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Biomedical subjects

A Altendorf-Hofmann

Publications and source records attributed to A Altendorf-Hofmann.

53 records · Page 3Linked to original sources
PubMed1992

[Organ-preserving therapy in invasive bladder carcinoma].

With the aim of organ preservation, transurethral resection with subsequent radiotherapy (until 1985) or combined radio- and chemotherapy (since 1986) was undertaken as part of a prospective trial in 175 consecutive patients (137 men, 38 women; mean age 65 [31-90] years) with invasive bladder carcinoma, tumour stage T1-4 N0-3 M0. All patients had a transurethral resection, followed 2-6 weeks later by definitive radiotherapy at a dose of 50.4 Gy to the bladder in 28 fractions. 85 patients simultaneously with the radiotherapy received chemotherapy with cisplatin (25 mg/m2 daily) or carboplatin (65-75 mg/m2 daily) in the first and fifth weeks of radiotherapy. The 5-year survival rate for the whole group (including inoperable cases) was 50%. The survival rate as related to the T category was 53% for T1 (n = 26), 68% for T2 (n = 34), 45% for T3 (n = 94) and 22% for T4 (n = 17). 139 patients (79%) were left with a normally functioning bladder. Cystectomy was performed in 36 patients because of remaining tumour or recurrence after radiotherapy. Combined radio- and chemotherapy improved the histological remission rate, compared with an earlier control group with radiotherapy only, but it did not affect the survival rate. These data indicate that in advanced bladder carcinoma organ-preserving treatment with transurethral resection and definitive radiotherapy or combined radio- and chemotherapy can be successful.

Adult↗
PubMed1991

Brachial plexus lesions following median sternotomy in cardiac surgery.

The incidence of neurological deficits of the upper extremity was studied in a prospective trial on 201 consecutive patients who underwent median sternotomy at cardiac surgery. In 13 patients (6.5%), a brachial plexus paresis was diagnosed postoperatively. We were unable to demonstrate any statistically significant correlation between brachial plexus paresis and the side of arm placement, the side of cannulation of the jugular vein, the duration of operation, the bypass time, sex, or type of operation. All patients who suffered from neurological deficit were aged 50 years and more, however without any statistically significant correlation. In our opinion, brachial plexus lesions following median sternotomy in cardiac surgery depend on the extent of sternal spread and the height of placement of the retractor in dependence of the rigidity of the rib cage. By reason of the iatrogenic cause of brachial plexus lesions, it appears to us that these complications should be included in those of which the patient needs to be informed preoperatively.

Brachial Plexus↗
PubMed1991

[Simultaneous radiotherapy and chemotherapy with cisplatin and 5-fluorouracil in advanced head and neck tumors].

Between 1.1. 1987 and 31.12. 1988 47 patients with locally advanced head- and neck tumours (UICC-stage II: one patient, stage III: 16 patients, stage IV: 30 patients) were treated with simultaneous radio-chemotherapy. Localisations were hypopharynx (23 = 49%), oropharynx (16 = 34%) and other sites (8 = 17%). Radiation therapy consisted of 60 Gy (primary region, N+) or 50 Gy (N0) in daily fractions of 2 Gy each over six weeks. During week 1 and 5 of radiotherapy two courses of chemotherapy with 5-FU (600 mg/m2/day, i.v. continuous infusion for five days) and cis-platin (25 mg/m2/day i.v. bolus for five days) were administered. 43/47 patients (91%) responded to therapy. 34/47 (72%) patients achieved a complete remission, 9/47 (19%) a partial remission, and 4/47 (9%) no change. With a minimum follow-up of 26 months 17/47 patients (36%) are alive and NED, 4/47 (9%) are alive with tumour. 18 patients (38%) died of cancer, eight patients (17%) died of second tumours, intercurrent diseases and of unknown reasons. Actuarial four-year survival is 45% (stage III: 56%, stage IV: 42%), four-year NED survival is 35% (stage III: 68%, stage IV: 18%). There were no loco-regional recurrences after additional surgical treatment of the primary and the neck following complete remission. In contrast after RCT alone and complete remission local recurrences in 6/21 patients (29%) and regional recurrences in 5/24 patients (21%) occurred. We conclude that simultaneous RCT is a new very effective treatment modality of locally advanced head and neck tumours producing superior loco-regional control compared to conventional management.

Adult↗
PubMed1991

[Regional chemotherapy of diffuse liver metastases of colorectal cancer].

From 1970 to 1987, a total of 112 patients underwent regional chemotherapy as primary treatment of colorectal liver metastases. 68 patients received 250-750 mg 5-FU 2-3 times per week via external devices, 40 patients with port catheters had 5-day courses of Mitomycin C (8 mg/m2/day 1) and 5-FU (600 mg/m2/day 1-5) at 4 week intervals, and four patients were treated with FUDR (0.2 mg/m2/day 1-14/28) using an Infusaid pump. Median and maximum survival were 13.2 and 58 months, respectively. The overall response rate in patients suitable to imaging criteria who underwent treatment for more than three months and was 83% (CR 14%, PR 40%, SD 29%). The influence of various factors on Kaplan/Meier survival was checked the Logrank test. Response to treatment was of superior importance (p = 0.0000016), but hepatomegaly, Karnofski index, the percentage of liver volume replaced by tumour, and various liver related biochemical tests were also highly significant prognostic determinants (p greater than 0.01). There was no difference between external and fully implantable devices. A subgroup of 68 patients without extrahepatic disease, treatment of more than three months was retrospectively compared to 121 untreated patients with a similar stage of disease. There was no obvious effect of regional chemotherapy on survival (p = 0.16). Although the untreated patients consist a historical control group only, this result indicates that regional chemotherapy must continuously be restricted to well prospective clinical trials.

Adult↗
PubMed1991

Indicators of prognosis after hepatic resection for colorectal secondaries.

From 1960 to 1988, 266 patients underwent resection of colorectal secondaries to the liver with curative intent. All patients were followed until April 1, 1990, or death, with a median follow-up time of 52 months. Nine patients with minimal macroscopic residual disease and 38 patients with all gross tumor removed but positive margins showed a poor prognosis with a median survival time of 13.3 months, the longest being 42 months. Of the 219 patients having potentially curative resection, 12 patients died postoperatively (5.5%). Actuarial 5, 10 and 20-year survival for the remaining 207 patients was 39%, 28%, and 18%, respectively. At April 1, 1990, 77 patients were alive with no evidence of disease for up to 24 years, and 12 patients had died without recurrence. The following factors were associated with less favorable crude survival: presence and extent of mesenteric lymph node involvement (p = 0.0003), grade III/IV primary tumor (p = 0.035), synchronous diagnosis of metastases (p = 0.017), satellite metastases (p = 0.0003), limited resection margins (p = 0.019), and nonanatomic procedures (p = 0.013). With respect to disease-free survival, grading of the primary (p = 0.055) and the extent of clear margins (p = 0.019) failed to achieve statistical significance. Two other criteria are commonly recommended as absolute contraindications to hepatic resection: extrahepatic disease and the presence of four or more independent metastases. A radical excision of all detectable disease may rarely be possible in these circumstances. Nevertheless, within the curative settings, no significant predictive value regarding either overall or disease-free survival was found in this series. Three corresponding "high risk" patients are alive without disease at 5 to 11 years from hepatic resection. These patients with more advanced intrahepatic or concomitant limited extrahepatic disease require a particularly thorough diagnostic work up. As no superior therapeutic alternative is currently available, an aggressive surgical approach may occasionally be justified, and may, in a small portion, result in definite tumor control.

Adult↗
PubMed1990

Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history.

From 1960 to 1987, 1209 patients with colorectal liver metastases were recorded, and followed until 1 January 1990. In 242 cases the diagnosis was based on external imaging, whereas 967 patients had operative confirmation and staging of their liver disease. Three groups of patients were analysed: group 1 involved 921 cases, of whom 902 were deemed non-resectable whereas 19 could not be unequivocally classified. Only 21 patients lived for longer than 3 years, seven survived for 4 years, but there were no 5-year survivors. Group 2 comprised 62 highly selected patients who at laparotomy demonstrated resectable metastatic spread confined to the liver, but this was not treated mainly because of a formerly different therapeutic approach. These patients had a significantly longer median survival time (14.2 versus 6.9 months), but also failed to achieve 5-year survival. The 226 patients forming group 3 underwent hepatic resection with intent to cure. Nine of them had minimal macroscopic disease left, and 34 with all gross tumour removed had positive margins. Survival of patients with these 43 eventually non-radical resections followed an identical course as in group 2 (median survival 13.3 months, maximum 42 months). Of the 183 patients with potentially curative resection ten died after surgery (5.5 per cent). Actuarial 5 and 10-year survival rates in the remaining 173 patients were 40 and 27 per cent with 25 and seven patients alive at respective periods of time. Until 1 January 1990, 64 patients remained free from recurrent disease for up to 24 years. In three patients the tumour status at death was unclear. The other 106 patients developed definite cancer relapse. Nevertheless they demonstrated a prolongation of survival time by a median of 1 year when compared with the 43 non-radically resected patients or the 62 untreated patients with resectable liver-only metastases, and accomplished a maximum survival time of 8 years. Radical excision of colorectal secondaries to the liver therefore offers effective palliation, and in a small number the chance of a cure.

Actuarial Analysis↗
PubMed1990

Pulmonary resection for metastatic colon and upper rectum cancer. Is it useful?

The predictive value of the route of venous drainage on prognosis was investigated in a consecutive series of 44 patients who underwent curative resection of pulmonary metastases from colorectal carcinoma. The primary tumor was located in the colon in 14 patients and in the upper third of the rectum in 11 patients, thus indicating blood drainage directed toward the portal vein (Group I). In 10 and 9 cases, respectively, the initial growth was in the middle and lower thirds of the rectum with the venous outflow at least partially directed into the vena cava (Group II). There was no obvious difference between the two groups regarding the initial site of cancer relapse. The liver was involved in 4 of 15 patients failing in Group I as opposed to 4 of 13 patients with hematogenous relapse in Group II. Median survival and tumor-free survival times were significantly longer in patients in Group I (58.4 and 50.2 months) than in patients in Group II (30.9 and 16.8 months), and, even more pronounced, in colon cancer patients (75.4 and 60.2 months) when compared with rectal cancer patients (31.0 and 17.9 months). In contrast, survival curves did not differ significantly if either the two groups with different routes of drainage (5-year survival 53 percent vs. 38 percent, 5-year tumor-free survival 43 percent vs. 37 percent), or tumors of the colon and rectum (5-year survival 67 percent vs. 38 percent, 5-year tumor-free survival 60 percent vs. 32 percent) were compared using the log-rank test. Similar trends were obtained for the subgroup of 34 patients without previous or simultaneous extrapulmonary recurrent disease at the time of lung resection. The primary tumor site does therefore not become a major criterion in selecting patients for surgical resection.

Adult↗
PubMed1990

Radiotherapy with and without cisplatin in bladder cancer.

From October 1985 to December 1988, 67 patients with invasive bladder carcinoma T1-4 N0-2 M0 were treated with irradiation (50.4 Gy in 28 fractions in 6 weeks) and simultaneous cisplatin (25 mg/m2 per day on 5 consecutive days in the first and fifth irradiation week). After transurethral resection and irradiation plus cisplatin, complete remissions were achieved in 8/11 T1-, 14/16 T2-, 27/36 T3- and 1/4 T4-tumors. The complete remission rate 6 weeks after treatment according to the extent of preceeding transurethral surgery (TUR) was: R0: 67% (8/12); R1: 83% (20/24); R2: 70% (21/30); Rx: 1/1. In patients with incomplete TUR (R1-2), the complete remission rate was 76% (41/54). This was superior to the results of a historical control (76% vs. 45%, p less than 0.01). The estimated 3-year survival according to T-stage was: T1: 73%, T2-3: 68%, T4: 25%. The overall 3-year survival was unchanged as compared to our historical control (66% each). Severe complications have not been observed. We conclude that cisplatin will likely increase the local control rate after incomplete transurethral surgery. An improvement of survival seems unlikely.

Aged↗
PubMed1990

[Surgical interventions in liver metastases].

Surgical treatment of hepatic metastases is predominantly aimed at "curative" resection. This can be achieved in about 20% of colorectal secondaries, and is associated with a 30-40% 5-year survival. One to three metastases in the absence of extrahepatic disease are regarded a clear indication to resection. Among patients with non-colorectal malignancies, occasional long term survival was reported in leiomyosarcoma, breast cancer, and renal cancer metastases, respectively. Endocrine tumors such as carcinoid, gastrinoma, or pheochromocytoma, are different because of their remarkable symptoms along with a protracted natural history. Quality of life may be considerably improved here by even non-radical debulking. The vast majority of patients, however, ist not suitable to undergo hepatic resection. Palliative therapeutic options involve hepatic artery ligation or embolization, cryo-surgery and percutaneous laser coagulation, and various types of regional chemotherapy. These methods may enable a temporary relief of symptoms, but no significant impact on survival time, and no true long term benefit has been proven. Prospective randomized trials against combined treatment as well as untreated patients are required for a more meaningful judgement and improved effectiveness.

Colorectal Neoplasms↗
PubMed1990

[Differential after care for early detection of recurrence: from the surgical viewpoint].

Tumor recurrence following "curative" resection (= R0) of gastrointestinal cancer occurs in 30% (colorectal carcinoma) to 70% (ductal pancreatic cancer) of patients. Only colorectal cancer recurrence involves a substantial chance of a reintervention which again may result in complete cancer clearance (local recurrence 17%, metachronous liver metastases 20%, other abdominal intracavitary relapse 12%, pulmonary secondaries 17%). Five-year survival after complete re-resection approaches 40% irrespectively of the site of recurrent disease. Recognition of resectable recurrence in asymptomatic patients is based on ultrasound, endoscopy, and chest X-ray. Laboratory investigations alone, and even CEA-screening, do not suffice.

Adult↗
PubMed1990

[Type I or IIa early stomach carcinoma. Comparative studies of the prognosis following limited or radical therapy].

In a retrospective study of 190 patients with type I (n = 100) or type IIa (n = 90) early gastric carcinoma, we investigated the question as to whether after limited therapy--endoscopic polypectomy (n = 49), large forceps biopsy (n = 4) or local surgical excision (n = 14)--or surgical resection (n = 123), differences in prognosis are to be found between the groups. In comparison with the age-adjusted 5-year survival rate, no differences were found between the limited therapy group and the resected group. Postoperative mortality was 3.0% in the limited therapy group and 17.1% in the resected group. Up to the fourth year of follow-up the prognosis was better for malignancy grade 1 than for malignancy grade 2 or 3, and also for tumours with a diameter of less than 3 mm than for those with larger diameters. No difference in 5-year survival rates was to be found with respect to the histological classification, depth of invasion, gross tumour type or multiple tumours. The results of these investigations indicate that limited treatment can be considered for type I or type IIa early gastric carcinoma when the carcinoma is restricted to the mucosa and is of the intestinal cell type of malignancy grade 1 or 2.

Adult↗
PubMed1990

Tumor implantation from needle biopsy of hepatic metastases.

Two patients with resectable secondaries in the liver developed needle track recurrence following intraoperative "Trucut"-needle biopsy and percutaneous thin needle aspiration cytology, respectively. In both cases the nature of the hepatic lesion was already clear before biopsy, from characteristic ultrasound, CT-scan, and a progressive rise in CEA levels. Although the overall risk is presumably low, biopsy must not become a diagnostic imperative. It may compromise definitive surgery in individual patients, and should therefore be restricted to situations in which results have a therapeutic or scientific impact.

Aged↗
PubMed1989

[Resection of lung metastases of colorectal cancer. Indications and indication limits].

From 1970 through 1986, a total of 62 patients underwent thoracotomy for colorectal metastases to the lungs. Four had exploration only, whereas in 13 a nonradical, and in 45 a "curative" resection was performed. There was one postoperative death. Cumulative 5-year survival following radical resection was 44%. Conversely, all other patients succumbed within 3 years. Extrapulmonary disease has not yet been associated with 5-year survival and may usually contraindicate resection. The impacts of multiple metastases exceeding 3 nodules or bilateral pulmonary involvement on prognosis can not been determined from our series, since the procedure in respective patients was not radical in the majority of cases. In turn, localisation and venous drainage of the primary tumor did not significantly influence long term survival.

Adenocarcinoma↗
PubMedDate not supplied

Resection of colorectal liver metastases.

From 1960 to 1992 a total of 1718 patients with liver metastases from colorectal carcinoma were recorded. Of these patients, 469 (27.3%) underwent hepatic resection, which was performed with curative intent in 434 patients (25.3%). Operative mortality in this group was 4.4%, being 1.8% (2 of 114) during the last 3 years. Significant morbidity was observed in 16% of patients with a decrease to 5% (6 of 112) for the last 3 years. A 99.8% follow-up until November 1, 1993 was achieved. Excluding operative mortality, there are 350 patients with "potentially curative" resection and 65 corresponding patients with minimal macroscopic (n = 19) or microscopic (n = 46) residual disease. The latter group demonstrated a poor prognosis, with median and maximum survival times of 14.4 and 56.0 months, respectively. Among the 350 patients having potentially curative resection, the actuarial 5-, 10-, and 20-year survivals were 39.3%, 23.6%, and 17.7%, respectively. Tumor-free survival was 33.6% at 5 years. In the univariate analysis, the following factors were associated with decreased crude survival: presence and extent of mesenteric lymph node involvement (p = 0.0001); grade III/IV primary tumor (p = 0.013); synchronous diagnosis of metastases (p = 0.014); satellite metastases (p = 0.00001); metastasis diameter of > 5 cm (p = 0.003); preoperative carcinoembryonic antigen (CEA) elevation (p = 0.03); limited resection margins (p = 0.009); extrahepatic disease (p = 0.009); and nonanatomic procedures (p = 0.008). With respect to disease-free survival, extrahepatic disease (p = 0.09) failed to achieve statistical significance, whereas patients with primary tumors in the colon did significantly better than those with rectal cancer (p = 0.04). The presence of five or more independent metastases adversely affected resectability (p < 0.05). However, once a radical excision of all detectable disease was achieved, no significant predictive value of an increasing number of metastases (1-3 versus > or = 4) on either overall (p = 0.40) or disease-free (p = 0.64) survival was found. Using Cox's multivariate regression analysis, the presence of satellite metastases, primary tumor grade, the time of metastasis diagnosis, diameter of the largest metastasis, anatomic versus nonanatomic approach, year of resection, and mesenteric lymph node involvement each independently affected both crude and tumor-free survival.

Actuarial Analysis↗
PubMedDate not supplied

Differences between colorectal adenomas removed endoscopically and surgically.

BACKGROUND/AIMS: To date, risk factors for severe dysplasia in colorectal adenomas have been studied mainly in endoscopically removed material. The aim of this study was to determine whether there are any differences between adenomas removed endoscopically and surgically in terms of patient and polyp characteristics. METHODOLOGY: Between 1978 and 1993, 5092 consecutive patients with 9874 colorectal adenomas attending the Medical and Surgical Departments of the University of Erlangen were prospectively documented in the Erlangen Registry of Colorectal Polyps, and statistically examined using regression analysis. RESULTS: 5995 adenomas were removed endoscopically from 3343 patients. 3879 adenomas were surgically resected in 1749 patients. 313 (9.4%) of the former, and 218 (12.5%) of the latter, patients harboured adenomas with severe dysplasia. The size of the adenoma and the tubulovillous or villous structure were the leading risk factors, both in endoscopically and surgically removed adenomas. Adenomas located in the right colon were at a lower risk in both endoscopic and surgical specimens. The risk factors in endoscopically removed adenomas can be described by a model of independent variables. However, the risk of severe dysplasia in surgically resected adenomas needs to be described in an interactive model. Villous structure act as a confounder which modifies the risk profile by increasing the risk associated with multiplicity and right-sided location. CONCLUSIONS: The risk of severe dysplasia in colorectal adenomas needs to be described in different models, depending on the method of adenoma removal-either endoscopic or surgical. A global model describing the colorectal dysplasia-carcinoma sequence will depend on the composition of the endoscopically or surgically removed adenomas and will be a more complex model than the clear and simple description applicable to purely endoscopic studies.

Adenoma↗