PubMed Health⌕ Search

Biomedical subjects

H P Heilmann

Publications and source records attributed to H P Heilmann.

At least 19 recordsLinked to original sources
PubMed1995

Small cell lung cancer with and without superior vena cava syndrome: a multivariate analysis of prognostic factors in 408 cases.

PURPOSE: Patients with small cell lung cancer (SCLC) and superior vena cava syndrome (SVCS) are widely believed to have a grave prognosis. The purpose of this study was to determine the prognosis of patients with SCLC and SVCS as compared to SCLC without SVCS. METHODS AND MATERIALS: A retrospective analysis of 408 cases of SCLC +/- SVCS was performed. Three- hundred and sixty showed no clinical signs of SVCS and 43 (11%) had SVCS; in 5 patients no adequate information was available about clinical signs of SVCS. All patients were classified as limited disease cases. About 98% received chemotherapy usually as the first treatment followed by radiotherapy. A median total dose of 46 Gy (range 30 to 70 Gy) was given at 2.0 Gy per fraction five times weekly. A prophylactic cranial irradiation was applied if a complete remission was achieved after chemotherapy or after 30 Gy of irradiation. Kaplan-Meier survival curves are shown and comparisons were made by the log-rank and the Gehan/Wilcoxon test. To adjust for prognostic factors, a proportional hazards analysis was done. RESULTS: Patients without SVCS had 5-year survival rates ( +/- SE) and a median survival time (MST; 95% confidence intervals) of 11% +/- 2% and 13.7 months (12.7-14.5) in UICC Stage I to III; in Stage III the figures were 9% +/- 2% and 12.6 months (11.2-13.7). In comparison, SCLC with SVCS had 5-year survival rates of 15% +/- 7% and MST of 16.1 months (13.8-20.5). The difference was significant in univariate analysis (Stage II disease: p = 0.008 by the log-rank test). In a multivariate analysis of all patients, Stage (Stage I + II > III; p = 0.0003), SVCS (yes > no; p = 0.005), and Karnofsky performance status ( < or = 70 < 80-100%; p = 0.008) were of significant importance. CONCLUSIONS: SVCS is a favorable prognostic sign in SCLC. The treatment should be curatively intended.

Adult↗
PubMed1995

Prognostic factors in high-grade malignant glioma. A multivariate analysis of 76 cases with postoperative radiotherapy.

PURPOSE: Patients with malignant gliomas have a limited survival prognosis. We retrospectively analyzed data of malignant glioma patients with the aim of defining prognostic factors on which individualized treatment strategies might be built on. PATIENTS AND METHODS: Seventy-six patients with primary malignant glioma (51 glioblastoma multiforme, 20 anaplastic astrocytoma, 4 anaplastic oligo-astrocytoma, 1 anaplastic glioma) were postoperatively irradiated with 5 and 8 Me V photons, 2 Gy per fraction to a median total dose of 60 Gy (range 50 to 70 Gy). RESULTS: The youngest quartile of patients (up to 45 years) had the highest 3-year survival rates (mean +/- SE: 15 +/- 8%) and median survival time (17.9 months, 95% confidence interval: 9.2, 24.2 months) as compared to the oldest quartile (> 61 years) with no 3-year survivor and a median survival time of 9.7 months (7.2, 12.3 months). The middle quartiles (46 to 61 years) showed intermediate results. The difference between the youngest and oldest quartile (p = 0.01) and the middle quartile versus the oldest quartile (p = 0.04) was significant. In univariate analysis, tumor size (p = 0.04 for -30 mm vs > 50 mm) was of importance. In multivariate analysis only age of the patient reached statistical significance (p = 0.03). As compared to the youngest quartile of patients, the oldest quartile had a relative risk of 2.1 (95% confidence interval: 0.9, 5.1) of dying from the disease; the age group of 46 to 61 years had a relative risk of 2.0 (0.9, 4.3). CONCLUSIONS: Age of the patient is the most important factor for survival prognosis favouring younger age (< or = 45 years). The possible implications for radiation therapy are discussed.

Adolescent↗
PubMed1990

[High dose intensity with COP-BLAM in Hodgkin's disease with unfavorable risk factors].

Thirty three patients with unfavourable risk factors suffering from Hodgkin's disease received COPBlAM polychemotherapy as first treatment in a phase-II study between 3/86 and 2/89. The median cumulative relative dose intensity (RDI) of 0.97, calculated as a measure for the given amount of cytostatics per time, was very high. Fourteen patients (43%) achieved a complete remission (CR); 11 (33%) additional cases were categorized as far-reaching remission (FRR) due to small residual tumors in the regions of originally large tumor masses, 7 (21%) as partial remission (PR), and one case (3%) as progression. As the small residual tumors of the patients grouped as FRR did not shrink during the following radiotherapy (RT), these cases were also classified as complete responders retrospectively. Thus, after chemotherapy 76% CR resulted. After completion of RT 91% of the patients have achieved a CR. The progress-free survival probability and the survival probability were 83% and 86% respectively after 45 months.

Adolescent↗
PubMed1990

[Bronchial cancer: radiation therapy].

Postoperative radiotherapy as a routine procedure has failed to show any benefit in prospective randomized studies. Local failure was diminished, but survival rates remained unchanged, probably because of radiation complications. By improvement of radiation techniques, however, reduction of single doses and total dose and focusing postoperative irradiation of lung cancer to high risk cases (N2, T4) survival rates with postoperative irradiation are about 20% after 5 years. The results of 191 treated patients are demonstrated.

Carcinoma, Bronchogenic↗
PubMed1989

[Psychosocial aspects and rehabilitation problems of patients with tumors of the ORL region with special reference to laryngectomees].

The operational therapy of malign tumours in the ORL is often connected with visible larger tissue organ lesions respectively. By this reason intensive efforts regarding comprehensive rehabilitation are necessary with the aim of overcoming the multiple impairments of familiar, social and occupational life. It is demonstrated with making inquiries concerning tight cooperation between patients, physicians, relatives, speech therapists and rehabilitation centres by example of laryngectomees as a premise for an successful reincorporation into a normal life.

Alcoholism↗
PubMed1988

Malignant mesothelioma of the pleura. A prospective therapeutic study of 132 patients from 1981-1985.

Between March 1981 and February 1985, 93 out of 132 patients with a histologically confirmed diagnosis of malignant pleural mesothelioma were eligible for therapy and were prospectively assigned to receive either combined therapy or best supportive care, according to their personal preferences. Fifty-seven patients underwent multimodal therapy including surgical resection where possible, polychemotherapy, and radiation therapy in case of partial remission. Thirty-six patients received maximal supportive care only, as did 39 patients who were not eligible for treatment. The median survival was 13 months for treated patients compared to 7 for those receiving best supportive care and 5 for patients not amenable to treatment. Median progress-free survival was 6, 2, and 1 month respectively. Surgical resection did not prolong life expectancy within the treated group. In view of significant differences in the distribution of various cofactors over the two study groups, stepwise Cox model analyses were performed. Prognostic nontreatment variables related to prolonged survival were: good performance status, stage I and II, absence of chest pain, age below 50 years, and epithelial histology. Although in the Cox model analyses the survival improvement of patients being treated could be greatly attributed to other cofactors, multimodal treatment showed some prolongation of life expectancy.

Adult↗
PubMed1988

[Phase III therapy study in patients with small cell bronchial cancer].

In a prospective randomized study 150 patients with small cell lung carcinoma (80 cases with extended, 70 cases with limited disease) received either cisplatin + etoposide (DDP/VP) or cyclophosphamide + etoposide (cyclo/VP) as induction chemotherapy. Patients were crossed over when less than complete remission was achieved. Treatment failures received a salvage regimen with adriamycin + vindesine (ADM/VDS). Remission rates (complete + partial remissions) achieved with DDP/VP were 87.4% (40.6% + 46.8%) in limited disease and 72.2% (10.1% + 62.1%) in extended disease; response rates seen following cyclo/VP were 78.8% (31.5% + 47.3%) in limited and 51.0% (6.9% + 44.1%) in extended disease. Median survival time for patients in complete remission was 12.0 months following DDP/VP and 14 months following cyclo/VP; for patients in partial remission 10.0 and 9.0 months, respectively. The analysis of the treatment results shows an equal effectivity of both induction regimes which, however, seem to be largely cross resistant. DDP/VP probably causes more stable longtime remissions. The salvage regimen ADM/VDS was ineffective. The results achieved with this rather complex therapeutic strategy are not superior to those seen with simpler regimes.

Adult↗
PubMed1988

[Long-term results in highly malignant stage I and II non-Hodgkin's lymphomas during management with polychemo- and radiotherapy].

In 159 patients treated from 1976-1986 with an age median of 62 (16-85) years the survival probability amounted to 66% after ten years, where stage I (n = 82) with 77% was more favourable than stage IIA (n = 54) with 60% and stage IIB (n = 23) with 43%. With 61% the prognosis of the 7th to 9th decade of age (n = 82) was not worse than that of younger age groups (n = 77) with 70%. In prognostic respect immunoblastic (n = 49), centroblastic (n = 65) and unclassifiable (n = 45) subtypes as well as sexes do not differ and, therefore, they could be evaluated in total. With 81% the relapse-free survival time after sequential or simultaneous combination of polychemo- and large-scale radiotherapy the relapse-free survival time was markedly higher in stage IA (n = 45), stage IB (n = 5) and stage IIA (n = 26) than after single radiotherapy (n = 21) with only 30%. Even in elder patients the combined method was so far not accompanied by a higher complication rate so that this procedure may be considered as an essential progress in the treatment of highly malignant lymphomas. Thus, certain uncertainties as to insufficient division of stages which have frequently to be taken into account in elder people due to their limited invasive burdening capacity may be neglected.

Adolescent↗
PubMed1988

[Possibilities of chemotherapy in patients with bronchial cancer].

The introduction of chemotherapy in the treatment of small cell lung cancer made this a potentially curable disease. Despite intensive efforts, non-small cell lung cancer, however, remains refractory to chemotherapy. In patients with small cell lung cancer efforts are concentrating on increasing the cure rates. In patients with non-small lung cancer efforts are directed at achieving an optimal combination of palliative action and quality of life.

Adult↗
PubMed1987

[Risk-adapted treatment of immunocytomas].

For 176 patients seen between 1976 and 1984, with a mean age of 65 years, the probability of survival after ten years was 56% for lymphoplasmocytoid (n = 86), lymphoplasmocytic (n = 38) and non-classifiable (n = 10) subtypes, while it was 0% at the end of 6.5 years for the polymorph cell type (n = 42). Patients up to 60 years of age had, at 68%, a generally better prognosis than older ones, at only 30%. Cases with bone-marrow infiltration or leukemic washout (n = 114) were, like chronic lymphoid leukemia cases, classified according to the scheme of Rai and co-workers, while the remaining cases (n = 62) were classified according to the Ann Arbor scheme. There was a three-step prognosis of ten-year probability of 85% for stages I A, Rai 0, Rai I (n = 49), 50% for II A/B, III A, Rai II (n = 43), and 27% for III B/IV B and Rai III/IV (n = 41) of the non-polymorph cell subtypes. For the polymorph cell forms there was also a triple division with 88%, 53% and 14% after only four years. Additional unfavorable factors were rapid lymphoma growth, leukemic course, high paraprotein gradient and autoimmune hemolysis. The flexible employment of polychemotherapy and large-field radiotherapy, adapted to the mentioned unfavorable risk factors and age, contributed to the improved results in this heterogeneous group.

Adult↗
PubMed1987

[Long-term results in 172 highly malignant non-Hodgkin's lymphomas with special reference to older patients].

In 172 patients of the years 1976-1984 with a median age of 61 (16-89 years) the probability of survival was 55% after nine years. The seventh to ninth decade of life (n = 88) did not differ significantly in terms of the survival prognosis (47%) from the younger age groups (n = 84) with 59%. Immunoblastic (n = 72), centroblastic (n = 65) and unclassifiable (n = 35) lymphomas were prognostically similar and could hence be evaluated together. Stages I A (n = 58) with 83% and IV B (n = 15) with 20% differed from all others (n = 99), for which a survival rate of 41% was calculated. With the CHOP scheme (n = 76), a complete remission could be induced in 70% of the stages II A/B, III A/B and IV A (n = 54) and in 95% of stage I A (n = 19). In stage IV B (n = 14), more intensive schemata were not successful, only inducing two remissions. After sequential combination of polychemotherapy and large-field radiotherapy, the relapse-free survival was higher than after radiation or cytostatics alone. This was shown most distinctly in stage I A, in which a value of 82% compared to only 29% after radiotherapy was found for the combined method. Since this was not associated with higher rates of complications so far even with the older patients, we regard this procedure as major advance in the therapy of prognostically unfavorable lymphomas.

Adolescent↗