ISSN:0378-584X    

DOI:10.1159/000219003

出版商:S. Karger GmbH    

年代:1997

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000219004

出版商:S. Karger GmbH    

年代:1997

数据来源: Karger

摘要:

Intraoperative radiation therapy (IORT) is able to contribute to local tumor control in the context of surgical resections by means of delivery of high single doses of ionizing radiation. In the treatment of gastric cancer IORT is applied either as sole irradiation modality with doses of 15-30 Gy or as component of combined radiation treatment in combination with external beam radiation therapy (EBRT) with doses of 10-20 Gy. The analysis of available randomized and nonrandomized studies indicates that in the treatment of gastric cancer IORT is most likely utilizable for locally advanced stages. Apparently local tumor control may be improved in these situations. Due to reported results from some studies, it can be assumed that this can be also translated into improved survival rates. However, IORT for gastric cancer should currently be considered an experimental modality due to a small data base from published studies, different study designs, different operation modalities, stage classifications, and quality of documentation.

ISSN:0378-584X    

DOI:10.1159/000219005

出版商:S. Karger GmbH    

年代:1997

数据来源: Karger

摘要:

In view of the growing number of postmenopausal women using estrogen replacement therapy for the prevention of acute and chronic consequences of hypoestrogenism, any possible associations between hormone therapy and manifestations of gynecologic cancer are an issue of increasing importance. We reviewed the published literature to evaluate the impact of estrogen replacement therapy on the occurrence of gynecologic malignancies including breast cancer. The tumor growth of ovarian, cervical, vaginal, and vulvar neoplasias is not fundamentally influenced by hormone therapy. However, long-term replacement therapy may be associated with an increased incidence of endometrial hyperplasia and even of neoplasia. This increased risk is related to the duration and cumulative dose of estrogen therapy. Addition of progestin probably reduces the risk of endometrial cancer to that observed in the general population. With regard to the relationship between hormone replacement therapy and the incidence of breast cancer, available epidemiologic data are contradictory. While therapy of less than 5 years appears not to be associated with an increased risk, long-term use may be related to a small but significant increase in the risk of developing breast cancer. It is important to note that the cyclic addition of a progestin to estrogen replacement does not affect this risk. After discontinuation of hormone replacement the increased relative risk returns to that of non-users. In conclusion, when considering estrogen replacement therapy for a postmenopausal woman, a slightly increased risk of developing breast cancer and the need to add progestin for protection of the endome-trium need to be mentioned. Bearing this in mind, the benefits of estrogen therapy in terms of a better quality of life and perhaps of a disease-free prolongation of life justify a wide use of hormonal preparations.

ISSN:0378-584X    

DOI:10.1159/000219006

出版商:S. Karger GmbH    

年代:1997

数据来源: Karger

ISSN:0378-584X    

DOI:10.1159/000219007

出版商:S. Karger GmbH    

年代:1997

数据来源: Karger

摘要:

In the international guidelines for the care of melanoma patients so far no serological tumor marker has reached an approved stage of relevance. The detection of cytokines (inter-leukin-8 and interleukin-10) in melanoma patients has demonstrated some correlation to tumor burden, but cytokines can be upregulated under several benign conditions, too. Even adhesion molecules such as ‘intercellular adhesion molecule 1’ (ICAM-1) have shown to be overexpressed in patients with a high tumor load, but several inflammatory diseases and immu-notherapeutic interventions can change serum levels as well. Thus, routine follow-up with adhesion molecule serum detection is not a useful diagnostic tool. Among the melanoma-associated antigens (MAA) detectable in serum, the Sangtec S100β protein has proved superiority compared with neuron-specific enolase (NSE) or lipid-bound sialic acid (LASA-P). Serum S100β measurements were demonstrated to serve as useful at least in the detection of advanced metastatic melanoma. Also in the monitoring of metastatic disease during the natural course of disease or during treatment, the marker proved to be of relevance. In contrast, tyrosinase reverse transcription polymerase chain reaction (RT-PCR) has failed to reach clinical significance due the low number of tyrosinase PCR-positive stage IV patients in the majority of published reports. Results of large trials with the ‘melanoma inhibitory activity’ (MIA) protein as well as optimized investigations on melanin-related metabolites (e.g. 5-S-Cysteinyl-DOPA) are awaited with great

ISSN:0378-584X    

DOI:10.1159/000219008

出版商:S. Karger GmbH    

年代:1997

数据来源: Karger

摘要:

Background: Treatment with biological response modifiers such as interferons resulted in reproducible responses in patients with renal cell carcinoma without proved benefit on survival and quality of life. Two trials were conducted to define the efficacy and the benefit on survival of interferons in the treatment of advanced renal cell carcinoma. Patients and Methods: Prospectively, 81 patients were treated subcutaneously (sc.) with interferon-α 2B (IFN-α) or interferon-γ (IFN--y). The first trial was randomized; 30 patients received weekly 200 µg IFN-γ alone, and 30 patients were treated with a combination of IFN-α 2B (3-6 ×106 IU/m2 3 times weekly) and interleukin-2 (IL-2) (4.8-19.2 ×106 IU/m2 5 times weekly) for 6 weeks. In the second trial, 21 patients received IFN-α 2B (10 × 10-6 IU sc.) combined with gradually escalating doses (15-300 µg sc.) of granulocyte-macrophage colony-stimulating factor (GM-CSF) 3 times weekly for 12 weeks. Results: The overall response proportion was 12% (5 complete and 4 partial responses; CR, PR). In the patient groups treated with IFN-α 2B, the overall response rate increased up to 20%. The median response duration was 10.2 months. The median survival duration was 12.7 months. A univariate statistical analysis on prognostic factors (age, sex, Karnofsky performance status, prior nephrectomy, lung metastases only, treatment regimen) showed that only prior nephrectomy was a significant prognostic factor for survival. Conclusion: Biological response modifiers such as IFN-α or IFN-γ had minimal antitumorigenic activity in patients with renal cell carcinoma. Combination therapies with IFN-α 2B resulted in significant higher response rates, but this did not translate into prolonged survival. Out of these studies only prior nephrectomy was identified as the predictor of long-term survival. Because of these disappointing results the study of new biological response modifiers re

ISSN:0378-584X    

DOI:10.1159/000219009

出版商:S. Karger GmbH    

年代:1997

数据来源: Karger

摘要:

Immunoreactive Tn is a pancarcinoma epitope resulting from aberrant glycosylation of mucins in primary carcinomas and their metastases; strong Tn epitope expression is associated with poor prognosis. All humans have anti-Tn antibodies, natural anticarcinoma antibodies, predominantly IgM, elicited primarily by their own intestinal flora. Anti-Tn IgM levels were determined by us, using an enzyme-linked immuno-sorbent assay and interrelated to the total IgM of the subject’s serum by the formula: Anti-Tn QMe = 100 × [(Anti-Tn IgM)2/ Total IgM]. Anti-Tn Qus naα! higher sensitivity and comparable specificity to anti-Tn IgM alone in breast carcinoma detection. Anti-Tn QMe results were positive in 79% of the 119 breast carcinoma patients tested; they were negative in 84% of the 32 patients with benign breast disease and in 94% of the 49 healthy controls. Further studies of immune responses to the pathogenetic functions of this marker in carcinoma are indica

ISSN:0378-584X    

DOI:10.1159/000219010

出版商:S. Karger GmbH    

年代:1997

数据来源: Karger

摘要:

Background: Castleman’s disease (CD) is a lymphoprolifera-tive disorder, probably of reactive origin but poorly regulated by a defective immune system, and therefore prone to oligoclonal evolution. Diagnosis is made by histopathological features, involvement of multiple lymph nodes, evidence of a multisystem involvement, and an idiopathic nature. The course is unpredictable, but a high mortality rate is reflected in the literature. Patients were treated with either corticosteroids or chemotherapy designed for lymphoma. Case Report: We present a case of a 63-year-old woman with multicentric CD who was admitted with weight loss, night sweat, fever, and generalized lymphadenopathy. Laboratory investigations showed a Coombs-positive hemolytic anemia and an elevated polyclonal immunglobulin level. Lymph node biopsy showed pulpic hyperplasia and proliferation of venules. Clinically, radiologically and biochemically, an autoimmune disorder, an infection as well as an underlying neoplasia were highly unlikely. Despite the introduction of immunosuppressive therapy with steroids (prednisone 100 mg/day), the patient developed a severe radiculopathy, predominantly with a paresis of the upper extremities in association with a total ophtalmoplegia and a dysphagia, consistent with the Miller-Fisher syndrome (ophtalmoplegia, ataxia, and areflexia). Therefore, plasma separation was performed for 6 days. In addition, cyclophosphamide was administered in a dosage of 3 g/m2. Following 2 courses of cyclophosphamide infusion a significant reduction in lymphadenopathy and an almost complete resolution of neurological symptoms was documented. After 6 courses chemotherapy with CHOP (cyclophosphamide, doxorubicine, dexamethasone and vincristin) the patient was still in partial remission. She died of pneumonia one year after diagnosis of Castleman’s disease. Conclusion: This is the first reported case of Castleman’s disease associated with polyradiculitis. Appropriate treatment for both, the polyradiculitis and the Castleman’s disease proved to be ef

ISSN:0378-584X    

DOI:10.1159/000219011

出版商:S. Karger GmbH    

年代:1997

数据来源: Karger

摘要:

Background: The incidence of gastrointestinal metastasis of lung cancers is low. However, if present the involvement is predominantly found in the esophagus, stomach, and small intestine. Clinical symptoms comprise of perforation, obstruction, or bleeding. Patient: We report on a 68-year-old male patient in whom a cytological diagnosis of adenocarcinoma of the lung with mediastinal lymph node metastasis was made in September 1993. After receiving radiation treatment to the chest, the patient developed further metastasis to the brain, liver, and bone. Radiotherapy to the brain (60 Gy) was applied with complete cerebral response. In April 1994 he complained of intermittent hematochezia, colonoscopy revealed a cecal tumor 5 cm in diameter. The histologic examination revealed a small-cell carcinoma consistent with a metastatic lesion. The original tumor was reclassified as combined small-cell cancer of the lung. Chemotherapy was initiated leading to a partial remission lasting for 6 months. Conclusion: The recognition of a symptomatic large-bowel tumor as a small-cell carcinoma led to reevaluation of primarily diagnosed adenocarcinoma of the lung now classified as a combined small-cell lung cancer. This widened diagnosis led to new chemotherapeutic options in an advanced disease situation with impressive clinical benefit and a partial remission for 6 months. Thus, histologic or cytologic analysis of metastatic lesions – especially if they are found in an atypical location – may have implications in regard to the primary diagnosis and consequently may lead to improved therapeutic strateg

ISSN:0378-584X    

DOI:10.1159/000219012

出版商:S. Karger GmbH    

年代:1997

数据来源: Karger