Biomedical subjects

L Buchelt

Publications and source records attributed to L Buchelt.

At least 19 recordsLinked to original sources

PubMed1990

High-intensity therapy versus low-intensity therapy in advanced breast cancer patients.

The aim of this study was to evaluate the significance of response to the first two cycles of FEC (5-fluorouracil, 4-epirubicin, cyclophosphamide) in patients with advanced breast cancer. A total of 99 patients entered the study. They showed either high risk criteria and were previously untreated or showed low risk criteria and were pretreated by hormonal therapies. Eighty-two patients were evaluable. In 22 (27%) who had disease progression despite two cycles of FEC, further therapeutic attempts proved ineffective, the median survival being 2.8 months. The remaining patients responded either by stable disease (SD, n = 29; 35%), by partial or by complete remission (PR, CR, n = 31; 38%). These 60 patients were randomized to two regimes of maintenance therapy: FEC every 3 weeks or LMF (leukeran, methotrexate, 5-fluorouracil) every 6 weeks. The subsequent course of the disease was not different in both arms. It was neither influenced by the quality of early response, i.e. SD, PR, CR, nor by the intensity of chemotherapy. The prognostic impact of early response to two cycles of FEC proved to be higher than other prognostic parameters in the patients examined. Thus, early response may serve as a valid guide to adapt maintenance chemotherapy in individual patients with advanced breast cancer.

Adult↗

PubMed1989

Compliance of physicians and patients with a consensus protocol for treatment of advanced breast cancer.

In a multicenter study we used a consensus protocol including more than five subsequent therapeutic steps for treatment of patients with advanced breast cancer. A total of 335 evaluable patients from 27 participating hospitals were allocated to a low- or high-risk group, receiving different therapies during the initial phase of treatment. About half of these patients were treated without protocol violations (compliers). The protocol non-compliers were divided into three groups: those receiving more intensive therapy than recommended, those with similarly intensive, and those with less intensive therapy. The reasons for protocol violations were analysed. The intensity of the therapy given actually was correlated with the survival of subgroups. Median survival times were significantly longer in 208 low-risk than in 127 high-risk patients (P less than 0.0001), marginally longer in 165 compliers than in 170 non-compliers (P less than 0.04), significantly longer in low-risk compliers than in low-risk non-compliers (P = 0.002), and significantly shorter in high-risk compliers than in high-risk non-compliers (P = 0.007). Survival of all subgroups of low-risk non-compliers was the same regardless of the actual therapies given. The survival of high-risk patients who received less intensive therapy was significantly longer than that of high-risk compliers (P = 0.015). After six cycles of successful chemotherapy there was no difference, either in time to progression or in survival, between patients who had received either maintenance therapy or no therapy. We postulate that the groups of low-risk and high-risk patients comprised patients with different prognoses. Among low-risk patients, survival of the subgroup with poor prognosis (low-risk non-compliers) was not influenced by therapy. Among high-risk patients, a subgroup with poor prognosis may have been overtreated by using standard chemotherapies as recommended in our consensus protocol.

Breast Neoplasms↗

PubMed1987

[Concept of treatment of metastatic breast cancer outside university clinics: description of the method and evaluation of efficacy].

It has been recognized during the past decade that it may be advantageous to develop complex strategies for treatment of metastatic breast cancer (MBC). In these strategies the type and efficacy of preceding therapies and the compliance of the patients have to be considered. Since about 80% of all patients with MBC are treated outside university hospitals it should be tested if a complex strategy for treatment of MBC can be realized in these institutions. The method was based on three principles: There was an exchange of data between participating institutions and study center after each visit of a patient. Second, there was one data sheet for admission of a patient to the study and fifteen sheets for follow-up documentation each with a different bottom line; in the bottom line of these sheets two therapies according to the strategy were proposed, one in case of 'no progression' and another in case of 'progression' of the disease. Third, a copy of completed sheets had to be returned to the study center; the study center provided the next sheet with the appropriate treatment recommendation. 335 evaluable patients were prospectively recruited from 27 participating institutions between January 1983 and December 1985. Based on the estimated incidence of MBC in the region, it was calculated that 45% of all MBC patients of the region had been admitted to the study. Only 27% of these patients were treated at the university hospital indicating that 85% of all MBC patients of the region were treated outside university hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1983

[Significance of skeletal scintigraphy for oncological practice].

Our experiences with more than 2000 bone scintigrams in 803 tumour patients underline the high ranking of skeletal scintigraphy in oncology. Among our patients--who, as a matter of fact, represented a selected material--the rate of false negative scintigraphs was less than 1%. The incidence mentioned in literature is between 1 and 3% (6, 11, 38, 41). By balanced and differentiated assessment of bone scintigrams and analogous x-ray films (plain radiographs, spot-film radiographs, if necessary x-ray tomograms), taking into consideration storage anomalies in respect of localization, form and storage intensity, false-positive results can be reduced to a minimum; as a matter of fact, we believe that in oncology patients the quota of false-positive results can be reduced to less than 3%. In tumour patients, the question as to whether there are any bone metastases, can be correctly answered with a probability of about 96% by means of skeletal scintigraphic imaging and the analogous x-ray film as a complementary examination. The bone scintigram is excellently suited for effecting malignoma staging. It is, in fact, superior to all other methods. Skeletal scintigraphic imaging enables the identification of metastases earlier than any other method. It is the most sensitive primary search method which can be utilized for on-target application of x-ray diagnostic methods. Both solitary and multiple osseous metastases can be accurately localized by scintigraphy. The early identification of skeletal metastases in skeletal regions with endangered stability, is particularly important, since an impending spontaneous fracture can be prevented by osteosynthesis or local radiation therapy. Changes in the growth of metastases under radiation and/or chemotherapy can be reliably observed by scintigraphic follow-ups, and can be assessed to determine whether there is a continued growth or a remission. If scintigram and x-ray film are employed side by side--a procedure which is imperative during first examination and later with specific courses of the disease, the low grade specificity of scintigraphy is largely compensated by the x-ray method.

Bone Neoplasms↗

PubMed1976

[Results of radiotherapy of bronchial carcinoma (author's transl)].

In a joint retrospective study by 17 radiotherapy clinics in German-speaking countries the results of treatment of bronchial carcinoma after radiotherapy were analysed in 7503 cases. The age peak was between the 60th and 70th year. Squamous-cell carcinoma was the most frequent histological type, followed by anaplastic carcinoma, with adenocarcinoma being rare. There was a high proportion of histologically not clearly identified cases (27% in central and 35% in peripheral carcinomas). Survival rate at one year was 31% for central (3662 patients) and peripheral (961 patients) tumours, but only 2% at five years. Prognostically there was no difference between histological types and kind of radiotherapy or technique, but total dose affected survival rate. At a total dose of less than 5000 rd the survival rate at five years was minimal. The prognosis of combined surgical and radiotherapeutic measures was slightly better than with a radiotherapy alone, but results were unpredictable for the individual case. It is concluded that radiotherapy aiming at cure should be used in imoperable bronchial carcinoma if the tumour state and general condition of the patient appear to make a cure possible. But if this is not the case, radiotherapy should be used only palliatively, i.e. only to ameliorate symptoms.

Adenocarcinoma↗

PubMed1976

[Biochemical investigations of cancer cachexia: I. Tumour induced changes of glycogenolysis and gluconeogenesis of Walker carcinoma bearing rats (author's transl)].

Rats (weight 150-200 g) bearing Walker-carcinoma showed tumour size dependent hypoglycemia, diminished mobilization of glycogen following glucagon stimulation and elevated values of the enzyme activity of glucose-6-(P)-ase. A further hormonal stimulation of this enzyme activity towards the values observed in normal rats after betamethasone stimulation was not possible. The values of the enzyme fructose-1,6-di-(P)-ase in liver of tumour bearing rats equalled those found in normal controls and did not show any rise after application of betamethasone. The serum levels of free fatty acids did not show any difference between normal controls and tumour bearing rats, and displayed an equal rise after intensive stimulation of peripheral lipolysis.

Animals↗

PubMed1976

[Biochemical investigations of cancer cachexia. II. Depletion of glycogenolysis and stimulation of gluconeogenesis in Walker carcinoma 256 bearing rats (author's transl)].

150-200 g heavy, Walker-carcinoma bearing, male Sprague-Dawley-rats showed rapid, tumour weight dependent, loss of liver glycogen until complete depletion in tumour groups heavier than 40 g/animal. Simultaneously the glycogen mobilization after massive glucagon stimulation, was successivly diminished and finally abolished in different groups with increasing tumor weight. Concomitantly the spontaneous and stimulated activity of liver phosphorylase a was found markedly reduced in advanced tumour cachexia, the extent of stimulation of liver phosphorylase a activity by intracardial injections of epinephrine not being altered. Tumour induced inhibition of glycogen mobilization thus appears to have been excluded. To account for the relative late pronounced hypoglycemia in peripherial rat blood in face of the early loss of liver glycogen, accelerated gluconeogenesis has been postulated. In accord with this spontaneous rise in liver tyrosine amino transferase was found in tumour bearing rats along with a doubled maximal stimulation value after medrol injection as compared to control groups. This behavior could not be shown for liver alanine aminotransferase and liver fructose 1,6-di-phosphatase. The former showed no differences between control and tumour groups neither of spontaneous nor of stimulated activity. The latter showed only a very reluctant rise after massive stimulation by triamcinolone for 3 days in the control groups, the tumour bearing groups showing no deviation from spontaneous control values.

Alanine Transaminase↗

PubMed1976

[Late recurrences in Hodgkin's disease following radiotherapy].

1. From 1950 to 1970, 92 patients with Hodgkin's disease stage I and II were treated by irradiation at the Universitäts-Strahlenklinik Marburg. Staging was performed without diagnostic laparotomy. More than a third might be staged wrong. 2. The over-all survival rates for both, stage I and II, are 65% after five years, 40% after ten years. 15% of the patients are expected to be cured. 3. Three late recurrences after 12 or 13 years are contradictory to the definition of cure in Hodgkin's disease, as a ten years lasting relapse-free interval after primary treatment. In two further cases lymphogranulomatosis developed 7 and 12 years after operation and irradiation of mediastinal tumors, which were histologically classified as lymphadenitis and polymorphcellular sarcoma, but here and there showed the features of lymphogranulomatosis. Two further cases of lymphogranulomatosis were seen with extraordinary long remissions of 11 and 17 years. 4. On the understanding that the primary tumor disease had been cured, we can look at the recurrences as at second tumor disease. Then a tumor-disposition in these patients must be discussed. 5. The occurrence of the prognostically advantageous histologic type of nodular sclerosis, the age of the patients between 27 and 37 years at the first manifestation of the disorder, and the tolerance of peripheral localisation of the tumor disease lead to the conclusion that histologic type and course show the ratio between tumor disease and immunologic situation of the patient. Probably, the histologic features might be the expression of this situation.

Adult↗

PubMed1974