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Biomedical subjects

J Aparicio

Publications and source records attributed to J Aparicio.

At least 37 records · Page 2Linked to original sources
PubMed1999

BOMP/EPI intensive alternating chemotherapy for IGCCC poor-prognosis germ-cell tumors: the Spanish Germ-Cell Cancer Group experience (GG)

BACKGROUND: Patients with poor-prognosis germ-cell tumors according to the IGCCC have a poor long-term survival. This study evaluates the efficacy and toxicity of the intensive alternating chemotherapy regimen BOMP/EPI in these patients. PATIENTS AND METHODS: Patients with IGCCC poor-prognosis germ-cell tumors treated at 13 centres were studied. Treatment consisted of bleomycin 30 mg, vincristine 2 mg, methotrexate 300 mg/m2 and cisplatin 100 mg/m2 (BOMP), alternating after a 14-day interval with etoposide 120 mg/m2 day 1-4, ifosfamide 1.3 g/m2 day 1-4 and cisplatin 25 mg/m2 day 1-4 (EPI). BOMP was administered 21 days after the EPI. Bleomycin was administered weekly per 12 weeks. RESULTS: Thirty-eight patients were treated. The median number of cycles administered was 7 (1-10 cycles). Eighteen patients achieved complete responses with chemotherapy alone (12 had necrosis and 2 mature teratoma at postchemotherapy resection), and four achieved complete responses with chemotherapy and surgical resection of viable cancer. Thus, an overall favorable response was achieved in 22 patients (60%). Four additional patients had marker-negative non-resected residual masses. Eleven patients were considered treatment failures, including one who died early and another who succumbed to granulocytopenic sepsis and renal failure. Hematologic toxicity was the most common, with 26 patients (70%) having grade 4 granulocytopenia. After a median follow-up of 41 months, the actuarial two-year overall survival and progression-free survival were 64% and 58%, respectively. CONCLUSION: BOMP/EPI is active in poor-prognosis germ-cell tumors according to the IGCCC criteria. The results obtained compare favorably with those expected with conventional chemotherapy, and justify further studies.

Adolescent↗
PubMed1999

ESHAP is an active regimen for relapsing Hodgkin's disease.

BACKGROUND: Refractory or relapsing Hodgkin's disease is associated with a poor prognosis. There is no widely accepted salvage chemotherapy regimen for these patients. However, the addition of high-dose chemotherapy followed by autologous hematopoietic transplantation (AHT) has proven of benefit to them. A prospective clinical trial was carried out to evaluate the efficacy and toxicity of ESHAP (etoposide, methylprednisolone, high-dose cytarabine, and cisplatin). PATIENTS AND METHODS: Twenty-two patients with refractory (5) or relapsing Hodgkin's disease (17) were entered and scheduled to receive three courses of ESHAP. Patients suitable for AHT were then given high-dose chemotherapy with CBV (cyclophosphamide, carmustine, and etoposide) plus AHT, whereas responding, non-AHT-suitable patients completed six ESHAP courses. RESULTS: Nine patients achieved complete responses and seven partial responses (overall response rate 73%) with ESHAP. Grade 3-4 myelotoxicity was seen in 13 patients (59%). Nine patients received CBV plus AHT. At a median follow-up time of 50 months (range 6-96), seven patients (32%) are alive and disease-free. Three patients died of toxic effects of ESHAP (1) or CBV (2). Actuarial overall survival and disease-free survival were 35% and 27% at three years. CONCLUSIONS: ESHAP is an active regimen for relapsing Hodgkin's disease, with myelosuppression as its dose-limiting toxicity. An increased risk of treatment-related mortality when it is combined with high-dose chemotherapy can not be ruled out.

Adolescent↗
PubMed1999

Etoposide sensitivity of human prostatic cancer cell lines PC-3, DU 145 and LNCaP.

Metastatic prostatic cancer is typically refractory to androgen ablation therapy due to the presence of androgen-independent clones in the neoplasia. A therapeutical approach which could effectively control androgen-dependent and independent cells is, thus, needed. Maybe the failure of certain cancer cells to engage in apoptosis could explain the inherent drug resistance of many tumors. Anyway, these cells can retain the ability to undergo apoptosis in response to an adequate stimulus. We tested whether etoposide, a topoisomerase II inhibitor, could induce apoptosis in androgen-dependent (LNCaP) as well as independent (PC-3 and DU 145) human prostate cancer cell lines. Morphological examination was performed, as it is regarded as one of the most reliable parameters for the detection of apoptotic changes. Complementarily, biochemical and flow cytometric studies were also used. Characteristical changes of apoptosis were demonstrated in PC-3, Du 145, and LNCaP cancer cells after treatment with etoposide. These cells, thus, retain the ability to undergo apoptosis under adequate conditions, in a promising approach to hormone refractory prostate cancer therapy.

Androgens↗
PubMed1998

Randomized trial comparing monthly low-dose leucovorin and fluorouracil bolus with weekly high-dose 48-hour continuous-infusion fluorouracil for advanced colorectal cancer: a Spanish Cooperative Group for Gastrointestinal Tumor Therapy (TTD) study.

PURPOSE: The objective of this multicenter study was to compare the efficacy and toxicity profiles of a combination of 5-fluorouracil (5-FU) given by bolus injection together with intravenous leucovorin (LV) versus high-dose 5-FU in continuous infusion (CI) in the treatment of advanced colorectal cancer. PATIENTS AND METHODS: A total of 306 patients were randomized to receive either 5-FU 425 mg/m2 given by bolus injection on days 1-5 plus intravenous (i.v.) LV 20 mg/m2 every four to five weeks or 5-FU 3.5 g/m2/week in a 48-hour CI. Therapy was continued until disease progression. Second-line chemotherapy was allowed in both arms. RESULTS: The response rates in 306 patients with measurable lesions were 19.2% (modulated arm) and 30.3% (CI arm, P < 0.05). The median progression-free survival times were 23.5 weeks (modulated arm) and 25 weeks (CI arm, P = NS). Median survival times were 42.5 weeks (modulated arm) and 48 weeks (CI arm, P = NS). There were no significant differences in grade 3-4 toxicity profiles but if we consider all grades we observed more mucositis in the modulated arm and more hand-foot syndrome in the CI arm. CONCLUSIONS: In terms of response rate, the continuous infusion regimen was more effective than the modulated regimen. There was no significant difference in survival and time to progression, and none in grade 3-4 toxicity.

Adult↗
PubMed1998

Malignant pleural effusion: prognostic factors for survival and response to chemical pleurodesis in a series of 120 cases.

Chemical pleurodesis is an effective treatment of malignant pleural effusions, but indications must be individualised to optimise its results. The aim of the present study was to investigate the relationship of various prognostic features with both the response rate to pleurodesis and the probability of patient survival. A non-concurrent cohort study was carried out in which 120 evaluable patients with malignant pleural effusion underwent pleurodesis. Lung (40%), breast (26.6%), and unknown primary site (12.5%) carcinomas were the most frequent neoplasms. Clinical data and pleural fluid parameters were analysed. Median overall survival was 9 months. Pleural fluid glucose (< 60 mg/dl), Karnofsky performance status (< 70), size of the effusion in chest radiographs (massive effusion), pleural fluid pH (< 7.20), presence of concomitant alterations in chest radiographs, and pleural lactic acid dehydrogenase levels (> 600 U/l) showed a significant association with the probability of failure. Patients with these features, along with those having non-chemosensitive tumours (in particular, non-small cell lung cancer), had a significantly worse actuarial survival. This study confirms that some pretreatment clinical data and pleural fluid parameters can predict both the outcome of pleurodesis and the survival of patients with malignant pleural effusion.

Aged↗
PubMed1997

Pretreatment prognostic factors for survival in small-cell lung cancer: a new prognostic index and validation of three known prognostic indices on 341 patients.

AIMS: a) To identify which pretreatment clinical or blood parameters were predictive of patients survival in small-cell lung cancer (SCLC) in a retrospective analysis. b) To validate three known prognostic indices: Royal Marsden Model (index 1), London Group (index 2) and Manchester Score (index 3). PATIENTS AND METHODS: From 1981 to 1993, 341 SCLC patients were treated with chemotherapy with or without surgery or radiotherapy. Univariate and multiple regression analyses of survival were performed and the feasibility of these models was explored, index 1: Karnofsky index, albumin, sodium and alkaline phosphatase; index 2: ECOG performance status (PS), albumin and alanine transaminase; and index 3; lactate dehydrogenase (LDH), disease extent, sodium, Karnofsky index, alkaline phosphatase and bicarbonate. RESULTS: Significant prognostic factors for survival after univariate and multiple regression analysis were: disease extent, PS, creatine kinase, neutrophilia, LDH, hypoalbuminemia, hyperglycemia and bicarbonate. A new prognostic index was performed that included LDH, hypoalbuminemia, neutrophilia, disease extent and PS. It defined three prognostic groups (PG). Median survival and two-year survival for these PG were 12.3, 8 and 3.4 months and 16.5%, 2.3% and 0%, respectively. The following PG were identified after application of the three models proposed: Index 1 identified two PG with 0% and 16.6% two-year survival (P < 0.001); index 2 detected three PG with 0%, 5% and 15.7% two-year survival (P < 0.001) and index 3 detected three PG with 0%, 2.5% and 16.2% two-year survivals, respectively (P < 0.001). CONCLUSION: A new prognostic index is proposed allowing identification of three different PG. The feasibility of three known prognostic models was validated and demonstrated. Variables other than disease extent or PS (albumin or LDH) should be taken into account in designing future clinical trials.

Aged↗
PubMed1997

Low levels of basic fibroblast growth factor (bFGF) are associated with a poor prognosis in human breast carcinoma.

It has been suggested that angiogenesis and angiogenic factors may be strong predictors of relapse in patients with breast carcinoma. We measured the levels of the angiogenic peptide basic fibroblast growth factor (bFGF) in 140 breast tumour cytosols using an immunoassay. There were no significant differences in bFGF levels between breast non-malignant lesions and primary carcinomas. In 124 cases with primary breast cancer, we observed an association of low bFGF levels (< 400 pg mg[-1]) with increasing tumour size (P = 0.023) and stage of disease (P = 0.002). bFGF levels did not correlate with other variables, including axillary nodes, hormone receptors, cathepsin D and the serum tumour markers CA15.3 and CEA. With a median follow-up of 44.0 months, breast cancer patients with low levels of bFGF had a significantly shorter disease-free survival (DFS) than patients with elevated bFGF (log-rank, P < 0.0001). In a multivariate analysis of DFS, only bFGF, T-stage and histological grade showed statistical significance. In a parallel evaluation of circulating bFGF, we did not observe a correlation between the serum and tissue bFGF levels in the 29 selected cases with matched determinations. Our results indicate that low bFGF levels in breast carcinoma are an independent prognostic indicator of poor prognosis and disease recurrence.

Adult↗
PubMed1997

Pleurodesis in malignant pleural effusions: a randomized study of tetracycline versus bleomycin.

Malignant pleural effusions are commonly managed with tube thoracostomy drainage followed by chemical pleurodesis. Both tetracycline and bleomycin have been shown to be effective for intrapleural instillation, although neither agent has definitively proved advantages over the other. The aim of the present study was to compare these two agents in terms of response rate and toxicity profile. A prospective, randomized trial was carried out in a single centre. Between May 1993 and January 1996, 62 evaluable patients with proved malignant pleural effusion were allocated to receive either intrapleural tetracycline (1.5 g) or bleomycin (60 mg) after the same drainage procedure. Demographic, clinical and fluid parameter data were comparable in both groups. Response was evaluated at 1, 3 and 6 months after pleurodesis. Mean survival and time to relapse did not differ between the two groups. No statistically significant differences were found in terms of efficacy at each evaluation time. Overall, 16 (52%) and 20 (64%) patients had a recurrence of pleural effusion during follow-up in the tetracycline and bleomycin arms, respectively. Fever was most common in bleomycin-treated patients (p=0.024) while pain was most frequent in the tetracycline arm (nonsignificant). Since no study agent was superior to the other in this trial, we suggest that economic costs, drug availability and medical skill should be considered in the choice of a sclerosing agent.

Adult↗
PubMed1996

Randomised comparison of ceftazidime and imipenem as initial monotherapy for febrile episodes in neutropenic cancer patients.

With the availability of new, broad-spectrum antibiotics, initial therapy with a single agent has become an alternative to classic combinations in the management of febrile, neutropenic cancer patients. The aims of this study were to compare the efficacy of ceftazidime and imipenem as empirical monotherapy of febrile episodes in neutropenic patients, and to examine the frequency with which second-line antibiotics (amikacin, vancomycin, or both) were required. A prospective clinical trial was carried out in a single centre. Eligible patients with solid tumours or lymphoma were randomised to receive monotherapy with ceftazidime or imipenem. In the event of no response, amikacin and/or vancomycin were added in 48-72 h intervals (sequentially, or according to clinical or microbiological data). Efficacy was evaluable for 111 assessable episodes. Median neutrophil count at entry was 100 cells/microliters and median duration of neutropenia was 4 days. Febrile episodes were classified as microbiologically (34%) or clinically documented (42%), and fever of unknown origin (24%). Gram-negative infections (57%) predominated over gram-positive isolates (30%). The overall success rate with monotherapy (69% versus 70%), or with modification (20% versus 23%) were equivalent for ceftazidime and imipenem (P = 0.75). The mortality in this series was 5%. Single-agent therapy with either ceftazidime or imipenem is effective for the empirical treatment of febrile episodes in neutropenic patients with solid tumours. Early addition of amikacin and/or vancomycin resolves most failures of the first step.

Adolescent↗
PubMed1996

Extragonadal nongestational choriocarcinoma involving the lung: a report of three cases.

Primary choriocarcinoma of the lung is an extremely rare tumour, with about 20 cases reported in the literature. The case records of 3 female patients with nongestational, extragonadal choriocarcinoma apparently arising in the lung are presented to illustrate its clinical spectrum, the utility of serum beta human chorionic gonadotropin, and responsiveness to chemotherapy. Most plausible origins of these malignancies and differential diagnosis are briefly discussed.

Adult↗
PubMed1996

Dietary intervention in a hypercholesterolemic school-aged population from Northern Spain.

A "before and after" intervention study, over a five year period, was done in order to find the degree of compliance to dietary recommendations and their effects on serum lipids in a hypercholesterolemic school-aged population. 383 children between 6 and 13 years of age, were identified with hypercholesterolemia (total serum levels above 4.8 mmol/l), in a previous randomized mass screening of 1095 individuals. Some dietary guidelines aimed at decreasing fat consumption and increasing fiber and carbohydrate ingestion were given to the families, and 226 of the children participated in the follow-up. Changes of address and/or school-center was the main cause of non-participation. The follow-up examination consisted in the evaluation of serum lipids and actual diet. Cholesterol serum levels decreased from a mean value of 5.4 mmol/l to 4.8 mmol/l. 59.3% of the sample had reached serum cholesterol levels below the risk threshold. Fat ingestion diminished significantly (40.3% of calories to 36.7%, p < 0.001), saturated fatty acids decreased from 15.3% of calories to 13.5% (p < 0.001), monounsaturated fatty acids decreased from 17.1% to 15.4% (p < 0.001) and polyunsaturated fatty acids remained unchanged. Carbohydrate consumption increased from 45% of the calories to 47.38% (p < 0.001). Dietary changes were greater in individuals out of risk than those who still had high cholesterol levels. These data indicate a good family compliance to the recommendations and that changes in food habits seem to be effective in controlling hyperlipidemia. Dietary changes are better accepted by younger children.

Adolescent↗
PubMed1995

Extragonadal germ cell tumors: prognostic factors and long-term follow-up.

The records of 23 patients (22 male and 1 female, median age 28 years) with extragonadal germ cell tumors (EGCT) treated between 1974 and 1993 were reviewed retrospectively to investigate long-term survival and prognostic factors. Treatment consisted of cisplatin-based chemotherapy plus local irradiation or surgery. There were 7 seminomas, 5 poorly differentiated carcinomas (PDC) with elevated biomarkers, and 11 nonseminomatous germ cell tumors (NSGCT). The primary sites were retroperitoneum (10 cases), mediastinum (5 cases), pineal gland (4 cases) and other (4 cases). Two partial and 14 complete responses (69.6% overall) were achieved with primary therapy. After a median follow-up of 63 months, 10 (43.5%) patients live disease-free and 5-year survival is 55%. Seminomas showed an excellent outcome. Retroperitoneal NSGCT behaved like testicular neoplasms. Between nonseminoma patients, PDC histology and mediastinal primary were associated with the worst prognoses. EGCT patients should be treated and reported separately according to histology and primary site.

Adolescent↗
PubMed1994

[The use of sublingual captopril in hypertensive crises].

The purpose of this study was to evaluate the antihypertensive efficacy of captopril (C) and its correlation with body mass index (BMI), age and initial blood pressure (BP) in hypertensive crises. The time of the beginning of the antihypertensive effect of C and its side effects were evaluated. Twenty patients, aged between 22 and 59 years, were included in this investigation. BP was measured after 15 min of rest; age, weight and height were recorded and BMI was calculated using the standard formula (Kg/m2). Patients were not taking antihypertensive medications. After the placebo was given to the patients, BP was measured at 30 and 60 min. Sublingual captopril 25 mg was administered and BP was again measured at 5, 10, 15, 30, 60, 120 y 240 min. There was not statistically significant difference between the values of BP before and after placebo. A significant decrease was observed post C, from 182.6/123.6 to 174.6/117.3 (p:SN/p < 0.02) in 10 min., to 169.9/114.9 (p < 0.04/p < 0.001) in 15 min., to 167.7/112.2 (p < 0.02/p < 0.0001) in 30 min., to 164.3/108.8 (p < 0.002/p < 0.0001) in 60 min., to 156.9/106.5 (p < 0.0001/p < 0.0001) in 120 min., to 161.3/107.0 (p < 0.0002/p < 0.0001) in 240 min. In 15 patients there was a decrease in diastolic BP > or = 5 mmHg, 10 min. post C. No correlation was found between decrease in BP and age, nor with BMI. Pearson r correlation index between the decrease in systolic BP and initial systolic BP was 0.63 (p < 0.003) and between the decrease in diastolic BP and initial diastolic BP, 0.59 (p < 0.005). Secondary effects were mild and well tolerated. In conclusion, C effectively reduced BP in hypertensive crises. Because the efficacy of C, its rapid onset of action and minimal side effects, sublingual Captopril should be considered a first line drug for hypertensive crises.

Administration, Sublingual↗
PubMed1993

[Cardiovascular risk factors in a population of schoolchildren in Asturias].

A transversal epidemiological study was carried out to discover the most important cardiovascular risk factors in the child population of Asturias, Spain. The study took place over a period of 4 years (1987-91) and consisted of a representative sample of boys and girls (6-13 years of age) from different socioeconomic and cultural backgrounds. Biochemical factors (serum total cholesterol, HDL-cholesterol, serum triglycerides and glucose) and anthropometric measures to evaluate obesity were analysed. Hypercholesterolemia appeared to be the most prevalent risk factor with a prevalence of 38.27% and a mean value of 178.31 mg/dl, followed by obesity (15.58%), hypertriglyceridemia (14.05%) and hyperglycemia (0.77%). Risk factors were more frequent in girls than boys, and in younger children in relation to older ones. Hypercholesterolemia and obesity were more prevalent in children from an urban environment while hypertriglyceridemia was the main risk factor in those from a rural one. Considering the high prevalence of the evaluated risk factors, the prevention and control of such is of extreme importance in leading children to becoming healthy adults.

Adolescent↗