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F Keuppens

Publications and source records attributed to F Keuppens.

At least 19 recordsLinked to original sources
PubMed2000

Quality of life of patients with newly diagnosed poor prognosis M1 prostate cancer undergoing orchiectomy without or with mitomycin C. Results from the EORTC Phase-III trial 30893.

OBJECTIVES: To compare the quality of life (QL) of patients with poor prognosis M1 prostate cancer treated with orchiectomy alone (ORCH) or orchiectomy combined with adjuvant mitomycin C (MMC; 15 mg/m(2) i.v. q 6 weeks: ORCH+MMC; EORTC trial 30893). METHODS: Patients with newly diagnosed M1 poor prognosis prostate cancer completed a truncated version of the EORTC QLQ-C30 (V 1.0) at randomization (baseline) and every 6-12 weeks thereafter until going off the protocol. Five ad hoc questions assessing lower urinary tract symptoms were included in the QL questionnaire. RESULTS: At least one QL form was completed by 177 of the 189 patients included in the trial, with baseline questionnaires available for 113 patients (ORCH n = 52; ORCH+MMC n = 61). In both arms, pain and urinary dysfunction improved during treatment. Compared with patients from the ORCH arm, the use of adjuvant MMC was associated with a significant reduction in global health status/QL and with impairment in 7 of 11 QL dimensions covered by the questionnaire. Some improvement in QL was observed after discontinuation of MMC. A survival benefit was not observed in the ORCH+MMC arm. CONCLUSIONS: Intravenous MMC (15 mg/m(2) q 6 weeks) cannot be recommended as adjuvant treatment in M1 poor prognosis prostate cancer due to its negative impact on QL and lack of efficacy. In general, QL assessments should be mandatory when adjuvant chemotherapy is evaluated in patients with metastatic prostate cancer.

Aged↗
PubMed1998

Maximal androgen blockade: final analysis of EORTC phase III trial 30853. EORTC Genito-Urinary Tract Cancer Cooperative Group and the EORTC Data Center.

OBJECTIVES: This prospective, randomized phase III study was initiated to compare the efficacy and side effects of bilateral orchiectomy versus a combination of a luteinizing hormone-releasing hormone agonist depot formulation, goserelin acetate (3.6 mg s.c. once every 4 weeks) and flutamide (250 mg 3 x daily) in patients with metastatic prostate cancer. METHODS: Relative treatment efficacy was assessed by comparing the two treatment groups with respect to response, time to first progression, progression-free survival, duration of survival and time to death due to malignant disease. RESULTS: There was a difference in response only with respect to a more frequent decrease to normal of the serum prostate acid phosphatase in patients assigned to maximal androgen blockade treatment. Additionally, maximal androgen blockade treatment showed significantly better results for duration of survival (p = 0.04), time to death due to malignant disease (p = 0.008), time to first progression (p = 0.009) and progression-free survival (p = 0.02). The most frequent side effects for both treatments included hot flushes and gynaecomastia. CONCLUSIONS: Increased time to progression and duration of survival is achieved by the combination of flutamide and goserelin when compared to bilateral orchiectomy.

Aged↗
PubMed1998

Benign papilloma of the bladder in a young adult.

Ultrasonographic and pathologic findings in a 26-year-old patient with a benign papilloma of the bladder are described. Ultrasound features include an irregular polypoid mass extending from the bladder wall.

Adult↗
PubMed1997

A feasibility study of high dose rate brachytherapy in solitary urinary bladder cancer.

PURPOSE: To determine the feasibility of high dose rate brachytherapy in the treatment of T1-T3 solitary bladder cancer and to compare results and side-effects to those obtained by others using conventional, i.e., low dose rate regimens. METHODS AND MATERIALS: Between July 1992 and 1995, 16 patients entered the study. Median age at diagnosis was 64 years (range: 45-79 years). Diagnostic transurethral resection showed four T1, five T2, and seven T3 lesions, all proven solitary by random biopsies. Radiotherapy consisted of low-dose preoperative external beam irradiation (3 x 3.5 Gy on the 3 consecutive days prior to implantation), followed by high dose rate brachytherapy (15 x 3 Gy during the 8 consecutive days thereafter). Median follow-up from the date of implantation was 23 months (range: 6-43 months). In 15 patients, cystoscopy was systematically performed during follow-up, whereas the 16th patient was followed on a clinical basis only. RESULTS: Recurrences have occurred in 2 of 15 evaluable patients (both stage T3): metastasis in 1 and combined local plus distant failure in the other patient. Cystoscopic evaluation showed persisting alterations of the implanted portion of the bladder mucosa in 11 of 15 evaluable patients (ulceration, calcifications, and/or punctiform bleedings). Symptomatic radiation cystitis was mild and transient in 14 but persisting and severe in 2 patients. CONCLUSION: This study documents the feasibility of high dose rate brachytherapy in a selected group of bladder cancer patients. Both patient outcome and side-effects are comparable to the best results obtained with low dose rate schedules. Additional follow-up is still needed to enforce the comparison.

Adenocarcinoma↗
PubMed1997

Baseline quality of life of patients with advanced prostate cancer. European Organization for Research and Treatment of Cancer (EORTC), Genito-Urinary Tract Cancer Cooperative Group (GUT-CCG)

Quality of life (QoL) is now commonly studied in prostate cancer. However, little is known about the appropriateness of the various QoL instruments in this group of patients. The purpose of this work was to study the baseline QoL assessment of patients with prostate cancer who were randomised into three EORTC phase III studies. The three trials included locoregional prostate cancer patients, poor prognosis metastatic patients and hormone resistance patients, respectively. In the three trials, patients were asked to complete a questionnaire assessing their physical and psychosocial functioning and their symptom levels. These questionnaires included questions from the EORTC QLQ-C30 (version 1): the physical functioning, role functioning, global health/QoL scales and a single pain item. The psychometric properties of the scales were assessed and an analysis was performed to investigate if differences existed in the scale scores between the three groups of patients, 638 baseline questionnaires were available for patients entered into the three trials. The Gutman coefficients of reproducibility and scalability were 0.94 and 0.71, respectively, for the physical functioning scale and 0.97 and 0.90, respectively, for the role functioning scale. The Cronbach's alpha reliability coefficients were 0.68, 0.48 and 0.90 for the physical functioning, role functioning and global health/QoL scales, respectively. The four scales were able to distinguish clearly between the patient populations under study. The physical functioning, role functioning, global health/QoL scales and the single pain item scale from the EORTC QLQ-C30 (version 1) are valid measures when used in the setting of prostate cancer.

Activities of Daily Living↗
PubMed1997

[Recurrent urethral stenosis treated with a Urolome Plus stent implantation: intermediate multicenter follow-up].

We present the medium-term results of 33 patients treated with Urolume Plus urethral stent between August 1990 and June 1996 in 9 Belgian and Luxembourg centers. They all had previous treatments for bulbo-membranous urethral stricture, but without sustained benefit (dilatation, internal urethrotomy, or/and urethroplasty). The mean age of the stricture was 5.4 years (+/- 4). The stent was inserted easily during a short hospitalisation. Median time of follow-up is two years (6 months to 4 years). Maximum flow rate at last follow-up was 20.7 ml/sec (+/- 7), and 83.3% of the patients were satisfied with the stent. In 70% of the cases, the stent achieved its purpose of maintaining a good urethral lumen. In 5 patients (15.15%), stricture recurred inside the stent and in 2 patients (6.06%) a new stricture appeared on another site. Among these 7 patients, 5 were satisfactorily treated by endoluminal resection (4 cases) or dilatation (1 case). There were 2 real failures (= 6%): one patient who has refused any complementary endoscopic treatment and the other one who is still undergoing repeated urethral dilatations. Having respected the right indications for this device, we are satisfied of the results. It is a good alternative after failure of other treatments for bulbar-membranous stricture.

Anesthesia↗
PubMed1995

Bilateral Wilms' tumor: in situ cooling of the kidney facilitates curative excision of tumors, with preservation of renal function.

Bilateral synchronous multifocal Wilms' tumor is a rare malignancy for which no optimum treatment has been established thus far. The need to preserve renal parenchyma whenever possible is obvious. The authors describe a patient who underwent removal of six subcapsular tumors from a kidney that had been protected from ischemia by in situ cooling with UW-Belzer solution and by surface cooling. This technique was safe, easy to perform, and allowed all the time required to resect the tumors under adequate visual control and to wait for analysis of the frozen sections. It might be a useful alternative to the more complicated "bench" technique.

Adenosine↗
PubMed1995

Endoscopic submucosal Teflon injection (STING): an alternative treatment of vesicoureteric reflux in children.

The authors present their results in treating vesicoureteric reflux with an endoscopic submucosal teflon injection (STING) of the refluxing ureter. One hundred refluxing units in 68 children were treated with a maximum follow-up of five years. Indications were high grade reflux (III-V), persistence or progression of reflux despite conservative therapy, breakthrough urinary infections despite antibiotic prophylaxis and finally bad antibiotic compliance. Treatment was performed on an outpatient basis and appeared to be free of complications. Reflux was cured with a success rate of 75% after a single injection and 96% after two injections. With respect to the grade of reflux, best results were obtained in low grade reflux (Grade I-II). A 60-70% success rate was obtained in high grade reflux (III-V). The main advantage over open reimplantations lies in its non invasiveness, simplicity and possibility of being repeated in case of failure.

Child↗
PubMed1995

The status of bladder-preserving therapeutic strategies in the management of patients with muscle-invasive bladder cancer.

The recommended treatment for medically fit patients with muscle-invading bladder cancer is usually radical cystectomy. However, transurethral resection of the tumor, partial cystectomy, irradiation and systemic chemotherapy are each effective in some patients. These latter treatments allow bladder preservation and cure as an alternative to radical cystectomy although when used unselectively the survival rates are inferior to those of radical cystectomy. The updated results of conservative surgery, radiation therapy and systemic chemotherapy as monotherapy, as well as strategies of combined modality treatment were reviewed. Based on this review many areas of consensus were reached which include: 1. The primary goal of any treatment for a patient with muscle-invading bladder cancer is survival; bladder preservation in the interest of quality of life is a secondary objective. 2. Only a small proportion of carefully selected patients may be cured by transurethral surgery alone, or by partial cystectomy alone. 3. Radiation therapy is currently the standard bladder-preserving therapy against which all other bladder-preserving methods must be compared. 4. Systemic chemotherapy as monotherapy is inadequate and cannot be recommended. 5. The addition of cisplatin-containing systemic chemotherapy to radiation therapy or conservative surgery appears to improve local control. While no multi-modality therapeutic regimen has yet been shown to be clearly optimal with regard to local efficacy and minimizing toxicity, monotherapy for bladder preservation is probably not desirable as a routine approach. 6. Deferring the patient from immediate cystectomy does not appear to compromise survival, nor does the addition of primary systemic chemotherapy appear to significantly increase the morbidity of cystectomy or radiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1994

Phase I trial of high-dose fosfestrol in hormone-refractory adenocarcinoma of the prostate.

Androgen deprivation displays the mean therapy of advanced stage prostatic cancer. The development of hormone-resistant disease leads to a fatal tumor progression. High-dose fosfestrol (diethylstilbestrol disphosphate) has been suggested to circumvent hormone resistance and to induce a direct cytotoxic effect. Twenty-one patients with hormone-refractory prostate cancer were enrolled in a phase I trial of continuous infusion of high, daily escalating dose of fosfestrol. Fosfestrol was given in a 3.5 hr infusion in 0.9% normal saline at a starting dose of 1.5 g/d. The dose was increased daily in the same patient according to the following schedule: 1.5, 1.8, 2.4, 3.0, 3.6, 3.9, 4.5, 5.1 and 5.7 g/d. The duration of the infusion was prolonged to 7 or 10.5 hr, if a major side effect occurred. There was neither hematological nor cardiovascular toxicity. The main dose-limiting toxicities were nausea/vomiting in 17 patients, edema in 2 patients, and more than 5% weight gain in 3 patients. The planned maximal dose was reached in 10 patients during a 3.5 hr infusion, and in 3 additional patients, after infusion prolongation. Seven patients experienced a subjective improvement: Prostatic acid phosphatase and prostatic specific antigen decreased in 4 out of 11 and in 7 out of 12 patients, respectively. The suggested dose to phase II trial is 4 g/d in 3.5 hr infusion for a duration of up to 10 days.

Acid Phosphatase↗
PubMed1994

How good is technetium-99m mercaptoacetyltriglycine indirect cystography?

The aim of the present study was to estimate the sensitivity of indirect radionuclide cystography (IRC) performed with technetium-99m mercaptoacetyl-triglycine (MAG3), in comparison with the micturition cystourethrography (MCUG) and direct radionuclide cystography (DRC), for the diagnosis of vesicoureteric reflux. Two groups of patients were selected: group I comprised 40 children who underwent IRC during the acute phase of urinary tract infection and an MCUG 6 weeks later; group II comprised 42 (other) children with known reflux, who underwent IRC and DRC during follow-up. Taking as the reference the total number of refluxing kidneys detected by means of any cystographic technique, 99mTc-MAG3 ICR missed two-thirds of the refluxing kidneys. Most of the small refluxes were missed, but so too were 50% of the major refluxes. Taking as the reference 99mTc dimercaptosuccinic acid (DMSA) scintigraphy, MCUG detected 91% of the patients with DMSA abnormalities on at least one kidney, DRC detected 95%, and IRC detected 46% and 43% respectively, in groups I and II. The use of 99mTc-MAG3 IRC as the sole technique for the detection of vesicoureteric reflux gives rise to an unacceptable number of false-negative results.

Adolescent↗
PubMed1994

Penile electromyography in the diagnosis of impotence.

Cavernous electromyography of the flaccid penis was done in 93 impotent patients that were evaluated with several types of electrodes. We found that the potentials are generated by the cavernous tissue and are not the reflections of distant electromyographic events. Using monopolar needle electrodes, accurate interpretation of the electromyographic tracings seems possible. Our results confirm the value of penile electromyography as a way to objectivate penile smooth muscle atrophy as well as pelvic autonomic neuropathy with subsequent penile smooth muscle desynchronization. A neuromuscular dysfunction may be the causative factor in 39% of our impotent patients.

Electrodes↗
PubMed1993

Orchidectomy versus goserelin plus flutamide in patients with metastatic prostate cancer (EORTC 30853). European Organization for Research and Treatment of Cancer--Genitourinary Group.

A total of 327 patients with metastatic prostate cancer were randomized to receive bilateral orchiectomy or treatment with Zoladex and flutamide. The trial aimed to evaluate subjective and objective time to progression, survival, and incidence and duration of response. Strict quality control and evaluation by independent ad hoc committees were organized. Progression was assessed for each of 13 parameters. The time to subjective and objective progression was in favor of the combination treatment, with statistical significances of P = 0.009 and P = 0.008, respectively. This delay in objective progression resulted in increased survival in favor of the combination treatment for death by cancer (P = 0.02) or overall survival (P = 0.05). Survival differences were more marked in the patients with better prognostic factors. The clinical significance of these differences for the individual patient requires detailed assessment.

Adult↗
PubMed1993

Imaging of renal cell cancer with radiolabelled octreotide.

Recently the presence of somatostatin receptors on human renal cell carcinomas has been demonstrated by autoradiographic techniques on surgically removed kidneys. In a prospective study we evaluated, by means of 111In-labelled octreotide scintigraphy, the in vivo tumour imaging in a group of patients with biopsy proven renal cell carcinomas at different tumour stages. Seven patients were studied. In three of them (43%) pathological tracer accumulation was demonstrated. In these patients 20 out of 23 known tumour localizations were clearly visualized. Tracer uptake could be inhibited by prior administration of cold octreotide. We conclude that 111In-octreotide scintigraphy can be used to demonstrate, in vivo, metastatic renal cell carcinoma.

Aged↗
PubMed1992

Adjuvant chemotherapy of recurrent superficial transitional cell carcinoma: results of a European organization for research on treatment of cancer randomized trial comparing intravesical instillation of thiotepa, doxorubicin and cisplatin. The European Organization for Research on Treatment of Cancer Genitourinary Group.

A total of 356 patients with recurrent superficial transitional cell carcinoma of the bladder was entered in a randomized clinical trial to compare intravesical thiotepa, doxorubicin and cisplatin with respect to the recurrence rate and disease-free interval. After complete transurethral resection of all visible lesions, the drugs were administered weekly for 4 weeks and monthly for 11 months. The recurrence rates per year were 0.50 for thiotepa, 0.54 for doxorubicin and 0.58 for cisplatin. Of 266 patients (mean followup 41 months) 35 reported an increase in T category and 19 of them had distant metastases. No association between treatment and progression was noted. Thus, there is no difference among treatments with respect to efficacy. However, severe anaphylactic reactions were observed in the cisplatin arm and chemical cystitis was more frequently reported in patients who received doxorubicin.

Administration, Intravesical↗
PubMed1992

The value of dynamic color duplex scanning in the diagnosis of venogenic impotence.

To determine the value of color duplex scanning in the diagnosis of venogenic impotence we examined 53 patients. The control population consisted of 26 psychogenically impotent men and 8 normal potent men who all had a firm erection after pharmacological stimulation. There was no significant difference in the values of duplex parameters between these 2 groups. The venous leak population was characterized by a bad erectile response to pharmacological stimulation despite a good arterial compliance and by a persistent diastolic flow as shown by duplex scanning. There was a significant difference with the control population for the parameters of resistance index after 10 minutes (p = 0.001), minimal resistance index (p = 0.016) and corporeal volume increase (p = 0.010). There was a good correlation between the results of duplex scanning and those of pharmacocavernosography-pharmacocavernosometry (93%). We conclude that dynamic color duplex scanning can be used as a screening procedure to diagnose significant venous leakage in an objective manner with the resistance index.

Aged↗