SEARCH · PubMed Health

Results for “multi-modal”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources

PubMed1978

The place of surgery in the treatment of ovarian cancer.

If the role of surgery has receded somewhat in other areas of gynaecological cancer, the reverse would seem to be true in ovarian cancer. The problem of the scope for increased surgical procedures outside the general run of gynaecological operations is high-lighted by the difficulty in achieving accurate preoperative diagnosis. Carcinoma of the ovary may well be found unexpectedly by the relatively inexperienced surgeon operating for a tumour presumed to be a fibroid uterus. Improvement in the survival of patients treated for cancer is only rarely the result of a single therapeutic advance. Generally it is achieved by the meticulous and individual application of multi-modal therapy. In this context careful and occasionally bold surgery remains a key treatment in the management of ovarian cancer.

Castration↗

PubMed1995

[Current perspectives in the treatment of epidermoid cancer of the esophagus].

Prior to the eighties, most patients with a diagnosis of epidermoid oesophageal cancer only received palliative symptomatic care. To date, most all undergo either surgery or medical treatment or both. Late diagnosis due to lack of clinical signs in the early phases of the disease, and perhaps insufficient attempts at identifying patients at risk who could benefit from systematic screening, is still an important problem although the number of diagnosed cases continues to rise (from 104 in 1985 to 151 in 1989 in Finistere in western France). Two different therapeutic attitudes could improve the prognosis: extensive surgery as proposed by the Japonese with dissection of all invaded lymph nodes whatever the localization and a multimodal approach combining radiochemotherapy and surgery. Although outcome can apparently be improved in certain types of oesophageal cancer, the proposal of aggressive extensive dissection could have an effect on respiratory complications and would not necessarily be adapted to the risk involved in western patients. Certain teams have nevertheless taken this route and will soon report their results. In France two phase II trials combining radiotherapy, chemotherapy (cisplatinum) and surgery have reported encouraging results with complete sterilization in 24% of the cases and 50% survival at 18 months. In our own series of 68 patients, we have obtained 41% sterilization and 56.3% survival at 3 years with the multi-modal protocol. The high number of non-responders to chemotherapy emphasies the importance of maintaining surgical resection whenever possible. The discouraging reports published before 1980 have been contradicted by improvements in outcome achieved over the last decade. Today, all patients with a diagnosis of epidermoid cancer of the oesophagus should benefit from either palliative or curative care based on the latest advances in radiotherapy, chemotherapy and surgery.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1995

[Treatment of breast cancer with ipsilateral supraclavicular node metastases].

During 1954-1977, among 2803 cases of breast cancer 99 (3.5%) had ipsilateral supraclavicular node mestastases. The results of treatment are reported, based on follow-up for more than 10 years. According to the treatment modality, the patients were divided into 4 groups: I. surgery with postoperative adjuvant chemotherapy and radiation therapy; II. radiation and chemotherapy; III. chemotherapy; IV. no treatment. In group I, surgical procedures consisted of segmental mastectomy in 6; simple mastectomy in 7; modified radical mastectomy in 16; standard radical mastectomy in 12, and extended radical mastectomy in 3. The over-all five-year survival rate was 9%. It was 18% (8/44) in group I, but only 5% (1/21) in group II. None survived for 5 years in group III and group IV. The results seem to indicate that more aggressive multi-modality treatment of breast cancer with ipsilateral supraclavicular lymph node metastases is indicated to expect better survival.

Adult↗

PubMed1995

[The efficacy of granisetron as a prophylactic anti-emetic agent used in conjunction with MCNU and VP16 chemotherapeutic regimens in the management of a pediatric case of hypothalamic anaplastic astrocytoma].

The management of a 12-year-old boy with hypothalamic anaplastic astrocytoma is reported herein. The pediatric patient underwent a subtotal removal of his brain tumor, and subsequently received multimodal treatment comprising radiotherapy (30.6 Gy to the whole brain and 50.4 Gy to the local lesion) and immunochemotherapy with MCNU (80 mg/m2, day 1), VP 16 (50 mg/day, days 2 to 6), and interferon-beta (3 x 10(6) units/day, initiating on day 2 for 4 weeks). The immunochemotherapy was given as of 4 weeks after radiotherapy. The administration of anti-cancer drugs caused severe nausea and vomiting, the intra-carotid infusion of MCNU being particularly emetogenic. The multi-modal treatment was then discontinued for a few weeks. A partial response was obtained, and the patient subsequently received 3 courses of maintenance therapy at six-month intervals using the same protocol as for the initial immunochemotherapy. During maintenance therapy, granisetron (40 micrograms/kg) was given intravenously 30 minutes before and one day after the injection of MCNU. Owing to the anti-emetic management of this patient, there were no complications throughout the chemotherapy. The patient has now survived for more than 3 years with a good quality of life, showing a Karnofsky performance score of 90.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1994

The associated targets methodology and the multi-isocenters radiosurgery treatment planning system Artemis-3D.

A new radiosurgical methodology, the "associated targets methodology" has been developed and tested by our group for the irradiation of complex cerebral arteriovenous malformations using our treatment planning system Artemis-3D. For the treatment of the arteriovenous malformations we used 15 MV photons generated by a Saturne 43 Linac, eight additional collimators (6-20 mm in diameter), the Betti fixation seat and the Talairach stereotactic frame. The successive steps of the associated targets' methodology are: -the prescription of a peripheral minimal therapeutic effective dose corresponding to the 60-70% cumulated isodose range; -the compartmentalization of the target volume into several sub-volumes, each of them having its own isocenter, collimator, irradiation space and isocenter dose weight; -the 3-dimensional computation and graphics requirements, and dose volume analysis; -the optimization evaluation criteria taking into account the dose inside and outside of the lesion. Two treatment planning software versions of Artemis-3D exist; the first one was developed for the sitting position and later for the supine treatment position, the second version is a multi-modalities imagery radiosurgical treatment planning system based on more powerful computers. Different types of stereotactic frames have been integrated. Three-dimensional visualization, stereotactic CT imaging, and angiography can be used for the sitting or supine position. We started using this methodology in 1990, and treated 44 patients during that year. For 26 single isocenter arteriovenous malformations, the obliteration rate was 22/26 (85%). In the 18 multi-isocenters irradiation cases, the overall obliteration rate was 11/18 = 61%. An example of successfully irradiated complex arteriovenous malformation is discussed to illustrate the methodology. With this three-dimensional methodology we have improved the results obtained during the first period (1986 to 1989) of our radiosurgical practice in which we used a two dimensional planification approach.

Dose-Response Relationship, Radiation↗

PubMed1995

Lymph node metastasis and surgical management of gastric cancer invading the esophagus.

In 88 resected patients with esophagus-invading gastric cancer, the factors determining the prognosis of this disease were investigated by multivariate analysis. Neither, age, sex, macroscopic type, thoracotomy, nor histological type proved to be independent prognostic factors. The presence or absence of lymph node metastasis, serosal invasion, tumor size, and the extent of esophageal invasion were found to be significant independent prognostic factors. Among lymph node metastases, involvement of para-aortic lymph nodes was especially important. The prognosis was significantly better in cases in which these nodes were carefully dissected (R4 gastrectomy), than in cases in which selected dissection was performed (R2). However, no patient with mediastinal lymph node metastasis survived for any lengthy period, and thus the mediastinal lymph nodes seemed to be nodes, the dissection of which brought little effect. Postoperative results were very poor in cases in which the extent of the esophageal invasion was 3 cm or more. These patients should be treated with multi-modal therapy such as neoadjuvant chemotherapy.

Adenocarcinoma↗

PubMed1995

The influence of age on the management of anal cancer.

The standard treatment for anal cancer is combination chemo-radiotherapy. Management decisions such as radical chemotherapy, resective surgery for poor response or relapse are frequently modified by age-associated comorbid factors. Between 1980 and 1990, our regional cancer center serving a population of 1.8 million saw 78 patients with squamous carcinoma of the anus. We have compared patients who were younger than 65 years (n = 38) with those older than 65 years (n = 38). The mean +/- standard deviation age for the whole cohort was 65 +/- 12 years, with a ratio of 2 females to each male presenting. Fewer of the elderly age group had major surgery (26% vs. 42%) (p = 0.03), and fewer suffered no toxicity (42% vs. 26%) (p = 0.03). However, 61% of the under-65-year age group are alive disease-free vs. 26% of the elderly group (p = 0.03). Similarly, only 18% of the under-65-year group died with disease compared with 37% of the elderly group (b = 0.03). For the series as a whole, the crude mortality was 42%, with 27% dying of their disease. The stage distribution, and the amount of radiotherapy or chemotherapy administered was not age-specific, but younger patients had more surgery and suffered more toxicity, with a greater proportion remaining alive and disease-free, and fewer dying of their disease. These data suggest that a more aggressive multi-modality approach in the elderly may improve disease response and survival.

Age Factors↗

PubMed1994

Clinical and pharmacokinetic studies of all-trans-retinoic acid in pediatric patients with cancer.

This review will summarize the rationale for pursuing investigations into the use of retinoids for pediatric patients with cancer, describe the phase I results of all-trans-retinoic acid (ATRA) in children, and discuss the results of a series of preclinical and clinical pharmacokinetic studies of ATRA. The prognosis for children with advanced stage neuroblastoma, the most common extracranial solid tumor of childhood, has remained poor despite significant increases in the intensity of multi-modality therapy. Observations that neuroblastoma has the potential in vivo to differentiate into the more mature neuronal phenotype of a ganglioneuroma or to spontaneously regress, combined with the ability of ATRA to induce differentiation of neuroblastoma cell lines in vitro, suggests that neuroblastoma may be a prime candidate for a retinoid-based approach to differentiation therapy. We previously performed a standard pediatric phase I trial of ATRA and defined the maximum tolerated dose (MTD) in children to be 60 mg/m2/day, significantly lower than the MTD in adult patients. Pharmacokinetic results revealed that the plasma half-life of ATRA was short (45 min) relative to 13-cis-RA (12-24 h), and that plasma drug exposure decreased significantly by day 28 of daily drug administration. Preclinical studies using an i.v. formulation of ATRA in a Rhesus monkey pharmacokinetic model then demonstrated that ATRA is eliminated by a capacity-limited (saturable) process. This elimination process was rapidly induced within the first week of daily i.v. ATRA administration, and suggested that an intermittent schedule of drug administration might allow for down-regulation of the elimination process. These pre-clinical studies formed the basis for investigating whether an intermittent schedule of ATRA administration would allow for repeated periods of relatively higher plasma drug concentrations. Preliminary results of two clinical trials using intermittent schedules of administration suggest that this approach may result in significantly higher plasma drug exposure over time. Plans to study the role of intermittent schedules of ATRA administration in pediatric phase II trials in patients with neuroblastoma are underway.

Adolescent↗

PubMed1995

[Pain and convalescence after ambulatory inguinal herniotomy during local anesthesia].

Postoperative pain and convalescence following ambulatory inguinal herniotomy in local infiltration anesthesia was evaluated in this descriptive study. Sixty consecutive patients (median age 63 yr) were included. Per- and postoperative pain treatment were pre- and postoperative oral tenoxicam and methadone plus infiltration of the surgical field with up to 60 ml of 0.25% bupivacaine. Intraoperative pain intensity was slight and was treated with supplemental bupivacaine. Patients were totally relieved of pain at rest and during mobilisation in the first hours after surgery, but more than half of the patients had moderate pain from the first to the third postoperative day and still had light pain seven days after surgery. Normal daily activity was re-established five days postoperatively (median). Fifty-two patients were satisfied with the anesthesia and eight patients not satisfied due to fear of intraoperative pain. This study shows that inguinal herniotomy can be performed routinely as an outpatient procedure under local infiltration anesthesia. However, late postoperative pain was significant and should be improved with multi-modal analgesia.

Adult↗

PubMed1994

[Pathogenetic therapy of pulmonary tuberculosis in adolescents].

The paper presents the therapeutical results of 82 adolescents suffering from respiratory tuberculosis. During multi-modality therapy by using tuberculin, oliphen plus prednisolone there were clear-cut changes in immunological parameters, an increase in therapeutical efficiency and an average 3-month reduction in hospital stay.

Administration, Oral↗

PubMed1994

[Systemic dysfunctions in patients with tuberculous spondylitis and their clinical significance for surgical treatment].

The paper provides the results of studies into the pathophysiological mechanisms of respiratory and cardiovascular dysfunctions in patients with tuberculous spondylitis complicated by spinal marrow disorders. It also shows their clinical value at various stages of surgical treatment. The authors shows it necessary to perform a multi-modality rehabilitative therapy by monitoring the functions in the postoperative period, which is aimed at recovering functions of vital viscera and systems of the body, as well as locomotor functions.

Adult↗

PubMed1994

A high-speed network for cardiac image review.

A high-speed fiber-based network for the transmission and display of digitized full-motion cardiac images has been developed. Based on Asynchronous Transfer Mode (ATM), the network is scaleable, meaning that the same software and hardware is used for a small local area network or for a large multi-institutional network. The system can handle uncompressed digital angiographic images, considered to be at the "high-end" of the bandwidth requirements. Along with the networking, a general-purpose multi-modality review station has been implemented without specialized hardware. This station can store a full injection sequence in "loop RAM" in a 512 x 512 format, then interpolate to 1024 x 1024 while displaying at 30 frames per second. The network and review stations connect to a central file server that uses a virtual file system to make a large high-speed RAID storage disk and associated off-line storage tapes and cartridges all appear as a single large file system to the software. In addition to supporting archival storage and review, the system can also digitize live video using high-speed Direct Memory Access (DMA) from the frame grabber to present uncompressed data to the network. Fully functional prototypes have provided the proof of concept, with full deployment in the institution planned as the next stage.

Cardiology↗

PubMed1994

Clinical and pharmacokinetic studies of all-trans-retinoic acid in pediatric patients with cancer.

Adolescent↗

PubMed1994

[Changes of immune and non-specific reactivity in patients with chronic suppurative obstructive bronchitis in comprehensive treatment with thymogen].

A total of 33 patients with chronic pyoobstructive bronchitis with immunological disorders (of T-cell and other links) and nonspecific responsiveness. The use of thymogen in multi-modality treatment contributed to normalization of T-cell immunity (increases in E-rosette formation, responses of blast cell transformation to phytohemagglutinin, Tx/Tc ratio), as well as nonspecific responsiveness parameters (C3c, NBT-test, natural killers), resulting in higher clinical efficacy.

Adjuvants, Immunologic↗

PubMed1993

Management of implant-related problems and infections.

Problem-solving and treating various types of infections that can cause alveolar bone loss or inferior alveolar nerve dehiscences by failed implants or teeth are discussed. The reasons why implants fail from either surgical or prosthetic errors are reviewed. Treatment remedies which have solved numerous implant-related problems are offered. The eclectic, multi-modal implant surgical and prosthetic abilities of the clinician necessary today for successfully treating patients presenting with troubled or infected implants are reviewed.

Blade Implantation↗

PubMed1994

[Progress of the treatment of gastric cancer in Cancer Institute Hospital, Tokyo].

From 1946 to 1990, a total of 10,485 cases of gastric cancer patients were treated at the Cancer Institute Hospital (CIH), Tokyo. During the past 46 years, CIH contributed to various aspects of surgical treatment of gastric cancer; extensive radical surgery for advanced cancer, safe reconstruction methods after total gastrectomy, modified surgery for early stage cancer, and multimodality therapy for moderately advanced cancer. Five-year survival rate was 20% for all cases in 1940s, and 66.5% for 1980s. Improvement in the treatment results could be attributed to the relative increase in the number of early stage cancers, the increase in the rate of curative surgery (R0), and incorporation of multi-modality therapy before or after curative surgery. Stage-oriented therapy is mandatory for further improvement in the treatment results and the patient's quality of life after surgery.

Adult↗

PubMed1993

[Dynamic magnetic resonance tomography in aortic valve insufficiency: methodologic comparison with aortography and color Doppler echocardiography].

To evaluate the usefulness of cine-MRI for the quantitative assessment of aortic valve regurgitation, 31 patients (54 +/- 15 years of age; 22 M, 9 F) and 10 normal volunteers underwent a multi-modality imaging protocol comparing cine-MRI with color Doppler echocardiography and contrast aortography. Twenty-one patients had aortic regurgitation with an associated transvalvular gradient, 10 patients had pure valve incompetence. Aortic insufficiency as assessed by the signal void from regurgitant flow on cine-MRI was best analyzed on transversal tomograms. Both the volume of the signal void caused by turbulence above a threshold velocity, and the ratio of the diameters of the regurgitant jet and the outflow tract (dAL-Jet/DLVOT) were found to correlate closely with the (Seller's) angiographic regurgitant score by r = 0.86 each (p < 0.001), and the color Doppler echocardiographic index by r = 0.74 and 0.89, respectively (p < 0.001). Cine-MRI failed to differentiate the angiographic grades I and II, however, clearly separated grades II, III, and IV in contrast to other non-invasive imaging modalities. Moreover, a semiquantitative index derived from cine-MRI allowed a rapid assessment of the severity of regurgitation, similar to color Doppler echocardiography and the semiquantitative angiographic Seller's score. Thus, cine-MRI volumetric evaluation of transvalvular flow turbulences provides a useful and reproducible means to quantify aortic regurgitation. It also allows serial atraumatic investigations as a diagnostic alternative to color Doppler examination in patients less suitable for echocardiographic evaluation and may prove helpful in monitoring the natural course of aortic valve disease.

Adult↗

PubMedDate not supplied

Laparoscopic evaluation of abdominal malignancy.

Diagnostic laparoscopy, developed in the early 1900s, has become an integral part of evaluation in the management of abdominal malignancy, including hepatocellular carcinoma, metastatic hepatic cancer, and abdominal lymphoma. When compared with computerized tomography and ultrasound, laparoscopic diagnosis is superior, or at least complementary, to conventional imaging. Laparoscopic evaluation and staging of abdominal cancer will become of greater importance because of the increasing role of palliative procedures and multi-modality therapy.

Abdominal Neoplasms↗