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L V Beex

Publications and source records attributed to L V Beex.

At least 37 records · Page 2Linked to original sources
PubMed1996

Mammographic screening after the age of 65 years: evidence for a reduction in breast cancer mortality.

We evaluated whether regular mammographic screening of women aged 65 years or older affected breast cancer mortality. In Nijmegen, a population-based screening program for breast cancer was started in 1975, with biennial mammography for women aged 35-64 years. Since 1977, elderly women have also been participating. For the present case-control study, women were selected who were over 64 years of age at the most recent invitation. Eighty-two of them had died from breast cancer. For these cases, 410 age-matched population controls were selected. The ratio of breast cancer mortality rates of the women who had participated regularly (ie., in the 2 most recent screening rounds prior to diagnosis) vs. the women who had not participated in the screening was 0.56 (95% CI = 0.28-1.13). The rate ratio was 0.45 in the women aged 65-74 years at the most recent invitation (95% CI = 0.20-1.02), whereas it was 1.05 in the women aged 75 years and older (95% CI = 0.27- 4.14). While the breast cancer survival rate of the non-participant patients was fairly equal to that of patients from a control population, the underlying incidence rate of breast cancer was higher in the participants than in the non-participants. Therefore, we conclude that bias was present, but that it had decreased our effect estimate. The real reduction in breast cancer mortality due to regular screening will be even larger. Regular mammographic screening of women over age 65 (at least up to 75 years) can reduce breast cancer mortality by approximately 45%.

Aged↗
PubMed1996

Does supportive pamidronate treatment prevent or delay the first manifestation of bone metastases in breast cancer patients?

The effect of pamidronate treatment on the first development of bone metastases was investigated in 124 patients with breast cancer, with either locally advanced disease (n = 33) or extraskeletal metastases (n = 91), but no bone metastases in a randomised, multicentre, open controlled study. Patients were assigned to treatment with oral pamidronate, 300 mg/day, (n = 65) or to a control group (n = 59). Tumour therapy was freely allowed. A first clinical event of skeletal morbidity occurred in 22% pamidronate and 20% control patients; unequivocal first radiological manifestation of bone metastases was found in 36% pamidronate and 27% control patients (n.s.). The actuarial risk of a first skeletal event was similar in both groups. Quality-of-life measurements of bone metastases-related aspects showed no differences between the two groups. 19 patients withdrew from the study because of gastrointestinal complaints attributed to pamidronate. We conclude that supportive oral pamidronate treatment (300 mg/day) does not prevent nor delay the development of bone metastases in breast cancer patients at risk.

Adult↗
PubMed1995

Punctal and canalicular stenosis associated with systemic fluorouracil therapy. Report of five cases and review of the literature.

Ocular side effects of systemic fluorouracil include excessive lacrimation, due to punctal and canalicular stenosis and fibrosis. Obstruction of the tear ducts after systemic therapy with fluorouracil is more frequent than is assumed. Five patients with breast cancer and punctal or canalicular stenosis are presented. Although complaints of epiphora usually resolve two weeks after cessation of systemic therapy, local antibiotics and steroids may be indicated. In patients with persisting complaints, and patients treated with fluorouracil for a prolonged period of time, prophylactic intubation of the tear ducts with silastic tubes has been advocated. (Conjunctivo)dacryocystorhinostomy may be unavoidable.

Aged↗
PubMed1995

Palliative chemotherapy with CMF after the same adjuvant regimen for breast cancer. The Breast Cancer Study Group.

BACKGROUND: The results of palliative chemotherapy with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in patients with advanced breast cancer who received adjuvant therapy with the same regimen were investigated. RESULTS: Of 47 patients, 14 (30%) achieved an objective remission (median duration 9.5, range 5-21 months) and 8 (17%) stabilisation of disease (median duration 6, range 3-17 months). Objective remissions were observed in premenopausal as well as in postmenopausal women, in patients with all categories of dominant localisation of disease and regardless of the oestradiol receptor status of the primary tumour or eventual previous endocrine therapy. One of 4 and 13 of 43 patients who started palliative chemotherapy within or later than 12 months after the last adjuvant course obtained an objective remission. The median survival time from start of therapy of all treated patients was 12 (range 1-40) months. Patients with an objective remission or stable disease and patients with progressive disease had a median survival time of 20 (range 6-40) and 6 (range 1-35) months respectively (p < 0.0001). CONCLUSIONS: Palliative treatment with CMF should not be rejected for patients who have relapsed after adjuvant chemotherapy with the same modality.

Adult↗
PubMed1994

The phase of the menstrual cycle has no influence on the disease-free survival of patients with mammary carcinoma.

We evaluated the outcome of treatment for mammary carcinoma in 89 premenopausal women in relation to the phase of the menstrual cycle. The phase of the cycle was determined on the basis of serum concentrations of 17 beta-oestradiol and progesterone. The serum samples were collected 1 day prior to or on the day of operation. After a median follow-up of 4.1 years no significant differences in disease-free survival were found between the preovulatory (proliferative), periovulatory and post-ovulatory (luteal) groups. No differences in survival were found in these subgroups between the N0 and N1 subgroup. On the basis of this study we cannot confirm that the phase of the menstrual cycle during surgery has any effect on the eventual outcome in mammary carcinoma patients. However larger studies of this type are required before definitive conclusions can be reached.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

[Compared to whole body scanning thyroglobulin assay is reliable in the follow-up of thyroidectomized patients with thyroid carcinoma].

OBJECTIVE: To determine whether it is reliable to do thyroglobulin measurements during thyroid hormone substitution (Tg ON) alone or whether it is also necessary to do 131I total body scanning (TBS) and Tg measurements after withdrawal of thyroid hormone substitution (Tg OFF) in the follow-up of patients with differentiated thyroid carcinoma. DESIGN: Retrospective. SETTING: University Hospital Nijmegen. METHODS: 202 Patients (151 females and 51 males, mean age 50.6 years) with differentiated thyroid carcinoma were examined in the period 1970-90. All patients had undergone total thyroidectomy and if necessary 131I ablation. 27 Patients with Tg antibodies were excluded (13.4%). In 175 patients Tg OFF levels were compared with TBS and clinical and radiological data. In 81 of them Tg ON levels were also compared. RESULTS: Specificity of Tg OFF and Tg ON measurement was 83 and 88%. Sensitivity of Tg OFF and Tg ON measurement was 100 and 92%. In detecting local residual thyroid tissue Tg OFF was superior to Tg ON. In detecting metastases Tg OFF and Tg ON were both superior to TBS. CONCLUSION: In the follow-up of patients with differentiated thyroid carcinoma it is reliable to do Tg measurements during thyroid hormone suppression. When Tg ON is detectable (> 3 pmol/l) TBS and Tg OFF measurement and if necessary further investigations have to be performed.

Adolescent↗
PubMed1993

Epidermal growth factor receptor and prognosis in human breast cancer: a prospective study.

The prognostic value of Epidermal Growth Factor Receptor (EGFR) in human breast cancer is a matter of debate. We conducted a prospective study that included 459 unselected patients with primary breast cancer (median follow-up 24 months) to assess the prognostic value of EGFR. EGFR was assessed using a standardized radioligand binding assay. Univariate analysis showed that EGFR is a factor indicative of a poor prognosis with respect to Disease Free Survival (DFS, P = 0.03) and Overall Survival (OS, P = 0.002), if an EGFR level of 50 fmol/mg of membrane protein is introduced as a cut-off for EGFR-positivity. Multivariate analysis showed that EGFR was not an independent factor. This prospective study shows that EGFR, although not an independent factor, is indicative of poor prognosis in human breast cancer.

Adult↗
PubMed1993

Long-term follow up of breast cancer patients treated for hypercalcaemia with aminohydroxypropylidene bisphosphate (APD).

No systematic data are available about the long-term follow up of breast cancer patients treated with amino-hydroxypropylidene bisphosphate (APD) for hypercalcaemia and about the results of APD treatment of recurrent hypercalcaemia in these patients. Treatment with intravenous APD (10-15 mg daily until normalization of the serum calcium level) normalized serum calcium in 29 of 31 patients with hypercalcaemia due to advanced breast cancer. Survival in these 29 patients varied between 8 and 693 days (median 140 days) and 7 patients achieved a partial remission or stabilisation of disease during subsequent anti-tumor therapy. In 16 of the 29 patients in whom APD treatment was initially successful, hypercalcaemia recurred after a median period of 65 days. Eleven of these patients received a second course of APD, which was equally successful as the first in terms of percentage of patients with normalization of serum calcium, total dose of APD needed, and duration to normalization of serum calcium. Recurrent hypercalcaemia occurred significantly faster after the second successful APD course (median 17 days) than after the first (median 65 days). When only patients with progressive disease were taken into account, recurrence of hypercalcaemia usually occurred early, both after a first (median 23 days) and after a second successful APD course (median 17 days). Normalization of serum calcium occurred in 4 of 6 patients receiving a third APD course, in all 3 patients receiving a fourth, and in 1 of 2 patients receiving a fifth course.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Clinical heterogeneity of hereditary breast cancer and its impact on screening protocols: the Dutch experience on 24 families under surveillance.

We investigated 24 families who satisfied a set of criteria for hereditary breast cancer. Five families had only breast cancer, four a combination of breast and ovarian cancer and the remaining 15 had also a variety of other cancers. The families include 86 patients, 78 of which had a malignant tumour and the rest had a benign lesion in the breast. The median age at diagnosis of the breast cancer was 47 years. Three of the 24 families were of a late onset variant. 58 of the 86 patients were symptomatic while 18 were identified during presymptomatic screening because of a positive family history. In 10 cases the reason for referral was not known. 56 of the symptomatic patients had a malignant breast lesion, 52% of which were with lymph node metastasis whereas 12 of the screening group had breast cancer with 2 patients showing lymph node involvement (P = 0.06). 22 of the symptomatic patients and none of the screening patients died of breast cancer after a median observation period of 6 and 7 years, respectively (P < 0.05).

Adult↗
PubMed1993

Palliative pamidronate treatment in patients with bone metastases from breast cancer.

PURPOSE: An open, randomized study was performed to assess the effects of supportive pamidronate treatment on morbidity from bone metastases in breast cancer patients. PATIENTS AND METHODS: Eighty-one pamidronate patients and 80 control patients were monitored for a median of 18 and 21 months, respectively, for events of skeletal morbidity and the radiologic course of metastatic bone disease. The oral pamidronate dose was 600 mg/d (high dose [HD]) during the earliest study years, then changed to 300 mg/d (low dose [LD]) because of gastrointestinal toxicity. Twenty-nine of 81 pamidronate (HD/LD) patients first received 600 mg/d and were then changed to 300 mg/d; 52 of 81 pamidronate LD patients received 300 mg/d throughout the study. Tumor treatment was unrestricted. RESULTS: An overall intent-to-treat analysis was performed. In the pamidronate group, the occurrence of hypercalcemia, severe bone pain, and symptomatic impending fractures decreased by 65%, 30%, and 50%, respectively; event-rates of systemic treatment and radiotherapy decreased by 35% (P < or = .02). The event-free period (EFP), radiologic course of disease, and survival did not improve. Subgroup analyses suggested a dose-dependent treatment effect. Compared with their controls, in pamidronate HD/LD patients, events occurred 60% to 90% less frequently (P < or = .03) and the EFP was prolonged (P = .002). In pamidronate LD patients, event-rates decreased by 15% to 45% (P < or = .04). Gastrointestinal toxicity of pamidronate caused a 23% drop-out rate, but other cancer-associated factors seemed to contribute to this toxicity. CONCLUSION: Pamidronate treatment of breast cancer patients efficaciously reduced skeletal morbidity. The effect appeared to be dose-dependent. Further research on dose and mode of treatment is mandatory.

Bone Neoplasms↗
PubMed1992

Human breast cancer: survival from first metastasis. Breast Cancer Study Group.

Survival from the detection of first metastasis (SAM) was analyzed in a single center series of 258 patients with advanced breast cancer. During the 15 year period covered by this study 230 patients died, 215 of their disease. The overall median SAM was 28 months. Univariate analysis of SAM stratified by first dominant site of metastasis, estrogen receptor status (ER), progesterone receptor status (PgR), tumor size, axillary lymph node status, patient age, menopausal status, and disease-free interval (DFI) showed the first dominant site of metastasis, ER, PgR, and axillary lymph node status to be significantly associated with SAM. Patients with visceral metastasis as first dominant site of metastasis had significantly shorter survival than those with either bone or soft tissue metastasis, median SAM 16 vs. 34 vs. 41 months respectively (P less than 0.001). SAM also differed according to the steroid hormone receptor status of the primary tumor: median SAM 34 and 33 months for patients with ER-positive or patients with PgR-positive tumors against 14 months for patients with ER-negative or with PgR-negative tumors (P less than 0.001). Patients with axillary lymph node involvement at primary disease had a shorter SAM than those without, median SAM 24 vs. 35 months (P = 0.006). No association between SAM and either tumor size, patient age, menopausal status, or DFI could be observed. Multivariate analysis including first dominant site of metastasis, ER, PgR, and axillary lymph node status showed the first dominant site of metastasis, ER, and axillary lymph node status to be independently associated with SAM.

Adult↗
PubMed1992

Dose intensity of chemotherapy with cyclophosphamide, methotrexate and 5-fluorouracil in the elderly with advanced breast cancer.

Toxicity and results of two different dose levels of chemotherapy with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in older (greater than 70 years) patients with advanced breast cancer were evaluated in a prospective (non-randomised) study. During the first three courses of chemotherapy dose reduction for haematological toxicity was necessary in all of 10 and 8 of 13 patients treated with an intended dose of 100% and 75% of standard dose CMF, respectively. The median percentages of CMF, administered during the first three courses were about 75% in both groups of patients corresponding with a median dose intensity of 72% (range 49-87%) and 64% (range 36-78%) for patients of the 100% and 75% dose group, respectively. In 34 younger postmenopausal women (mean age 57 years) treated in our institution for advanced breast cancer the median percentages of CMF in the second and third course were 86% and 84%, respectively with a median dose intensity during the three courses of 82%. Dose reductions of CMF and bone marrow toxicity, though interdependent, were statistically significantly correlated with the endogenous creatinine clearance, but not with age. 1 patient died during severe leukopenia and thrombocytopenia. Non-haematological side effects were most pronounced in the 100% group. Results of therapy in both groups of patients were about equal and compared well with those of CMF therapy in general. It is advised that the dose of CMF in patients above 70 years should not exceed 75% of standard dose. Further dose reduction of methotrexate in case of severe renal failure is required.

Age Factors↗
PubMed1992

Epidermal growth factor receptors in human breast cancer: a plea for standardisation of assay methodology.

In a prospective study 200 primary human breast cancer specimens were analysed for epidermal growth factor receptor (EGFR) content by means of a multiple point ligand binding assay, proposed by the EORTC Receptor Study Group to be the standard EGFR assay. In 54% of the tumours the presence of saturable high affinity binding sites for epidermal growth factor could be demonstrated. The median EGFR level was 34 fmol/mg of membrane protein, the median Kd 0.50 nmd. Univariate analysis of the EGFR data stratified according to patient age, menopausal status, tumour size, axillary lymph node status, histological tumour type, tumour differentiation grade or the tumours' steroid hormone receptor status showed EGFR to be positively associated with younger age (P = 0.03), tumour dedifferentiation (P = 0.04) and steroid hormone receptor negativity (P less than 0.001). No association between EGFR and menopausal status, tumour size, axillary lymphnode status or histological tumour type could be demonstrated.

Adult↗
PubMed1992

Epidermal growth factor receptor levels are lower in carcinomatous than in normal colorectal tissue.

A series of 24 paired samples of colorectal carcinoma and the respective normal colorectal mucosa were analysed for Epidermal Growth Factor Receptor (EGFR) content by means of a standardised ligand binding assay. We, for the first time, found that EGFR levels are statistically significantly higher in normal colorectal mucosa biopsy samples than they are in colorectal carcinoma biopsy samples, the median EGFR levels being 77.5 fmol mg-1 of membrane protein (range 35-239), against 46 fmol mg-1 of membrane protein (range 22-81), respectively, P less than 0.001. In addition, we found that there are significant regional differences in EGFR expression in the normal human colon mucosa. The EGFR levels were significantly higher in samples from the proximal part of the colon than they were in samples from the distal part, the median EGFR levels being 124 fmol mg-1 of membrane protein (range 70-239) vs 55 fmol mg-1 membrane protein (range 35-156), P less than 0.05. The EGFR levels of the colorectal carcinoma samples did not show any regional variation.

Aged↗
PubMed1992

Results of cyclophosphamide and cisplatin combination chemotherapy in patients with ovarian carcinoma.

An unselected group of 30 patients with advanced epithelial ovarian cancer, FIGO stage IIb-IV, was treated with cyclophosphamide (750 mg/m2) and cisplatin (75 mg/m2) both administered intravenously on a single day at a 3-weeks interval (CP). At a median follow-up time of 25 months this treatment had resulted in a remission rate of 73% and an estimated median overall survival time of 29 months, which resembles the results of prospective randomized trials. Major side-effects encountered in our patients were renal toxicity and neurotoxicity requiring termination of chemotherapy with CP in 9 patients. Patients with residual tumor smaller than 1 cm had a significant survival benefit as compared to patients with residual tumor greater than 1 cm. Also, patients with stage III ovarian cancer had a significant longer duration of survival than patients with stage IV disease. After a median period of chemotherapy of 7 monthly the median time without symptoms of progression and without treatment was 9 months for patients with an objective remission. We found the CP regimen to be the best therapy to hand: improvement of the prognosis might be attained by other new treatment modalities.

Adult↗