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M Rørth

Publications and source records attributed to M Rørth.

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

Lung cancer.

In small cell lung cancer, combination chemotherapy including platinum compounds (cisplatin and carboplatin) and the podophyllotoxins (teniposide and etoposide) continues to be the backbone of therapy. Complete plus partial responses to combination chemotherapy occur in 80-90% of all patients. Median survival is at present 11-17 months depending on the initial tumour stage. Overall 5-year survival is approximately 5%. The duration of treatment has been shortened to 5-6 months. The results of the use of hematopoietic growth factors have hitherto been disappointing with respect to survival, while a definite effect on the degree and number of infections has been documented, when aggressive chemotherapy is administered. For epidermoid-, adenoid- and large cell carcinoma, results are emerging indicating that preoperative and preirradiatory chemotherapy in stage IIIa non-small cell lung cancer might have a substantial role in the overall management based on results from phase III trials. The studies are, however, rather modest in number and longer follow-up is necessary before recommendations for general use can be made. For patients with advanced non-small cell lung cancer (stage IIIb and IV), meta-analyses have yielded a small survival benefit (6 weeks) in favour of patients receiving chemotherapy vs. best supportive care. The treatment of this type of NSCLC should, however, still be considered to be experimental in order to define new innovative treatments. No improvement of the therapy of mesotheliomas has been reported.

Carcinoma, Non-Small-Cell Lung↗
PubMed1994

Current concepts of radiation treatment of carcinoma in situ of the testis.

During a recent international workshop on carcinoma in situ and cancer of the testis held in November 1992, there was consensus about the management of the contralateral testis in patients with unilateral testicular cancer [20]. Such men should be offered a biopsy of the contralateral testis. This consensus was based on (1) the high prevalence of carcinoma in situ (CIS) in the contralateral testis found not only in Danish men but also in studies from other countries and (2) the possibility of eradicating the CIS and thereby preventing the development of invasive cancer by means of localized irradiation with preservation of testosterone production in the testis. The aim of this paper is to outline the present status of the radiation treatment of CIS of the testis.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Dose-dependent impairment of testicular function in patients treated with cisplatin-based chemotherapy for germ cell cancer.

BACKGROUND: The enormous differences in semen quality following cisplatin-based combination chemotherapy reported in previous studies may be caused by differences in the cisplatin dosages. PATIENTS AND METHODS: We examined thirty-three patients treated with conventional-dose PEB (cisplatin 20 mg/m2 x 5, q3w, etoposide 100 mg/m2 x 5 q3w and bleomycin 15 mg/m2 q1w) and 21 patients treated with high-dose PEB (cisplatin 40 mg/m2 x 5 q3w, etoposide 200 mg/m2 x 5 q3w and bleomycin 15 mg/m2 q1w). RESULTS: The sperm density was significantly higher (median 5.83 mill/ml) in the conventionally-treated group than in the group of high-dose-treated patients (median 0.005 mill/ml) (p = 0.008). Azoospermia was present in 19% of the conventionally- and in 47% of the high-dose-treated patients. All patients treated with a cumulative cisplatin dose above 600 mg/m2 had severe oligospermia or azoospermia. Serum values of basal follicle-stimulating hormone (FSH) (median 27.2 iu/l vs. 15.2 iu/l) and stimulated FSH (median 57.7 iu/l vs. 28.4 iu/l) were significantly higher in the high-dose group than in the conventionally-treated group. No differences could be detected in basal or stimulated testosterone or in luteinizing hormone in serum. CONCLUSION: In patients treated with PEB for testicular cancer, we found strong evidence that the impairment of spermatogenesis is dose-dependent.

Adolescent↗
PubMed1994

Lung cancer.

In SCLC, combination chemotherapy including agents such as etoposide, teniposide, cisplatin, carboplatin, doxorubicin, vincristine and cyclophosphamide continues to be the backbone of therapy. Epipodophyllotoxin derivatives, together with cisplatin or carboplatin are being increasingly used as part of the initial therapy. Complete plus partial responses to combination chemotherapy occur in 80-90% of all patients with a median duration of 9-11 months. Median survival in these studies is at present 11-16 months, depending on the initial tumour stage. At this point, 5-year survival is around 5% and includes a small fraction of patients (1%) initially presenting with extensive disease. The optimum duration of treatment is still uncertain, but the tendency is to shorten the duration of treatment to 6-9 months. The results of intensifying the treatment with the use of hematopoietic growth factors have hitherto been disappointing. The results of several phase II studies stress the importance of dose scheduling of etoposide in SCLC, with continuous treatment of 5 days' duration or more being superior. The therapeutic results for squamous cell carcinoma, adenocarcinoma, large cell carcinoma and mesothelioma are essentially unchanged. The treatment of patients with these types of lung cancer should continue to be considered experimental, since no standard chemotherapy has as yet been developed, neither when given as single modality nor in combination with surgery or radiotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Surveillance following orchidectomy for stage I seminoma of the testis.

From 1985 to 1988, 261 unselected patients entered a nationwide Danish study of surveillance only for testicular seminoma stage I. The median follow-up time after orchidectomy was 48 months, range 6-67 months. 49 patients relapsed (19%). Sites of relapse were paraaortic lymph nodes in 41 patients, pelvic lymph nodes in 5, inguinal lymph nodes in 2 and lung metastases in 1 patient. The median time to relapse was 14 months, range 2-37 months. The 4-year relapse-free survival was 80%. 37 of the relapsing patients (76%) had radiotherapy as relapse treatment. Of these patients, 4 (11%) had a second relapse and received chemotherapy. 1 died of disseminated seminoma. Of the relapsing patients, 12 (24%) had chemotherapy as relapse treatment because of bulky (11 patients) or disseminated disease (1 patient). None of these patients have had a second relapse. However, 2 patients died of infection due to chemotherapy-induced neutropenia. Thus, there have been three seminoma-related deaths (1.1%). The testicular tumour size had an independent prognostic significance. The 4-year relapse-free survivals were 94, 82 and 64% for tumours < 3, 3 to < 6 and > or = 6 cm, respectively. Patients with tumours > or = 6 cm will now be given prophylactic radiation treatment, whereas we will continue to use surveillance only after orchidectomy for patients with tumours < 6 cm.

Adult↗
PubMed1993

A phase II study of ifosfamide, carboplatin and cisplatin in advanced and recurrent squamous cell carcinoma of the uterine cervix.

BACKGROUND: Discouraging response duration and long-time survivals have so far been the result of cisplatin-containing combination chemotherapy against advanced or recurrent squamous cell carcinoma of the uterine cervix. In order to increase the platinum-based effect upon this tumor without an increase in the specific toxicity of cisplatin, we combined it with carboplatin, added ifosfamide, which has been shown to possess a comparable degree of single-agent activity. PATIENTS AND METHODS: Thirty-six patients with advanced or recurrent squamous cell carcinoma of the uterine cervix not curable by radiation or surgery were treated with a combination of ifosfamide 1.5 gr/m2 i.v. days 1-3, carboplatin 200 mg/m2 i.v. day 1, and cisplatin 50 mg/m2. Thirty-one patients were evaluable for response and 34 patients for toxicity. RESULTS: Twenty-three patients responded (64%), 11 (31%) of them completely, and 12 (33%) partially. Median response duration was 23 weeks (range 8-107 weeks), reaching 27 weeks and 21 weeks for patients with and without disease in previously irradiated areas, respectively. Median survival is 40 weeks (range 1-114 weeks). Toxicity consisted mainly of moderate to severe myelosuppression, resulting in 2 toxic deaths. CONCLUSION: The response rate, also for earlier irradiated areas, compares favorably with other known cisplatin-containing regimens. The combination deserves investigation in a randomized setting.

Adult↗
PubMed1993

Should the contralateral testis be biopsied? Round table discussion.

Testicular tumours are bilateral in 5.2% of cases although the incidence of bilaterality is affected by the mode of treatment of the primary tumour. A biopsy of the contralateral testis of testicular tumour patients will reveal carcinoma in situ in 5.5% of cases. In Denmark, most testicular tumour patients have a contralateral biopsy at the time of the primary orchidectomy, but in many countries general urologists and surgeons are not always aware of the advantages of simultaneous contralateral biopsy. Some specialist centres perform a contralateral biopsy as a secondary procedure once the patient has been referred. It has not been the policy in USA to take a contralateral biopsy at the initial orchidectomy, nor to offer a biopsy to patients after referral to a specialist centre. As a result of the discussions at this conference, urologists in USA will now be encouraged to take a contralateral biopsy at the time of initial surgery. If this is not performed, patients should be offered a biopsy after a full discussion of the advantages and possible side effects of the procedure so that informed consent can be given.

Biopsy↗
PubMed1993

Lung cancer.

In small cell lung cancer, combination chemotherapy including agents such etoposide, teniposide, cisplatin, doxorubicin, ifosfamide, vincristine and cyclophosphamide continues to be the cornerstone of therapy. The importance of dose scheduling of etoposide with continuous treatment of 5 days' duration or more is becoming more and more clear. Complete or partial responses secondary to combination chemotherapy occur in 80-90% of all patients with median durations of 9 to 11 months. Median survival in these studies is unchanged, at present 11-16 months depending on the initial tumour stage. The optimum duration of treatment is still uncertain, but generally a period of 6 to 9 months is used. The use of G-CSF with combination chemotherapy leads to reductions in the incidence of fever, duration and severity of grade 4 neutropenia, and in the total number of days of treatment with i.v. antibiotics and days of hospitalization. No differences have been observed in response rates, duration of response or survival. Therapeutic results for epidermoid, cancer, adeno carcinoma, large cell carcinoma and mesothelioma are essentially unchanged. The treatment of patients with these tumours should continue to be considered experimental since no standard chemotherapy has as yet been developed, neither when given as single modality nor in combination with surgery or radiotherapy. Two studies published in 1991 comparing induction chemotherapy before irradiation versus irradiation alone have resulted in improvement of median and 2-year survival, while a third study did not show such an improvement. The fact remains that three-fourths of patients with local disease die within 3 years, and further improvements in both systemic and local treatment are needed.

Adenocarcinoma↗
PubMed1992

Secondary surgery in patients with malignant germ cell tumors.

A total of 102 men treated for germ cell tumor with chemotherapy containing cisplatin was referred for a secondary operation with signs of tumor in the retroperitoneum or chest. Of the patients 85 underwent laparotomy, 14 underwent thoracotomy and 3 had both operations. Residual tumors were completely resected in 66 patients and incompletely resected in 30, while no tumor was found in 6. The resected specimen was malignant in 18 patients, of whom 11 had complete removal of all malignant tissue. All patients with malignancy in the resected specimen received further chemotherapy. Long-term disease-free status was obtained in 75% of those patients who had a complete resection, compared with 14% in the group with incomplete resection. There was no evidence of malignant disease at operation in 78 patients but 5 of them later died of the disease. Malignant tissue was present in the residual tumor in only 1 of 15 patients whose primary tumor was seminoma alone. Resection was attempted in 14 patients despite abnormal tumor markers preoperatively. Only 5 of these patients achieved a disease-free status and 2 of them died later of malignant disease. Over-all 79 of the 102 patients are without evidence of disease (medium postoperative observation 23 1/2 months). We conclude that a secondary operation constitutes an important part of the treatment of patients with germ cell cancer.

Adolescent↗
PubMed1992

Treatment of poor-risk germ-cell tumors with high-dose cisplatin and etoposide combined with bleomycin.

Seventy-two patients with far advanced ('high-risk') germ-cell tumors were treated with cisplatin 40 mg/m2 i.v. and etoposide 200 mg/m2 i.v. daily for 5 days and bleomycin 15 mg/m2 i.v. once a week. At least 3 cycles of this treatment were given at three-week intervals to all patients. Seventy-five percent of the patients obtained CR and 67% are without evidence of disease after a median observation time of 47 months (range 5 to 80 months). Hematologic toxicity was severe and 10% of the patients died due to treatment-related toxicity. Neurotoxicity was a clinical problem in 58% of the patients. Glomerular filtration rate decreased significantly after 3 cycles (29% +/- 16%). No clinically significant pulmonary toxicity was observed. The specific role of high-dose cisplatin in such intensive treatment has until now been the subject of only one randomized study in which no superiority of high-dose cisplatin was found. Significant improvement of therapeutic outcome over that of today's standard treatment conceivably necessitates an even greater increase in dose intensity of the active drugs--or inclusion of new drugs.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Management of extragonadal germ-cell tumors and the significance of bilateral testicular biopsies.

Forty-nine patients with assumed extragonadal germ-cell tumors (retroperitoneum: 39, mediastinum: 8, CNS: 2) were included in the present study. The patients were treated with 'high' (40 mg cisplatin/m2 and 200 mg etoposide/m2 daily x 5) or 'conventional' (20 mg cisplatin/m2 and 100 mg etoposide/m2 daily x 5) doses of cisplatin and etoposide together with bleomycin, depending on the presence or absence of poor prognosis factors. Forty-six patients were evaluable for response and 3 patients were classified as non-responders (1 early death, 2 toxic deaths). Eighty percent obtained complete remission and 76% are alive without evidence of disease after a median observation time of 41 months (88% of patients with primary tumor in the mediastinum, 72% with tumor in the retroperitoneal area, 87% of patients with seminoma and 71% with non-seminoma, respectively). In 48 patients testicular biopsies were performed. In 42% of patients with primary retroperitoneal tumors, carcinoma in situ testis (CIS) was diagnosed. None of the patients with tumors in mediastinum or CNS had CIS in the testicles. The therapeutic outcome for patients with extragonadal germ-cell tumors is now similar to that of patients with very advanced testicular cancer when considered in relation to the presence of prognostic factors. The coexistence of CIS and retroperitoneal tumor could indicate that these tumors are not truly extragonadal or that these lesions have a common malignant progenitor.

Adolescent↗
PubMed1992

Leukaemia and reproductive outcome among nurses handling antineoplastic drugs.

During the past decades conclusive evidence has accumulated that alkylating antineoplastic drugs (ADs) can cause cancer, most notably acute non-lymphocytic leukaemia, and that most ADs are reprotoxic. Studies on health workers handling ADs have shown significantly increased risks for miscarriages (two studies) and malformations (two studies). The present study monitored the risk for cancer and adverse reproductive outcome among Danish nurses handling ADs. No increased risks were found for miscarriages, malformations, low birth weight, or preterm birth among the offspring of nurses handling ADs during pregnancy. The sex ratio was normal. The relative risk (RR) for leukaemia was significantly increased (10.65) but based on only two cases, one of acute myeloblastic and one of chronic myeloid leukaemia. From the available exposure data occupational exposures to ADs were apparently higher in the studies that have reported increased risks for miscarriages and malformations than in the present one. Regarding reproductive outcome the study gives some confidence that the safety measures which were implemented in the oncology departments around 1980 can protect the health personnel against adverse effects of ADs on reproduction. As the study is as yet the only negative one in a well protected setting, it should be followed up by other studies of well protected health personnel handling ADs. The findings concerning the leukaemia risk, although based on small numbers, encourage larger studies.

Abnormalities, Drug-Induced↗
PubMed1992

Acute monocytic or myelomonocytic leukemia with balanced chromosome translocations to band 11q23 after therapy with 4-epi-doxorubicin and cisplatin or cyclophosphamide for breast cancer.

PURPOSE: To report five cases of acute monocytic or myelomonocytic leukemia after chemotherapy with 4-epidoxorubicin for breast cancer and to evaluate the risk of leukemia after the use of this drug. PATIENTS AND METHODS: One hundred fifty-seven patients with advanced breast cancer were randomized to either 4-epi-doxorubicin plus cisplatin or 4-epi-doxorubicin alone. An additional 203 patients were treated prospectively with 4-epi-doxorubicin alone. All were observed closely for leukemic complications. RESULTS: Three patients from the randomized study developed leukemia; all were in the subgroup of 74 patients who received 4-epi-doxorubicin plus cisplatin, whereas no leukemia was observed among the remaining 83 patients in the randomized study or among the additional 203 patients who were treated prospectively with 4-epi-doxorubicin alone (P = .023, log-rank test). In the subgroup of 74 patients who were treated with 4-epi-doxorubicin plus cisplatin, the cumulative risk of leukemia was 16.0% +/- 9.9% (mean +/- SE) 33 months after the start of therapy; the relative risk was 668 (95% confidence interval [Cl], 138 to 1,953). Two other cases of acute monocytic and myelomonocytic leukemia were observed after 4-epi-doxorubicin plus alkylating agents were administered for breast cancer. Three of five cases of leukemia presented balanced translocations to chromosome band 11q23 and two, loss of a whole chromosome no. 7 or its long arm. CONCLUSIONS: 4-epi-doxorubicin is leukemogenic, and the leukemias are often acute monocytic or myelomonocytic with balanced chromosome translocations to band 11q23, such as in the leukemias after therapy with the epipodophyllotoxins. Furthermore, our results suggest a synergistic effect in leukemogenesis between 4-epi-doxorubicin targeting DNA-topoisomerase II and directly genotoxic drugs such as cisplatin or alkylating agents.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Lung cancer.

In small cell lung cancer, combination chemotherapy including agents such as etoposide, teniposide, cisplatin, doxorubicin, vincristine and cyclophosphamide continues to be the backbone of therapy. Epipodophyllotoxin derivatives, together with cisplatin, are used increasingly as part of the initial therapy. Complete plus partial responses to combination chemotherapy still occur in 80-90% of all patients with a median duration of 9-11 months. Median survival in these studies is at present 11-16 months depending on the initial tumour stage. Deaths from small cell lung cancer continue to occur until 7 years after diagnosis, but rarely thereafter. At this point, overall survival is around 5% and include a small fraction of patients (1%) initially presenting with extensive disease. The optimum duration of treatment is still uncertain. For patients with extensive disease, the use of alternating chemotherapy has been shown in a couple of randomized studies to yield the best results, as judged by long-term survival. The results of several phase II studies stress the importance of dose scheduling of etoposide in small cell lung cancer, with continuous treatment of 5 days' duration or more being superior. The therapeutic results for epidermoid, adenoid, large cell carcinoma and mesothelioma are essentially unchanged. The treatment of patients with these types of lung cancer should continue to be considered experimental, since no standard chemotherapy has as yet been developed, neither when given as single modality nor in combination with surgery or radiotherapy. One single study comparing induction chemotherapy before irradiation vs irradiation alone has resulted in an improvement of median survival of 4 months and doubled the number of long-term survivors. Since three-fourths of the patients with locoregional disease will die within 3 years, further improvements in both systemic and local treatment are needed.

Antineoplastic Combined Chemotherapy Protocols↗