BEACOPP therapeutic regimen for patients with Hodgkin's disease and HIV infection.

BACKGROUND: Hodgkin's disease (HD) is the most common non-AIDS-defining tumor diagnosed in HIV-infected patients. Antineoplastic treatment is difficult considering the underlying immunodeficiency caused by HIV itself and may increase the risk of opportunistic infections. The purpose of this study was to evaluate the efficacy and safety of the chemotherapeutic regimen bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone (BEACOPP) in HIV-infected patients with HD (HIV-HD). PATIENTS AND METHODS: Twelve patients with HIV-HD were scheduled to receive six cycles of BEACOPP. Five patients received concomitant antiretroviral therapy. Two patients received additional radiotherapy. Restaging was carried out after three and six cycles of chemotherapy. CD4 counts and HIV RNA levels were regularly monitored during the course of chemotherapy. RESULTS: Complete remission (CR) was achieved in all patients. Of 12 patients, eight patients received the intended six cycles of BEACOPP. Two patients died of opportunistic infections within the treatment period, one patient died of a relapse after 26 months. The other nine patients remain in CR for their individual follow-up period, median 49 months (range 13-108). The most commonly observed toxicity was bone marrow suppression with National Cancer Institute Common Toxicity Criteria (NCI-CTC) grade 3/4 leukopenia in 75% of all cases. The mean decline of CD4+ lymphocytes was 238 +/- 230/ micro l, with a mean recovery of 272 +/- 329/ micro l 6 months after the last cycle. Plasma levels of HIV RNA increased moderately or even declined under chemotherapy if highly active anti-retroviral therapy was given concomitantly with BEACOPP. CONCLUSIONS: The BEACOPP regimen is feasible and highly effective in HIV-HD patients. With respect to its overall moderate toxicity, BEACOPP is a safe regimen even in the immunocompromised patient.

[Therapeutic results of ultrasonically-guided kidney cyst punctures]. / Therapeutische Ergebnisse der ultraschallgeführten Nierenzystenpunktion.

The behaviour of renal cysts following puncture was studied in 62 patients on whom a simple diagnostic puncture had been performed and on fourteen patients who, in addition, had some of their own blood injected into the cyst. Twenty-one patients (34%) of the first group and eight patients (57%) of the second group showed definite reduction in the size of the renal cyst after an average period of observation of fifteen months. In 7%, the cyst disappeared completely following puncture. Parapelvic cysts showed much less tendency to disappear than did cortical cysts. The results of injecting autologous blood are comparable with those of injecting lipid soluble contrast media as a sclerosing agent. Before surgical removal of a symptomatic renal cyst is contemplated, puncture and evacuation of the cyst with autologous blood injection is recommended.

[Reduced-dose adjuvant CMF-chemotherapy combined with postoperative irradiation in breast cancer with lymphatic metastases. A prospective study of 45 patients]. / Adjuvante CMF-Chemotherapie mit reduzierter Dosis kombiniert mit postoperativer Bestrahlung beim lymphogen metastasierten Mammakarzinom. Eine prospektive Studie an 45 Patientinnen.

From 1978 to 1982, 45 postoperative cases of breast cancer with lymphatic spread received radiation to the chestwall and axillary, supra- and infraclavicular lymph nodes up to 40 Gy. In addition, we gave 600 mg cyclophosphamide, 50 mg methotrexate and 750 mg 5-fluorouracil intravenously on day 1 of altogether nine 21-day cycles. The median follow-up is 37 months, and we calculate a 5-year over-all actuarial survival-rate which was 83% in the premenopausal and 77% in the postmenopausal patients. The disease-free 5-year survival-rate was 74% for the premenopausal and 61% for the postmenopausal women. There were twice as many patients with stage N2 in the postmenopausal group. No severe side-effects were observed. These promising preliminary results and the good tolerance of the above-mentioned combined therapy recommend it for future randomized studies.

[Ultrasound-guided thin-needle biopsy in focal liver diseases. II. Benign focal liver diseases]. / Ultraschallgeführte Feinnadelbiopsie herdförmiger Lebererkrankungen. Teil II: Benigne herdförmige Lebererkrankungen.

Sixty patients with benign focal liver disease underwent sonography-guided percutaneous fine needle biopsy for definitive diagnosis. The benignancy of all lesions was determined accurately by cytohistologic evaluation. All 44 liquid space-occupying lesions (30 hepatic cysts, 9 abscesses, 3 hematomas, 2 serous residual cavities after surgery) could be classified by cytological, biochemical and bacterial examination. The diagnosis of hepatic hemangiomas by fine needle puncture is problematic, because the cytological identification of benign endothelial cells is difficult. The histological examination of tissue cylinders of 4 small echogenic lesions revealed focal fatty change of the liver. Tissue fragments of focal nodular hyperplasias and liver cell adenomas showed histologically typical liver cells arranged in trabecular structure. The additional identification of bile ducts supplies proof of focal nodular hyperplasia and excludes liver cell adenoma. Percutaneous puncture of liver abscesses and cysts afforded effective therapeutic decompression. Eight out of 9 liver abscesses were cured by evacuating fine needle puncture. More than 50% of the liver cysts showed long-term growth shrinkage subsequent to puncture. The histological confirmation of benign and malignant liver tumors by sonographyguided fine needle biopsy is considered a decisive step forward in the diagnostic possibilities of update imaging methods.

[Ultrasound-guided thin-needle biopsy in focal liver diseases. I. Malignant hepatic tumors]. / Ultraschallgeführte Feinnadelbiopsie herdförmiger Lebererkrankungen. Teil I: Maligne Lebertumoren.

Eighty-six patients with focal liver disease underwent sonography-guided percutaneous fine needle biopsy for definitive diagnosis. Twenty-five out of twenty-six neoplastic liver tumors were correctly recognized as malignant. A sensitivity of 96% and a specificity of 98% (25 true positives, 60 true negatives, 1 false negative) was obtained. The high accuracy rate of this diagnostic procedure is explained by the precision of sonographic guidance and the copious excision of tissue material. In 57% of the malignant tumors, small tissue cylinders were obtained besides cytological material, which allowed a definitive tumor diagnosis in 11 out of 15 cases by histologic examination. In addition, the histologic evaluation of tissue fragments enables the differentation between primary and secondary hepatic malignomas. Because of the higher specificity of histological diagnosis, fine needle puncture of solid liver tumors should always provide tiny tissue cylinders for histologic examination.

[Induction of solid tumors by ionizing radiation]. / Induktion solider Tumoren durch ionisierende Strahlung.

Secondary malignancies are a rare complication after irradiation. 31 observations of such tumours are described, which appeared 4 to 56 years after radiotherapy. The NSD values varied between 400 and 3500 ret. 19 patients developed sarcomas and 12 others carcinomas. The hypotheses of radiation induced tumours and their clinical relevance are discussed. Three patient groups at risk may be distinguished: 1. children, 2. patients who received several treatment series, 3. patients who received combined radio- and chemotherapy.

[Results of standardized postoperative radiotherapy in circumscribed breast cancer. A retrospective study of 432 patients]. / Ergebnisse der standardisierten postoperativen Strahlentherapie beim lokal begrenzten Mammakarzinom. Eine retrospektive Studie an 432 Patientinnen.

From 1970 through 1981 232 women with breast cancer (190 with T1 N0 M0 and 242 with T2 N0 M0 disease) received postoperative radiotherapy . The usual surgical procedure was simple mastectomy with axillary lymph node dissection. The chest wall was irradiated using 137Caesium up to 40 Gy, while supraclavicular, infraclavicular and axillary lymph node areas were irradiated using 5,7 MeV photons up to 45 Gy. The rate of local recurrence was 2,4% and 3,3% in stage T1 and T2 respectively. The corresponding projected ten-year-survival was 88% and 78%, respectively. These data and results obtained by others may strengthen the grounds for recommending conservative surgical approaches in early stage breast cancer, in combination with tumoricidal radiotherapy, individualized according to the anatomic tumor site.

[Ultrasonically guided antegrade pyelography in kidney transplantations]. / Ultraschallgeführte antegrade Pyelographien bei Nierentransplantaten.

The indications for, and technique of ultrasound-guided antegrade pyelography of renal transplants are illustrated by eight patients. Because of the detailed anatomical information which the antegrade method provides, it is superior to other diagnostic methods for the investigation of ureteric obstruction or fistulae. The severity of renal pelvis dilatation as shown by sonography must not be taken as a criterian for the grade of obstruction, since transplants may show dilated collecting systems, even in the absence of obstruction. In our view, real time sonography with a suitable probe provides the best means of achieving successful puncture of the renal pelvis. The combination of ultrasound-guided puncture and radiological contrast examination of the ureter is the best diagnostic method available and lead, in all eight cases, to immediate and definitive treatment.

Sonographic criteria for renal allograft rejection.

In order to define sonographic criteria for acute rejection of renal allografts, the following sonographic criteria were evaluated: (a) parenchymal thickness, (b) index of maximal sagittal to maximal longitudinal diameter, (c) cortical echos, (d) sinus echo changes, and (e) the medullary pyramids. Thirteen kidneys were removed for rejection. All had ultrasound studies 24 hours preoperatively. The sonographic changes in rejected kidneys were compared to those in 21 normal allografts. We found that renal enlargement, enlarged medullary pyramids, and a reduction in or a disappearance of the sinus echos were seen in acute rejection but were not seen in normal renal transplants. We conclude that these criteria are early signs of acute rejection and may be helpful in diagnosis, particularly if control sonograms are available.