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Biomedical subjects

G Pizzocaro

Publications and source records attributed to G Pizzocaro.

At least 55 records · Page 3Linked to original sources
PubMed1987

Adjuvant medroxyprogesterone acetate to radical nephrectomy in renal cancer: 5-year results of a prospective randomized study.

From July 1, 1979 to June 30, 1983, 136 consecutive patients from 5 centers in Lombardy entered a prospective randomized study to compare 500 mg. adjuvant medroxyprogesterone acetate 3 times a week for 1 year to no treatment following radical nephrectomy for category M0 renal cancer. After a median followup of 5 years (range 42 to 90 months) 40 of 120 evaluable patients (33.3 per cent) experienced relapse after a median interval free of disease of 17 months (range 2 to 74 months). Relapses occurred in 19 of 58 evaluable patients in the adjuvant treatment group (32.7 per cent) and in 21 of the 62 evaluable controls (33.9 per cent). Sex steroid hormone receptors were studied in 102 of the 120 evaluable patients with the dextran-coated charcoal technique. No significant correlation could be found among receptors, relapses and treatment. On the other hand, 33 (56.9 per cent) of the 58 treated patients experienced 39 complications related to the long-term hormonal therapy. Three patients had to discontinue medroxyprogesterone acetate for severe toxicity after 2 to 3 months. Medroxyprogesterone acetate cannot be recommended as adjuvant therapy to radical nephrectomy in patients with renal cell carcinoma.

Adolescent↗
PubMed1987

Difficulties of a surveillance study omitting retroperitoneal lymphadenectomy in clinical stage I nonseminomatous germ cell tumors of the testis.

Between August 1981 and December 1984, 85 consecutive patients with clinical stage I nonseminomatous germ cell tumors of the testis who were suitable for close observation entered a surveillance study after orchiectomy alone. All patients had unequivocally negative chest x-ray, bipedal lymph-angiography, and computerized tomography of the abdomen and pelvis, and normal levels of alpha-fetoprotein and human chorionic gonadotropin before entering the study. Patients were followed closely for 24 to 64 months (median 42 months) with regular chest x-rays, plain films of the abdomen for lymphangiography control, and serum determinations of alpha-fetoprotein and human chorionic gonadotropin but it was difficult to obtain computerized tomography scans of the abdomen at scheduled intervals for such a long period. Followup was closed December 31, 1986. At that date 62 patients (73 per cent) were continuously free of disease after orchiectomy alone and 23 (27 per cent) suffered relapse. The over-all occurrence rate of retroperitoneal relapses was 16.5 per cent and they usually were detected late, 4 to 36 months (median 10 months) after orchiectomy. Lung metastases were detected much earlier, 2 to 10 months (median 3 months) after orchiectomy. Alpha-fetoprotein and human chorionic gonadotropin elevations preceded the radiographic demonstration of metastases in 8 patients only (35 per cent) and in 1 they were the only sign of relapse. All but 1 patient with relapse were cured with chemotherapy and/or surgery, with an over-all survival rate free of disease of 98.8 per cent. Invasion of the epididymis, rete testis and spermatic cord, primary scrotal surgery, peritumor vascular invasion and embryonal carcinoma were associated with a higher risk for relapse but it was impossible to find clear-cut indications to select patients for adjuvant chemotherapy, retroperitoneal lymphadenectomy or no treatment. Furthermore, the followup of retroperitoneal nodes proved to be much more difficult than expected. Unilateral or modified retroperitoneal lymphadenectomy facilitates management of clinical stage I nonseminomatous germ cell tumors of the testis: only the chest and markers must be followed, the status of the retroperitoneal nodes is known immediately and antegrade ejaculation is preserved in the majority of cases.

Adult↗
PubMed1987

Retroperitoneal lymph node dissection in clinical stage IIA and IIB nonseminomatous germ cell tumours of the testis.

From 1980 to 1984 inclusive, ninety-one consecutive evaluable patients underwent primary retroperitoneal lymphadenectomy for clinical stage IIA or IIB nonseminomatous germinal testicular cancer. Nodes were negative in twenty cases (22%), and forty-seven patients (52%) were treated with chemotherapy either postoperatively (thirty clinically understaged patients) or at relapse (seventeen cases). After a median follow-up period of nearly 5 years (range 18-78 months) the disease-free survival was 98%. None of thirty patients with radiographic abnormalities greater than or equal to 3 cm in the retroperitoneal nodes had negative histology, and twenty-two (73%) were treated with chemotherapy. Preoperative serum levels of AFP and hCG were not useful in selecting patients with positive nodes. Primary chemotherapy is now used in patients with radiographic evidence of retroperitoneal metastases greater than or equal to 3 cm.

Choriocarcinoma↗
PubMed1987

Reliability of diagnostic imaging after orchiectomy alone in follow-up of clinical stage I testicular carcinoma: excessive cost with potential risk.

From 1981 to 1984, 86 consecutive patients with previously untreated nonseminomatous testicular carcinoma were classified as clinical radiological stage I and treated with orchiectomy alone. The follow-up program included chest x-ray and lymphangiography (LAG) every month and abdominal computed tomography (CT) bimonthly. All patients were followed for 15 to 63 months after orchiectomy (median 32 mo.). Metastases developed in 23 patients (26.7%) and in 13/23 there was retroperitoneal lymphadenopathy. Time of relapse after orchiectomy ranged from 2 to 36 months (median 7 mo.) with a shorter interval for chest (4 mo.) compared with retroperitoneal metastases (7 mo.). Lung metastases were readily identified at an early stage (less than 2 cm) whereas more than one-third of retroperitoneal nodal metastases were greater than 5 cm at time of diagnosis. LAG detected metastases in 8/11 patients (72.7%), abdominal CT in 8/10 (80%), and both together (LAG and CT) 7/8 (87.5%). In clinical stage I nonseminomatous testicular carcinoma, the high incidence of concomitant but often asymptomatic regional and distant metastases and the relatively high cost and inconvenience of follow-up using abdominal CT imaging, LAG and chest x-ray suggest that orchiectomy is best combined with retroperitoneal node dissection at time of initial presentation to insure more accurate and safe staging of tumor dissemination.

Follow-Up Studies↗
PubMed1986

Cisplatin combination chemotherapy in advanced seminoma.

Thirty-one patients were treated with cisplatin combination chemotherapy for advanced seminoma (26 Stage III or bulky Stage II testicular, and five disseminated extragonadal). Seventeen (89%) of 19 patients not previously pretreated and four (80%) of five who had received only abdominal irradiation entered continuous complete remission (CR), versus only two (28%) of seven patients who had received extensive infra- and supradiaphragmatic radiotherapy. Results were not significantly influenced by stage, human chorionic gonadotropin (HCG) titers and histologic subgroups, whereas patients with lactic dehydrogenase (LDH) values exceeding 500 mIU/ml did worse (50% continuous CR rate in 12 cases) than those with normal or less elevated titers (89% continuous CR rate in 19 cases). After a median follow-up period of 34 months (range, 12+ to 77+ months), 23 patients (74.5%) remain alive in continuous CR, two (6%) died in CR and another one (3%) entered CR after deferred treatment of residual disease. Five patients (16%) died of cancer. Toxicity was severe in extensively irradiated patients, but it was acceptable in those not pretreated and in those who had received only subdiaphragmatic radiotherapy. Cisplatin combination chemotherapy can be successfully and safely used as the primary treatment of choice in patients with advanced seminoma. It is also an excellent salvage therapy for patients who had received subdiaphragmatic irradiation only. On the contrary, it is very difficult to treat with chemotherapy extensively irradiated patients.

Adult↗
PubMed1986

Application of an in vitro antimetabolic assay to human germ cell testicular tumors for the preclinical evaluation of drug sensitivity.

An in vitro assay, which evaluates the effect of drugs on labeled nucleotide precursor incorporation 3H-thymidine and 3H-uridine after 3 hours of in vitro treatment, was applied to human germ cell testicular tumors. The assay was feasible on 78% of the 259 tumors, and the results were evaluable in 95% of these, which shows the good potential of its clinical application. In vitro response rates to conventional agents were comparable to clinical response rates reported in the literature for monochemotherapy regimens, thus demonstrating the accuracy of the assay in reproducing the sensitivity of the tumor type. The specificity of the assay in predicting drug sensitivity of individual tumors was investigated on 28 lesions from 24 patients who had residual disease after surgery. A significant correlation was found between in vitro and clinical sensitivity to the same drugs (P = 0.026), with an overall agreement of 92% when tumor metastases were tested in vitro. In contrast, no significant correlation, and a poor agreement (62%) was found when the primary tumor was tested.

Antimetabolites, Antineoplastic↗
PubMed1986

Chemotherapy with adriamycin and vincristine alternated with cyclophosphamide and actinomycin D in testicular germ cell tumors refractory to cisplatin, vinblastine and bleomycin.

Eighteen patients with testicular cancer refractory to cisplatin, vinblastine and bleomycin (PVB) were treated with a non-cross-resistant regimen including adriamycin, 60 mg/m2 i.v. on day 1, and vincristine, 1.2 mg/m2 i.v. on days 1 and 8, alternated q 3 weeks with cyclophosphamide, 600 mg/m2 i.v. on days 1 and 8, and actinomycin D, 1 mg/m2 i.v. on days 1 and 8. The median number of administered cycles was 8 (range 3-14). The results were analyzed according to previous response to PVB. One of two patients relapsing after the first-line therapy obtained a transient second complete response (CR) (duration 7 months). None of seven patients who showed no response to PVB obtained a CR; in 3/9 patients with a partial response (PR) after PVB, the achievement of CR could not be definitely attributed to salvage therapy. Toxicity was mild; no cardiac failure or drug-related deaths were observed. In conclusion, these two alternating regimens were well tolerated, but this treatment was not found to be useful in patients not responsive to PVB, for whom new and alternative therapies are required. The favorable impact on prognosis, evident only in the subgroup of patients with PR, was probably attributable to PVB rather than to this salvage regimen.

Adult↗
PubMed1986

Adjuvant medroxyprogesterone acetate and steroid hormone receptors in category M0 renal cell carcinoma. An interim report of a prospective randomized study.

From July 1, 1979 to June 30, 1983, 136 consecutive patients with category M0 renal cell cancer who had undergone transperitoneal radical nephrectomy at 5 centers entered a prospective randomized trial to compare 500 mg. adjuvant medroxyprogesterone 3 times a week for 1 year to no treatment. Sex steroid hormone receptors also were studied in the renal tumor and in the surrounding healthy parenchyma with the dextran-coated charcoal technique. After a median followup period of 3 years (range 13 to 60 months) 30 of 121 evaluable patients (24.8 per cent) experienced relapse, usually in the lung or bones. Relapses occurred in 15 of 58 evaluable patients in the adjuvant treatment group (25.8 per cent) and 15 of 63 evaluable controls (23.8 per cent). The disease recurred more frequently (35.1 per cent) in the 57 patients with no receptors in the tumor than in the 45 with at least 1 receptor (17.8 per cent). These results were independent of adjuvant therapy. After a median 3-year followup, adjuvant medroxyprogesterone acetate was of no therapeutic benefit in patients who had undergone radical nephrectomy and the side effects of the therapy were evident in more than 50 per cent of the patients.

Antineoplastic Agents↗
PubMed1986

Orchiectomy alone in clinical stage I nonseminomatous testis cancer: a critical appraisal.

Sixty-two consecutive patients with clinical stage I nonseminomatous testicular cancer were entered into a prospective study to receive no treatment after orchiectomy until clinical evidence of recurrent disease. Of 59 evaluable cases, 41 (69.5%) remained continuously disease free for a median duration of 30 months (range, 18 to 46 months), and evidence of metastatic disease developed in 18 patients (30.5%) from 2 to 36 months after orchiectomy. The median disease-free interval for relapsing patients was 6 months. Retroperitoneal metastases developed in ten patients; seven patients had pulmonary metastases, and one patient had progressive elevation of the serum alpha-fetoprotein level. Relapses were significantly more frequent in patients with either embryonal carcinoma, infiltrating testicular cancer (pT greater than 1), peritumoral vascular invasion, or in those who underwent transscrotal biopsy. One patient with relapse refused salvage therapy and died. The remaining 17 patients have been rendered disease free with cisplatin combination chemotherapy and/or surgery. However, two patients showed further recurrence, with one in the lung and the other one also in the retroperitoneal nodes. In our opinion, surveillance following orchiectomy will provide useful information in clinical stage I nonseminomatous testicular cancer, but it is a difficult study. For the time being, it should be restricted to specialized centers only. In the meanwhile, retroperitoneal lymphadenectomy remains the standard treatment.

Adolescent↗
PubMed1986

Retroperitoneal lymphadenectomy in clinical stage I nonseminomatous germinal testis cancer.

Thirty-six consecutive patients underwent retroperitoneal lymphadenectomy for clinical stage I nonseminomatous germinal testis cancer from January 1980 to August 1981. Retroperitoneal lymphnode metastases were pathologically documented in 8 cases (22.2%). No patient received adjuvant therapy following surgery. The disease relapsed in 4 patients (11.1%) always in the lung, from 5 to 7 months after lymphadenectomy. The pulmonary disease was minimal in 3 cases and bulky (1 lung nodule greater than 2 cm) in 1 patient. All the relapsed patients entered continuous complete remission with cisplatin, vinblastine and bleomycin (plus surgery in one case). All the 36 patients in this series are alive and disease-free after a follow-up period of 40-60 months from lymphadenectomy. Antegrade ejaculation was lost by 10 out of 13 cases who had undergone the bilateral lymphadenectomy (77%) and by 2 of the 21 adult patients who had had the unilateral dissection (9.5%). Unilateral retroperitoneal lymphadenectomy is recommended in patients with negative intra-operative findings who undergo surgery for clinical stage I nonseminomatous testis cancer.

Adolescent↗
PubMed1985

Cisplatin and etoposide salvage therapy and resection of the residual tumor in pretreated germ cell testicular cancer.

Thirty-two consecutive patients with pretreated germinal testis cancer received three to four inductions of cisplatin and etoposide therapy (PE). Patients not pretreated, or only partially pretreated with bleomycin (B), also received this drug for a maximum of 12 doses. Sixteen patients underwent secondary surgery for the removal of residual masses. Twelve (37.5%) entered complete remission (CR) with chemotherapy alone, and an additional 9 cases (28%) were rendered tumor-free by surgery. The 21 disease-free patients (65.5%) received two further inductions and no maintenance. Toxicity was moderate, and 1 of the 16 patients who underwent surgery died postoperatively of pulmonary embolism. After a median follow-up period of 26 months (range, 9-60), 2 patients have died in CR and 15 (47%) are currently alive and have been continuously disease-free. The major determinant of tumor response was prior therapy. Eleven of 14 (78%) patients who were not pretreated with cisplatin achieved a continuous disease-free status versus only 4 of the 18 pretreated patients (22%, P less than 0.01). In this set of cases, complete responders to prior PVB therapy did better than incomplete responders treated for tumor progression. It can be concluded that normal-dose PE +/- B therapy, followed by surgical resection of the residual tumor, is a satisfactory salvage therapy in patients not pretreated with cisplatin and is also active in complete responders to prior PVB therapy.

Adolescent↗
PubMed1985

Cisplatin, etoposide, bleomycin first-line therapy and early resection of residual tumor in far-advanced germinal testis cancer.

Forty consecutive patients with far-advanced germinal testis tumors (lymph node metastases greater than 10 cm, pulmonary nodules greater than 5 cm, extrapulmonary spread, alpha-fetoprotein greater than 1000 ng/ml, human chorionic gonadotropin greater than 50,000 mIU/ml) were treated with five courses of cisplatin, etoposide, and bleomycin (PEB). Twenty-five patients underwent surgery for the removal of residual masses after the first three inductions. Fibrotic-necrotic tissue was resected in 11 cases, 12 had mature teratoma, and residual cancer was found in 2. After the combined-modality treatment, 37 patients (82.5%) entered complete remission (CR): 25 (62.5%) with PEB and 12 (30%) with PEB and complete removal of the residual tumor. One patient progressed on therapy, and two others had incomplete resection of the residual disease. Hematologic toxicity was moderate and gastrointestinal toxicity was very mild. After a median follow-up period of 24 months (range, 13-40), 33 patients (82.5%) remain continuously disease-free, and 4 experienced relapse. Only one of these was salvaged with further surgery and chemotherapy. First-line PEB therapy combined with early resection of residual tumor induced a very high continuous CR rate in patients with far-advanced germinal testis cancer, and toxicity was moderate.

Adolescent↗
PubMed1985

Early resection of residual tumor during cisplatin, vinblastine, bleomycin combination chemotherapy in stage III and bulky stage II nonseminomatous testicular cancer.

Sixty consecutive patients with Stage III or bulky Stage II nonseminomatous germinal testis tumors were treated with cisplatin, vinblastine, bleomycin combination chemotherapy (PVB). One patient died of acute toxicity after the first course of therapy, 16 entered complete remission (CR) after two or three inductions, and 36 underwent surgery for removal of residual masses after the third cycle. No residual tumor was found in 16 cases, 10 had mature teratoma, and residual malignant tumor was completely resected in 8 of 10 patients. On the whole, 52 of 59 cases (88%) who completed the therapy entered CR, 34 (58%) with PVB and 18 (30%) with PVB and resection of the residual disease. The major beneficiaries of surgery were patients with bulky metastases (17 of 45, 38%) and those with primary teratocarcinoma (13 of 24, 54%). All of the patients who entered CR received two additional inductions and no maintenance. After a median follow-up period of greater than 3 years, 40 patients (68%) remain continuously disease-free, 1 died in CR, and 3 of the 11 who had relapse were salvaged. All of the 32 patients with lung deposits less than 5 cm and/or lymph node metastases less than 10 cm entered CR after the combined treatment modality, and 29 (91%) are alive disease-free. Also, 20 of 27 patients (74%) with far-advanced disease (lung and lymph node metastases larger than 5 and 10 cm, respectively, extrapulmonary disease) entered CR after PVB and surgery, but only 11 (41%) are continuously disease-free. Early resection of the residual tumor during PVB combination chemotherapy greatly increased the CR rate, but relapses were very frequent in patients with far-advanced disease.

Adolescent↗
PubMed1985

Unilateral lymphadenectomy in intraoperative stage I nonseminomatous germinal testis cancer.

Bilateral retroperitoneal lymphadenectomy is mainly a staging procedure in patients with stage I nonseminomatous testis cancer, and it causes permanent loss of antegrade ejaculation in approximately two-thirds of the cases. Between May 1978 and August 1981, 61 consecutive patients with no intraoperative evidence of lymph node involvement underwent unilateral retroperitoneal lymph-adenectomy for nonseminomatous germinal testis tumors. Microscopic metastases were found in 1 to 4 retroperitoneal nodes in 6 cases (9.8 per cent). Antegrade ejaculation was absent postoperatively in 11 patients (18 per cent), with no significant difference between patients who underwent lymph node dissection on the left or right side. Ejaculation returned spontaneously in 3 patients, 1 of whom fathered a child. The disease recurred in 10 patients 3 to 35 months after lymphadenectomy (median 6 months). Disease recurred in 8 of 55 patients (14.5 per cent) with negative nodes and 2 of 6 (33.3 per cent) with positive histological findings. No patient suffered retroperitoneal recurrence. The more than 3-year survival rates free of disease were 96.4 and 83.3 per cent in patients with pathological stages I and II disease, respectively. Unilateral retroperitoneal lymphadenectomy in patients with intraoperative stage I nonseminomatous germinal testis cancer preserves antegrade ejaculation in more than 80 per cent of the cases without apparently compromising the long-term survival.

Adolescent↗
PubMed1985

Lymphangiography and computerized tomography in testicular carcinoma: how accurate in early stage disease?

The usefulness of lymphangiography and computerized tomography was evaluated in 167 consecutive patients with pathological stages I and II testicular carcinoma and metastases of less than 5 cm. Lymphangiography demonstrated 74.4 per cent sensitivity, 77.6 per cent specificity and 76.0 per cent over-all accuracy. Computerized tomography revealed comparable results, with 74.3 per cent over-all accuracy, 73.7 per cent sensitivity and 75.0 per cent specificity. The combination of lymphangiography and computerized tomography performed in 35 patients consistently improved the diagnostic possibilities of either technique alone in patients with positive nodes, reducing the false negative rate from 27 to 10 per cent. On the other hand, this combination increased the false positive rate from 25 to 37 per cent in patients with negative nodes. In patients with clinical stage I disease for whom a wait-and-see policy after orchiectomy is adopted at our institute both methods must be considered mandatory. In all other situations computerized tomography alone should be the preferred procedure in the diagnosis of retroperitoneal lymph node metastases from testicular carcinoma.

Carcinoma↗
PubMed1985

Surveillance or lymph node dissection in clinical stage I non-seminomatous germinal testis cancer?

Surveillance following orchiectomy alone has gained popularity in the management of clinical stage I non-seminomatous germ cell tumours (NSGCT) of the testis. However, long-term follow-up of the retroperitoneal nodes can be difficult. We analysed the results of 71 consecutive patients followed for more than 1 year. Fifty men (70.5%) remain disease-free and 21 (29.5%) have relapsed. Relapses occurred 2 to 36 months after orchiectomy (median 6 months). Retroperitoneal nodes were involved in 12 cases (17%). In only one patient were retroperitoneal metastases diagnosed when smaller than 2 cm and in four they were diagnosed when larger than 5 cm. Furthermore, the late relapses occurred in the retroperitoneal nodes. After treatment of metastases, 69 patients (97%) are alive, disease-free and off therapy. As retroperitoneal relapses do not occur after a properly executed retroperitoneal lymph node dissection (RPLND) and ejaculation problems can be avoided with unilateral RPLND, it is suggested that RPLND can be used for clinical stage I NSGCT of the testis in experienced surgical centres, with the advantage of an easier follow-up.

Adolescent↗
PubMed1985

Relapse pattern of pathologic stage I nonseminomatous germ cell tumors of the testis following orchidectomy and lymphadenectomy.

A retrospective analysis of patients with pathologic stage I nonseminomatous germinal testis tumors treated with orchidectomy and retroperitoneal lymphadenectomy was done in an attempt to define the relapse pattern and to eventually identify risk factors predisposing to tumor recurrence. Of 102 patients, 91 (89.2%) remain disease free with a median follow-up of greater than 5 years (range 3-10 years), and 11 (10.8%) suffered relapse 3-35 months after lymphadenectomy (median free interval 6 months). 9 of 11 patients developed primarily intrathoracic recurrences. The tumor was so rapidly progressing at relapse, that it was diagnosed when clinically advanced in 7 of 11 cases. Nevertheless, 8 of 11 patients were salvaged with effective available chemotherapy and resection of residual disease. Only scrotal violation showed a significant increased risk of tumor recurrence (5 of 24 cases, versus 6 of 78 who had inguinal orchidectomy, p less than 0.05). We recommend a very close follow-up for all patients with pathologically assessed stage I nonseminomatous germinal testis tumors during the first 3 years following orchidectomy and retroperitoneal lymphadenectomy. With early recognition of relapse, an approximately 100% cure rate will be achieved with effective available chemotherapy.

Adolescent↗