Biomedical subjects

W T Van Der Graaf

Publications and source records attributed to W T Van Der Graaf.

4 recordsLinked to original sources

PubMed1999

The changing distribution of stage in nonseminomatous testicular germ cell tumours, from 1977 to 1996.

OBJECTIVE: To determine the changes between 1977 and 1996 in the distribution of stages of testicular cancer (TC). PATIENTS AND METHODS: The stage distribution was assessed, using various classifications, i.e. the Royal Marsden (RM), Indiana, European Organization for Research and Treatment of Cancer (EORTC), International Germ Cell Cancer Collaborative Group (IGCCCG) and the Medical Research Council (MRC), in 517 patients with nonseminomatous testicular germ cell tumours (NSTGCTs) diagnosed at a single institution between 1977 and 1996. RESULTS: The number of patients in four consecutive 5-year periods (1977-81, 1982-86, 1987-91, 1992-96) was 119, 141, 141, and 116, respectively. Frequency analyses showed a significant increase of RM stage I, in proportion to stage II-IV, in 1982-86 (55%, odds ratio, OR, 2.54), 1987-91 (53%, OR 2.33) and 1992-96 (61%, OR 3.24) compared to the period 1977-81 (33%). A separate analysis of patients with disseminated disease showed a proportionate significant decrease of RM stage II in 1992-96 (29%, OR 0.43) compared with 1977-81 (49%). There was also a relative decrease of good-prognosis patients with disseminated disease in 1992-96 compared with 1977-81, using analyses of the Indiana (from 56% to 33%, OR 0.39) and EORTC classification (from 78% to 56%, OR 0.36). Analyses of the IGCCCG and MRC classification showed a significant decrease of good-prognosis patients in the 1982-86 compared with the first 5-year period (for IGCCCG, from 54% to 35%, OR 0.46, and for MRC, from 43% to 24%, OR 0.42). CONCLUSION: The stage distribution of NSTGCT over the past two decades has changed. The proportion of stage I patients has increased since the early 1980s, apparently resulting from a shift of low-extent disseminated disease to stage I disease. This finding is relevant in reducing the treatment required in a higher proportion of patients and the subsequent reduction of long-term risk from treatment.

Adolescent↗

PubMed1998

[Malignant or nonmalignant pericarditis].

Pericardial effusion can occur as the first manifestation of disseminated cancer, as was demonstrated in the case of a 59-year-old woman who presented with respiratory insufficiency. In contrast, in three breast cancer patients aged 44, 55 and 53 pericardial effusion was shown to have a non-malignant cause, such as radiation or chemotherapy. Careful diagnostic procedures, including pericardiocentesis, should be performed to adjust the treatment to the underlying cause and to optimize the prognosis. It should be kept in mind that pericarditis in about half the patients suffering from a malignancy has a non-malignant cause.

Adult↗

PubMedDate not supplied

Dacarbazine DTIC and carboplatin as an outpatient treatment for disseminated malignant melanoma.

Occasionally long-term survival in disseminated melanoma can be obtained through chemotherapy. We treated 22 patients with disseminated melanoma with an outpatient regimen consisting of dacarbazine (DTIC) and carboplatin. Three patients had a complete response lasting 4+, 9 and 9 months (survival 4+, 10 and 16 months), respectively; 3 patients had a partial response lasting 4, 6 and 8 months (survival 6+, 11+ and 14 months), respectively. Overall response was 27% (95% confidence interval 11-50%). Toxicity was relatively mild and mainly due to nausea. In 3 patients the dose of carboplatin was reduced because of grade 4 haematological toxicity. This described easy outpatient regimen shows comparable results as other polychemotherapeutic regimens in disseminated melanoma, but with a relatively mild toxicity profile.

Adolescent↗

PubMedDate not supplied

Pulmonary function after high-dose chemotherapy with autologous bone marrow transplantation and radiotherapy in patients with advanced loco-regional breast cancer.

Our aim was to study the extent of pulmonary toxicity after high-dose chemotherapy and radiotherapy in breast cancer patients. In a retrospective study the pulmonary symptoms and chest X-rays were analyzed before, during and after treatment in 17 patients, treated with loco-regional radiotherapy to the breast/chest wall and the regional lymph nodes after the completion of high-dose chemotherapy and autologous bone marrow transplantation for locally advanced breast cancer. Lung function was evaluated between 15 and 46 months after completion of the irradiation. Nine patients (53%) had pulmonary symptoms during and/or within two months from irradiation. Radiographic changes were seen in twelve patients (71%) and a decreased diffusion capacity occurred in nine patients (53%). The spirometric values (VC and FEV1) were abnormal in two patients (12%). There is a high incidence of radiation pneumonitis, although no consistent correlation between the various parameters (pulmonary symptoms, chest X-rays and lung function tests) could be found.

Adult↗