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Biomedical subjects

R Joss

Publications and source records attributed to R Joss.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Frequent errors in planning and clinical management of tumor therapy].

Frequent and important errors in the management of cancer patients are reviewed. Mistakes can occur during diagnostic work-up, treatment planning, the actual treatment phase, evaluation of the response and of treatment-related side effects, the continuation or termination of a therapy, follow-up of the cancer patient and on several other occasions. Despite the fact that human knowledge and human actions are less than perfect, the knowledgeable and alert physician can avoid many errors in caring for cancer patients.

Adult↗
PubMed1990

[Sense and nonsense of tumor markers in practice].

Tumor markers can be used for screening, diagnosis, planning and monitoring of therapy, for early detection of relapse and for psychological reasons. Unfortunately none of the currently available tumor markers can be used for all these purposes. An ever increasing number of tumor markers can be determined; however, the advantage for the individual patient's management is less obvious. We therefore critically review the routine use of some tumor markers such as CEA, AFP, beta-HCG, LDH, CA-125, CA 19-9, prostate acid phosphatase, prostate specific antigen and CA 15-3. The use of tumor markers requires a sound knowledge of the biology of the marker, the neoplastic disease and the available treatment. When tumor markers do not add new information and have no diagnostic or therapeutic consequences, their use becomes an expensive medical nonsense!

Antigens, Neoplasm↗
PubMed1989

[BRL 43694A--a 5-hydroxytryptamine receptor blocker as an antiemetic in cytostatic therapy].

An open study of the new antiemetic BRL 43694A, a 5-hydroxytryptamine-3-receptor antagonist, was performed in 29 patients undergoing highly emetogenic cancer chemotherapy (25 patients received cisplatin in a dose greater than or equal to 50 mg/m2). Patients received BRL 43694A as a 30-minute infusion one hour after the administration of chemotherapy. 7 patients were treated with 40 micrograms/kg and 13 patients with 100 micrograms/kg BRL 43694A; the last 9 patients received an initial dose of 40 micrograms/kg with a provision for two additional interventional doses over 24 hours in the event of prolonged nausea or vomiting. 14 patients experienced no vomiting (48%) and 13 patients (45%) had 1-5 vomiting episodes over 24 hours following administration of the cytostatic agents. BRL 43694A did not cause major side effects. Based on our preliminary experience the new 5-HT3-receptor antagonist BRL 43694A is a potent antiemetic drug for the treatment of chemotherapy-induced nausea and vomiting.

Adult↗
PubMed1989

[Chemotherapy of bronchus carcinoma].

The use of chemotherapy will eventually be discussed in most patients with lung cancer, due to the systemic nature of the disease. In small cell lung cancer combination chemotherapy will achieve a response in the majority of patients and will lead to a five-fold increase in median survival. A small proportion of these patients will survive disease-free for a prolonged period of time and may be cured of their disease. In non-small cell lung cancer about one third of all patients will achieve an objective tumor response with the use of cisplatin-based combination chemotherapy. There is a small, but definite increase in median survival with the use of combination chemotherapy compared to best supportive care alone. Also in non-small cell lung cancer a small proportion of patients will survive after combination chemotherapy for a prolonged period of time. The use of cytotoxic treatment in lung cancer is associated with considerable toxicity so that optimal supportive care is mandatory.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

A randomized comparison of doxifluridine and fluorouracil in colorectal carcinoma.

In a randomized study 52 patients with advanced colorectal cancer and measurable lesions were treated with doxifluridine 4000 mg/m2 or fluorouracil 450 mg/m2 i.v. on 5 consecutive days over 3 weeks. None had prior fluoropyrimidines except two who received adjuvant fluorouracil. Partial responses with a duration ranging from 259 to 406 days were observed in five patients treated with doxifluridine and two patients treated with fluorouracil. Toxic reactions were evaluated in 88 doxifluridine courses and 105 fluorouracil courses. The most frequent adverse effects were neurotoxicity (48% of patients) and mucositis (43%) for doxifluridine, leukopenia (48%) and nausea/emesis (37%) for fluorouracil. Mucositis, diarrhea, nausea, emesis and skin reactions were observed in both treatment groups. Fluorouracil produced neurotoxic effects in 26% of patients. Reversible cardiac dysfunctions were observed in four patients treated with doxifluridine, expressed by ectopic ventricular beats (2) precordial pains (1) and ventricular fibrillation (1). This latter toxicity justified the premature interruption of the study. Doxifluridine is an active agent in colorectal cancer. Compared to fluorouracil it produces, when used i.v., a lower myelosuppression and a greater incidence of neurological and cardiac toxicity.

Adenocarcinoma↗
PubMed1988

[Surgical treatment concepts in soft tissue tumors of the locomotor system].

Soft tissue tumors of the extremities require a definitive histopathological diagnosis and adequate treatment unless they are known to have been present for years without any clinical change. For lesions with a straightforward clinical diagnosis (ganglion of the wrist) and for superficial tumors smaller than 3 cm, excisional biopsy is adequate. For all other lesions an open incisional biopsy should be performed. If the lesion is potentially malignant, all the appropriate staging studies must be performed before biopsy; if the tumor has been biopsied without prior staging and unexpectedly reveals a malignant lesion, complete staging must be performed before definitive surgery is undertaken. Soft tissue sarcomas extend rapidly within the tissue of the compartment they originated in, but tend to respect compartmental boundaries. Radical resection of the entire compartment containing the sarcoma is thus the surgical treatment of choice. Adjuvant radio- and/or chemotherapy are necessary in the majority of these cases and should be integrated into the treatment strategy.

Biopsy↗
PubMed1987

[Metoclopramide, methylprednisolone and flunitrazepam in cytostatic-induced vomiting].

The antiemetic efficacy of a combination of high-dose metoclopramide, methylprednisolone and flunitrazepam was tested in an open pilot study in 30 tumor patients undergoing strongly emetic chemotherapy. 26 of 30 patients (87%) were partially or completely protected from nausea and vomiting. In 11 of 12 patients receiving the strongly emetogenic cytostatic agent cisplatin in a dose of greater than or equal to 50 mg/m2, the gastrointestinal side effects were partially or completely abolished. The antiemetic efficacy of the combination was maintained during subsequent courses of chemotherapy. All patients experienced somnolence after administration of flunitrazepam. Only 2 of 30 patients had a shortlived extrapyramidal reaction. The combination of high-dose metoclopramide, methylprednisolone and flunitrazepam is an effective antiemetic treatment and should be considered as first-line antiemetic treatment in patients receiving strongly emetic cancer chemotherapy.

Adolescent↗
PubMed1986

Etoposide, cisplatin and doxorubicin in patients with small cell lung cancer: tumor response and long term survival.

One hundred and fourteen patients with small cell lung cancer received a combination of etoposide 80 mg/m2 IV days 1,2,3,15,16,17, cisplatin 20 mg/m2 IV days 1,2,3 and doxorubicin 40 mg/m2 IV day 1, repeated every 4 weeks. The observation time from the initiation of treatment is longer than 4 years for all patients. An 85% response rate (38% complete response) was obtained after 1-4 cycles in 105 evaluable patients (96 without prior antitumour treatments). The response rate was not influenced by initial performance status and minimally by disease extension, whereas the same prognostic factors correlated significantly with complete responses. For limited disease and WHO performance 0 all responses were complete. For extensive disease and performance 3 no complete response was obtained. Various chemotherapy regimens with or without radiotherapy were used during the maintenance phase. Forty five per cent of first relapses were in the lung or mediastinum and 18% in the nervous system (20% without and 7% with prophylactic cranial irradiation). The median survival was 13.4 months for limited and 8.5 months for extensive disease, and correlated with performance and response. Only 2 patients survived free of disease after 4.8 and 5.5 years. We conclude that the induction treatment as used here produces a high rate of partial and complete responses but a low rate of long survivors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Phase I study of intravenous menogaril administered intermittently.

Thirty-three adult patients with solid tumors were treated with menogaril, a new anthracycline antibiotic. The drug was given as a two-hour infusion every 4 to 5 weeks at doses ranging from 17 to 250 mg/m2. The maximum tolerated dose was 250 mg/m2. Reversible and dose-related leukopenia was the dose-limiting toxicity. Thrombocytopenia was less frequent. Hematologic toxicity was maximal 2 weeks after treatment, and recovery usually occurred within 4 weeks. There was no dissociation between WBC and neutrophil counts, and myelosuppression did not appear to be cumulative up to 200 mg/m2. Myelosuppression was more severe for patients with heavy pretreatment and/or bone marrow involvement. Local toxicity consisting of phlebitis and/or erythema was the most common nonhematologic toxicity, especially at 250 mg/m2 (eight out of nine patients). Usually, erythema appeared within 24 hours after treatment at or near the infusion site and resolved within a few days. Occasionally, a more persistent (several weeks) orange discoloration suggesting cutaneous deposits of menogaril was observed. Nausea and vomiting were uncommon and never severe. Alopecia and mucositis were rare. Minor arrhythmias were seen in several patients during treatment, but their relationship with menogaril therapy was unclear, and in no patient did heart failure develop. Plasma concentrations were best described by a tricompartmental model with a mean terminal half-life of 29.5 hours and a mean total-body clearance of 20.2 L/h/m2. Doses of 160 and 200 mg/m2 are recommended for phase II trials in poor- and good-risk patients, respectively.

Adult↗
PubMed1985

[Follow-up of potentially cured cancer patients. Object, method and duration?].

The follow-up of potentially cured cancer patients is discussed. After outlining the goals, requirements and problems of posttreatment follow-up, practical guidelines for gastrointestinal, breast and lung cancer, the malignant lymphomas and testicular cancer are suggested for the benefit of the medical practitioner, who often directs the follow-up care of a patient after completion of primary treatment for cancer.

Breast Neoplasms↗
PubMed1985

Hormono-chemotherapy in the treatment of advanced breast cancer.

The current situation in the treatment of metastatic breast cancer is reviewed. Overall the concurrent use of endocrine treatment and chemotherapy does not improve the therapeutic results as compared to a treatment encompassing only one modality. However, results diverge widely in different subgroups. Data emerging from various randomized trials are beginning to define subgroups of patients, who should be treated differently. Such data are discussed and their importance for future trials in the field of advanced breast cancer reviewed.

Adult↗
PubMed1985

The treatment of ovarian cancer by a multimodality approach: remission induction with chemotherapy--hexa PAMP and PAMP regimens--followed by whole-abdominal radiation.

Seventy-six evaluable patients with ovarian carcinoma stages FIGO IIb, IIc, III, and IV, either received cis-platin (P) (80 mg/m2 iv. day 1), melphalan (PAM) (12 mg/m2 i.v. day 2) and hexamethylmelamine (HEXAPAMP) (135 mg/m2 orally days 8 to 21) or the same dose of cis-platin and melphalan but no hexamethylmelamine (PAMP) every four weeks. In 24 patients (32%) a surgically ascertained CR was achieved. 16 of these received follow-up radiation treatment to the whole abdomen. At present 19 patients are without relapse (average time 24 months). The trial has not been concluded. Particularly no predictions can be made on the value of follow-up radiation therapy in obtaining long-term remission rates.

Adult↗
PubMed1984

[Adenocarcinoma of the kidney (hypernephroma)].

Adenocarcinomas of the kidney are rare tumors. This malignancy has been called the "internist's tumor" because of its often unusual presentation and systemic symptoms. The diagnosis is largely based on urography, sonography and CT-scan. Radical tumornephrectomy is the only treatment with curative potential. Interventional angiography with tumor embolization has become an important tool for palliation. On the other hand, the results of systemic treatment, such as hormone therapy, chemotherapy or immunotherapy, remain disappointing.

Androgens↗
PubMed1984

[Extrapulmonary small-cell carcinoma - a rarity with important therapeutic consequences].

A report is presented on 12 patients with extrapulmonary small cell carcinoma. In 9 patients the primary tumor could be localized (cervix in 3, esophagus in 3, prostate in 2, pancreas in 1) whereas no primary was found in 3. Seven of 12 patients presented with distant metastases and four developed metastases later. Five of 12 had CNS metastases (brain metastases in 4, spinal cord compression in 1). Six patients were initially treated by surgery or radiotherapy (2 and 4 respectively). All six developed distant metastases during or shortly after local treatment. Five of 6 patients initially treated with chemotherapy responded to the treatment. Three of 12 patients are surviving 18+, 80+ and 81+ months after the initial diagnosis without evidence of disease. The biology and clinical course of extrapulmonary small cell carcinoma are similar to those of its pulmonary counterpart. In planning therapy for extrapulmonary small cell carcinoma, particular importance should be attached to systemic treatment.

Adult↗