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Biomedical subjects

A Bono

Publications and source records attributed to A Bono.

At least 55 records · Page 3Linked to original sources
PubMed1993

Orchidectomy versus goserelin plus flutamide in patients with metastatic prostate cancer (EORTC 30853). European Organization for Research and Treatment of Cancer--Genitourinary Group.

A total of 327 patients with metastatic prostate cancer were randomized to receive bilateral orchiectomy or treatment with Zoladex and flutamide. The trial aimed to evaluate subjective and objective time to progression, survival, and incidence and duration of response. Strict quality control and evaluation by independent ad hoc committees were organized. Progression was assessed for each of 13 parameters. The time to subjective and objective progression was in favor of the combination treatment, with statistical significances of P = 0.009 and P = 0.008, respectively. This delay in objective progression resulted in increased survival in favor of the combination treatment for death by cancer (P = 0.02) or overall survival (P = 0.05). Survival differences were more marked in the patients with better prognostic factors. The clinical significance of these differences for the individual patient requires detailed assessment.

Adult↗
PubMed1993

Goserelin acetate and flutamide versus bilateral orchiectomy: a phase III EORTC trial (30853). EORTC GU Group and EORTC Data Center.

Maximal androgen blockade (MAB), the eradication of the effects of adrenal androgens on prostate cancer cells after castration, has been used with differing success in the treatment of prostatic carcinoma. The aim of this randomized phase III study was to compare the efficacy and side effects of bilateral orchiectomy versus a combination of a luteinizing hormone-releasing hormone agonist (LHRH-A) depot formulation, goserelin acetate (3.6 mg s.c. once every four weeks), and flutamide (250 mg three times daily), in patients with metastatic cancer. Treatment usually continued until disease progression (or for a minimum of three months). Efficacy was assessed by response, time to disease progression, and duration of survival. Clinical evaluations, standard laboratory tests, and imaging examinations were carried out regularly. A total of 327 patients were entered in this study. There was a difference in response only for prostatic acid phosphatase (PAP) with a more frequent decrease of the serum values to normal in the serum in patients assigned to MAB treatment. The MAB treatment, however, proved significantly better for time to subjective progression, time to objective progression, time to first (subjective and objective) progression, and duration of survival. The most frequent side effects for both treatments included hot flushes and gynecomastia. In conclusion, significant time to progression and survival benefits are achieved by adding flutamide to an LHRH-A regimen, probably improving the quality of life of patients with metastatic cancer.

Aged↗
PubMed1993

Laser surgery for small perianal neoplasms.

Excisional laser surgery was used to treat 62 patients suffering from perianal, perineal, and anal canal neoplasms. 48 patients had benign epithelial or pigmented tumours, 12 had carcinoma in situ and 2 had invasive squamous cell carcinoma. Laser surgery was performed under local anaesthesia, in association with the operating microscope on an outpatient basis. 59 out of 62 patients (95%) had clear margins of resection after primary laser surgery, and 3 patients required a second excision for uncleared margins. 3 patients of the group of carcinoma in situ recurred, and 2 had new disease in an untreated area. These patients underwent re-section with the same technique. No significant local complications were observed for single or multiple operations at the perianal and anal canal level. All patients are disease-free in a follow-up ranging from 4 to 113 months, with a median of 25 months. Laser excisional surgery appears to be a suitable method for treating superficial tumours.

Adolescent↗
PubMed1993

Effect of splenectomy on von Willebrand factor multimeric structure in thrombotic thrombocytopenic purpura refractory to plasma exchange.

Treatment-related changes in plasma von Willebrand factor (vWf) multimers were studied in two patients with thrombotic thrombocytopenic purpura (TTP) undergoing splenectomy because of refractoriness to plasma exchange. In both cases, a decrease in the largest normal vWf multimers was found at presentation. In one case, splenectomy resulted in a long-term remission and was followed by a normal multimeric pattern. In the other case, splenectomy failed to produce a remission and was followed by the appearance of ultralarge multimers, which disappeared--resulting in a normal pattern--when a sustained remission was achieved after vincristine infusion and further plasma exchanges. These results suggest that splenectomy per se has no consistent effect on the vWf multimeric structure in TTP patients, and provide further evidence on the good prognostic value of the achievement of a normal multimeric pattern in these patients.

Adolescent↗
PubMed1992

Mondor's disease and breast cancer.

Mondor's disease or thrombophlebitis of the subcutaneous veins of the chest region is an uncommon condition and is rarely associated with breast cancer. From January 1980 to June 1990, 63 cases of Mondor's disease were diagnosed (57 women and 6 men). In 31 patients, no apparent cause was determined (primary disease), whereas in 32 cases, the disease was secondary because the etiopathogenesis could be discerned. The identified potential causes were three cases of myentasis (all in men), eight cases of accidental local trauma (seven in women), seven cases of iatrogenic origin (three surgical breast biopsies, one skin biopsy, one needle biopsy, one mastectomy, and one reconstruction operation), six cases of inflammatory process, and eight cases associated with breast cancer (all females). Three of the tumors were less than 1 cm in diameter. The authors performed conservative surgery in four patients and demolitive in the other four. In this series, the incidence of breast cancer in association with Mondor's disease was the highest yet reported (12.7%). It was concluded that Mondor's disease may at times be caused by breast carcinoma. This association is by no means exceptional and implies that mammography should always be performed for Mondor's disease, even when the results of a physical examination are negative.

Adult↗
PubMed1992

Which therapy for unexpected phyllode tumour of the breast?

216 consecutive female patients with histologically confirmed phyllode tumour, the largest series yet reported, were operated on from 1970 to 1989 at our institute and followed-up for a mean period of 118 months. The type of surgery in relation to tumour histotype and natural history were investigated in order to identify the best treatment for this rare breast neoplasm when found unexpectedly at the final histological examination. For the 140 benign tumours, 55 enucleations, 52 enucleoresections, 29 wide resections and 4 mastectomies were performed; the 30 malignant lesions were treated with 3 enucleations, 7 enucleoresections, 9 wide resections and 11 mastectomies; the 46 borderline cases received 11 enucleations, 12 enucleoresections, 18 wide resections and 5 mastectomies. 28 underwent radical surgery following histological diagnosis. There were 27 relapses: 11 (7.9%) in benign, 7 (23.3%) in malignant and 9 (19.6%) in borderline cases. The average disease-free intervals were 32 months for benign, 22 months for malignant and 18 months for borderline phyllode tumours. It is concluded that a wide resection in healthy tissue is indispensable for malignant and borderline phyllode tumours, while where benign phyllode tumour is encountered unexpectedly, even if a limited resection was performed, a wait-and-see policy is justified.

Adolescent↗
PubMed1991

Palliative surgery of metastatic bone disease: a review of 83 cases.

Of a total of 83 patients with metastatic bone disease, surgery was performed in 17 cases at the prefracture stage, in 54 cases after complete fracture and in 10 cases to decompress the spinal cord. Positive short-term results were obtained in 75% of cases. 7 patients presented mild complications. In 2 cases, the patients had to be reoperated. 55% of the patients were still alive after 6 months, 31% after 12 months and 10% after 2 years.

Adult↗
PubMed1991

Total androgen ablation: European experience. The EORTC GU Group.

Zoladex plus flutamide significantly delays the time to progression (subjective, objective, first progression) compared with orchiectomy, but no difference in survival (death from all causes or from malignant disease) could be detected. Thus, a delay in the appearance of progression has not improved survival. In fact, the duration of survival after progression tends to be shorter on Zoladex plus flutamide. There is thus no evidence to suggest any survival benefit with Zoladex plus flutamide. The quality control of our data revealed acknowledged problems in defining responses in patients with advanced prostate cancer. The review of the Bone Scan Committee provided the data for Tables 5 to 7. These data must provoke some reflections and emphasize once again the heterogeneity of the studied patient population. Table 4 on pain response after 4 weeks is just one of the many items to be analyzed by the committees for response criteria and quality of life. We expect that the other trials face similar problems. More work and patience are needed to obtain a firm answer to this clinical problem. These efforts will never be wasted, however, because the combined results of these trials will increase our knowledge of the treated history of prostate cancer and will, we hope, indicate a net treatment benefit in some subsets of patients. An individually tailored treatment for each patient selected from the anonymous mass of cases of advanced prostate cancer would be the highest reward of our continued collaboration with all the study groups.

Aged↗
PubMed1990

Orchidectomy versus Zoladex plus Eulexin in patients with metastatic prostate cancer (EORTC 30853).

A total of 327 patients with metastatic prostate cancer have been randomized to either orchidectomy or treatment with goserelin (Zoladez) 3.6 mg depot preparation combined with flutamide (Eulexin) 250 mg t.i.d. in a phase III study (EORTC 30853). A small but statistically significant difference in time to subjective and objective progression of disease was found in favour of the combination treatment. However, time from objective progression to death was longer in the group initially allocated to orchidectomy. Thus no difference was found in overall survival between the two treatment groups. The clinical significance of these differences requires further follow up and analysis.

Aged↗
PubMed1990

Some limitations of the radioisotope bone scan in patients with metastatic prostatic cancer. A subanalysis of EORTC trial 30853. The EORTC Urological Group.

This article reviews the serial bone scans of 149 of 327 patients entered into a randomized prospective trial comparing orchidectomy versus zoladex and flutamide in patients with metastatic prostatic cancer. Attention is drawn to the difficulty of evaluating the response rate and of the importance of tumor load in determining survival. The use of sequential bone scans once the diagnosis of metastatic disease has been confirmed is of questionable value as the scans are expensive and contribute little to the further management of the patient in the absence of symptoms requiring relief.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Orchidectomy vs. Zoladex plus flutamide in patients with metastatic prostate cancer. The EORTC GU Group.

Treatment with bilateral orchidectomy was compared with Zoladex, 3.6 mg depot, plus flutamide, 250 mg t.i.d., in a randomized prospective study by the European Organization for Research and Treatment of Cancer (EORTC). Small but statistically significant differences in time to subjective and objective progression of disease were found in favor of Zoladex plus flutamide. However, time from objective progression to death was longer in the orchidectomy group. The clinical significance of these differences requires further follow-up and analysis. No difference was found in overall survival between the 2 treatment groups.

Aged↗
PubMed1990

Small sized phyllodes tumor of the breast.

From 1970 to 1988, 106 women (aged 13-63 years) suffering from phyllodes tumor of the breast underwent surgery at the Day Hospital in the Istituto Nazionale Tumori, Milan. Treatment consisted of enucleation in 57, enucleoresection in 42 and wide resection in seven. Ninety-two cases (86.8%) were benign, 12 (11.3%) borderline and two malignant. All the borderline and malignant tumors were submitted to wider resection as inpatients. The 12 borderline cases underwent wide resection while a subcutaneous mastectomy was performed in the two malignant cases. A mean follow-up of 49 months was carried out on 85 patients (range 1-186). The relapses, all in the benign group (6 cases; 6.52%), were much lower than reported by other authors (20-33%). This may be related to neoplasia size (less than 40 mm in 85.3%) and not to type of limited surgery. Although limited surgery was performed in 93.4% of cases (pre-operative diagnosis being unknown) the number of relapses was so low that re-operation with wider resection in healthy glandular tissue was not justified. However it is still performed in borderline and malignant phyllodes. The natural history of this tumor requires a prolonged follow-up since relapses may occur many months after operation (in our series 52).

Adolescent↗