ABSTRACT
The report reviews the experience gained with radio- and chemotherapy-related injuries suffered by bladder cancer patients. It corroborates the opinion of most European specialists that indications for radical cystectomy be extended with due considerations of up-to-date potential in anesthesiology, extensive care and pharmacology. Possible untoward side effects of radiation and intravesical chemotherapy as well as means of solution of the problem are discussed. It is urgent considering the constantly growing number of such patients, their age and associated somatic problems.
Subject(s)
Antineoplastic Agents/administration & dosage , Antineoplastic Agents/adverse effects , Urinary Bladder Neoplasms/pathology , Urinary Bladder/drug effects , Urinary Bladder/radiation effects , Administration, Intravesical , Adult , Aged , Chemotherapy, Adjuvant/adverse effects , Female , Humans , Male , Middle Aged , Mucous Membrane/drug effects , Mucous Membrane/radiation effects , Neoplasm Staging , Radiotherapy, Adjuvant/adverse effects , Urinary Bladder/pathology , Urinary Bladder Neoplasms/drug therapy , Urinary Bladder Neoplasms/radiotherapyABSTRACT
A prognostic model for Hodgkin's disease was worked out using the data on disease-free survival among patients receiving 4-8 courses of COOP(MOPP)/ABVD plus (sub)total irradiation. Patients with stage I-II Hodgkin's disease (less then 4 lesions) without large involved mediastinal masses, intoxication symptoms and focal splenic involvement were referred to the favorable prognosis group. The poor prognosis group featured stage III(2)-IV tumor as well as large masses of involved mediastinal tissue, focal splenic involvement at any stage plus 7 or more lesions. An assessment of tumor advancement across lesions is more significant for radiotherapy planning rather than that of organ involvement. It is reasonable to distinguish two substages--III(1) and III(2). Our model was compared with GHSG and it was suggested that ways be found to use both of them in prognosing of disease outcome.
Subject(s)
Hodgkin Disease/diagnosis , Models, Statistical , Hodgkin Disease/pathology , Humans , Neoplasm Staging , PrognosisABSTRACT
Data are presented on our 5-year experience with combination chemotherapy of stage II-IV Hodgkin's disease (110), the unfavorable prognosis group, using a novel regimen of chemotherapy--CEA/ABVD (belustin, etoposide, doxorubicin, bleomycin, vinblastine, dacarbazine). Complete remission after 4 courses of CEA/ABVD chemotherapy was reported in 31.8%, unconfirmed complete remission--45.5%, objective effect--100% and an 80% regression of tumor mass--93.2%. No chemo-resistant forms were identified. Five-year actuarial relapse-free survival was 96.4%; overall 5-year survival--97.7%. Death from complications recorded during medication period occurred in 2.3% (1 out of 44), recurrence--2.3% (1 out of 44). Recurrence-free survival rose by 25% (p < 0.05) while overall survival--by 20% (p = 0.04 in year 3), as compared with COOP(MOPP)/ABVD (179 patients with poor prognosis). Our regimen opens up new vistas in managing Hodgkin's disease.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hodgkin Disease/drug therapy , Adult , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Bleomycin/administration & dosage , Carboplatin/administration & dosage , Dacarbazine/administration & dosage , Disease-Free Survival , Doxorubicin/administration & dosage , Drug Administration Schedule , Etoposide/administration & dosage , Female , Follow-Up Studies , Hodgkin Disease/pathology , Humans , Male , Middle Aged , Neoplasm Staging , Prognosis , Survival Analysis , Treatment Outcome , Vinblastine/administration & dosageABSTRACT
A randomized study included 167 patients with metastases to the bone (breast cancer--73%). 117 patients received distance radiotherapy on an area-by-area basis: 2 areas--30, and 3 or more areas--20. Radiotherapy was not used until chemo-hormonal proved useless. The following four regimes were used (1) 4 fractions of 6.5 Gy each (overall dosage--26 Gy) (2 fractions per week); (2) 5 fractions of 6.5 Gy each (overall dosage--32.5 Gy) (2 fractions per week); (3) 4 daily fractions of 6.5 Gy each (overall dosage--26 Gy), and (4) 23 fractions (overall dosage--46 Gy) (5 weekly fractions). Overall efficacy was 96.7% (complete response--66.7%; pain syndrome in the exposed area--4.2%). No differences between large-fraction irradiation regimes were reported. Late-onset radiation-induced lesions (soft-tissue fibrosis stage II-III) were significantly more frequent after standard low-dosage fractionated irradiation (28.6+/-17.0%).
Subject(s)
Bone Neoplasms/radiotherapy , Radiation Dosage , Female , Humans , Male , Neoplasm MetastasisABSTRACT
Different combinations of radical mastectomy, radiotherapy and cycle polychemotherapy were compared in 330 patients with T2N2 and T3-4N0-2M0 breast cancers: preoperative radiotherapy followed by surgery and adjuvant chemo-hormonal therapy (CT/HT)-118: neoadjuvant polychemotherapy (neCT) combined with preoperative radiation, surgery and adjuvant CT/HT-105; surgery, postoperative radiotherapy (PoRT) and adjuvant CT/HT-51, and neoCT followed by surgery, PoLT and adjuvant CT/HT-56. Advantage offered by postoperative radiotherapy proved significant only in the T2N2 and T3N1M0 groups and only in cases of combined PoLT and neoadjuvant polychemotherapy. Neoadjuvant polychemotherapy proved advantageous only in combination with postoperative surgery, and, on the whole, its application was as effective as adjuvant administration of cytostatic drugs. However, considering significant increase in recurrence-free survival in neoCT-sensitive patients within the first years of follow-up, one can expect to obtain higher stable effect in application of methods leading to more frequent complete regression.
