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Results for “multimodal therapy”

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PubMed2026

Multimodal Therapy With Metformin, Inositol and Dietary Restriction Improves Insulin Resistance and Endocrine Outcomes in Women With Polyendocrine Metabolic Ovarian Syndrome: A Randomized Controlled Trial.

INTRODUCTION: Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), is a common endocrine-metabolic disorder characterized by insulin resistance, hyperandrogenism and ovulatory dysfunction. Metformin, inositol supplementation and lifestyle modification are widely used treatments, but direct comparative evidence remains limited. Multimodal therapy combining metformin, inositol and dietary restriction produces greater metabolic and reproductive improvement than single-modality interventions. METHODS: We conducted a 12-week randomized controlled trial in 192 women aged 18-35 years diagnosed with PMOS according to Rotterdam criteria. Participants were allocated to metformin (1500-2000 mg/day), inositol (myo-inositol 2 g plus d-chiro-inositol 50 mg twice daily), calorie-restricted diet (1200-1500 kcal/day), or combination therapy. Primary outcomes included changes in body mass index (BMI) and insulin resistance assessed by HOMA-IR. Secondary outcomes included testosterone, LH/FSH ratio and menstrual regularity. Analysis was performed using analysis of covariance (ANCOVA), with post-intervention values as dependent variables and corresponding baseline values as covariates. Categorical outcomes were compared using the Chi-square test. RESULTS: All interventions improved metabolic and endocrine parameters. Combination therapy resulted in the greatest reduction in HOMA-IR (- 2.64, 95% CI - 2.82 to -2.46, p < 0.001) and BMI (- 2.8 kg/m2, 95% CI - 3.05 to -2.55, p < 0.001). Menstrual cyclicity improved across all groups, with the highest proportion of participants reporting cycle regularisation in the combination therapy group (85.4%), compared with dietary restriction (72.9%), inositol (64.6%), and metformin (39.6%) (p < 0.001). Given the short follow-up duration, these findings reflect early improvements rather than sustained normalisation. CONCLUSION: Multimodal therapy was associated with superior metabolic and reproductive outcomes compared with single-modality interventions in women with PMOS. CLINICAL TRIAL REGISTRATION: ClinicalTrials. gov (NCT07380841).

Humans↗

PubMed1992

Multimodal therapy of small cell lung cancer in TNM stages I through IIIa.

Since 1977, Innsbruck University Hospital has been employing a multimodal therapy concept for small cell bronchial carcinomas in stages I to IIIa. This concept includes all three treatment forms effective in this tumor, namely, chemotherapy, surgery, and radiotherapy. The therapy scheme is stage-dependent and begins in stages T1-3 N0-1 with lung resection and in stage N2 with chemotherapy. To date, 45 patients have been included in a prospective, nonrandomized (phase II) trial: 7 in TNM stage I, 11 in stage II, and 27 in stage IIIa (6 T3 and 21 N2). The actuarial 5-year survival rate of the entire group (including therapy-related lethality, early recurrences, and protocol violations) is 36%; it is 57% for those in stage I, 28% for those in stage II, and 34% for those in stage IIIa. Median survival time is 18 months. Patients with completed multimodal treatment have a 5-year survival rate of 56% regardless of disease stage. Three patients died of tumor-unrelated causes after 47, 52, and 54 months.

Adult↗

PubMed1992

Adjuvant therapy for patients with colon and rectal cancer: clinical indications for multimodality therapy in high-risk groups and specific surgical questions for future multimodality trials.

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Chemotherapy, Adjuvant↗

PubMed1978

L2C guinea pig leukemia. A potential model for structuring multimodality therapy.

L2C guinea pig leukemia is a lymphoblastic neoplasm that arose spontaneously in a nonirradiated female strain 2 guinea pig over 20 years ago. Mutation of the original tumor probably accounts for the discordant results which have been reported. The LE-L2C subline was used to develop a multimodality therapy model of acute leukemia. Syngeneic strain 2 animals challenged with 3 x 10(5) LE-L2C cells developed overt leukemia in 14 +/- 3 (SD) days. When treated with cytoreductive chemotherapy, they relapsed with either systemic or central nervous system (CNS) disease. However, CNS relapse was prevented by craniospinal irradiation, yielding a uniform pattern of relapse. Preliminary studies suggest that active immunotherapy with nonspecific agents, such as BCG, or immunoreconstitution with thymosin may prolong the duration of remission and increase the percentage of long-term survivors. L2C leukemia may represent a useful animal model for structuring the principles that govern the interrelationship between chemotherapy and immunomudulation.

Animals↗

PubMed1979

Metabolic response to surgery in the cancer patient: consequences of aggressive multimodality therapy.

The metabolic response to uncomplicated surgery in the patient undergoing primary therapy for malignancy is no different than the response to surgery of similar magnitude for benign disease. Hemodynamic, nutritional-endocrine, and convalescent changes are similar. However, with current aggressive approaches to the management of cancer, the patient often comes to surgery with evidence of major debilitating side effects from his progressive malignancy or from aggressive multimodality therapy. The surgeon must be aware of the consequences of the use of combination therapies on the expected metabolic response to surgery. Awareness of such problems such as the nutritional deficit will allow preventive methods to supercede metabolic salvage procedures.

Animals↗

PubMed1977

Acute myelogenous leukemia as a late complication of the multimodality therapy for Hodgkin's disease.

Progressive thrombocytopenia developed in a patient following the completion of total lymphoid irradiation and combination chemotherapy for Hodgkin's disease. Thorough evaluation eventually yielded a diagnosis of acute myelogenous leukemia (AML). Previous workers have suggested that the development of thrombocytopenia with a hypoplastic marrow following total lymphoid irradiation indicated recurrent Hodgkin's disease. When the combination cytopenias and hypoplastic marrow is recognized these workers have recommended early combination chemotherapy. Recent data suggest a 1300-fold increase in the risk of AML following multimodality therapy for Hodgkin's disease. We feel that a careful search for AML should be conducted in patients with deteriorating hematologic parameters following therapy for Hodgkin's disease and that this search should include sampling bone marrow outside irradiated areas.

Adult↗

PubMed1992

[Long-term results of small cell lung cancer treated by surgical resection and multimodality therapy].

241 patients with small cell lung cancer (SCLC) were operated in our hospital from 1957 to 1985. The early postoperative mortality was 1.7%. The 5-yr survival rate was 23.2% (56/241). The 10-yr survival rate was 16.5% (15/91) (only 4 patients died during 5-yr to 10-yr after surgery but none of them died of SCLC). We analysed the 5-yr survival group. The 5-yr survival rate for stage I patients was 52.3% (23/44), stage II 34.1% (14/41), stage III 12.8% (19/149) [IIIa12.3% (17/138),IIIb 18.2% (2/11)]. Stage IV 0 (0/3). The P value: I vs IIIaP < 0.001, II vs IIIaP < 0.01. 125 patients received chemotherapy (CT) and/or radiotherapy (RT) postoperatively (group A) and the other 112 cases received surgical resection only (group B). 4 patients (3 IIIa, 1 IIIb) who died in early postoperative period were not counted. The 5-yr survival rate for group A and B was 40.8% (51/125) and 4.5% (5/112) respectively, P < 0.001; for group A and B stage I was 71.4% (20/28) and 18.8% (3/16), P < 0.01;for group A and B stage II was 54.5% (12/22) and 10.5% (2/19), P < 0.01; for group A and B stage IIIa was 25.4% (17/67) and 0 (0/71), P < 0.001. There were no differences in 5-yr survival rate on types of surgical resection and locations of the disease. The present results revealed that the total 5-yr survival rate for SCLC was 23.2%, among them for resection only was 4.5% and for resection plus multimodality therapy was 40.8%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Ten-year outcome of patients with advanced epithelial ovarian carcinoma treated with cisplatin-based multimodality therapy.

PURPOSE: At the end of the 1970s it was thought that advanced epithelial ovarian cancer (EOC) could be cured by multimodality treatment using surgery, cisplatin-based combination chemotherapy, and radiotherapy (RT). Such multimodality treatment was used as standard therapy at our institution. Our long-term results are reviewed. PATIENTS AND METHODS: One hundred ninety-five previously untreated patients with stage III or IV EOC were treated between April 1979 and December 1982. All patients were to have debulking surgery, when feasible, followed by the administration of doxorubicin and cisplatin at 50 mg/m2 every 3 weeks until a total dose of doxorubicin of 450 mg/m2 had been reached. RT was used in addition in patients with disease remaining after the chemotherapy. Maintenance chemotherapy with oral cyclophosphamide and hexamethylmelamine (altretamine) was administered to patients who did not have a documented histologic complete remission. RESULTS: The 10-year overall and failure-free survivals were 4% and 8%, respectively. The median overall survival was 2 years. The achievement of a histologic complete response (n = 32) did not equate to cure because 20 (63%) of the patients eventually relapsed. Multivariate analysis identified residual disease of greater or less than 2 cm as the only independent prognostic factor. CONCLUSIONS: Our multimodality treatment program was noncurative for the majority of the patients. Innovative therapies are needed before we can hope to cure such disease.

Adult↗

PubMed1979

A follow-up of alcoholics treated by multimodal therapy.

A general hospital sponsored for the psychotherapeutic treatment of alcoholism is described. In this context a multimodal approach, emphasizing methods derived from principles of learning, is applied to training the individual in new life-style skills for the management of alcoholism. Demographic characteristics of the population served by the program are of a predominantly blue collar clientele, mostly employed (72%), married (61%), and from urban centers (95%). Attrition as a major problem in evaluating results at the follow-up stage is identified and a method of reporting follow-up results taking this factor into account is presented. This method showed that under the most stringent conditions for reporting results, 36.64% of a sample of 131 alcoholics were showing improvement at 12 months, while under the least stringent condition 84% were showing some improvement over the same period.

Adult↗

PubMed1977

Preliminary results of aggressive multimodality therapy for metastatic osteosarcoma.

Ten patients with metastatic osteosarcoma were treated at the Joint Center for Radiation Therapy, the Sidney Farber Cancer Institute, and the Children's Hospital Medical Center from 1973 to 1976. Patients were treated with an aggressive multimodality approach with included surgery, chemotherapy, and radiation therapy. Three of 10 patients are alive with no evidence of disease, five are alive, with disease, and two are dead of disease. The median survival is 12+ months. Local control data for radiation combined with high dose methotrexate in metastatic osteosarcoma is shown.

Adolescent↗

PubMed1992

Integrated multimodal therapy of children with attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) affects about 3-9% of children in the United States. It is a complex, multidetermined ailment that causes profound difficulty not only for the children but also for their families and those in the broader social environment (e.g., schools). Although medication helps an ADHD child's day-to-day functioning, it is less effective in producing long-lasting improvement when used alone. The author therefore discusses the rationale and techniques for multimodal treatment, including the use of education, cognitive-behavioral therapy, behavior modification, and structural and dynamic therapy, as well as medication. He emphasizes that the use of multiple modalities produces therapeutic benefit greater than the sum of each modality's contribution. The author's basic premise is that psychodynamic understanding is crucial in determining how to combine various therapies and make them mutually facilitative.

Attention Deficit Disorder with Hyperactivity↗

PubMed1975

The success and failure of multimodal therapy for cancer in children.

Achievements, as well as limitation, in combination treatment of childhood malignancies are discussed. Tumor types are grouped according to response (definite, probable, unknown) to combined treatment. Improvements in survival rates have occurred following the addition of chemotherapy to surgery and radiation therapy in children with Wilmes' tumor, and Ewing's and soft tissue sarcoma, probably by suppression of microscopic metastases. So far, advances are not yet apparent following multimodal treatment of neuroblastoma, hepatoma, and ovarian tumors.

Adolescent↗

PubMed1977

Blindness during remission in two patients with acute lymphoblastic leukemia: a possible complication of multimodality therapy.

Two patients with acute lymphoblastic leukemia treated on the same protocol became blind during complete remission. Therapy consisted of systemic combination chemotherapy, prophylactic central nervous system irradiation and monthly intrathecal cytosine arabinoside. Eight months after CNS irradiation visual acuity in both patients began to decrease. Meningeal leukemia in the area of the chiasm was suspected but despite additional radiotherapy, steroids and continued intrathecal therapy, both patients were blind within 6 months. Numerous lumbar punctures were negative for leukemic cells. Extensive investigation, including craniotomy in one case, failed to reveal the cause of blindness. Biopsy of the optic nerve in one case was compatible with radiation toxicity. We postulate that potentiation of radiation toxicity to the optic nerves and chiasm by systemic chemotherapy, intrathecal chemotherapy, or both, may have led to blindness. The patients continue in complete hemotologic and CNS remission 12 and 29 months after becoming blind.

Acute Disease↗

PubMed1977

Acute and late effects of multimodal therapy on normal tissues.

The increasing use of combined radiation, chemotherapy, and surgery had led to an increased incidence of acute and late complications. The complications are, in general, similar to those seen with each modality alone, but occur with increased incidence. Enhanced effects of combined radiation and surgery are modest in number and consist primarily of problems with wound healing and fibrosis, as well as late gastrointestinal damage. Combinations of radiotherapy and chemotherapy have shown a greater degree of enhanced acute and late reactions. Drugs, such as actinomycin-D and Adriamycin, are particularly dangerous if the marked enhancement of radiation effects caused by the drugs in almost all organs is not appreciated and the radiation dose not adjusted accordingly. Proper selection of drugs can lead to enhanced local control by radiotherapy and/or surgery, as well as eradication of microscopic distant metastases, without increased normal tissue injury. Late induction of malignancy can occur with either radiation or chemotherapy alone and, in some cases, this appears to be enhanced when they are combined.

Antineoplastic Agents↗

PubMed1979