Adjuvant therapy for patients with node negative breast cancer.
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Antineoplastic Combined Chemotherapy Protocols↗
Biomedical subjects
F Boccardo
Publications and source records attributed to F Boccardo.
Endometrial effects of pure antiestrogens.
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Endometrium↗
Medical treatment of endometrial cancer.
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Antineoplastic Combined Chemotherapy Protocols↗
[Post-mastectomy lymphedema: surgical therapy].
After some preliminary remarks concerning epidemiological data about post-mastectomy lymphedema, on the basis of specific etiologic and pathophysiologic aspects, authors report a modern clinical and instrumental staging of lymphedema and an accurate diagnostic protocol, which allows not only to study lymphedema at late stages, but also to individuate the disease at earliest stages. Protocols of medical, physical and rehabilitative treatment mostly used today are schematically described, and they include proper igienic measures for the prevention bacterial and micotic infections, manual lymph drainage, sequential compression therapy, exercises, thermotherapy, bandages and elastic garments. Authors underline above all the importance of Microsurgery in treating post-mastectomy lymphedema, by means of modern methods of lymphatic microsurgery, derivative or reconstructive (multiple lymphatic-venous anastomoses, lymphatic-venous-lymphatic plasty). The operation of multiple lymphatic-venous anastomoses represent the mostly used technique. The registry consists of 194 microsurgical operations, performed in patients treated and followed-up statistically in the last 15 years, with positive result in over 80% of cases.
Arm↗
[Disability and lymphedema].
Axillary lymph-nodal dissection (ALD) for the surgical treatment of breast cancer plays an important role in consideration above all of the incidence of early and late complications (upper limb edema, pain at thoracic wall, impaired function of the limb), that sometimes can hide the real benefit for the patient. Arm lymphedema due to breast cancer treatment particularly represents a significantly disabling complication, from both physical and psychological points of view. It is useful, therefore, to inform patients about the necessity of a preventive treatment aimed at improving prognosis in relation to a possible future disability. Authors report some clinical experiences of work groups who studied psycho-physical damage due to lymphedema after breast cancer treatment. Finally, therapeutic and preventive procedures are pointed out with the aim of reducing the psycho-physical burden of disability correlated to lymphedema.
Arm↗
[Lymphedema secondary to breast cancer treatment: possibility of diagnostic and therapeutic prevention].
We performed a prospective randomized study upon 50 patients who had undergone a breast cancer treatment, considering particularly the possibility of appearance of arm secondary lymphedema. The patients were divided in two groups of 25 patients each. In the 1st group, we performed only a clinical follow-up, whilst in the 2nd one, we used also lymphoscintigraphy. The aim of the study was to compare the incidence of arm secondary lymphedema in the two groups, and relate the data with those of the international literature, in order to identify diagnostic procedures indicative of the risk of development of lymphedema and find proper therapeutic preventive measures. It is certainty complex to foresee the appearance of arm lymphedema due to breast cancer treatment. No specific preventive therapeutic methods based upon particular diagnostic investigations were ever reported. Patients had undergone surgery and radiation for breast cancer in the period between April 1992 and June 1994, and controlled at over 5 years after operation. Upper limb lymphoscintigraphy was performed only in one of the two groups of 25 patients, before operation and, furthermore, after 1-3-6 months and 1-3 years from the treatment. Patients who presented lymphoscintigraphic alterations (dermal back flow, diffused or delayed transit of the tracer, etc.), before edema appeared clinically, underwent physical and rehabilitative therapy (bandages, manual lymphatic drainage, mechanical lymph drainage, elastic garments, etc.) and microsurgery (lymphatic-venous anastomoses at the arm), performed early (stages Ib and II) in patients not responsive to physical therapy. In the first group followed only clinically, secondary arm lymphedema occurred in 9 cases (36%), and appeared after a period variable from 1 week to 2 years (3-6 months averagely). In the second group, lymphoscintigraphy, performed preoperatively, permitted to find lymphatic impairment (absence of deltoid way, reduced axillary lymph nodal tracer uptake, delayed transit of the tracer) at the upper limb in 4 patients (15%). After breast cancer surgery, lymphoscintigraphy pointed out alterations of lymphatic circulation in 5 patients (20%) after 1 month, in other 6 cases (56%) at 6 months, other 5 (76%) after 1 year and 3 (88%) at 3 and 5 years. Physical preventive therapy performed in patients with positive lymphoscintigraphy, even before the clinical appearance of edema, allowed to find a clinically evident lymphedema only in 2 cases (8%). The last two patients underwent early (at stage Ib and II) microsurgical operation of lymphatic-venous anastomoses, with complete regression of edema and improved lymphatic drainage of the arm controlled by lymphoscintigraphy (appearance of preferential lymphatic pathways, absence of dermal back flow). Secondary arm lymphedema due to breast cancer treatment appears in 20-25% of cases till 35% when surgery is associated with radiotherapy. Lymphoscintigraphy allows to pointout alterations of lymphatic drainage before the clinical appearance of edema. Preventive physical and rehabilitative measures allows to reduce the clinical appearance of lymphedema significantly. Microsurgical operation performed precociously, at the early stages of the disease, permits to obtain the complete regression of the pathology thanks to the repair of preferential lymphatic pathways before of fibrosclerotic tissural alterations occur, which cause progressive worsening of clinical conditions, together with recurrent attacks of acute lymphangitis.
Adult↗
Lusorian artery simulating rheumatic diseases.
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Adolescent↗
4-OH tamoxifen does not interfere with bicalutamide inhibitory effects on human prostatic cancer cells in vitro.
BACKGROUND: The present study was aimed at investigating the effects of the co-administration of 4-OH Tamoxifen (4HT) and bicalutamide (BIC) on the human prostate cancer cell line LNCaP in vitro. MATERIALS AND METHODS: The LNCaP FGC prostate cancer cell line was grown in vitro within a three-dimensional matrix formed by collagen gel under dihydrotestosterone (DHT) (0.1 nM) stimulation. Cells were incubated in the presence either of BIC at escalating concentrations (1 nM; 100 nM; 10 microM) or 4HT Tamoxifen (10 nM; 100 nM) or both compounds at the different concentrations studied. The cells were incubated for 144 hours, and growth was evaluated in non trypsinised cells by crystal violet vital dye staining assay. RESULTS: BIC appeared to exert a dose-dependent inhibitory action, with the maximum inhibitory effect achieved by the 10 microM concentration. A comparable inhibitory effect was also observed after exposure to 4HT at both doses tested. No statistically significant interference was observed when BIC was combined with 4HT. CONCLUSION: 4HT, even at the higher concentration employed here, showed no major interference with the inhibitory effects of BIC.
Androgen Antagonists↗
Adjuvant systemic treatment of resectable breast cancer: eleven years results of a monoinstitutional chemo-hormone-immunotherapy trial.
131 patients with resectable, node-positive breast cancer were treated at the National Institute for Cancer Research of Genoa, Italy with a systemic adjuvant regimen based on 14 cycles of chemotherapy, immunostimulation with levamisole, and--for postmenopausal patients--hormone therapy with tamoxifen. The present evaluation is performed eleven years after the admission of the first patient: so far, 75 patients (57.3%) have relapsed and 52 (39.7%) have died. An analysis of prognostic factors for relapse and death shows that the number of positive axillary lymph nodes and the dimension of the primary tumor are significantly associated with survival and relapse-free survival, while age and menopausal status are not.
Age Factors↗
Plasma retinol levels and side effects following high-dose retinyl acetate in breast cancer patients.
Plasma retinol levels and toxicity were evaluated in thirteen metastatic breast cancer patients treated orally with high-dose (300,000 I.U./day) retinyl acetate in combination with oral tamoxifen. Following the first dose of the drug, there was a drop of plasma retinol concentrations followed by a recovery to the pre-treatment levels and by a further increase to reach a plateau six to eight hours after drug administration. During the first two months of treatment cumulative increase of plasma retinol was seen, and long-term systemic concentrations in the +50-60% range level were maintained by the treatment. The toxicity observed was acceptable and included gastrointestinal symptoms, skin toxicity and headache. These toxicities could be related to the long-term increase of retinol systemic concentrations. We concluded that the daily dose of 300,000 I.U. retinyl acetate can be administered to cancer patients over a period of several months, is well tolerated and yields a substantial increase of systemic retinol.
Antineoplastic Combined Chemotherapy Protocols↗
[Adjuvant hormone therapy of breast neoplasms. A critical review of the literature and perspectives].
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Animals↗
Endocrine treatment of prostate cancer: standard treatment and new perspectives.
The hormonal treatment of advanced prostate cancer is still a controversial matter although new drugs are being tested in clinical trials all over the world. The results of these trials are the subject of dispute for reasons related to the natural history and clinical evolution of prostate cancer.
Androgen Antagonists↗
Suramin and serum insulin-like growth factor levels in metastatic cancer patients.
Suramin, a polysulphonated naphthylurea, inhibits the activity of several growth factors in in vitro experiments and clinical responses have been reported in human solid tumors. We decided to investigate the relationship between suramin treatment and serum levels of insulin-like growth factor I (IGF-I) and II (IGF-II) in advanced breast, prostate and lung cancer patients. The serum IGF-I, IGF-II levels were determined by radioimmunoassay. A significant decline of IGF-I and IGF-II serum levels was demonstrated in suramin treated patients. Our results suggest that suramin-induced IGF suppression could be one of the possible mechanisms of suramin action.
Aged↗
Combination therapy with subcutaneous interleukin-2 and interferon-alpha in advanced renal cancer patients with poor prognostic factors.
Sixteen patients with metastatic renal cell carcinoma were treated with a combination of low-dose subcutaneous interleukin-2 (IL-2) and recombinant interferon (IFN)-alpha. One treatment course included 6 weeks of treatment followed by a 2-week rest. Patients received therapy as outpatients. All patients were assessable for toxicity and response assessment. Nine patients experienced severe toxicities resulting in dosage modification. The major treatment-limiting side effects were gastrointestinal, cutaneous, fever and flu-like symptoms. One patient (6%) had partial remission and six patients (37.5%) had disease stabilization. Overall median survival was 8 months. In our study IL-2 and IFN-alpha showed a low activity and a quite high toxicity. It seems that the prognostic factors per se rather than treatment options might impact the treatment results in advanced renal cancer patients.
Adult↗
Somatuline (BIM 23014) and tamoxifen treatment of postmenopausal breast cancer patients: clinical activity and effect on insulin-like growth factor-I (IGF-I) levels.
Somatostatin analogues have been shown to suppress some hormones and growth factors involved in breast tumour growth and a direct in vivo and clinical antimumour effect has recently been reported. In our study the effects of tamoxifen, combined with a depot somatostatin analogue in 33 postmenopausal untreated breast cancer patients, have been evaluated. Blood samples were obtained before treatment, after 14 days and then monthly, in order to evaluate the behaviour of serum IGF-I, GH and somatuline levels. The drug combination resulted in a significant and synergistic reduction of plasma IGF-I concentration. No significant changes of serum GH were observed. 12.5% of patients exhibited a complete response and 37.5% a partial response for an overall objective response rate of 50% (95% CL 35-69%). The high remission rate reported, the absence of overlapping side effects between tamoxifen and somatuline and the synergistic activity on IGF-I suppression justify a further evaluation of the drug-combination.
Aged↗
Assessment of response to carboplatin in patients with hormone-refractory prostate cancer: a critical analysis of drug activity.
The clinical presentation of prostate-hormone refractory tumours in 90% of patients is characterised by sclerotic bone metastasis which is not assessable by classic phase II response criteria. Restriction of investigational study of new agents to the minority of patients, with bidimensionally measurable lesions, assessable by conventional WHO response criteria, has been criticised because such cases may represent a highly selected tumour cell population. To circumvent this problem, a variety of response criteria have been proposed. However, prostate specific antigen (PSA) levels have become an integral component, used singly or in combination with other markers of response evaluation. As a result, different response proportions could also be reported using the same single agent in this category of patients. This study repors a different evaluation of carboplatin activity by using WHO, NPCP modified criteria and PSA post-therapy decline as measures of carboplatin activity. It is suggested that treatment efficacy in this category of patients wold be more correctly measured by the proportion of patients who "fail treatment" after a reasonable number of therapy courses, rather than those achieving a conflicting definition of "objective response". Finally, in hormone refractory prostate cancer PSA post therapy declines may represent a measure of treatment efficacy and can be used as a surrogate end point for clinical phase II trials.
Adenocarcinoma↗
Predictive factors for outcome in invasive bladder cancer treated with alternating chemoradiotherapy.
PURPOSE: In order to select patients properly for a bladder preservation program, this retrospective study aimed to evaluate the predictive role of pretreatment- and treatment-related factors in a group of patients with invasive bladder cancer treated with alternating chemoradiotherapy at a single institution. METHODS AND MATERIALS: From 1986 to 1994, 72 patients with invasive bladder cancer, stages T1 poorly differentiated or T2-4M0 refusing surgery or not eligible for surgery, were treated with alternating chemoradiotherapy. Each patient had a pretreatment cystoscopy with an attempted complete transurethral resection of the bladder tumor (TURB). The treatment schedule consisted of chemotherapy (cisplatin, 5-fluorouracil, or methotrexate) alternated with radiotherapy. Over the years, the treatment schedule was modified with respect to the total number of chemotherapy cycles, the type of chemotherapy drugs, the dose per fraction and total dose of radiation therapy, and the presence of a planned treatment gap at midtreatment. Treatments were aligned in order of their received average relative dose intensities of both chemotherapy (ARDICT) and radiotherapy (RDIRT). RESULTS: Twenty-two patients (76%) developed infiltrative bladder recurrences for an estimated 5-year pelvic control rate of 68% +/- 6%; 5-year actuarial survival with intact bladder is 40% +/- 6%. Obstructive uropathy at diagnosis, residual disease after TURB, and ARDICT value equal or below the median were independent predictive factors for pelvic failure, with hazard ratios of 2.87 (95% confidence interval [CI], 1.16-7.04), 8.13 (95% CI, 2.74-24.1), and 3.36 (95% CI, 1.29-8.74), respectively. A more detailed model including interactions among these factors showed that the negative prognostic effect of obstructive uropathy at diagnosis was not modified by ARDICT or TURB resection; on the contrary, the risk of local failure for patients with incomplete TURB was markedly affected by different levels of ARDICT. Also, a trend toward a better local outcome was observed for patients with RDIRT above the median. Hydronephrosis and incomplete TURB were also independent predictors of distant metastases and overall survival, but no effect was found for ARDICT on these endpoints. DISCUSSION: As a result of this analysis we believe that (1) patients with obstructive uropathy should not be offered a bladder-sparing approach, (2) gross total TURB of the primary tumor should be maximized, (3) prompt surgery should be considered for patients with incomplete TURB who are not compliant with the combined-modality treatment, and (4) the intrinsic value of dose intensity of both chemotherapy and radiotherapy should be confirmed in a prospective, controlled study.
Adult↗