Search PubMed⌕ Search

Biomedical subjects

B Hoerni

Publications and source records attributed to B Hoerni.

At least 109 records · Page 6Linked to original sources

[Treatment of elderly cancer patients].

Management of cancer in the elderly differs from that in other age groups only as far as concerns practical issues. The gradual deterioration of somatic and psychologic tolerance capacities is often associated with multiple pathological conditions which may delay diagnosis and hinder the implementation of therapy. Major therapeutic risks are mainly ascribable to chemotherapy which requires strict application of contraindications and close monitoring during treatment. Under these conditions, carefully determined by a thorough workup prior to treatment, the elderly patient, although fragile, can nevertheless benefit from adequate and efficient therapy. Although seemingly aggressive in some instances, this active outlook is preferable to systematic palliative therapy chosen only because of age, often constraining and not always useful or safe. Age in itself is not a reason for systematic abandon when significant results can be obtained without unacceptable risks until an advanced age through well-adjusted measures and continuous attention.

Aged↗

Lymphoblastic lymphoma with convoluted nuclei. A report of 19 cases.

A clinically homogeneous population of patients who presented with lymphoblastic lymphoma of convoluted nuclear type was isolated using a histopathological criterion that can easily be applied by trained pathologists. This disease type preferentially affects young male patients, in over half of whom there is initial mediastinal involvement. There is a tendency for the disease to become leukemic and to invade the central nervous system. In spite of heavy chemotherapy and early neuromeningeal prophylaxis, the prognosis is poor.

Adolescent↗

[Rationalization of adjuvant chemotherapy by induction chemotherapy].

An induction chemotherapy, before any local treatment, allows to precise the chemosensitivity of the primary tumor. These data may help to improve indication and type of a further adjuvant chemotherapy. However there are many biological differences between different sites of the same tumor and along the time, without or after treatment. It is thus impossible to be sure that a chemotherapeutic regimen effective as first treatment on the primary will be equally active on micro-metastases some months later. Many questions in this field will be answered only by controlled studies and careful observations.

Antineoplastic Agents↗

Early-phase pharmacokinetics of doxorubicin in non-Hodgkin lymphoma patients. Dose-dependent and time-dependent pharmacokinetic parameters.

The early-phase (20 min) pharmacokinetics of doxorubicin was studied in 18 patients suffering from non-Hodgkin lymphoma and receiving various schedules and/or dosages of the drug. This pharmacokinetics was time-dependent in most patients over a 2-week interval: repeating similar doses in patients leads to a decrease of the drug exposure due to a decrease of the half-life and/or to a decrease of the extrapolation to 0 time (intercept parameter). The pharmacokinetics was generally time-independent within a 6-h interval in most patients. During this time interval, the kinetics was not linear: increasing the dose by large proportions does not lead to a proportional increase of drug exposure. This time- and dose-dependence of doxorubicin pharmacokinetics makes it very difficult to monitor the treatments according to the individual pharmacokinetic patterns of patients.

Adolescent↗

[Quality of life during and following radiochemotherapy for Hodgkin's disease. Evaluation of 60 patients].

Sixty patients treated for Hodgkin's disease by radio + chemotherapy and remaining in complete remission with a median follow-up of 26 months answered a questionnaire dealing with their quality of life during and after treatment. Their main request was to be better informed about their disease, treatment and its side effects. Therapeutic toxicity is mainly due to chemotherapy and is digestive in nature (nausea and vomiting) symptoms. The majority of patients complained of disturbances in their personal and professional lives. It is concluded that more complete knowledge of all patients' disorders may help doctors to improve treatment planning in order that the patient's quality of life be less disturbed.

Adolescent↗

[Attitudes of physicians and medical students towards cancer and cancer patients].

We used the Cancer Attitude Survey (Haley-Blanchard) to investigate attitudes of general practitioners, oncologists in a cancer center, and medical students (during the second part of medical studies (DCEM), at the beginning and the end of a clinical course, and at the last examination ("Cliniques")) towards cancer and cancer patients. This CAS is designed to determine mainly attitudes on inner resources of patients to cope with cancer, value of early diagnosis, aggressive treatments and preparation for, and acceptance of death. There are significant differences between different groups, and for younger students between the beginning and the end of a clinical course in a cancer hospital. There are also differences between French and American doctors. In comparison with American, French mainly underestimate the inner resources of cancer patients while their attitudes are similar for early diagnosis and aggressive treatment. Such a survey is able to give objective data on present attitudes and also to examine how they change with time.

Attitude of Health Personnel↗

[Pharmacokinetic study of doxorubicin in the treatment of malignant non-Hodgkin's lymphomas].

We have studied the plasma kinetics of doxorubicin treatment in nine patients with non-Hodgkin's malignant lymphoma. Four patients were studied following the first two injections of this drug, the other five patients were studied only after the first injection. Our results corroborate the existence of three successive phases of doxorubicin plasma decay, with mean half-lives of 3.81 min, 1.19 h and 29 h. We observed an important variation of the pharmacokinetic parameters related to the distribution volumes. The total plasmatic clearance ranged between 32 and 67 l/h. The kinetics of doxurubicin are time-dependent, i.e. an important variation of the pharmacokinetic parameters related to the distribution volumes. The total plasmatic clearance ranged between 32 and 67 l/h. The kinetics of doxurubicin are time-dependent, i.e. an important variation of the pharmacokinetic parameters existed after the 2nd injection of the drug in three out of four patients. These 3 patients showed either an increase of the elimination half-life (1 case) or an increase of the distribution volume (1 case) or a decrease of the distribution volume (1 case) after the 2nd injection. We observed a significant correlation between the age of the patients and the early clearance of the drug, the youngest patients eliminating the drug more rapidly than the oldest ones. This observation may lead to the administration of different dosages of doxorubicin according to the age of the patient.

Adolescent↗

Age dependence of the early-phase pharmacokinetics of doxorubicin.

By gathering the results that we had obtained on the pharmacokinetics of doxorubicin in 37 patients, we observed a correlation between the early clearance of this drug and the age of the patients, the youngest patients having the highest clearances. The data presented by another group (Piazza et al., Cancer Treat. Rep., 64: 845-854, 1980) allow calculations leading to the same findings. In view of the clinical importance of the first phase of the kinetics of doxorubicin, which is in agreement with cellular pharmacology observations, we propose an age-dependent modulation of the dose of doxorubicin injected in patients.

Adolescent↗

[Treatment of inflammatory breast cancer. Controlled study of a combination therapy program].

The authors report 27 cases of inflammatory carcinoma of the breast (T3-T4, M0) and propose: induction chemotherapy (adriamycin, vincristin, methotrexate) conventional local and regional radiotherapy, sometimes complementary surgical exeresis, and a complement of consolidation chemotherapy (cyclophosphamid, methotrexate, fluoro-uracil or adriamycin, vincristin, and methotrexate). In these forms, where the prognosis is very bad, this therapeutic regimen may improve considerably the median remission and survival rates. But important therapeutic progress remains.

Adenocarcinoma↗

Maintenance immunotherapy with BCG in non-Hodgkin's malignant lymphomas: a progress report of randomized trial.

Ninety-eight patients with non-Hodgkin's malignant lymphoma were first put into complete remission by a combination of chemotherapy and radiotherapy, and then received one course of chemotherapy as reinforcement. They were then randomized to receive either maintenance BCG therapy or no other treatment. Ninety-three patients were available for this analysis. There was a significant difference (P = 0.021) in relapse-free survival times between the two groups of patients. This difference is particularly significant in male patients, in patients ages 50-65 years, in all histologic classes, in patients treated after an initial relapse, and in clinical stages I and II. There was also a difference in crude survival, but the difference was not significant.

Aged↗

Pharmacokinetics of adriamycin in patients with breast cancer: correlation between pharmacokinetic parameters and clinical short-term response.

The pharmacokinetics of adriamycin was evaluated in the plasma of 12 patients with breast cancer after injection of an i.v. bolus. The patients were suffering from a locally advanced tumor, were free of metastases and had received no prior treatment. They received a chemotherapy consisting in adriamycin (50 mg/m2) on day 1, vincristine (1 mg/m2) on day 2 and methotrexate (6 mg/m2) on days 3, 4 and 5. The response to chemotherapy was assessed as the percentage of reduction of the palpable tumoral mass. Plasma samples were collected at various times after injection of the drug. Adriamycin and its metabolites were extracted using an original column purification technique and were evaluated by high-performance liquid chromatography with fluorometric detection. Pharmacokinetic parameters were calculated with a computer program based upon an algorithm of non-linear function minimization. The three successive half-lives presented little individual variations and were 4.75 min, 0.822 hr and 18.9 hr. On the other hand, the A, B and C parameters were highly scattered. The total plasma clearance of the parent drug ranged from 28.3 to 98.7 1/hr. A highly significant correlation was observed between parameter A and the short-term clinical response. Moreover, a mild correlation exists between the half-life of the 1st phase and the short-term clinical response. We can therefore assume that the efficacy of the drug may be dependent upon its distribution in the organism. Such a relationship may allow the development of new protocols of chemotherapy in order to obtain an optimal distribution of the drug in every patient.

Adult↗

Non-Hodgkin's malignant lymphomas: treatment of localized relapses with chemo + radio + BCG-therapy.

16 patients with relapsing non-Hodgkin's malignant lymphomas considered as clinical stage I or II were treated by an association of chemo + radiotherapy and thereafter by maintenance BCG therapy. 5 of them were included in a randomized trial and have a significantly different disease-free survival from patients receiving the same treatment but without BCG. 11 were systematically treated by BCG and they also have a fairly good disease-free survival. Such a treatment appears to be of value in treating these patients and even probably of curing some of them.

Adult↗

[Prognosis of lymphosarcomas. Multivariate analysis in a series of 334 patients].

In this retrospective study, we analysed prognostic factors of 334 previously untreated patients with non Hodgkin's malignant lymphoma. The importance of the different prognostic variables was first studied with survival curves. Next, using a "segmentation" method and a logistic regression analysis, we studied the factors influencing the complete remission rate which is the most important prognostic factor. For the "low-grade" lymphosarcomas, with the segmentation method, we obtained five patients groups for which the complete remission rates varied between 7 and 95.5 per cent according to clinical staging, age and mediastinal involvement. For the "high-grade" lymphosarcomas, we obtained four patients groups in which the complete remission rates varied between 8.7 and 84.7 per cent according to mediastinal and sub-diaphragmatic involvement and clinical staging. Lastly, the Cox model was used in order to determine the best variable combination capable of predicting the survival of patients with clinical stages I or II. These variables were pathological grading, complete initial remission, clinical staging and BCG immunotherapy. With scores deduced from the Cox model, we were able to determine three prognostic groups for which the survivals at 3 years were very significantly different (7 to 89%).

Adolescent↗

[High dose metoclopramide during cancer chemotherapy. Phase II study in 80 consecutive patients].

From november 1981 to january 1982, 80 consecutive patients received high dose metoclopramide, adjoined to different cancer chemotherapy regimens containing cisplatine, dacarbazine, actinomycin D or mithramycin. Nineteen of them (23,75%) had no chemotherapy induced nausea or vomiting, 30 (37,5%) had nausea alone or vomited only once, and 17 (21,3%) had 3 to 5 episodes of vomiting. The overall efficacy of high-dose metoclopramide was 83,7 per cent. It has been seen whatever the chemotherapeutic agents used, and was inchanged for the following courses in 33 of 37 patients who received 2 to 4 courses. In 25 out of 33 patients who had already received the same chemotherapy without high dose metoclopramide, the digestive tolerance have been improved by the antiemetic treatment. Toxicity of high dose metoclopramide had been encountered in 17 (21,5%) of the patients and necessited this treatment to be stopped in 10. There were mainly extrapyramidal syndroms, diarrhea and drownsiness. The toxicity of high dose metoclopramide was of concern mainly in patients younger than 30, and/or when dosage escalation have been attempted.

Adolescent↗