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Biomedical subjects

H Boot

Publications and source records attributed to H Boot.

At least 19 recordsLinked to original sources
PubMed2001

Histological and immunological parameters to predict treatment outcome of Helicobacter pylori eradication in low-grade gastric MALT lymphoma.

Helicobacter pylori eradication is generally accepted as the first choice of treatment for stage IE low-grade gastric MALT lymphoma (mucosa-associated lymphoid tissue-type lymphoma). Treatment failure may be attributed to the extent of the disease and to progression into an antigen-independent phase. This study assessed the value of morphological grading and the expression of the co-stimulatory markers CD40, CD80 and CD86 and their ligands to predict clinical outcome in 23 consecutive low-grade MALT lymphoma patients treated with H. pylori eradication. Complete regression was achieved in 13/23 patients (56%), partial regression in two (9%), and no response in eight (35%). Histological grading was highly predictive of clinical response, especially in stage IE(1) patients, with complete remissions in 10/12 tumours with purely low-grade (type A) morphology and 1/8 tumours with increased numbers of blasts (type B) (p=0.0046) and was related to the expression of costimulatory markers (p=0.0061). Moreover, CD86 as a single marker proved to be of predictive value for treatment outcome (p=0.0086). These results suggest that morphological grading and immunological criteria can be defined to recognize the transition into the antigen-independent phase of gastric MALT-NHL. In addition to clinical stage, these critera may in future serve as a practical pathological guide to the choice of therapy.

Adult↗
PubMed2001

Extensive cytoreductive surgery followed by intra-operative hyperthermic intraperitoneal chemotherapy with mitomycin-C in patients with peritoneal carcinomatosis of colorectal origin.

Peritoneal seeding from colorectal cancer has a very poor prognosis and is relatively resistant to systemic chemotherapy. We performed a phase I/II trial to investigate the feasibility and effectiveness of extensive cytoreductive surgery in combination with intra-operative hyperthermic intraperitoneal chemotherapy (HIPEC) in these patients. 29 patients with peritoneal carcinomatosis of colorectal origin without evidence of distant metastases underwent cytoreductive surgery and intra-operative HIPEC with mitomycin-C (MMC), followed by systemic chemotherapy with 5-fluorouracil (5-FU)/leucovorin. Surgical complications occurred in 11 patients (38%). One patient died directly related to the treatment, resulting in a mortality rate of 3%. MMC toxicity existed mainly of leucocytopenia (in 15 patients; 52%). After a median follow-up of 38 months (range 26-52 months) we found a 2- and 3-year survival rate (Kaplan-Meier) of 45 and 23%, respectively. Extensive cytoreductive surgery and HIPEC is feasible in patients with peritoneal seeding of colorectal cancer. First results suggest that a higher median survival could be achieved compared with conventional palliative surgery and systemic chemotherapy, therefore a randomised phase III study is now being conducted.

Adult↗
PubMed2000

Clinical presentation, endoscopic features, and treatment of gastric metastases from breast carcinoma.

BACKGROUND: Breast carcinoma is the most common malignancy in women. Metastatic involvement of the stomach is not well known. METHODS: Endoscopic features and treatment options were evaluated retrospectively for 51 patients with gastric metastases of breast carcinoma. RESULTS: The presenting sites of metastases were skeleton (43%), stomach (27%), lung (8%), and liver (4%). Diagnosis of gastric involvement was histologically confirmed in 41 patients and based on endoscopic features, despite negative biopsies in 10 patients. Six patients (12%) presented with nonfatal hemorrhage; in the others, symptoms were nonspecific: anorexia (71%), epigastric pain (53%), and vomiting (41%). Endoscopy showed 3 patterns: 18% localized lesions, 57% diffuse infiltration, and 25% external compression at the cardia or pylorus. Histology showed mainly lobular breast carcinoma (n = 36) compared with ductal carcinoma (n = 10) and other types (n = 5), contrary to the usual distribution. The overall response to systemic therapy was 46% (17 of 37 treated patients). Median survival from detection of gastric metastases was 10 months, with a 2-year survival rate of 23%. CONCLUSIONS: Gastric metastases usually derive from lobular rather than ductal breast carcinoma. Endoscopy revealed mainly a diffuse linitis plastica-like infiltration. Chemotherapy or hormonal treatment may result in fair palliation in selected patients, although many patients are heavily pretreated.

Adult↗
PubMed2000

Sequence-dependent toxicity profile in modified FAMTX (fluorouracil-adriamycin-methotrexate) chemotherapy with lenograstim support for advanced gastric cancer: a feasibility study.

For advanced irresectible gastric cancer, sequential high-dose methotrexate and 5-fluorouracil (both on day 1) combined with adriamycin on day 15 (FAMTX regimen), cycled every 28 days, is a fairly effective but toxic treatment, with a high incidence of neutropenic fever, dose reductions and dose delays. In order to improve FAMTX toxicity, we studied the feasibility of two modified FAMTX regimens with lenograstim support. Seven advanced gastric cancer patients were treated with all three FAMTX drugs on day 1 followed by lenograstim 150 microgm(-2)for 10 days, in 21-day cycles (FUMA regimen). The next seven patients were treated with the same drugs at the same doses, but with adriamycin 1 day prior to methotrexate and 5-fluorouracil administration (AFUM regimen). Patients were monitored for toxicity, response, and survival. The total number of courses was 27 for FUMA and 35 for AFUM with a median of four courses per patient in each cohort. In the FUMA regimen, considerable toxicity consisting of mucositis and fatigue as well as grade 4 neutropenia occurred, and forced four out of seven patients to stop treatment. The consecutive AFUM regimen showed only mild toxicity, and all patients could finish treatment without dose reductions or delays. We found unanticipated and probably sequence-dependent toxicity profiles in two investigational, modified FAMTX schedules with lenograstim support, leading to high rates of dose-limiting toxicity in the FUMA regimen as opposed to mild toxicity in the AFUM regimen, even though the same total drug doses and treatment cycle length (dose intensity) were employed.

Adenocarcinoma↗
PubMed2000

Histological grading with clinical relevance in gastric mucosa-associated lymphoid tissue (MALT) lymphoma.

Treatment choice in gastric mucosa-associated lymphoid tissue (MALT) lymphoma is dependent on the stage and biological rate of progression and transformation as reflected by grade. In pre-treatment, endoscopic biopsy samples, histological and biological criteria to recognize tumor components with a significantly adverse impact on prognosis have to be defined to select patients who may benefit from Helicobacter pylori (H. pylori) eradication as single modality treatment and those who need "classical" anti-cancer therapy. In a consecutive series of 106 patients with gastric MALT-non-Hodgkin's lymphoma (NHL), it was possible to define criteria to differentiate between low-grade and high-grade (transformed) disease. Moreover, within the low-grade group, a category with a diffuse large cell component of 1-10% with or without non-confluent clusters of blasts could be separated with a significantly worse prognosis (10-year disease-specific survival 90% versus 75%). No clinical parameters of known prognostic significance could account for this difference. In a separate series of 19 patients treated with H. pylori eradication, this morphology was strongly related to the chance of reaching complete remission as an independent risk factor. This suggests that it is possible to define criteria in endoscopic biopsy samples to recognize clinically relevant tumor-progression and that these criteria may serve as a guideline in the choice of therapy.

Adult↗
PubMed2000

Improved effect of 131I-MIBG treatment by predosing with non-radiolabeled MIBG in carcinoid patients, and studies in xenografted mice.

BACKGROUND: 131I-meta-iodobenzylguanidine (MIBG) has been used with success for the palliation of metastatic carcinoid. To qualify more patients for this treatment, we evaluated the effect of predosing with non-radiolabeled MIBG on 131I-MIBG tumour targeting in carcinoid patients and in mice with BON human carcinoid xenografts. PATIENTS AND METHODS: Ten carcinoid patients with a faint tumour imaging on a diagnostic 131I-MIBG scan (1 mCi = 37 MBq, 5 mg MIBG) received non-radiolabeled MIBG prior to a second scintigraphy. In case of improved tumour targeting patients were treated with 200 mCi (7.4 GBq) 131I-MIBG following a pharmacological predose of 20-40 mg/m2 MIBG. RESULTS: In six patients. highly increased 'tumour/non-tumour' ratios were seen due to reduced levels in normal tissues and increased tumour accumulation. The combined treatment applied in five patients, considerably improved symptoms in all (duration 6-12 months), accompanied by biochemical response in three. In BON carcinoid xenografted mice, MIBG was injected intraperitoneally followed by intravenous 125I-MIBG with similar findings: increased 'tumour/non-tumour' radioactivity ratios by 1.5-3-fold. CONCLUSION: Predosing with non-radiolabeled MIBG resulted in improved 131I-MIBG tumour targeting, prolonged palliation and encouragingly often biochemical responses in carcinoid.

3-Iodobenzylguanidine↗
PubMed2000

Long-term results of uvulopalatopharyngoplasty for obstructive sleep apnea syndrome.

OBJECTIVES: Assessment of the long-term effect of uvulopalatopharyngoplasty (UPPP) on snoring, excessive daytime sleepiness, and nocturnal oxygen desaturation index (ODI) in patients with obstructive sleep apnea syndrome. STUDY DESIGN: Evaluation of snoring, excessive daytime sleepiness, and ODI in patients treated by UPPP earlier. MATERIALS AND METHODS: Patients (n = 58) with a follow-up period of 11 to 74 months (median, 34 mo) were included in this study. Snoring and excessive daytime sleepiness were scored on specially designed semiquantitative scales. In all patients ODI was calculated from pulse-oximetry combined with polysomnography at base line and by polygraphy (MESAM 4) during follow-up in 38 patients. Long-term response was compared with 6-month response in the same cohort. RESULTS: There was a long-term improvement of snoring in 63% of patients, no change in 23%, and a deterioration in 14% (P < .00001). Overall snoring increased slightly between 6 months and long-term follow-up. There was an improvement of excessive daytime sleepiness in 38%, no change in 27%, and a deterioration in 35% (P = .80). Excessive daytime sleepiness showed a relapse to preoperative levels between 6 months and long-term follow-up. The median improvement of ODI was -1 (95% interpercentile range, 73-51) and was not significant (P = .35). In 5 of 13 patients in whom ODI at baseline exceeded 20, ODI was reduced to less than 20. In 4 of the 38 patients ODI was reduced to less than 5. The improvement of ODI decreased significantly between 6 months and long-term follow-up (P = .03). No relation was found between body mass index, Mueller maneuver, X-cephalometry, and long-term outcome. An additional finding was that the ODI decreased after UPPP in combination with tonsillectomy, compared with a slight increase after UPPP alone; the difference was significant (P = .008). CONCLUSION: The response to UPPP for obstructive sleep apnea syndrome decreases progressively over the years after surgery. UPPP in combination with tonsillectomy was more effective than UPPP alone.

Adult↗
PubMed2000

Enhancement of 131I-MIBG uptake in carcinoid tumours by administration of unlabelled MIBG.

Iodine-131 metaiodobenzylguanidine (131I-MIBG) has been used with success for the palliation of symptomatic, metastatic carcinoid tumours. However, only 70% of cases are MIBG-avid and tumour uptake is not always sufficient for therapy. At The Netherlands Cancer Institute 34 carcinoid patients with no or insufficient uptake were treated with escalating doses of unlabelled ('cold') MIBG. No objective remissions were recorded, but a palliative effect (i.e. subjective disappearance of symptoms and/or reduction of medication by more than 50%) was observed in 60% of cases (mean duration 4.5 months). In 24 of the patients undergoing therapy with 'cold' MIBG, total body scintigraphy using 37 MBq 131I-MIBG was performed before and after infusion of 'cold' MIBG. The biodistribution of 131I-MIBG and its tumour to non-tumour ratios were compared. After 'cold' MIBG the 131I-MIBG uptake in the salivary glands was suppressed in all patients, myocardial uptake in 21, and uptake in normal liver tissue in 14. Pulmonary uptake was increased in 13 patients. More importantly, the tumour to non-tumour (T/NT) ratios improved in 17 of the 24 cases (by 7.8-111.4% at 24 h). Of the initial six patients demonstrating a significant increase in the T/NT ratio, five have subsequently received combined treatment of 7.4 GBq 131I-MIBG following the administration of 'cold' MIBG (both by 4 h intravenous infusion), resulting in a good palliative response in four of them. These patients had previously been excluded from therapy with 131I-MIBG only. It is concluded that the administration of unlabelled MIBG may not only provide palliation to patients with carcinoid tumours, but may also alter the biodistribution of MIBG, enabling 131I-MIBG therapy to be used in cases not qualifying for this treatment due to insufficient tumour uptake.

3-Iodobenzylguanidine↗
PubMed1999

[Hyperthermic intra-peritoneal chemotherapy (HIPEC) in patients with peritoneal pseudomyxoma or peritoneal metastases of colorectal carcinoma; good preliminary results from the Netherlands Cancer Institute].

OBJECTIVE: To apply (HIPEC) using mitomycin in patients with peritoneal carcinomatosis. DESIGN: Descriptive. METHOD: The HIPEC treatment includes cytoreductive surgery and subsequent peritoneal lavage with exposure of the superficial tumour residues to a high concentration of a cytostatic drug at an intra-abdominal temperature of 40-42 degrees C. The HIPEC treatment was given to 24 patients with pseudomyxoma peritonei and to 29 patients with peritoneal carcinomatosis of colorectal origin. The adequate dose of mitomycin was determined in the Netherlands Cancer Institute in 26 patients: doses of 15 mg/m2 (n = 8), 25 mg/m2 (n = 3), 35 mg/m2 (n = 7) and 40 mg/m2 (n = 8) were administered. RESULTS: The maximal tolerable dose of mitomycin appeared to be 35 mg/m2, while unacceptable toxicity was recorded at a dose of 40 mg/m2. Therefore 35 mg/m2 was used in subsequent cases. Among the patients with pseudomyxoma peritonei 8 developed severe complications, two of which were fatal. After a median follow-up of 12 months, 21 patients were alive of whom 18 were free of disease. Among the patients with peritoneal carcinomatosis of colorectal origin one patient died from a treatment-related complication. After a median follow-up of 18 months, 18 patients were alive of whom 11 were free of disease. The actuarial 2 year survival was 59%. CONCLUSION: In the Netherlands Cancer Institute HIPEC treatment is considered the treatment of choice for pseudomyxoma peritonei. The results in cases of peritoneal carcinomatosis of colorectal origin are promising, but the results of a randomized trial are awaited.

Antibiotics, Antineoplastic↗
PubMed1999

[Carcinoid tumors of the intestines: developments in the Netherlands for diagnosis and palliative treatment].

Carcinoid tumours in the intestine are slowly growing neuroendocrine tumours. Patients as a rule report symptoms of the carcinoid syndrome: attacks of diarrhoea and of flushing. When the earliest symptoms manifest themselves, metastases are already present, virtually always localized in the liver. At a late stage, heart failure may occur, difficult to treat and caused by fibrosis of the tricuspid valve in the presence of protractedly raised blood serotonin levels. To diagnose carcinoid tumours, use is made of radioactive substances binding to hormone receptors such as 131I-MIBG and 111-In-octreotide. When multiple metastases exist, only palliative treatment is possible. The drugs used are the somatostatin analog octreotide, interferon alpha, radioactive MIBG and non-radioactive MIBG; these drugs may also be used in combination. The therapies mentioned have approximately the same effect: symptoms improve in 60-80%, while 30-50% show a biochemical response, i.e. decrease of the number of breakdown products in the urine of the hormones produced by the tumour; tumour size decreases in 0-12%.

Carcinoid Heart Disease↗
PubMed1999

Controversies and consensus in the diagnosis, work-up and treatment of gastric lymphoma: an international survey.

BACKGROUND: Variations in diagnostic criteria and staging procedures in cancer patients have important consequences for patient selection and often preclude meaningful comparison of published series. In gastric lymphoma, these effects will play a role, since diagnostic criteria are controversial. Moreover, staging procedures and therapeutic choices are influenced by insights from different clinical specialisms. METHODS: To review the management of gastric lymphoma, formatted questionnaires were mailed to leading institutes with a special interest in this field in Europe, the United States and Japan. RESULTS: Nineteen centers agreed to contribute. Minimum histological criteria varied among pathologists with a notable influence of the classification system used in the different countries. Detailed evaluation of the lymphoma distribution in the gastric wall and routine staging of the GI-tract differed between groups leaded by medical oncologists and gastroenterologists. This results in basically different patient selections and bias in treatment outcome. Similar effects were recorded for the role of gastric resection and radiotherapy. CONCLUSIONS: This study gives insight in the basis of the decisions that result in different approaches in the management of gastric MALT-NHL and in the effects for patient selection and treatment results and may help in the design of future clinical trials.

Antineoplastic Agents↗
PubMed1999

Long-term palliation in metastatic carcinoid tumours with various applications of meta-iodobenzylguanidin (MIBG): pharmacological MIBG, 131I-labelled MIBG and the combination.

Carcinoid tumours are rare, but well known for their characteristic presentation with diarrhoea and flushes due to overproduction of serotonin in the case of liver metastases. Treatment is mainly based on the reduction of vasoactive peptide hypersecretion and symptomatic improvement Octreotide and interferon are widely applied and effective treatment options to induce symptomatic improvement and, to a lesser extent, biochemical response. The main drawbacks, however, are the need for frequent injections and/or the occurrence of side effects. A rather new approach is the application of meta-iodobenzylguanidine (MIBG), which resembles noradrenalin and serotonin. In carcinoid patients, MIBG is taken up in the tumour cells and stored in the neurosecretory granules. When labelled with 131 iodine, radionuclide imaging is positive in up to 70% of the patients. In these patients, two cycles of a therapeutic dose of radioactive MIBG may induce long-lasting palliation (8 months) by internal irradiation. Also, the non-radioactive MIBG compound may be effective in palliation, even in patients with a negative scan. The mode of action is based on specific tumour acidification as found in animal models, and/or based on its effect as a false neurotransmittor. Three case reports demonstrate different therapeutic possibilities of MIBG: 1) symptomatic relief with unlabelled MIBG, which is a safe and simple treatment; 2) the longterm palliation following radioactive treatment; and 3) an additional new aspect of predosing with unlabelled MIBG followed by radioactive MIBG led to improved tumour targeting and impressive clinical response.

3-Iodobenzylguanidine↗
PubMed1998

[Sealing esophagobronchial fistulae: better results with self expanding stents than with an esophagobronchial fistula].

OBJECTIVE: To compare the results of plastic endoprostheses and of self expanding stents in patients with an esophagobronchial fistula. DESIGN: Retrospective, descriptive. SETTING: Nederlands Kanker Instituut/Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands. METHOD: Forty-two patients with an esophagobronchial fistula caused by a malignant tumour in the oesophagus, lungs or mediastinum were fitted with an endoprosthesis during the period 1 January 1991-31 August 1995. Use was made initially of a plastic endoprosthesis with a special tulip funnel (n = 24), later of a coated self expanding stent (n = 18). In seven patients, the fistula had been the first manifestation of the tumour; in 35, a recurrence after earlier treatment was involved. The initial characteristics (sex, age, diagnosis, earlier therapy, signs and symptoms) were the same in both groups. RESULTS: Dilatation immediately before insertion of a plastic endoprosthesis was necessary in 23 patients (96%); such dilatation was necessary in four of the patients (22%) fitted with a self expanding stent. Complete sealing of the fistula was achieved in 19 (79%) and 15 (83%) patients, respectively. Reoperations were necessary in eight (33%) and three (17%) patients. Early major complications occurred in four (17%) and two (11%) patients. CONCLUSION: The selfexpanding stent was faster and easier to insert than a plastic endoprosthesis, and effective in sealing an oesophagobronchial fistula.

Bronchial Fistula↗
PubMed1998

Localization in situ of costimulatory molecules and cytokines in B-cell non-Hodgkin's lymphoma.

Costimulatory molecules are essential in cognate interactions between T and B lymphocytes. To study the prerequisites of functional interactions between malignant B cells and intermingled T cells in B-cell non-Hodgkin's lymphomas (B-NHL), we examined the expression of CD40, CD80 and CD86 and their ligands CD40 ligand (CD40L, CD154), CD28 and CTLA4 (CD152) using immunohistochemistry and confocal laser scanning microscopy. Almost all mucosa-associated lymphoid tissue (MALT) NHL were positive for CD40 and CD80 and in nine out of 14 cases were positive for CD86. The majority of follicle centre cell lymphomas (FCCL) expressed CD40, but were heterogeneous in their expression of CD80 and CD86. Most diffuse large cell lymphomas (DLCL) were CD80+, but lacked expression of CD86. These patterns reflect the differences in phenotype of normal marginal-zone B cells (as counterparts of MALT NHL) and germinal centre cells (as counterparts of FCCL and DLCL). Counter-receptors on T cells were detectable in 13 of 14 MALT NHL, 12 of 16 FCCL but only occasionally in DLCL (three of 12 cases). A subgroup of FCCL was identified with T-cell expression of CD40L, CD28 and CTLA4 simultaneously with strong expression of CD40 and CD86 on the tumour B cells. These results indicate that MALT NHL and a subset of FCCL are most optimally equipped for functional interactions with T cells. This may be supported by the demonstration of cytokine production - mainly in T cells - in MALT NHL [interleukin-2 (IL-2), interferon-gamma (IFN-gamma), IL-10] and FCCL (IL-2, IFN-gamma) and to a lesser extent in DLCL.

Abatacept↗
PubMed1998

Expandable stents compared to conventional plastic endoprostheses in malignant oesophageal obstruction, especially in cardiac cancer and fistulas: the experience of the Netherlands Cancer Institute.

BACKGROUND: Advanced oesophageal carcinoma usually causes debilitating dysphagia. An endoprosthesis can offer adequate palliation. The self-expandable metal stents provide several advantages over the plastic endoprostheses: less traumatic introduction and stronger attachment to the oesophageal wall. OBJECTIVE: To evaluate whether the self-expandable stents are more effective, especially in the technically challenging group of patients with a cardiac carcinoma or a fistula. SETTING: A single-institution study (cancer hospital). METHODS: A retrospective study of 132 consecutive patients (92 men and 40 women; median age 67 years) in whom a stent was inserted between 1991 and 1996. A plastic stent was applied in 72 patients, and from 1994 onwards an expandable stent in 60 subsequent patients. RESULTS: Overall technical success rate was high for both types of stents: 93 vs 88%. Clear improvement of dysphagia occurred more often with the expandable stents (80%) compared to the plastic stents (62%). Unfortunately, loss of appetite remained a problem in 30% of the patients. In the more troublesome subgroup of cardiac carcinoma (n = 55) and (imminent) fistula (n = 42) stenting was equally effective. Early complications were significantly less often encountered for the self-expandables: 3 vs 45%, the same was true for insertion related mortality: 0 vs 10%. Also the need for reintervention was less frequent: 12 vs 23%. This was especially on the account of the plastic stent in fistulas. CONCLUSIONS: Technical success rate was excellent for all types of stents, but in particular for the self-expandable stents which were also associated with fewer side effects. The subgroups of fistula and cardia carcinoma did equally well, probably related to adequate choice of stent.

Adult↗