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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The clinical benefit of adjuvant chemotherapy in pancreatic cancer patients is still questionable. Phase II studies using radiochemotherapy based on 5-fluorouracil (5-FU) provided evidence of an increase in median survival times. Because palliative chemotherapy by celiac artery infusion (CAI) led to an increase in survival in pancreatic cancer, we treated 24 patients with adjuvant CAI following resection of the head of the pancreas for pancreatic cancer (21 patients with Union Internationale contre le Cancer (UICC) stage III, 2 with UICC stage II, 1 with UICC stage I). Catheters were placed angiographically into the celiac artery and remained there for 5 consecutive days. One cycle of chemotherapy consisted of mitoxantrone, 5-FU, folinic acid, and cisplatinum. This treatment was repeated five times at monthly intervals. CAI was well tolerated, and World Health Organization (WHO) grade III toxicities were observed in 8%; WHO grade IV was seen in none of the treatment cycles. Furthermore, we observed pain reduction in nearly all patients under CAI. Median survival times in patients who received CAI were 23 months for all patients, whereas in patients who did not receive adjuvant treatment the median survival was 10.5 months. With Kaplan-Meier regression analysis of the patients who were curatively resected (R0 resection) and received CAI, the overall 4-year survival was 54%, whereas in patients without CAI the 4-year survival was 9.5%. The occurrence of liver metastases in the CAI group went down to 17%. These results demonstrate that CAI is well tolerated, reduces the risk of liver metastasis, and increases the survival time of pancreatic cancer patients.
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  • 2
    ISSN: 1439-099X
    Keywords: Schlüsselwörter: Pankreaskarzinom ; Strahlentherapie ; Chemotherapie ; Resektion ; Überleben ; Biologisch effektive Dosis ; Bestrahlungsvolumen ; Key Words: Pancreatic carcinoma ; Radiotherapy ; Chemotherapy ; Resection ; Survival ; Biologically effective dose ; Treatment volume
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Purpose: To identify the impact of treatment factors on overall survival in patients with pancreatic carcinoma. Patients andMethods: We performed a follow-up study on 38 patients with adenocarcinoma of the pancreas treated from 1984 to 1998. 18/38 patients were resected. Irradiated volume included the primary tumor (or tumor bed) and regional lymph nodes. Thirty-seven patients received in addition chemotherapy consisting of mitoxantrone, 5-fluorouracil and cis-platin, either i.v. (14/38) or i.a. (23/38). The influence of treatment related factors on the overall survival was tested. Biologically effective dose was calculated by the linear-quadratic model (α/β = 25 Gy) and by losing 0.85 Gy per day starting accelerated repopulation at day 28. Results: Treatment factors influencing overall survival were resection (p = 0.02), overall treatment time (p = 0.03) and biologically effective dose (p 〈 0.002). Total dose and kind of chemotherapy had no significant influence. Treatment volume had a negative correlation (r = −0.5, p = 0.06) with overall survival, without any correlation between tumor size, tumor stage, and treatment volume. In multivariate analysis only biologically effective dose remained significant (p = 0.02). Conclusions: Among with surgery, biologically effective dose strongly influences overall survival in patients treated for pancreatic carcinoma. Treatment volume should be kept as small as possible and all efforts should be made to avoid treatment splits in radiation therapy.
    Notes: Ziel: Behandlungsfaktoren zu identifizieren, die einen Einfluß auf das Überleben von Patienten mit Pankreaskarzinom haben. Patienten und Methode: In einer nichtrandomisierten Studie wurden 38 Patienten ausgewertet, die von 1984 bis 1998 wegen eines Adenokarzinoms des Pankreas behandelt worden waren. Bei 18/38 Patienten war eine Resektion vorgenommen worden. Das Bestrahlungsvolumen beinhaltete den Primärtumor bzw. das Tumorbett und die regionären Lymphknoten. Zusätzlich erhielten 37 Patienten mehrere Chemotherapiezyklen mit Mitoxantron, 5-Fluorouracil und Cis-Platin, entweder intravenös (14/38) oder intraarteriell (23/38). Der Einfluß von Behandlungsfaktoren auf das Überleben wurde untersucht. Die biologisch effektive Dosis wurde mit Hilfe des linearquadratischen Models (α/β = 25 Gy) berechnet bei einem täglichen Wirkungsverlust von 0,85 Gy ab Tag 28. Ergebnisse: Behandlungsfaktoren, die das Überleben beeinflußten, waren die Resektion (p = 0,02), die strahlentherapeutische Behandlungszeit (p = 0,03) und die biologisch effektive Dosis (p 〈 0,002). Gesamtdosis und Applikationsart der Chemotherapie hatten keinen signifikanten Einfluß. Das strahlentherapeutische Behandlungsvolumen wies eine negative Korrelation (r = −0,5 mit p = 0,06) mit dem Gesamtüberleben auf, ohne daß eine Korrelation zwischen Tumorgröße, Tumorstadium und Behandlungsvolumen nachweisbar war. In der multivariaten Analyse behielt allein die biologisch effektive Dosis mit p = 0,02 ihre Signifikanz. Schlußfolgerungen: Neben der Resektion beeinflußt die biologisch effektive Dosis das Überleben der Pankreaskarzinompatienten. Das Bestrahlungsvolumen soll so klein wie möglich gehalten und eine Unterbrechung der Strahlentherapie soll vermieden werden.
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  • 3
    ISSN: 1435-2451
    Keywords: Key words Pancreatic cancer ; Immunotherapy ; Cancer vaccines ; Monoclonal antibodies ; Immune monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: In pancreatic cancer, multimodal protocols, involving chemotherapy, radiation, or regional treatment, are initiated to improve oncological outcome. Since pancreatic adenocarcinoma has been shown to be susceptible to immune stimulation, several immunotherapy approaches have been investigated to define the role of immunotherapy in pancreatic cancer. Method: A review of current and past data concerning experimental and clinical immunotherapy in pancreatic cancer is presented in the context of basic immunotherapeutic principles. Past pitfalls and future developments are analyzed and a synthesis of immune stimulation and immune suppression is deduced on the basis of published data. Results: Preclinical and initial clinical studies with monoclonal antibodies CO17-1A, BW494/32 and anti-epidermal growth factor receptor (EGFR) have been conducted, and various targets suitable for immunotherapy have been identified involving new molecular and gene technology. Targets on pancreatic cancer cells currently under investigation are mucins (MUC-1), glycoproteins (GA733), ras peptides and EGFRs. Side effects are minor and rarely auto-immune reactive. Another approach combines randomized regional with systemic chemoimmunotherapy (mitomycin C, 5-fluorouracil, folinic acid, carboplatin, epirubicin; interferon-gamma, interleukin-2) in nonresectable pancreatic cancer and obtains significant differences in median survival rates (14 months vs 4.5 months in controls) and quality of life. Conclusion: Although single remarkable improvements in the immunological approach to treatment of pancreatic cancer have been made, immunotherapy in pancreatic cancer is still experimental. On the basis of reliable preclinical data, new immunotherapy protocols will have to be evaluated clinically. Careful monitoring of immune responses and side effects, and assessment of quality of life will ensure identification of effective immunotherapy protocols for human pancreatic cancer in the near future.
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  • 4
    ISSN: 1435-2451
    Keywords: Follow-up Colorectal cancer Cost-effectiveness
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Background: Follow-up programs in colorectal cancer have been under question recently due to their low efficacy. Some meta-analyses found a survival benefit and four randomized studies suggested the opposite. Therefore, this paper analyzes existing and proposed follow-up programs for costs and efficacy. Methods: One thousand and fifty-four colorectal cancer patients intensively followed-up in Ulm (endoscopy, chest radiography, abdominal ultrasound, computed tomography (CT) pelvis) were prospectively evaluated for recurrence, salvage surgery rate, survival and costs. Costs were compared among existing and proposed international follow-up programs retrieved by a MedLine search. Results: A total of 350/1054 colorectal cancer patients (33.2%) relapsed asymptomatically, as detected by follow-up. 56/350 (local 47%, distant 53%) recurrences were resectable (16%), 21/350 patients survived (6%). The efficacy of follow-up was 21/1054 patients (2%). Costs were, per patient, 2220 euros (colon) or 4851 euros (rectum). Costs in five randomized studies varied between 616 euros for minimal and 5049 euros for intensive follow-up. Four proposed follow-up concepts include risk-adaption, which claim to reduce costs by 50–60% and range between 889 (colorectal) and 5910 (high-risk, rectum) euros. The recommended German follow-up guideline costs 610 euros (low-risk, colorectal), 1120 euros (high-risk, colon) or 2252 euros (high-risk, rectum). Conclusion: Follow-up concepts for colorectal cancer should aim at the identification of curable patients with recurrence. Evidence-based concepts, including life quality tests, remain to be defined, but currently abdominal ultrasound, endoscopy and carcino-embryonic antigen (CEA) determination at 6-month intervals for 2 years and annual intervals for 3 years seem to identify this patient sub-group.
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