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  • 1
    ISSN: 1432-0843
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The kinetics of melphalan leakage into the peripheral blood were studied in 21 patients undergoing hyperthermic isolation perfusion of the upper or lower limb as an adjuvant treatment in high-risk melanoma; in 5 patients cisplatin was added. The melphalan concentrations in the peripheral blood rose predominantly during the first 20 min of perfusion and levelled out to an apparent steady state of about 0.28 μg/ml in upper extremity perfusions, and 0.34 (without cisplatin) and 0.37 μg/ml (with cisplatin) in lower extremity perfusions. Erythrocytes labelled with technetium Tc 99m, which were added concomitantly with melphalan to the perfusion medium, appeared in the systemic circulation of the patients at an almost constant rate of 0.32% (lower and upper limb perfusions without cisplatin and 0.37% (with cisplatin) of total tracer/min. This perfusate flow rate indicated by labelled erythrocytes completely explained the leakage of melphalan from the perfusion circuit into the peripheral blood. Peak concentrations of melphalan in the peripheral blood were observed immediately after reconstitution of normal hemodynamic conditions once isolation perfusion had been teminated. This fraction of melphalan might originate from tissue-binding sites, but also from vascular compartments; therefore, a thorough washing-out procedure might minimize this effect.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1573-7217
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: In the early 1980s breast preservation was a rarely applied therapeutic modality in the primary treatment of breast cancer in the Federal Republic of Germany. Reports coming from retrospective studies as well as preliminary results from randomized trials made it desirable to introduce breast preservation in the form of a controlled clinical trial. Study design: In stage pT1 N0 M0 breast cancer, mastectomy as the standard treatment was to be compared with radiotherapy of the remaining breast tissue. The study design originally planned as a randomized trial had to be changed into a prospective observation study due to the low randomization rate. Univariate analysis of prognostic variables was the first step to a valid treatment comparison. Those factors determined as being significant were included together with the treatment effects in a multivariate analysis. A high therapeutic standard was guaranteed by quality control. Results: 1036 out of 1119 recruited patients are evaluable. After a median follow-up of 48 months the following preliminary results can be reported. With the exception of death without recurrence from breast cancer, the 143 events are evenly distributed among the two treatment groups. Locoregional recurrence of the whole patient population was 5%. Out of all prognostic factors examined only tumor size and grading are significant in regard to recurrent disease. Recurrence-free survival decreased in cases with ‘uncertain’ tumor margins, whereas the width of the margin had no influence on recurrent disease. There was no significant difference in quality of life between the two treatment groups. Conclusions: The four-year results of this study are in accordance with those of other breast preservation trials: There is no significant difference between the two treatment groups in the occurrence of locoregional failure. Incomplete tumorectomy has a negative influence on recurrence. Quality of life seems more dependent on the acceptance of the therapy by the patient than on the therapeutic modality itself. Breast preservation can also be performed appropriately in smaller institutions if the therapeutic standard is guaranteed by quality control.
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  • 3
    ISSN: 1435-2451
    Keywords: Breast cancer ; Breast preserving primary treatment ; Necessary prerequisites ; Mammacarcinom ; Brusterhaltende Primärtherapie ; Erforderliche Voraussetzungen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Seit der Veröffentlichung Fishers im März 1985 steht man der brusterhaltenden Therapie zunehmend unkritisch gegenüber. Zur Vermeidung von Lokalrezidiven ist diese Therapiemodalität nur im Zusammenhang mit einer Radiatio vertretbar, deren negative Auswirkungen häufig negiert werden. Einwandfreie chirurgische Technik, sorgfältige pathologische Aufarbeitung des Tumormaterials und eine computerisierte Bestrahlungsplanung als Voraussetzung für die Homogenbestrahlung der Brust sind unabdingbar für die Durchführung einer brusterhaltenden Therapie. Juristischethisch ist eine Darstellung der Vor- und Nachteile von brusterhaltender und radikaler Operation zwingend. Eine Umsetzung der brusterhaltenden Behandlung ist derzeit nur unter Studienbedingungen vertretbar.
    Notes: Summary Since Fisher's publication in March 1985 conservative breast cancer treatment is viewed ever more uncritically. In order to avoid local recurrence this therapeutic modality can only be justified in connection with radiotherapy the negative effects of which are often neglected. Thoroughly competent surgical technique, careful pathological work-up of the tumor material and a computerized radiation planning as a prerequisite for a homogeneous radiotherapy of the breast are necessary to perform conservative breast cancer therapy. Legal-ethical aspects make it imperative to inform the patient about the advantages and disadvantages of conservative versus radical therapy. The realization of conservative breast cancer treatment on a broad basis is, at present, only justifiable under study conditions.
    Type of Medium: Electronic Resource
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