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E Cvitkovic

Publications and source records attributed to E Cvitkovic.

At least 145 records · Page 8Linked to original sources
PubMed1981

Adjuvant chemotherapy with VAB-3 of stage II-B testicular cancer.

A recent report from the Memorial Sloan-Kettering Cancer Center has indicated that patients with resected Stage IIB (N-2B and N-3) testicular cancer are at significant risk for relapse. Of patients with resected Stage IIB disease (N-2B, 19%; N-3, 54%), 34% relapsed after having undergone relatively mild adjuvant chemotherapy consisting of vinblastine, actinomycin D, bleomycin, and chlorambucil (VAB). In this study, 29 patients with resected Stage IIB testicular cancer underwent treatment with adjuvant VAB-3 which has been used as primary treatment for Stage III disease. All patients have remained in complete remission with a median follow-up time of 24 months. Three patients received broad spectrum antibiotics when fever and leukopenia developed. No patient experienced renal failure. The results of this study demonstrate the capability of aggressive adjuvant chemotherapy to prevent recurrence in the high-risk setting of resected Stage II (N-2B and N-3) disease. Optimal adjuvant treatment remains to be defined.

Antineoplastic Agents↗
PubMed1981

VAB-4 combination chemotherapy in the treatment of metastatic testis tumors.

Forty-two patients with advanced testis carcinoma without previous chemotherapy were treated with VAB-4, and 41 were evaluable. The program consisted of three in-hospital inductions 16 weeks apart, and outpatient treatments every three weeks. Of the patients, 80% achieved complete remissions (CR). Chemotherapy alone induced CR in 61%, partial remissions (PR), in 24% and minor response (MR), in 15%. An additional 20% of patients (six PRs and 2 MRs) achieved CR following resection of residual tumor deposits. With a median follow-up of 27 months, the median duration of CR has not been reached. Of those achieving CR to chemotherapy alone, 12% had relapses. Bulk and extent of metastatic disease, histology of primary tumor, and tumor markers at the beginning of therapy influenced the frequency of CR. Of those with minimal disease, 90% achieved CR. The CR rate was 67% for those with advanced thoracic disease and 29% for those with advanced abdominal disease. Patients who had embryonal carcinoma and those who had no elevation of alpha-fetoprotein had a higher frequency of CRs. Myelosuppression with a leukocyte count drop less than 1000/mm3 occurred in three patients, and no patient had chronic renal failure or pulmonary fibrosis. One patient died from sepsis while in complete remission.

Adolescent↗
PubMed1981

Adjuvant chemotherapy combination of vinblastine, actinomycin D, Bleomycin, and Chlorambucil following retroperitoneal lymph node dissection for stage II testis tumor.

In an attempt to reduce recurrence of nonseminomatous germ cell tumors of testis stage II, 62 patients were treated with vinblastine, actinomycin D, bleomycin, and chlorambucil after retroperitoneal lymph node dissection. Of the patients, 84% have remained in complete remission with median follow-up of three years: 33/33 stage II-A (N-1,N-2A) and 19/29 (66%) stage II-B (N-2B,N3). The relapse rate in patients who had histologic evidence of extranodal extension of the tumor (N-3) was 54% (7/13). This program did not cause any serious toxicity. Adjuvant chemotherapy is effective in reducing relapses. More recently, with the current availability of chemotherapy with a high efficacy for control of disseminated disease, patients with resected stage II-A (N-1,N2A) have been followed closely and treated only if they developed evidence of recurrence. Patients with resected stage II-B (N-2B,N-3) have been placed on a more aggressive adjuvant program.

Adult↗
PubMed1981

Adjuvant chemotherapy in non-seminomatous testis cancer: "mini-VAB" regimen: long-term followup.

Since 40 to 50 per cent (range 20 to 80 per cent) of patients with stage II non-seminomatous germ cell tumors of the testis suffer relapse after orchiectomy and retroperitoneal lymph node dissection, relatively non-toxic adjuvant chemotherapy (consisting of vinblastine, actinomycin D, bleomycin and chlorambucil) was given to 62 patients after lymphadenectomy. Of these patients 82 per cent remained free of disease with a 4-year median followup and 18 per cent had relapse. Retrospective analysis reveals that no patient (0 of 33) with stage IIA and 38 per cent (11 of 29) with stage IIB disease had relapse. Patients with histologic evidence of extranodal extension of disease (N3 category) had the highest relapse rate (62 per cent). Based on our experience we recommend that patients with resected stage IIB disease, particularly those with extranodal extension of tumor, receive aggressive adjuvant chemotherapy.

Antineoplastic Agents↗
PubMed1980

Small-cell carcinoma of the esophagus: treatment by chemotherapy alone.

Small-cell carcinoma of the esophagus is a rare tumor. In most reported cases, surgery has been the major mode of therapy. Most patients have relapsed rapidly with disseminated disease. We treated a patient with small-cell carcinoma of the esophagus with a multi-drug regimen being used in small cell-carcinoma of the lung. Within two months of beginning therapy, the primary lesion, as evaluated by barium esophogram, had completely resolved. Residual disease was seen on panendoscopy. The patient was considered to be in partial remission. She relapsed nine months after starting therapy and died with widespread metastases. Small-cell carcinoma of the esophagus should not be treated surgically but rather in the same fashion as is small-cell carcinoma of the lung, i.e., with multi-drug chemotherapy and radiation therapy.

Aged↗
PubMed1979

Neurological complications of malignant germ cell tumors of testis: biology of brain metastases (I).

Central nervous system metastases are a common complication of disseminated germ cell tumors of the testis. They occurred in 16% of 242 patients treated and in 25% of the patients who died in our VAB chemotherapy series. Pulmonary metastases preceded or coincided with the development of brain metastases. The frequency of brain metastases differed with the histology of the primary tumor. They occurred in 13% of pure embryonal carcinomas, 18% of mixed tumors containing embryonal or choriocarcinoma elements, and 83% of pure choriocarcinomas. Embryonal carcinoma and choriocarcinoma were the principle histologies found in brain metastases. Characteristically, pure choriocarcinoma deposits in the brain were multiple (8/9) and cerebellar involvement was common (5/9). Pure embryonal carcinoma CNS metastases were typically single (6/8) or very few and cerebellar involvement was not observed. The interval from the diagnosis of malignancy to the diagnosis of brain metastases was longer for embryonal carcinoma than for pure choriocarcinoma (23 mos. vs. 6.5 mos.). Survival following the diagnosis of brain metastases was poor. There was a tendency toward longer survival for histologically pure embryonal carcinoma deposits in the brain than for the pure choriocarcinomas (6.5 mos. vs. 1 mo.).

Brain Neoplasms↗
PubMed1979

Cerebrospinal fluid markers in central nervous system metastases from testicular carcinoma.

Serum values of alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG) have been used to monitor disseminated testicular carcinoma. Serial measurements of these markers have been used to monitor the response to therapy, to follow the progress of disease, and to detect subclinical recurrences. With increasingly effective chemotherapy for systemic disease, central nervous system (CNS) metastases in testicular carcinoma are becoming increasingly important as a cause of treatment failure. Cerebrospinal fluid (CSF) values of AFP and HCG seem to be important ancillary acids in the neurosurgical management of CNS metastases from testicular cancer. Our preliminary experience with three cases suggests that these CSF markers (plus computerized tomograhic scanning) should be evaluated in patients with this disease.

Adult↗
PubMed1979

Spontaneous pneumothorax as a result of intensive cytotoxic chemotherapy.

Spontaneous pneumothorax occurring as a complication of the antitumor effect of cytotoxic chemotherapy has been reported in occasional cases of osteogenic sarcoma. Its occurrence in other tumors has not been described. This report describes two cases of this complication in patients with germinal tumors and discusses possible pathophysiologic mechanisms.

Adult↗
PubMed1978

Factors influencing postoperative morbidity and mortality in patients treated with bleomycin.

Patients treated with bleomycin are at risk of developing the acute adult respiratory distress syndrome post-operatively. In a prospective study of 12 patients who had received bleomycin preoperatively and were undergoing removal of retroperitoneal lymph nodes or pulmonary metastases several preventive factors were established. These were the use of low concentrations of inspired oxygen during operation and in the immediate postoperative period, careful monitoring of fluid replacement, and restriction of crystalloids in favour of colloids.

Adolescent↗
PubMed1978

Results of combined chemo-surgical therapy for pulmonary metastases from testicular carcinoma.

Between 1966 and 1976, 34 patients had 42 thoracotomies for resection of recurrent or residual metastatic germinal cell carcinoma primary in the testes in addition to chemotherapy. Of the 34, 18 (53%) are alive and well free of evidence of disease from 4 months to 104 months. Systemic chemotherapy of this group of tumors has improved markedly and many patients are now rendered free of disease and are potentially cured. In some however, an occasional pulmonary nodule did not completely respond or recurred after complete disappearance. The surgery was done to remove the last evidence of disease, and to establish the histology of the metastases.

Adolescent↗
PubMed1978

Germ cell tumors (II): VAB II in metastatic testicular cancer.

Between June 1974 and January 1976, 50 patients with metastatic non-seminometous testicular carcinoma were treated with the VAB II protocol. The induction phase consisted of vinblastine (0.4 mg/kg) and actinomycin D (0.02 mg/kg) on day 1. Bleomycin (0.5 mg/kg) was given by continuous infusion for 7 days, and cis-diammine-dichloroplatinum (II) (DDP) (1 mg/kg) was given on day 8. A weekly maintenance of vinblastine and bleomycin, with actinomycin D and DDP on a rotating schedule was given followed by vinblastine, actinomycin D and chlorambucil every 3--4 weeks. Therapy was discontinued after 30--36 months of treatment in the face of continued remission. The response rate was 50% CR, 34% PR with 60% CR and 36% PR in previously untreated patients. Second-look surgery and excision of residual lesions was performed in selected cases. Alopecia, mucositis, nausea, and vomiting were universal. One patient died in the postsurgical period of toxicity from the combination of bleomycin and high concentrations of oxygen. There were seven instances of allergic reactions to DDP. Eleven of 25 complete responders and 4 partial or minor responders who underwent excision of stable disease remain alive from 19 to 35 months following start of therapy, 12 of them without evidence of disease.

Adolescent↗
PubMed1978

cis-Platinum ototoxicity.

The incidence and spectrum of ototoxicity secondary to cis-platinum administration in 104 cancer patients ranging in age from 8-78 years were determined. Pure tone thresholds from 500 to 8000 Hz were evaluated prior to and following cis-platinum administration. The most sensitive frequencies were 6000 and 8000 Hz. Younger patients had lower threshold increases per administered dose than older patients. High drug dosages caused larger threshold elevations and extended to lower frequencies. Prehydration and mannitol infusion did not alter ototoxicity. Audiographic evaluation appears necessary for monitoring the treatment of cancer patients with cis-platinum.

Adolescent↗
PubMed1978

Acute renal failure after cis-dichlorodiammineplatinum(II) and gentamicin-cephalothin therapies.

Combined gentamicin-cephalothin therapy in four patients after treatment with cis-dichlorodiammineplatinum(II) (CPDD) for advanced solid tumors was complicated by severe acute renal failure. The total dose of gentamicin varied from 240 to 945 mg and that of cephalothin varied from 28 to 48 g. Low-dose (0.5 mg/kg x 8) CPDD was given to one patient, high-dose (3 mg/kg) CPDD was given to two patients, and very high-dose (5 mg/kg) CPDD was given to one patient. The high and very high doses of CPDD were given with concomitant mannitol diuresis. CPDD therapy was complicated by mild transient azotemia in three patients and by severe acute renal failure in one. In the latter, the azotemia began to improve on Day 7 after CPDD treatment. Following gentamicin-cephalothin therapy, all patients developed severe acute renal failure which persisted until death. At autopsy, all patients had extensive renal tubular necrosis at various stages. These findings indicate that gentamicin-cephalothin therapy after treatment with CPDD can be severely nephrotoxic, and that this antibiotic combination should be given with great caution, if at all, to patients receiving CPDD treatment for malignancy.

Acute Kidney Injury↗
PubMed1978

cis-Dichlorodiammineplatinum(II) and bleomycin in the treatment of esophageal carcinomas.

Forty-seven patients with squamous cell carcinoma of the esophagus were treated with a combination of cis-dichlorodiammineplatinum (II) (cis-DDP) and bleomycin by infusion. cis-DDP at a dose of 3 mg/kg with mannitol and prehydration was given on Day 1. On Day 3, bleomycin was started as a 10--15-unit/m2 loading dose followed by a 10--15-unit/m2 24-hour infusion for 4--7 days. Three groups of patients were treated: group 1 (no clinical evidence of metastatic disease) included 25 patients, all with no prior therapy; group 2 (measurable metastatic disease) included 13 patients, eight previously treated with surgery and/or radiation; group 3 (known nonmeasurable metastatic disease) included nine patients, all previously treated with surgery and/or radiation and/or chemotherapy. A second course of therapy was given on Day 28 to groups 2 and 3, and as soon after surgery as possible in group 1. Nineteen percent of patients had complete or partial responses with another 44% having minor regressions. Toxic effects were mainly renal effects, alopecia, nausea and vomiting, and stomatitis. There were two drug-related deaths. The combination of cis-DDP and bleomycin is useful in the treatment of patients with squamous cell carcinoma of the esophagus.

Adult↗