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Biomedical subjects

C Clemm

Publications and source records attributed to C Clemm.

At least 37 records · Page 2Linked to original sources
PubMed1993

Testicular cancer and Hodgkin disease in the same patient.

BACKGROUND: Although testicular cancer and Hodgkin disease are the neoplasms with the highest incidence in young men, only 13 cases of metachronous and 2 cases of synchronous occurrence in the same person were reported before 1991. METHODS: A 30-year-old man is described, in whom, 2 years after radiation therapy for Stage IIIA Hodgkin disease, a testicular nonseminomatous germ cell tumor developed with metastatic spread to the retroperitoneal lymph nodes, lung, and left supraclavicular fossa. The second case report describes a 31-year-old man in whom a metastasizing nonseminomatous testicular cancer, with elevation of levels of the serum tumor markers alpha-fetoprotein and human chorionic gonadotropin, developed simultaneously with axillary lymphadenopathy that was histologically confirmed Hodgkin disease. RESULTS: After five cycles of cisplatin-based chemotherapy and secondary retroperitoneal lymphadenectomy, the patient with metachronous disease has remained in complete remission for 8 years. The patient with synchronous occurrence has been disease-free for 14 months after five cycles of chemotherapy consisting of cisplatin, etoposide, and doxorubicin (Adriamycin, Adria Laboratories, Columbus, OH). CONCLUSIONS: The metachronous and synchronous occurrence of testicular cancer and Hodgkin disease is a rare association of two curable neoplasms. The presence of both malignant neoplasms should be taken into consideration in young male patients, especially if disease distribution diverges from a regular pattern.

Adult↗
PubMed1993

A phase I/II study of a stepwise dose-escalated regimen of cisplatin, etoposide and ifosfamide plus granulocyte-macrophage colony-stimulating factor (GM-CSF) in patients with advanced germ cell tumours.

In order to improve the survival of patients with metastatic advanced disease germ cell tumours (according to Indiana University classification), 77 patients were treated by a stepwise dose-escalated combination regimen of platinum (P), etoposide (E) and ifosfamide (I) (PEI) followed by application of granulocyte-macrophage colony-stimulating factor (GM-CSF) (10 micrograms/kg subcutaneously per day at levels 2 and 3) starting the first day after chemotherapy for 10 consecutive days. The maximally tolerated dose was reached at the third dose level with P 30 mg/m2, E 200 mg/m2 and I 1.6 g/m2, all given for 5 days, once every 21 days, for a total of four cycles. Sixty-seven per cent of patients had three or more metastatic sites. Twenty-two per cent of patients had extragonadal primary tumours. 49 (65%) patients achieved complete remission, and 9 additional patients (12%) achieved marker normalisation with unresectable residual disease. After a median follow-up of 27 months, the overall survival is 80%, with 67% of patients remaining free from progression. The dose-limiting toxicities were WHO grades 3/4 mucositis/enteritis in 33% of patients and prolonged thrombocytopenia < 20.000/microliters (> 10 days). Adverse reactions to GM-CSF occurred in 13% of patients. The use of a single haematopoietic growth factor allowed only a moderate increase in dose intensity (factor 1.37). Peripheral blood stem cells will be additionally incorporated into the treatment protocol in order to deliver multiple cycles of an upfront dose-intensified PEI regimen in patients with "poor risk" germ cell tumours with less toxicity.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Prognostic implications of tumour marker analysis in non-seminomatous germ cell tumours with poor prognosis metastatic disease.

86 unselected patients with poor risk metastatic non-seminomatous germ cell tumours (NSGCT) treated from 1979 to 1990 at a single institution were reviewed with regard to the prognostic relevance of tumour marker analysis. The number of elevated tumour markers was not able to distinguish patients into prognostic subgroups. Pretreatment levels of human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH) did not have a significant influence on clinical outcome. HCG and AFP half-life analysis during the first chemotherapy cycles also failed to define prognostic subgroups. If early deaths within 90 days after the onset of chemotherapy were excluded, patients with a half-life of HCG decline greater than 3.5 days tended to have a poorer prognosis which did not reach significance.

Adult↗
PubMed1993

Etoposide, cisplatin, bleomycin, and cyclophosphamide (ECBC) as first-line chemotherapy for poor-risk non-seminomatous germ cell tumors.

Sixty-one patients with advanced metastatic non-seminomatous germ cell tumors were treated with etoposide 120 mg/m2, cisplatin 30 mg/m2, bleomycin 12 mg/m2, and cyclophosphamide 300 mg/m2 daily for four days; and additional bleomycin bolus injection of 15 mg was given on day 1. Fifty patients (82%) were treated with four to six courses at 3-week intervals. Forty patients (66%) attained complete remission, and further 7 patients (11%) achieved a marker-negative partial remission accounting for a favorable response rate of 77%. Hematologic toxicity was considerable and there were two treatment-related deaths. After a median observation time of 47 months (range 12 to 108 months), 43 patients were alive, of which 38 had continuous complete remission, one a second complete remission, two marker-negative stable disease and two progressive disease. Our results are similar to those reported by other investigators for poor-risk metastatic non-seminomatous germ cell tumors treated with dose-intensified regimens.

Adolescent↗
PubMed1993

[Current status of therapy of CNS metastases of germ cell tumors].

The incidence of CNS metastases in germ cell tumors is 2-5% and in very advanced disease over 20%. We report on 37 patients in whom CNS metastases were diagnosed with the CAT scanner. Twenty-nine patients were subsequently treated. In 19 cases, treatment consisted of radiotherapy, 1 patient was only operated on, and in 9 cases patients received combined surgery and radiotherapy. Two patients had seminomatous germ cell tumors, 27 patients non-seminomatous tumors. HCG levels were high in 11 cases. In 31 patients the disease was in the advanced stages; in 6 the disease was at the early stage. If there was just a solitary tumor, operation was the preferred mode of treatment. Radiotherapy consisted of 50 GY whole-brain irradiation, with a tumor saturation up to 60 GY. In 2 cases we suspected radiogenic necrosis. There were no other severe side effects. Of the 37 patients, 4 obtained a long-term cure (observation time 34-90 months). Therapy must take all methods of treatment into consideration and should only be carried out in fully equipped medical centers. Only then can we hope to obtain long-term cures in individuals with this usually fatal disease.

Adult↗
PubMed1991

[Rehabilitation of patients with malignant germ cell tumor].

The progress achieved in the treatment of the malignant germ cell tumor of the male is based on the introduction of cisplatin in polychemotherapy and of consistent interdisciplinary cooperation (including surgery). Thus more than 70% of testicular cancer patients are now cured long term. Early diagnosis and consistent therapy increase the chances of survival additionally. The chances of successful therapy are markedly higher in early tumor stages (90%) than in late tumor stages (less than 50%), where intensive therapy modalities are being tried (bone marrow transplantation, cytokines). After reaching complete remission, consistent follow up programmes are important in order to detect a relapse (10-15%), and to enable the patient to return to his profession. Psychosocial care is also an important factor. The patient should under no condition be pensioned off, more than 90% of the mainly very young patients (median age 20-35) can return to work after the phase of intensive therapy (3-6 months). In the case of our 222 patients, only 13 had to be pensioned and 7 received new professional training. A disabled pass should be issued, whereby the extent of the disability is reduced from at first 80%-100% to 20% after a period of 5 years. The entry into civil service and a life insurance policy are also usually possible after 5 years. To aid in the consistent and necessary follow up of this group of hopeful and highly curable patients, we have had good experiences in Bavaria with a follow up calendar.

Combined Modality Therapy↗
PubMed1990

Donor leukocyte transfusions for treatment of recurrent chronic myelogenous leukemia in marrow transplant patients.

Three patients with hematologic relapse after bone marrow transplantation for chronic myelogenous leukemia were treated with interferon alpha and transfusion of viable donor buffy coat. All had complete hematologic and cytogenetic remission, which persisted 32 to 91 weeks after treatment. In two patients graft-versus-host disease developed and was treated by immunosuppression. These results are an example of adoptive immunotherapy without cytoreductive chemotherapy or radiotherapy in human chimeras.

Adult↗
PubMed1989

[Long-term side effects of successful anti-tumor therapy. 2: Effects on fertility and bone marrow function; risk of secondary neoplasms].

Although long-term adverse effects can also manifest as a persistence of acute adverse reactions, true late sequelae of prior treatment often occur like a "bolt from the blue", as it were. In Part I of this paper, long-term adverse reactions affecting the skin, blood vessels, nerves were described. In the second part of this paper, the adverse effects on fertility are discussed, with attention being paid to mutagenicity, the rate of anomalies and miscarriages, and disorders of bone marrow function. Finally, the question as to secondary malignant disease, in particular the risk of secondary leukemia, is considered.

Antineoplastic Agents↗
PubMed1989

[The long-term side effects following successful anti-tumor therapy. 1: Effects on internal organs, skin, nervous system, skeleton and endocrine glands].

Adverse effects of the treatment of malignant diseases can manifest early and acutely, but may also appear late and become chronic. While the former reactions are usually readily recognizable and well-known, late sequelae have a greater range of fluctuation, depending upon the type of therapy employed (radiotherapy or chemotherapy, or a combination of the two), the drug administered (mechanism of effect, dose) and the influence of the disease itself (type of tumor, curability). The age of the patient is also a considerable factor; thus, treatment of childhood tumors is associated with late sequelae that often do not appear until late adulthood or even in the next generation. This paper discusses a number of the long-term side effects. In the first part, undesired effects on the skin (and hair), lungs and heart, kidneys and the urinary bladder, stomach, bowels and liver, blood vessels, nerves, bones and endocrinological functional disorders, are described.

Antineoplastic Agents↗
PubMed1989

[Treatment of stage I-IIB nonseminomatous testicular tumors].

Data on 90 patients (median age 26 years, range 15-65) with nonseminomatous testicular tumour (NTT) were analysed retrospectively to evaluate the effectiveness of adjuvant chemotherapy: 55 patients had received postoperatively (semicastration, retroperitoneal lymphadenectomy) adjuvant chemotherapy. They have now lived tumour-free for a median period of 67 (range 8-107) months. These results were compared with a group of 35 patients with recurrence of NTT who, after the primary operation, had been merely followed-up but, on diagnosis of recurrence, had received intensive chemotherapy with removal of the recurring tumour, if indicated. Nonetheless, only 24 of these 35 patients (69%) went into a lasting remission. A favourable factor was regular follow-up examinations with early diagnosis of any recurrence. Thus in a quarter of the patients a possible curative chance was missed despite an initially low tumour stage. The results suggest that omission of operative or chemotherapeutic measures is justified only if careful followup is assured.

Adolescent↗