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Biomedical subjects

C Mercke

Publications and source records attributed to C Mercke.

At least 37 records · Page 2Linked to original sources
PubMed1996

Effect of hemithorax irradiation alone or combined with doxorubicin and cyclophosphamide in 47 pleural mesotheliomas: a nonrandomized phase II study.

In order to assess the value of radiotherapy in the treatment of pleural mesotheliomas, we studied tumour response and survival after hemithorax irradiation alone (RT), or radiotherapy combined with doxorubicin and cyclophosphamide chemotherapy (RTCT). Forty seven patients with pleural mesotheliomas received irradiation of the diseased hemithorax at 8 MV (megavolt) photons to a total dose of 40 Gy, administered in 20 daily fractions of 2 Gy for 5 days a week. One month after RT, patients aged < or = 70 yrs with a good performance status were offered supplementary chemotherapy (CT) with doxorubicin 30 mg.m-2 body surface on Day 1 and Day 8, combined with cyclophosphamide 600 mg.m-2 on Day 1, in cycles of 21 days. Tumour response was evaluated by computed axial tomography (CAT) before and 1 month after RT and/or CT. Only 3 of the 47 (95% confidence interval (95% CI)-0.6-13%) irradiated tumours responded with a partial response (PR). In 31 patients treated with RT alone, one PR was observed; whereas, in the combined treatment group, 2 out of 16 responded with PR to RT. CT with doxorubicin and cyclophosphamide induced only 2 out of 16 PRs (95% CI -3.4-28.4%), and the combined treatment consisting of RT followed by CT induced 2 out of 16 PRs. The median survival following the initiation of RT was 7 months in all patients (n = 47), 6 months in the RT group (n = 31), and 13 months in the combined RTCT group (n = 16). Chest pain, performance status and body weight were not favourably affected by the radiotherapy. We conclude that hemithorax irradiation of pleural mesotheliomas with a moderately high dose is not useful, since it produces no improvement in chest pain, few objective tumour responses and no prolongation of survival.

Aged↗
PubMed1996

Advanced laryngeal cancer T3-T4 in Sweden: a retrospective study 1986-1990. Survival and locoregional control related to treatment.

Different treatment modalities for advanced laryngeal cancer are much discussed in the literature. One-hundred-and-sixty patients with T3-4, N0-3, M0-1 laryngeal cancer diagnosed in Sweden between 1986 and 1990 were retrospectively analysed. One hundred (65 T3: 35 T4) received radical radiotherapy with salvage surgery (RRSS) in case of residual or recurrent disease. Thirty-eight (11T3: 27 T4) patients received surgery with or without radiotherapy (S +/- RT). Twenty-two patients received no treatment. After a median follow up of 4.4 years, the estimated 5-year actuarial corrected survival and 3-year locoregional control were 59% and 44% for T3 RRSS and 47% and 54% for T3 S +/- RT. No significant difference between the different treatment modalities was found. The 5-year corrected survival rate and the locoregional control at 3 years between T4-RRSS (32%; 26%) and T4-S + RT (58%; 68%) groups were significantly different (p < 0.05 and p < 0.01). This might suggest that surgery with or without radiotherapy still has its place as a treatment modality for patients with advanced T4 laryngeal carcinoma.

Adult↗
PubMed1993

Prognostic factors for local control and survival of cancer of the oral tongue. A retrospective analysis of 230 cases in western Sweden.

During the 19-year period from 1970 to 1988, 289 cases of squamous cell carcinoma of the oral tongue were diagnosed in Western Sweden. In 230 of these, treatment regimens and results were analysed in an attempt to define prognostic factors for local control and survival. Tumour stages were: T1 26%, T2 32%, T3 30% and T4 13%. Nodal disease was seen in 32% of the patients. Sixty per cent of the patients had surgery, 74% external with or without combination with interstitial irradiation; and 32% received chemotherapy. The local control rate at five years was 59% (T1 66%, T2 67%, T3 44% and T4 0%). Survival at five years was 37% (T1 61%, T2 51%, T3 19% and T4 0%). By a multivariate procedure we demonstrate that the tumour related variables T-category, N-category and extension to the tonsillar region had a significant association with survival. Extension to the tonsillar region, extension to the floor of the mouth and level of neck nodes were significantly associated with local-regional control.

Adult↗
PubMed1992

Potential impact on tumor control and organ preservation with cisplatin and 5-fluorouracil for patients with advanced tumors of the paranasal sinuses and nasal fossa. A prospective pilot study.

METHODS: Twelve patients with advanced epithelial nonadenocarcinoma of the paranasal sinuses and nasal fossa were treated with three cycles of cisplatin (100 mg/m2, day 1) and 5-fluorouracil (1000 mg/m2/24 hours on days 1-5 by continuous infusion), followed by preoperative external radiation therapy of 48 Gy and limited surgery, clearing the paranasal sinuses and nasal fossa. RESULTS: After chemotherapy, 11 of 12 patients were free of the previous symptoms of disease. Clinical response rates were different, however, with an overall response rate of approximately 70% with no complete responses. Histopathologic analysis of resected specimens showed no vital tumor in eight patients, minimal microscopic disease in three patients, and infiltrating tumor in one patient. Local control was achieved in 11 of 12 patients. Ten patients are alive with no evidence of disease (mean follow-up, 27 months). Surgical mutilation was avoided, with no functional or cosmetic loss. CONCLUSIONS: The results of this small pilot study seem to indicate a high chemosensitivity of carcinomas of the paranasal sinuses and nasal fossa, which, in this study, has meant significant relief of symptoms and an unusually high rate of local control (90%) without mutilation.

Actuarial Analysis↗
PubMed1991

Induction chemotherapy (cisplatin + 5-fluorouracil) and radiotherapy in advanced squamous cell carcinoma of the head and neck.

A phase II study was made of 58 consecutive patients with previously untreated locally advanced squamous cell carcinomas of the head and neck. The induction chemotherapy consisted of 3 courses of cisplatin (100 mg/m2) and a subsequent 120-h infusion of 5-fluorouracil (1,000 mg/m2/24 h) repeated every 3 weeks. It was followed by radiotherapy to a median target dose of 66 Gy and surgery for residual tumour. A total of 91 per cent received all 3 courses of chemotherapy, which was well tolerated. Complete response (CR) was obtained in 20 patients (35%) after chemotherapy and in 40 patients (69%) after subsequent radiotherapy. The median observation time was 28 months (range 15-57). The actuarial survival at 2 years for complete responders to chemotherapy was 83 per cent, implying a prolonged survival (p = 0.002) compared to those with less than CR. Complete responders after chemotherapy had also a significantly longer recurrence-free survival, though 19 out of 20 did not undergo surgery. Complete response after this induction therapy is thus an important prognostic predictor.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Primary radiotherapy for glottic laryngeal carcinoma stage I and II. A retrospective study with special regard to failure patterns.

A retrospective study has been made of 302 patients with vocal cord carcinoma stage I and II treated between 1963 and 1983, emphasizing treatment failure patterns. The primary treatment modalities were radiotherapy for 266 patients and surgery for 36 patients. The minimum follow-up was 4 years. After primary radiotherapy there were 63 local recurrences and 7 neck lymph node recurrences, all appearing outside the target volume. The actuarial loco-regional recurrence-free rates at 5 years were 78% for T1, 76% for T2a (normal cord mobility) and 60% for T2b (impaired cord mobility) tumors. The actuarial regional lymph node recurrence-free rates at 5 years were 99, 100 and 93% for T1, T2a and T2b tumors respectively. The actuarial corrected survivals at 5 years were 95, 96 and 79% for T1, T2a and T2b tumors with primary radiotherapy and salvage surgery for recurrence. Salvage surgery was less successful in T2b compared to T1 and T2a tumors. In conclusion, after primary radiotherapy with salvage surgery the loco-regional control rate was high and very similar for glottic cancer T1 and T2a but less satisfactory for T2b tumors. Regional lymph node metastases were not a large problem in any of the subgroups. More effective radiotherapy with higher dose levels or an altered fractionation might increase the local control rate for T2 tumors with impaired cord mobility.

Adult↗
PubMed1991

Cisplatin and 5-FU combined with radiotherapy and surgery in the treatment of squamous cell carcinoma of the esophagus. Palliative effects and tumor response.

The combination of cisplatin (90-120 mg/m2) and 5-fluorouracil (5-FU) (1,000 mg/m2/day in continuous infusion for five days) was given for 2-3 cycles, prior to combined radiotherapy and surgery, to 73 patients with esophageal squamous cell carcinoma, 60 with limited disease (LD), and 13 with extensive disease (ED) (i.e. with metastasis) of whom 3 had recurrent disease. Before preoperative radiotherapy among 60 LD patients, 12 (20%) had complete response, 21 (35%) partial response, 25 (42%) had stable disease, and 2 (3%) progressive disease. Swallowing was improved in 35/73 (48%) of the cases. In the resected specimens, no tumor was found in 8/53 (15%) of the cases, microscopic tumor in 18/53 (34%) and macroscopic tumor in 27/53 (51%). In the ED group, complete response of distant metastases was obtained in 6/13 (48%) of the patients, one of whom is still alive with no evidence of disease 62 months after the start of treatment.

Aged↗
PubMed1990

Glottic laryngeal carcinoma with fixed vocal cord treated with full-dose radiation, total laryngectomy or combined treatment.

The results of the therapy of 46 patients with glottic squamous cell cancer with a fixed vocal cord and without regional lymph nodes (glottic T3N0) are reported. Primary surgery (total laryngectomy) in combination with preoperative irradiation gave significantly higher loco-regional control rate and survival rate than surgery alone. Primary radiotherapy with doses of 70 Gy or more and adequate follow-up was found to be an alternative to preoperative radiation and laryngectomy. The result of different treatment modalities speaks in favour of primary irradiation allowing preservation of the larynx and a good voice function. In case of recurrence salvage surgery with total laryngectomy is preferred.

Carcinoma, Squamous Cell↗
PubMed1988

Adverse cardiac effects during induction chemotherapy treatment with cis-platin and 5-fluorouracil.

Survival for patients with advanced head and neck carcinoma and esophageal carcinoma is poor with radiotherapy and/or surgery. Obviously, there is a need for effective chemotherapy. In the present study, cis-platin (80-120 mg/m2BSA) and 5-FU (1000 mg/m2BSA daily as a continuous infusion during 5 days) were given to 76 patients before radiotherapy and surgery. The aim of the study was to clarify the incidence and severity of adverse cardiac effects to this treatment. Before treatment all patients had a cardiac evaluation and during treatment serial ECG recordings were performed. In the pre-treatment evaluation, signs of cardiovascular disease were found in 33 patients (43%). During treatment, adverse cardiac effects were observed in 14 patients (18%). The mean age of these patients was the same as for the entire group, 64 years. The incidence of cardiotoxicity was not higher in patients with signs of cardiovascular disease than in those without in the pre-treatment evaluation. The most common signs of cardiotoxicity were chest pain, ST-T wave changes and atrial fibrillation. This was followed by ventricular fibrillation in one patient and sudden death in another. It is concluded that patients on 5-FU treatment should be under close supervision and that the treatment should be discontinued if chest pain or tachyarrhythmia is observed.

Adult↗
PubMed1987

Effects of fractionated irradiation on the esophageal mucosa: a scanning and transmission electron microscopic study.

The mucosa of rabbit esophagus was irradiated with daily fractions of 2 Gy to an accumulated dose of 20 Gy. Specimens were taken for scanning electron microscopy, transmission electron microscopy and light microscopy investigations. Examination was made 1-10 days after each fractionation schedule. Light microscopy showed dose-dependent edema of the irradiated mucosa which also could be seen and scored from SEM pictures. SEM investigations showed that this was accompanied by loosening of microridges and a slightly increased cell loss. By SEM, a varying amount of bacteria could be seen which did not make intimate contact with the surface cells. During the first five days there was a steady decrease of the number of bacteria in relation to the absorbed dose. In the later period of examination, the amount of bacteria increased up to a given dose of 10 Gy. Thereafter, the number faded off to about zero when 20 Gy had been administered.

Animals↗
PubMed1987

Effects of cis-dichlorodiammineplatinum alone and in combination with ionizing radiation of the esophageal mucosa: a scanning and transmission electron microscopic study.

Cis-dichlorodiammineplatinum (cis-DDP) has for more than 20 years been part of the therapeutic arsenal of oncology. Most of the knowledge about its biological action is based on clinical investigations and therefore an examination of the influence of cis-DDP at the cellular and sub-cellular level is necessary. Five mg of cis-DDP was given intraperitoneally (i.p.) to ten rabbits. Ultrastructural examinations were performed on the upper and lower parts of the esophagus each day after the injection on the following ten days. Another 50 rabbits were given 5 mg cis-DDP and were irradiated in an area just beneath the hypopharynx. They were given 2 Gy at each irradiation and were maximally treated with up to 20 Gy. Examinations were carried out from the first day after the final treatment and each day during ten consecutive days. Five animals were used as controls. Cis-DDP proved to have a deleterious effect on the epithelial layer of the esophageal mucosa with cell loss and structural disarrangement of the microridges and whorls on the surface. This finding was an early phenomenon and lasted for all ten examination days. The changes were not more exaggerated when irradiation was added to the experiments. Repopulation of new cells from the matrix was noticed about five days after the administration of cis-DDP alone.

Animals↗
PubMed1986

Intra-arterial mitomycin C and intravenous bleomycin as induction chemotherapy in advanced head and neck cancer--a phase II study.

Fifty-six patients with previously untreated, unresectable squamous cell carcinomas of the head and neck region were treated with repeated intra-arterial chemotherapy with mitomycin C using a selective or super-selective angiographic technique, and bleomycin given i.v., followed by radical radiotherapy. In addition, restricted tumour-reductive surgery was done in 18 of these patients. The response rate (CR + PR) after completion of the integrated treatment was 89%, with 63% of the patients showing CR. The toxicity of this regimen was, however, far from negligible. The median survival for this series of patients with advanced head and neck cancers is 19 months, and 17 are still alive after 16 + -66 + months.

Aged↗
PubMed1986

Ciliated cells of the trachea of the rabbit, treated with cis-diamminedichloroplatinum (II) alone, or in combination with ionizing radiation.

The ciliated epithelium of the rabbit trachea was irradiated with daily fractions of 2 Gy to an accumulated dose of 20 Gy (TD: 2, 6, 10, 16, or 20 Gy). Fifteen to forty-five minutes before start of the first irradiation (treatment day 1), 5 mg cis-DDP was given by intraperitoneal injection to each rabbit. Examination was made 1 - 10 days after each fractionation schedule, when specimens were taken for investigations. Scanning electron microscope investigations showed a gradual development of ciliary damage from blebs on the cilia to swollen tips, broken and bent cilia and finally an epithelial lining with areas free from cilia with a surface covered with microvilli-like structures. SEM also showed cell loss, and remnants of dead cells on the surface together with detritus. By transmission electron microscope ciliary damage, cell death and cell loss of the ciliated cell layer as well as exfoliation of portions of goblet-like cells on the surface could be confirmed. The irradiated ciliated epithelium and the untreated control epithelium in each animal showed no difference in this respect. Thus no enhancement of the effects of radiation could be observed. The development of ultrastructural damage may be due to a cytotoxic effect of the drug on the ciliated epithelium. However, 19 days after the start of cis - DDP injection, a hyperplasia of the basal cell layer was observed, which indicates that the observed cytotoxicity of the drug is reversible and a normalisation occurs during the last days of observation in this study.

Animals↗
PubMed1985

Scanning electron microscopy and transmission electron microscopy of the ciliated cells of the trachea of the rabbit treated with misonidazole alone and in combination with ionizing radiation.

The trachea is often located in the treatment volume when irradiating malignant tumours in the thorax. In order to evaluate possible synergism between misonidazole and irradiation on this tissue, the following studies were made. Fifty rabbits were treated with daily injections of 100 mg misonidazole given i.p. on consecutive days from 1 to 10 days. Morphological investigations of the trachea were made with scanning electron microscopy (SEM), transmission electron microscopy (TEM) and light microscopy (LM). Physiological examinations were performed with recording of the ciliary beat frequency. The results were compared with those from a group of 100 rabbits given misonidazole in a similar manner and exposed to irradiation (2 Gy) 15-30 min after each injection. Ten rabbits were used as controls. The results are compared to the effect of fractionated irradiation alone with 2 Gy/day. Fractionated irradiation of the ciliary epithelium in the trachea of the rabbit has shown dose-dependent physiological and morphological effects. Misonidazole potentiates these effects of radiation with a more pronounced change of the ciliary beat frequency and an increased metabolic activity as could be visualized on TEM. The combination of drug and irradiation also induced a hyperplasia of the ciliary epithelium. Misonidazole itself had no effect on the ciliary beat frequency, but caused a hypoplasia of the ciliary epithelium.

Animals↗
PubMed1985

Reaction of the vascular system in the trachea of the rabbit exposed to fractionated irradiation with and without the addition of misonidazole.

As the radiation field used in the radiation therapy of malignancies in the thoracic cavity often exposes the trachea to ionizing irradiation, it is important to ascertain the effects of radiation on this tissue either as a single therapy or in combination with radiosensitizers. In the study reported here the vascular area in the subepithelial layer of the trachea has been calculated in 160 rabbits treated in four ways: (1) 10 rabbits received no treatment and served as controls; (2) 50 rabbits were given 100 mg misonidazole daily on consecutive days, with the individual total dose ranging from 100 to 1000 mg; (3) 50 rabbits were treated with misonidazole in the same way, but were also exposed to radiation (2 Gy/F) at 15-30 min later; (4) 50 rabbits received only fractionated radiation (2 Gy/F). The total radiation dose in the irradiated animals ranged from 2 to 20 Gy. In the treated groups, an oedema was observed in both the ciliary cell layer and in the subepithelial area. In the group given only irradiation, this oedema was dose-dependent, but no such dose-dependency was observed in the two groups treated with misonidazole. The vascular area in the groups treated with misonidazole was significantly increased as compared with the group given only irradiation and the control group; this was valid both with and without correction for the oedema. There was a significant correlation between the oedema and the vascular area in the groups treated with misonidazole, which was not found in the group irradiated without the drug.

Animals↗