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Biomedical subjects

A Ojala

Publications and source records attributed to A Ojala.

At least 19 recordsLinked to original sources
PubMed2003

Oral vinorelbine in combination with cisplatin: a novel active regimen in advanced non-small-cell lung cancer.

BACKGROUND: A phase II trial of alternating i.v. and oral vinorelbine in combination with cisplatin was designed to determine the response rate, safety profile, progression-free survival, overall survival and quality of life (QoL) in advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Fifty-six chemotherapy-naïve patients received cisplatin 100 mg/m(2) and i.v. vinorelbine 25 mg/m(2) on day 1, followed by oral vinorelbine 60 mg/m(2) on days 8, 15 and 22, every 28 days. RESULTS: After an independent review, the response rate was 33% [95% confidence interval (CI) 20% to 46%]. Median progression-free and overall survival were 5.5 months (95% CI 3.7-6.4) and 8.9 months (95% CI 8.8-11.7), respectively. The most frequent hematological toxicities were neutropenia (grade 3-4 in 73% of patients) and anemia (grade 3-4 in 11% of patients). Grade 3-4 infections and non-hematological toxicities occurred occasionally. QoL for lung cancer related symptoms was stable or improved. CONCLUSIONS: The efficacy and safety of the alternating vinorelbine schedule (i.v. on day 1, oral on days 8, 15 and 22) in combination with cisplatin in advanced NSCLC are similar to those of the standard regimen using exclusively i.v. vinorelbine, whereas ease of administration and patient comfort may favor the novel approach.

Administration, Oral↗
PubMed2000

CT lung densitometry in assessing intralobular air content. An experimental and clinical study.

PURPOSE: To introduce a parameter called "intralobular air content percentage" to replace the CT number of the lung and to establish a proper protocol for its assessment. MATERIAL AND METHODS: We calibrated the HU (Hounsfield unit) scale for low densities with foam and evaluated the influence of certain acquisition and reconstruction parameters on the accuracy of CT densitometry of the lungs. The reproducibility of the results obtained in human experiments and the intralobular air content percentage of normal and diseased lung tissue were assessed. RESULTS: Air content could be reliably derived from the calibrated CT number of an area within a secondary lobulus. The mean intralobular air content of normal lungs varied from 77.8% to 88.0% in full inspiration. Helical or axial recording with a 10-mm slice thickness, a standard or soft algorithm and high tube currents and voltage settings, was suitable for the measurements. CONCLUSION: Before absolute lung density measurements (as a HU number or an air content percentage), the CT equipment has to be calibrated for low densities. The intralobular air content percentages of cooperative patients were reliably reproducible.

Absorptiometry, Photon↗
PubMed1999

Quality control in health care: an experiment in radiotherapy planning for breast cancer patients after mastectomy.

PURPOSE: The importance of evaluating and improving quality in clinical practice is now generally acknowledged. In this study we estimated different sources of variation in radiotherapy planning for breast cancer patients after mastectomy and sought to test the applicability of a reproducibility and repeatability (R&R) study in a clinical context. METHODS: Eleven radiation oncologists planned radiotherapy three times for three different kinds of breast cancer patients without knowing they were handling the same patient three times. Variation was divided into different components: physicians as operators, patients as parts, and repeated measurements as trials. Variation due to difference across trials (repeatability), that across the physicians (reproducibility), and that across the patients (variability) were estimated, as well as interactions between physicians and patients. Calculation was based on the sum of squares, and analysis was supported by various graphical presentations such as range charts and box plots. RESULTS: Some parts of the planning process were characterized by higher and different kinds of variation than the others. Interphysician variation (i.e., reproducibility) was not high but there were some clearly outlying physicians. The highest variation was in repeatability (= intraphysician variation). The major part of the variation was, however, that from patient to patient: 33% of the total in Parameter 1 and 85% of the total in Parameter 2. CONCLUSIONS: R&R studies are applicable and are needed to evaluate and improve quality in clinical practice. This kind of analysis provides opportunities to establish which kinds of patients require particularly careful attention, which points in the process are most critical for variation, which are the most difficult aspects for each physician and call for more careful description in documents, and which physicians need further training.

Analysis of Variance↗
PubMed1999

DNA flow cytometry in surgically treated lung cancer--prognostic significance.

Although DNA aneuploidy and high proliferative activity (S-phase fraction, SPF) of tumour cells, measured by flow cytometry, have proved to be indicators of poor prognosis in most solid tumours, there have been conflicting results in lung cancer studies. During a four-year period we studied the prognostic significance of DNA ploidy and SPF in 99 surgically treated lung cancer patients. Flow cytometric analysis was done from archival, formalin-fixed, paraffin-embedded tumour specimens. DNA index and SPF were determined, using MultiCycle software with sliced nuclear correction to compensate for debris. There were 61 DNA diploid and 38 DNA aneuploid tumours. The median SPF was 10.2%. Neither ploidy nor SPF was associated with previously known prognostic factors. Survival was poorer in patients with aneuploid tumours than in the other patients, but the difference was not statistically significant. DNA ploidy and SPF thus do not seem to be useful prognostic indicators in surgically treated lung cancer.

Aged↗
PubMed1999

Prognosis of surgically treated lung cancer.

BACKGROUND AND AIMS: This retrospective study clarifies the prognosis of surgically treated lung cancer in a teaching university hospital. MATERIAL AND METHODS: During a four year period 141 patients were operated for lung cancer in a teaching university hospital. After five years follow up the case records were analysed. The operative and microscopical findings were classified using the AJC pTNM staging system and WHO's histologic classification of lung tumours. There were 120 (85 %) male and 21 (15 %) female. The median age for males was 62 years and females 64 years; range was 29 to 76 years for both sexes. RESULTS AND CONCLUSIONS: The perioperative mortality of all patients was 5,0 %, of 84 patients operated with lobectomy 2.4 %, of 32 patients operated with pneumectomy 15,6 %, and of 25 patients operated with explorative thoracotomy 0 %, respectively. The five year survival of all patients was 33 % including perioperative mortality. The survival was significantly better for 83 patients with stage I disease (49 %) than 17 stage II (6 %), 24 stage IIIa (20.8 %), and 17 stage IIIb or IV disease (0 %). The survival was significantly better after lobectomy (44.1 %) than after pneumectomy (25.0 %) or explorative thoracotomy (8.0 %). Our study shows the good effect of surgery in stage I, and confirms it's usefulness in stage IIIa lung cancer. The histologic types of tumours did not affect survival.

Carcinoma, Non-Small-Cell Lung↗
PubMed1998

High-resolution computed tomography for the diagnosis of community-acquired pneumonia.

We compared high-resolution computed tomography (HRCT) with chest radiography (CR) to determine if there is any advantage to using HRCT in the diagnosis of community-acquired pneumonia (CAP). Simultaneously obtained chest radiographs were compared with HRCT scans for 47 patients with clinical symptoms and signs suspicious for CAP, HRCT identified all 18 CAP cases (38.3%) apparent on radiographs as well as eight additional cases (i.e., 55.3%); P = .004. The corresponding figures for bilateral involvement were six by CR (33.3%) and 16 by HRCT (61.5%), P = .001. CR did not show changes particularly affecting the upper and lower lung lobes and the lingula. Bronchopneumonia was visualized by CR in 11 cases (61.1%) and by HRCT in 22 cases (84.6%). The corresponding figures for airspace pneumonia were four (22.2%) and one (3.8%), respectively. The use of HRCT seems to increase the number of CAP cases confirmed by imaging and to improve the accuracy of diagnosing and typing of CAP.

Adult↗
PubMed1998

Human plasma antioxidant capacity during radiotherapy for lung cancer: a clinical study.

Even though it is well established that oxygen-free radicals are the main mechanism responsible for the cytotoxicity produced during radiotherapy, the role of the human antioxidant defense system in clinical radiation oncology is still to be clarified. Changes in the human plasma total peroxyl radical trapping capacity (TRAP) and its individual components were followed during clinical radiotherapy for lung cancer. Sixteen patients receiving radical-aimed radiotherapy provided blood samples nine times during the treatment. Our hypothesis was that oxygen-free radical production increased by irradiation should decrease the plasma TRAP as a consequence of oxidative stress. Only a moderate reduction of the plasma TRAP was found during the therapy in the study group taken as a whole, but the development pattern of TRAP and its unidentified components were clearly different in those patients showing complete or partial response to the treatment and those in which the disease progressed unabated. Plasma ascorbate levels showed no significant changes during radiotherapy. A decrease in vitamin E concentrations was seen after 6 Gy (p=0.05). Uric acid concentrations increased towards the end of the radiotherapy in both response groups (p=0.02 at 50 Gy). In this study, 26.6% of the plasma TRAP was due to unidentified antioxidants (UNID).

Adult↗
PubMed1994

Carboplatin and etoposide in extensive small cell lung cancer.

The combination of carboplatin and etoposide was evaluated in 61 previously untreated patients with extensive small cell lung cancer. Treatment was given at four-week intervals with 450 mg/m2 of carboplatin intravenously (i.v.) on day 1 and etoposide 100 mg/m2 i.v. on days 1-3. The response was complete in 5 (9%) and partial in 28 (50%) of the 56 evaluable patients (overall response rate 59%). The median time to progression after response as well as the median survival time in all evaluable patients was 4.6 months. WHO grade 3 and 4 leukopenia and thrombocytopenia occurred in 8% and 11% of the courses respectively. Two treatment-related deaths were registered. The combination of carboplatin and etoposide used in the present study produced acceptable response rate and toxicity, but duration of response and median survival were shorter than expected from earlier studies.

Adult↗
PubMed1992

Carboplatin and etoposide (CarE) combined with radiotherapy and vincristine, doxorubicin and cyclophosphamide (VAC) in limited small cell lung cancer. A phase II study.

Sixty-eight patients with limited small cell lung cancer were treated between April 1988 and October 1990 with combination carboplatin 450 mg/m2 i.v. on day 1 and etoposide 100 mg/m2 i.v. on days 1-3 (CarE) for two courses, followed by thoracic radiotherapy (TRT) 50 Gy, and then vincristine 1 mg/m2, doxorubicin 50 mg/m2 and cyclophosphamide 750 mg/m2 on day one (VAC) for four courses. Prophylactic cranial irradiation (30 Gy) was given to patients with CR after completion of chemotherapy. Sixty patients (89%) achieved an objective response (40% complete responses). The median time to progression was 8.5 months and median survival time 12.1 months. Predicted one- and two-year survival was 50% and 12% respectively. Myelosuppression was the main toxicity, with WHO grade 3 and 4 leukopenia occurring in 32% of VAC courses. There were 5 (7%) treatment-related deaths, all of them during VAC. We conclude that the present combination is active in terms of response rate, but it did not demonstrate any superiority in survival. The frequency of haematological toxicity was substantial during VAC courses.

Adolescent↗
PubMed1992

Radical radiotherapy of inoperable non-small cell lung cancer. Irradiation techniques and tumor characteristics in relation to local control and survival.

The relation between tumor characteristics, irradiation technique, local tumor control and survival was retrospectively studied in 323 patients with non-small cell lung cancer who started radical radiotherapy in 1974-1981. At that time three non-randomized different fractionation schedules were used: 16 x 3.25 Gy, total dose 52 Gy, 3 fractions/week (schedule 1), 11 x 4 Gy, total dose 44 Gy, 2 fractions/week (schedule 2) and 25 x 2 Gy, total dose 50 Gy, 5 fractions/week (schedule 3). The highest survival rates were observed in the patient group treated according to schedule 2. The 2-year survival rate was 30% compared with 18% and 6% in the patients treated according to schedule 1 and 3 respectively. However, this can at least partly be explained by patient selection. A correlation between size of the tumor, target volume and survival was observed: the larger the tumor, the poorer the survival. Pleural effusion showed to be an unfavorable prognostic factor. The prognosis of inoperable lung cancer on the whole remained poor: the 1-year survival rate was 43% and 2-year survival rate 16%. Only 3% of the patients lived at least five years.

Adult↗
PubMed1990

Vincristine, doxorubicin and cyclophosphamide with and without etoposide in limited small cell lung cancer.

A total of 80 patients with limited disease of small cell lung cancer were randomized to receive either vincristine 1 mg/m2 (max. 2 mg), doxorubicin 50 mg/m2 and cyclophosphamide 750 mg/m2 (VAC) i.v. on day 1, or the same drugs and etoposide 80 mg/m2 i.v. daily for 3 days (VACE) every 3 weeks for nine courses. Chest irradiation was given in both regimens after the second course. The response rate was 84% for VAC (41% complete responses) and 75% for VACE (46% complete responses). The median survival time was 10 months with VAC regimen, and 14 months with VACE (difference statistically not significant). The median duration of remission was 8 months with VAC and 14 months with VACE (p = 0.03), and the median survival for complete or partial responders was 12 months and 20 months respectively (p = 0.006). Myelosuppression was significantly greater in the VACE group, and there was one treatment related death in the group receiving VACE. In this study the addition of etoposide to VAC improved the duration of response, but did not lead to longer survival of patients with limited disease of small cell lung cancer.

Adult↗
PubMed1988

Correlation between serum tumor marker levels and tumor proliferation in small cell lung cancer.

We analyzed serum lactate dehydrogenase (LDH), neuron-specific enolase (NSE) and thymidine kinase (TK) levels in 22 patients with small cell lung cancer. Tumor proliferation was expressed as the proportion of S-phase cells (SPF), determined by DNA flow cytometry, from concomitantly taken biopsy samples. A positive correlation between serum NSE (r = 0.41) or LDH (r = 0.65, p = 0.05) levels and tumor SPF was noted, but was not found between serum TK levels and the SPF. The correlation between NSE and SPF was even more pronounced if only patients with extensive disease were considered (r = 0.77). The serum NSE and LDH, but not TK levels, were significantly greater in the patients with extensive disease (NSE 50.4 ng/ml, LDH 621 U/ml) compared to the patients with limited disease (NSE 21.0 ng/ml, LDH 272 U/ml, p = 0.05). Our results suggest that the combined determination of serum LDH and NSE levels gives valuable data on the primary tumor mass and its proliferative activity in small cell lung cancer.

Adult↗
PubMed1986

Effects of fractionated radiotherapy on bone blood flow in man.

Effects of fractionated irradiation on bone blood flow during and some months after the radiotherapy were measured with a 133Xe washout method from the greater trochanteric regions of human femurs. The results suggest that at low dose levels (CRE from 250 to 1050 reu) the decrease in bone blood flow is small. However, there seems to be a significant decrease in blood flow (about 50%) several months after the irradiation.

Adult↗
PubMed1983

Combination chemotherapy in metastatic or recurrent non-small cell bronchogenic carcinoma. 5-year results.

A controlled clinical trial was performed to test two different chemotherapy regimens (doxorubicin + cyclophosphamide + vincristine versus CCNU + vincristine) in 100 patients with metastatic or recurrent non-small cell bronchogenic carcinoma. There was no significant difference between treatment groups in survival or in response. Only 4 patients had a partial remission and there were no complete responders. Median survival was 7 months and 8 patients lived over two years, one patient is still alive (65 + months). The benefit of combined chemotherapy in non-small cell bronchogenic carcinoma remains minimal.

Adult↗