

DOI:10.1159/000218237

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Background: In order to evaluate our experience with the isoelastic shoulder prosthesis in primary and secondary tumors of the proximal humerus, subjective and functional results were examined and survival rates calculated in the present study. Material and Methods: An isoelastic shoulder prosthesis was implanted in 37 patients with tumors of the proximal humerus. Preoperatively and 8 weeks after surgery all patients were given a systematic examination, where pain and movement were evaluated and X-rays taken from the anterior-posterior and axial views. Those patients who were not registered dead in the Central Tumor Record or in our own documents were requested in for a retrospective follow-up. The complete outcome in all 37 patients is known.Results: Eight weeks following surgery only 19% of all patients still had severe or moderate pain, in contrast to 98% preoperatively; movability of the shoulder was sufficient for functions of daily living. Patients with secondary tumors showed a median survival of 1 year, those with primary tumors of 7 years. Conclusions: In primary tumors correct surgical resection with endoprosthetic replacement allows avoidance of an amputation. In secondary tumors pain and function can be improved considerably.

ISSN:0378-584X    

DOI:10.1159/000218238

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger

摘要:

Background: Refractory malignant ascites in extensive carcinomatous peritonitis presents a major problem in oncology, especially in patients with extensive tumor dissemination and final-stage cancer. Patients near death require treatment that is effective while providing major palliative benefits, and that is something neither paracentesis nor chemotherapy can offer. Patients and Methods: Recombinant human tumor necrosis factor (rhuTNF, Knoll AG, Ludwigshafen) was given to 13 female patients with refractory malignant ascites and imminently terminal cancer. The substance was administered 33 times in total by the intraperitoneal (i.p.) route. Depending on response and general condition the patients were treated 2 or 3 times at weekly intervals at a dose of 0.08 mg/m2 of body-surface area.Results: Regeneration of ascites stopped in all cases. As expected, a significant life-prolonging effect was not achieved. Side effects were kept at a minimum by taking careful account of the condition of each individual patient and administering co-medication accordingly. Conclusion: Intraperitoneal infusion of rhuTNF can help to control ascites in carcinomatous peritonitis patients while causing almost no side effects, thus providing comfort for incurably ill patients.

ISSN:0378-584X    

DOI:10.1159/000218239

出版商:S. Karger GmbH    

年代:1993

数据来源: Karger