[Combined conservative treatment of localized stomach lymphoma]. / Kombinierte konservative Behandlung von lokalisierten Magenlymphomen.

In a twelve-year period (1980-1992) 23 patients (9 men, 14 women; mean age 65 [25-82] years) with malignant non-Hodgkin lymphoma of the stomach, in localized stage I or II (Ann Arbor classification), were given chemo- and radiotherapy without preceding operation. The results were compared with those of a group of 34 patients (19 men, 15 women; mean age 55 [17-77] years) who had been admitted during the same period, having first been treated by surgical resection and most of them additionally by chemo- and/or radiotherapy. Three not previously operated patients with inadequate response to chemotherapy subsequently underwent laparotomy and remained in remission after further treatment. There was in each group one fatal recurrence. Five-year total probability of survival in the operated and non-operated groups was 90% and 92%, respectively; five-year total recurrence-free probability was 88% and 86%, respectively. There were no cases of severe bleeding or perforation. These results demonstrate that conservative management of localized gastric lymphoma by combined chemo- and radiotherapy does not bring about a rise in recurrence rate and does not seem to be inferior to surgical treatment.

[High dose intensity with COP-BLAM in Hodgkin's disease with unfavorable risk factors]. / Hohe Dosisintensität durch COPBlAM beim Morbus Hodgkin mit ungünstigen Risikofaktoren.

Thirty three patients with unfavourable risk factors suffering from Hodgkin's disease received COPBlAM polychemotherapy as first treatment in a phase-II study between 3/86 and 2/89. The median cumulative relative dose intensity (RDI) of 0.97, calculated as a measure for the given amount of cytostatics per time, was very high. Fourteen patients (43%) achieved a complete remission (CR); 11 (33%) additional cases were categorized as far-reaching remission (FRR) due to small residual tumors in the regions of originally large tumor masses, 7 (21%) as partial remission (PR), and one case (3%) as progression. As the small residual tumors of the patients grouped as FRR did not shrink during the following radiotherapy (RT), these cases were also classified as complete responders retrospectively. Thus, after chemotherapy 76% CR resulted. After completion of RT 91% of the patients have achieved a CR. The progress-free survival probability and the survival probability were 83% and 86% respectively after 45 months.

Malignant mesothelioma of the pleura. A prospective therapeutic study of 132 patients from 1981-1985.

Between March 1981 and February 1985, 93 out of 132 patients with a histologically confirmed diagnosis of malignant pleural mesothelioma were eligible for therapy and were prospectively assigned to receive either combined therapy or best supportive care, according to their personal preferences. Fifty-seven patients underwent multimodal therapy including surgical resection where possible, polychemotherapy, and radiation therapy in case of partial remission. Thirty-six patients received maximal supportive care only, as did 39 patients who were not eligible for treatment. The median survival was 13 months for treated patients compared to 7 for those receiving best supportive care and 5 for patients not amenable to treatment. Median progress-free survival was 6, 2, and 1 month respectively. Surgical resection did not prolong life expectancy within the treated group. In view of significant differences in the distribution of various cofactors over the two study groups, stepwise Cox model analyses were performed. Prognostic nontreatment variables related to prolonged survival were: good performance status, stage I and II, absence of chest pain, age below 50 years, and epithelial histology. Although in the Cox model analyses the survival improvement of patients being treated could be greatly attributed to other cofactors, multimodal treatment showed some prolongation of life expectancy.

[Long-term results in highly malignant stage I and II non-Hodgkin's lymphomas during management with polychemo- and radiotherapy]. / Langzeitergebnisse bei hochmalignen Nicht-Hodgkin-Lymphomen der Stadien I und II in Abhängigkeit von Polychemo- und Radiotherapie.

In 159 patients treated from 1976-1986 with an age median of 62 (16-85) years the survival probability amounted to 66% after ten years, where stage I (n = 82) with 77% was more favourable than stage IIA (n = 54) with 60% and stage IIB (n = 23) with 43%. With 61% the prognosis of the 7th to 9th decade of age (n = 82) was not worse than that of younger age groups (n = 77) with 70%. In prognostic respect immunoblastic (n = 49), centroblastic (n = 65) and unclassifiable (n = 45) subtypes as well as sexes do not differ and, therefore, they could be evaluated in total. With 81% the relapse-free survival time after sequential or simultaneous combination of polychemo- and large-scale radiotherapy the relapse-free survival time was markedly higher in stage IA (n = 45), stage IB (n = 5) and stage IIA (n = 26) than after single radiotherapy (n = 21) with only 30%. Even in elder patients the combined method was so far not accompanied by a higher complication rate so that this procedure may be considered as an essential progress in the treatment of highly malignant lymphomas. Thus, certain uncertainties as to insufficient division of stages which have frequently to be taken into account in elder people due to their limited invasive burdening capacity may be neglected.

Development, radiological zone patterns, and importance of diffuse pleural thickening in relation to occupational exposure to asbestos.

The radiographic appearance of the lateral pleura was divided into an upper, a middle, and a lower zone. Bilateral changes of the pulmonary layer of the pleura (diffuse pleural thickening) within the upper pleural zones were found in 863 (71%) of 1204 workers exposed to asbestos and in 249 (40%) of 622 non-exposed controls. Downwards along the chest wall this ratio of 7:4 increased progressively up to 10:1 at the lower parts of the pleura. Bilateral diffuse pleural thickening in at least two adjacent zones on each side was found in 652 (54%) of exposed and in only 86 (14%) of unexposed subjects. The difference was even more striking when comparing bilateral involvement of all three zones (28% and 3% respectively). Unilateral change was rare (4.8% and 7.8% respectively) and often due to causes other than exposure to asbestos. Pleural findings were the earliest radiographic features detectable associated with former exposure to asbestos. Bilateral diffuse thickening in at least two adjacent zones on each side seems to be a striking feature and an early indication of former occupational asbestos damage. Modifications of the International Labour Organisation 1980 classification are proposed.

[Risk-adapted treatment of immunocytomas]. / Risikoadaptierte Behandlung von Immunozytomen.

For 176 patients seen between 1976 and 1984, with a mean age of 65 years, the probability of survival after ten years was 56% for lymphoplasmocytoid (n = 86), lymphoplasmocytic (n = 38) and non-classifiable (n = 10) subtypes, while it was 0% at the end of 6.5 years for the polymorph cell type (n = 42). Patients up to 60 years of age had, at 68%, a generally better prognosis than older ones, at only 30%. Cases with bone-marrow infiltration or leukemic washout (n = 114) were, like chronic lymphoid leukemia cases, classified according to the scheme of Rai and co-workers, while the remaining cases (n = 62) were classified according to the Ann Arbor scheme. There was a three-step prognosis of ten-year probability of 85% for stages I A, Rai 0, Rai I (n = 49), 50% for II A/B, III A, Rai II (n = 43), and 27% for III B/IV B and Rai III/IV (n = 41) of the non-polymorph cell subtypes. For the polymorph cell forms there was also a triple division with 88%, 53% and 14% after only four years. Additional unfavorable factors were rapid lymphoma growth, leukemic course, high paraprotein gradient and autoimmune hemolysis. The flexible employment of polychemotherapy and large-field radiotherapy, adapted to the mentioned unfavorable risk factors and age, contributed to the improved results in this heterogeneous group.

Cytogenetic studies in 69 patients with myelodysplastic syndromes (MDS).

Cytogenetic studies were performed in 69 patients with myelodysplastic syndromes classified according to the FAB proposals. Overall incidence of chromosomal anomalies was 48% with 5q-, +8, 12p-,-7/7q- being the aberrations most often found. The 12p- chromosome showed a close correlation with a prior exposure to mutagenic agents and CMML. Although there were no group-specific cytogenetic anomalies, FAB classification strongly influenced their incidence. They were lower (36%) in RA/RA-S than in RAEB/RAEB-T/CMML (53%). Chromosomal anomalies were significantly more often found in patients with a prior exposure to carcinogenic agents (80%) than in unexposed patients (33%). The presence of chromosomal anomalies did not predict a higher risk of leukemic transformation.

[Long-term results in 172 highly malignant non-Hodgkin's lymphomas with special reference to older patients]. / Langzeiterfolge bei 172 hochmalignen Nicht-Hodgkin-Lymphomen unter besonderer Berücksichtigung älterer Patienten.

In 172 patients of the years 1976-1984 with a median age of 61 (16-89 years) the probability of survival was 55% after nine years. The seventh to ninth decade of life (n = 88) did not differ significantly in terms of the survival prognosis (47%) from the younger age groups (n = 84) with 59%. Immunoblastic (n = 72), centroblastic (n = 65) and unclassifiable (n = 35) lymphomas were prognostically similar and could hence be evaluated together. Stages I A (n = 58) with 83% and IV B (n = 15) with 20% differed from all others (n = 99), for which a survival rate of 41% was calculated. With the CHOP scheme (n = 76), a complete remission could be induced in 70% of the stages II A/B, III A/B and IV A (n = 54) and in 95% of stage I A (n = 19). In stage IV B (n = 14), more intensive schemata were not successful, only inducing two remissions. After sequential combination of polychemotherapy and large-field radiotherapy, the relapse-free survival was higher than after radiation or cytostatics alone. This was shown most distinctly in stage I A, in which a value of 82% compared to only 29% after radiotherapy was found for the combined method. Since this was not associated with higher rates of complications so far even with the older patients, we regard this procedure as major advance in the therapy of prognostically unfavorable lymphomas.

[Sequential polychemotherapy and large-field radiotherapy of non-Hodgkin's lymphoma]. / Sequentielle Polychemotherapie und Grossfeld-Radiotherapie von Non-Hodgkin-Lymphomen.

The combination of polychemotherapy and large-field radiotherapy essentially promoted the improved total results achieved during the period of 1976 and 1982 in 272 patients with non-Hodgkin's lymphomas (NHL) of low and high malignancy. In case of centroblastic-centrocytic (cb/cc) NHL of stages II A/III A, the recurrence-free survival after radiotherapy (n = 21) could be increased by the combined method (n = 25) from 17% to 60%, and the probability of seven-year survival could be improved from 70% to 90%. All of the ten initially irradiated patients in the stages I A/II A/III A of centrocytic (cc) NHL suffered from a recurrence, whereas the development seems to be more favorable in the five patients submitted to combined treatment who had only one recurrence. The recurrence-free seven-year survival of the highly malignant NHL in stage I A/II A increased from 40% after unique radiotherapy (n = 15) to 70% after combined therapy (n = 39), the survival probability increased from 55% to 75%. Despite the partly insufficient therapy results after unique radiotherapy and polychemotherapy, the combined method has largely contributed to achieve after eight years the total survival rates of 76% for cb/cc NHL (n = 123) and of 55% for the highly malignant immunoblastic NHL (n = 57), centroblastic NHL (n = 35) and NHL with uncertain classification, whereas the cc-NHL (n = 36) hitherto has a relatively unfavorable prognosis with only 29%.

[Prognostic differences in low-malignancy germinal center cell lymphomas and immunocytomas. Relationship to histological subtypes, stages and therapy]. / Prognostische Unterschiede bei niedrig-malignen Keimzentrumslymphomen und Immunozytomen. Beziehung zu histologischen Subtypen, Stadien und Therapie.

Based on repeated interval analyses, radiotherapy and cytostatic drug therapy were stepwise intensified and combined in 264 patients diagnosed between 1976 and 1981 as having histopathologically low-malignant centroblastic-centrocytic (cb/cc; n = 106), centrocytic (cc; n = 34) or immunocytic lymphoma (n = 124). The number of treatment failures and recurrences were clearly reduced. There were three prognostic steps in survival probability: 90% after seven years for stages IA-IVA of the cb/cc lymphoma as well as for the extranodal lymphoplasmocytoid and lymphoplasmocytic immunocytomas, stages I-IV of Ann Arbor, and stages 0-II of the Rai classifications. In the Rai stages III and IV these immunocytomas had a definitely worse prognosis, at 60%. Prognostically most unfavourable, at levels of around or below 30%, were the B forms of cb/cc lymphomas, all stages of centrocytoma and the polymorph-cell immunocytomas. The survival rate of the cb/cc lymphomas was increased by about 33%, compared with cases of Brill-Symmers' disease between 1970 and 1975. The alternating use of cytostatic combinations seems to be more favourable among the previously little affected centrocytomas and the polymorph-cell immunocytomas.

[Combined chemotherapy-radiotherapy study of small cell bronchial carcinoma: chemo-/radiotherapy vs radio-/chemotherapy]. / Kombinierte Chemotherapie-Radiotherapie-Studie des kleinzelligen Bronchuskarzinoms (CCR-Studie): Chemo-/Radiotherapie gegen Radio-/Chemotherapie.

The authors studied the effect of a chemo-/radiotherapy or radio-/chemotherapy on 52 cases of microcellular bronchial carcinoma, classification "limited disease". The survival curves were slightly better for the patients submitted to primary chemotherapy, but the difference was not statistically significant, and the curves coincided again after 18 months. 60 to 80% of the patients had no complaints or only unimportant complaints during more than half of their survival time. In 23 patients with "extensive disease" who received only a symptomatic therapy or a combined palliative chemotherapy, chemotherapy had a slightly better effect, but this was not statistically significant.