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Biomedical subjects

B Glimelius

Publications and source records attributed to B Glimelius.

At least 235 records · Page 13Linked to original sources
PubMed1991

Determinants of prognosis in advanced colorectal cancer.

The relations between patient characteristics and prognosis were examined in 340 patients with advanced colorectal cancer treated with chemotherapy. Variables were tested for relation to survival and responses in univariate and multivariate analyses. Performance status (P less than 0.001), number of symptoms (P less than 0.001) and haemoglobin level (P less than 0.001) were the most important variables for survival in univariate analyses. In the multivariate analyses of survival, haemoglobin level (P less than 0.001) and disease-free interval (P less than 0.01) were the most influential variables. In addition, number of symptoms (P less than 0.01), performance status (P less than 0.05) and treatment of the primary tumour (P less than 0.05) were independently related to survival. The main independent determinant of response was haemoglobin level (P less than 0.01). Besides these pretreatment characteristics, type of chemotherapy regimen influenced both response rate and survival in multivariate analyses (P less than 0.001). We conclude that haemoglobin level, disease-free interval, symptoms and performance status are important prognostic factors in advanced colorectal cancer. The distribution of these variables may influence the results of clinical trials.

Adult↗
PubMed1991

Treatment outcome in Hodgkin's disease in patients above the age of 60: a population-based study.

All persons in three Swedish counties afflicted with Hodgkin's disease between 1979 and 1988 were traced. The objective was to analyze, in unselected, population-based material, whether an assumed worse prognosis in the elderly could be due to differences in staging procedures, treatment intensity, decreased tolerance to therapy or to a more aggressive disease. After histopathological revision, 163 of 202 patients (autopsy cases excluded) were accepted as HD, 61 (37%) of them above the age of 60. Although staging procedures had been more intense in the young, the elderly patients had a more advanced stage at diagnosis, and tended more often to have B-symptoms. The intensity of staging procedures did not seem to influence survival. The 5-yr relative survival was 37% above and 85% below the age of 60. Radiotherapy was the primary treatment in 12 (20%) above and 41 (41%) below the age of 60 with 5-yr relative survival figures of 84% and 85%, respectively. Thirty-seven patients (61%) above and 61 (59%) below 60 were treated with combination chemotherapy (MOPP/ABVD, MOPP, ChlVPP/OPEC) with curative intent. The 5-yr relative survival was 33% and 86%, respectively. The majority of the elderly patients (54%) received less than 40% of the planned chemotherapy dose. The main reason for this pronounced reduction was intolerance to therapy, with 8 treatment-related deaths. We conclude that tolerance to combination chemotherapy in the elderly patients with HD is poor and could be the major reason for poor treatment outcome in this age group.

Adolescent↗
PubMed1991

Complications after double and single stapling in rectal surgery.

Stapled anterior resections were carried out in 131 patients between October 1980 and July 1990. Double stapling was used in 87 cases and single stapling in 44. Clinical leaks occurred in 20 patients (15%) and subclinical leaks in 10 (8%) giving a total leak rate of 30/131 (23%). This proportion was similar after double (19/87, 22%) and single (11/44, 25%) stapling. Three fistulas to adjacent organs developed (two after double and one after single stapling). Stenoses occurred in 27 patients (21%), 15/87 (17%) after double, and 12/44 (27%) after single stapling. A permanent stoma was the outcome of an anastomotic complication in 9/87 (10%) patients after double and in 4/44 (9%) after single stapling. The main risk factors were: the number of blood transfusions was related to the risk of dehiscence (p = 0.01), a small cartridge size increased the risk of stenosis (p = 0.002) and previous radiotherapy increased the probability of a permanent stoma (p = 0.0005).

Adult↗
PubMed1990

The risk of subsequent primary malignant diseases after cancers of the colon and rectum. A nationwide cohort study.

The occurrence of a second primary malignant disease was analyzed in 38,166 patients with cancer of the colon and 23,603 patients with rectal cancer reported to the Swedish Cancer Registry between 1960 and 1981. The overall relative risk (RR) of developing a second primary malignant disease was significantly (P less than 0.05) increased both after cancer of the colon (women, RR = 1.4; men, RR = 1.3) and rectum (women, RR = 1.4; men, RR = 1.3). Besides confirming an increased risk of metachronous colorectal cancer this study suggests that cancer of the small intestine, breast, endometrium, and possibly of the ovary and prostate may have etiologic factors in common with cancer of the large bowel, notably those located in the colon.

Adult↗
PubMed1990

Relationship between age and survival in cancer of the colon and rectum with special reference to patients less than 40 years of age.

The relative survival of all patients (n = 61,769) in the entire Swedish population reported to have a malignant tumour of the colon and rectum between 1960 and 1981 was analysed with special reference to patients under 40 years of age. The 5-year relative survival rate of patients with a tumour of the colon, irrespective of histopathological diagnosis, was 62.0 per cent below the age of 40 years and 44.4 per cent in those 40 years of age or older (P less than 0.05). The corresponding figures for patients with a tumour of the rectum were 46.6 per cent and 39.1 per cent, respectively. When the relative survival was analysed separately for patients with a histopathologically demonstrated adenocarcinoma, the 5-year survival rate among patients with a cancer of the colon was 50.9 per cent in patients below 40 years of age and 48.6 per cent in those 40 years of age or older. In patients with adenocarcinoma of the rectum, the 5-year relative survival rate was 41.1 per cent in patients younger than 40 years of age and 40.7 per cent in patients 40 years of age or older. Thus, patients below the age of 40 years with an adenocarcinoma of the colon and rectum as a group appear to have the same or even a better prognosis than older patients if all tumours are considered, irrespective of histopathological diagnosis.

Adenocarcinoma↗
PubMed1990

Anorectal malignant melanoma in Sweden. Report of 49 patients.

Clinicopathologic features and prognosis of 49 patients with anal malignant melanoma were investigated in the total Swedish population between 1970 and 1984. Median age was 71 years (range, 50 to 87 years), and there was a female predominance (31 females, 18 males). The most common symptom at presentation was bleeding. The majority of tumors ranged between 2 and 5 cm in diameter and all invaded at least into the submucosa and/or the lamina propria. At diagnosis, one third of the patients had either regional or distant metastasis with a median survival of 5 months. The remaining patients were surgically treated with curative intent, either by abdominoperineal resection (APR) or local excision. Median survival was poor in both treatment groups (APR, 12 months; local excision, 13 months). Most patients died with distant metastasis. Our results confirm the opinion that APR offers no more curative potential than a more conservative surgical approach. However, tumor sizes were on average smaller in the group treated by local excision. This could indicate that, in the absence of known distant metastasis, radical surgery should be performed, particularly since local recurrences tended to be more common after a local excision.

Adult↗
PubMed1990

Sequential 5-fluorouracil and leucovorin in patients with advanced symptomatic gastrointestinal cancer.

50 patients with advanced symptomatic gastrointestinal cancer were treated with sequential 5-fluorouracil (5-FU)/leucovorin. Patients received an intravenous bolus injection of 5-FU (500 or 600 mg/m2) and leucovorin 30-40 min later, either 50 mg (41 patients) or 200 mg (9 patients). Treatment was given in repeated courses either once weekly or on 2 consecutive days every other week until progression. Toxicity was mild with the lower leucovorin dose, although grade 2 toxicity, particularly diarrhoea, occurred in 27 (66%) patients. All patients receiving the higher leucovorin dose had grade 2-4 toxicity. Toxicity was less with the lower 5-FU dose. Out of 40 patients with colorectal cancer, 34 received leucovorin 50 mg and 6 received 200 mg. Partial response occurred in 10 (29%) and 1 of these patients, respectively. This sequential 5-FU and intermediate-dose leucovorin regimen has acceptable toxicity and a definite anti-tumour activity.

Adult↗
PubMed1990

Pre- or postoperative radiotherapy in rectal and rectosigmoid carcinoma. Report from a randomized multicenter trial.

Between October 1980 and December 1985, 471 patients with a resectable rectal carcinoma entered a randomized multicenter trial for comparison of pre- and postoperative irradiation. Two hundred thirty-six patients were allocated to receive high-dose fractionated preoperative irradiation (total dosage, 25.5 Gy in five to seven days) and 235 patients to receive postoperative irradiation to a very high dosage level with conventional fractionation (60 Gy in a total 8 weeks). The postoperative treatment was delivered only to a high-risk group of patients (Astler-Coller stages B2, C1, and C2). The preoperative irradiation was well tolerated, with no immediate irradiation-related complications and no increased postoperative mortality (3%, 7 of 217 patients, compared to 5%, 10 of 215 patients in the postoperatively irradiated group). More patients in the preoperative irradiation group had perineal wound sepsis after abdominoperineal resection and this prolonged the stay in hospital after surgery. In 50% of the patients the postoperative treatment could not be commenced until more than 6 weeks after surgery. The postoperative treatment was not as well tolerated as the preoperative one. The local recurrence rate was statistically significantly lower after preoperative than after postoperative radiotherapy (12% versus 21%; p = 0.02). In both groups more patients developed a local recurrence if the bowel was perforated at surgery or if the resection line was microscopically close to the tumor. To date, with a minimum follow-up of 3 years and a mean follow-up of 6 years, there is no difference in survival rates between the two groups.

Adult↗
PubMed1990

Methyl-GAG, ifosfamide, methotrexate and etoposide (MIME) as salvage therapy for Hodgkin's disease and non-Hodgkin's lymphoma. The Swedish Lymphoma Study Group.

One hundred and three patients with recurrent or refractory Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) treated with MIME (methyl-GAG, ifosfamide, methotrexate, etoposide) were retrospectively studied. Thirty-seven of the 44 patients with HD, 34/47 with high-grade malignant and 9/12 with low-grade malignant NHL were evaluable for response. Of the 37 evaluable patients with HD, 16 (43%) achieved complete remission (CR) and 4 partial remission (PR), giving a total response rate of 54%. Of the 34 evaluable patients with high-grade NHL, 5 achieved CR and 8 PR, giving a response rate of 38%. Of 9 evaluable patients with low-grade NHL, 2 achieved CR. The main toxicity was leukopenia, thrombocytopenia and infections. Twenty-six per cent of the patients developed septicaemia, which was fatal in 6 cases (6%). We conclude that MIME as salvage regimen can induce complete remissions in lymphoma patients, particularly in HD with previous heavy treatment, and that it is relatively well tolerated.

Adult↗
PubMed1990

Anterior versus abdominoperineal resections in the management of mid-rectal tumours.

In order to assess if results after anterior resections (AR) compared with abdominoperineal resections (APR) for mid rectal tumours have changed since the circular stapler was introduced into clinical practice, two consecutive series of patients were reviewed. The first series comprises 81 patients treated between 1974-79. Sixteen were treated with AR and 65 with APR. Except for the later part of 1979, the stapling instrument was not available during this period. The second series comprises 156 patients (51 AR and 105 APR) operated on during the period 1980-85, when the circular stapler was in extensive use. All patients had curative operations for tumours 6-11 cm from the anal verge. In the first series the local recurrence rate was 5/13 (39%) after an AR and 25/61 (41%) after an APR, and in the second series 8/50 (16%) and 17/100 (17%) after AR and APR, respectively. Cancer specific survival did not differ between operations in any of the series. Thus no deterioration in results could be detected since the stapling technique became part of surgical routine.

Abdomen↗
PubMed1989

Preoperative prediction of outcome in patients with rectal and rectosigmoid cancer.

This study evaluated the possibility of dividing patients with primary rectal carcinoma into prognostic groups before surgery based on preoperative serum levels of carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), and an antigen defined by the monoclonal antibody C-50 (CA-50), as well as on some easily available clinical characteristics providing prognostic information. The evaluation was made both for patients who were "potentially curable" by surgery and, among those, for patients who were "potentially cured." Using the Cox regression model, the serum levels of the three tumor markers, together with the knowledge of whether or not the tumor was polypoid were combined to make up the set of variables that best predicted patient outcome. These variables and their associated regression coefficients were used to classify the patients according to prognosis. The cancer-specific mortality rate for the 24% of potentially curable patients with the best prognosis was 15%; for the 26% of potentially curable patients with the worst prognosis, the cancer-specific mortality rate was 57%. For potentially cured patients among those who were potentially curable, the cancer-specific mortality rates for patients with the best and worst prognoses were 14% and 47%, respectively. The information provided by these preoperatively available variables together was comparable with that given by Dukes' staging system, but the latter system was more informative. On the other hand, some of the preoperative variables provided information not provided by Dukes' staging system.

Adult↗
PubMed1989

Ischaemic strictures in patients treated with a low anterior resection and perioperative radiotherapy for rectal carcinoma.

In five (6 per cent) of 78 consecutive patients treated with an anterior resection for rectal carcinoma, a stenosis of the sigmoid colon just above the anastomosis was observed. Four patients had received preoperative radiotherapy over a period of 1 week to a total dose of 25.5 Gy and one patient had received postoperative radiotherapy (60 Gy) over a total of 8 weeks. The length of the stenosis varied from 4 to 120 cm. Two patients subsequently underwent reoperation with an abdominoperineal resection and three patients with a Hartmann procedure. In all patients the inferior mesenteric artery had been ligated close to the aorta. It is proposed that the stenosis may have been due to insufficient circulation in the marginal artery. This insufficiency may have been aggravated by the irradiation, as the retained part of the sigmoid colon was partly included in the irradiation target.

Aged↗
PubMed1989

Management of anal epidermoid carcinoma--an evaluation of treatment results in two population-based series.

Between 1978 and 1984, two unselected population-based groups of patients with anal epidermoid carcinoma were analysed: (1) a retrospective group (Stockholm region, 90 cases), where the treatment varied considerably (partly radiation therapy +/- chemotherapy +/- surgery, partly surgery alone), and (2) a prospective group (Uppsala region, 51 cases) mainly treated by primary irradiation +/- chemotherapy followed by surgery in some cases. At diagnosis, 106 of the patients were free from metastases. Two of these patients died before treatment began. Of the remaining 104 patients, 77 received primary radiotherapy +/- chemotherapy, 44 to a dose of 30-40 Gy and 33 to a higher dose level, 55-65 Gy. Radiotherapy was followed by surgery in 28 cases. Twenty-seven patients were operated on primarily. The projected 5-year survival rate was significantly higher in the Uppsala than in the Stockholm region (all patients: 55% versus 43%; patients with no initial dissemination: 75% versus 48%). The prognosis was better in patients initially treated with radiotherapy than in those initially treated with surgery. Long-term disease-free survival was 88% in patients treated with radiation alone to an adequate (high) dose level. Multivariate analyses indicated that besides stage and sex, initial treatment and region gave statistically significant prognostic information. There was no evidence that chemotherapy (Bleomycin) conferred any additional benefit. It is concluded that the initial treatment in anal carcinoma should be radiotherapy (+/- chemotherapy). In patients with no initial dissemination, this therapy seems to improve 5-year survival by 25-30% compared with primary surgery.

Anus Neoplasms↗
PubMed1989

Preoperative prediction of late cancer-specific deaths in patients with rectal and rectosigmoid carcinoma.

The possibility of predicting late cancer-specific deaths from (a) the preoperative serum levels of three tumour markers, carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA) and an antigen defined by the C-50 antibody (CA-50), from (b) one clinical factor of independent prognostic relevance, polypoid tumour growth, and from (c) Dukes' stage was evaluated in 276 patients with rectal carcinoma operated upon with curative intent ("potentially curable"), and in the 251 of those patients who were considered to be "potentially cured" after surgery. Using the Cox regression model, the preoperative serum levels of the tumour markers strongly predicted the cancer-specific mortality within the first year after surgery. This ability of S-CEA and S-CA-50 diminished for the mortality during the second year after surgery, and virtually disappeared thereafter. The ability of S-TPA to predict cancer-specific deaths did not change as dramatically with time as that of the other two markers, particularly in the group of "potentially cured" patients. Patients with polypoid tumour growth had a good prognosis which did not appear to change with time. Similarly, the prognostic information provided by Dukes' staging system was valid at all studied time intervals after surgery, although it declined after the second year. The importance of these results in relation to the selection of patients for adjuvant treatment is discussed.

Adenocarcinoma↗
PubMed1989

Homogeneous penetration but heterogeneous binding of antibodies to carcinoembryonic antigen in human colon carcinoma HT-29 spheroids.

The monoclonal antibodies 38S1, directed against the carcinoembryonic antigen (CEA), were tested for penetration and binding in human colon carcinoma HT-29 spheroids. Penetration was studied with a method which has not previously been used in immunological investigations. The method, which allows unbound substances to be visualized, is based on freeze drying, vapour fixation, dry sectioning and dry autoradiography. The antibodies penetrated easily and all parts of the HT-29 spheroids seemed to be reached within 15 min. The penetration was even faster than in control glioma U-118MG spheroids that did not express CEA. Binding of the 38S1 antibodies was demonstrated after processing with conventional histology and autoradiography. The binding in the HT-29 spheroids was, after a 1-h incubation period, extremely heterogeneous and occurred mainly in the peripheral parts. More cells were binding the antibodies after 8-h and 32-h incubations and these cells were arranged in peripheral clusters. No binding at all was seen in the CEA-negative glioma spheroids. The distribution of CEA antigens in monolayers and in frozen sections of spheroids of HT-29 cells was analysed with immunohistochemical staining using polyclonal CEA antibodies. The CEA antigens were heterogeneously distributed in both spheroids and monolayers and were as heterogenous as the binding of the monoclonal antibodies in the living spheroids. Thus, the heterogeneous binding in the living spheroids was not due to penetration barriers, but instead to the heterogeneity in the CEA antigen expression.

Adenocarcinoma↗
PubMed1989

Quality of life during cytostatic therapy for advanced symptomatic colorectal carcinoma: a randomized comparison of two regimens.

Physician- and patient-rated 'quality of life' was studied in patients receiving chemotherapy for advanced symptomatic colorectal cancer. The patients participated in a Nordic multicentre randomized study comparing single-drug 5-fluorouracil (5-FU) with a combination of sequential methotrexate-5-FU with leucovorin rescue (MFL). Forty-four patients (all patients included at one of the hospitals) entered this associated 'quality of life' study, 22 in each group. In the MFL group, five patients had a partial remission (PR) and seven prolonged stationary disease (SD), whereas in the 5-FU group, only one patient had a PR and two SD. Median survival was longer in the MFL group (9 months) than in the 5-FU group (4 months). According to the physicians' judgement, 12 (55%) of the patients randomized to MFL experienced improved 'quality of life' compared to five (23%) in the 5-FU group. Patients' ratings gave the same figure (55%) in the MFL group, whereas only two (9%) patients in the 5-FU group considered themselves improved. The correlations between physicians' and patients' ratings were good. Adverse effects of treatment were minor and influenced ratings negatively only in one patient (5-FU group). Items that reflected changes in everyday activities discriminated better than other items in the 'quality of life' assessment. Since 'quality of life' measures were better in the MFL group in this associated study, and since objective and subjective responses, changes in Karnofsky performance status (KPS) and in survival also were better in the MFL group, not only in this study but also in the Nordic trial (249 patients randomized), we conclude that MFL is superior to 5-FU as a palliative treatment.

Adult↗