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H Zincke

Publications and source records attributed to H Zincke.

At least 163 records · Page 9Linked to original sources
PubMed1990

Observation after orchiectomy in clinical stage I nonseminomatous germ cell tumor of testis. Mayo Clinic experience.

We report a retrospective review of our experience with close observation after orchiectomy in clinical stage I nonseminomatous germ cell tumors (NSGCT) of the testis during a 10-year period. Twenty-four patients were followed between 1977 and 1986 for a median duration of 47 months (24-112 months). Six of 24 (25%) relapsed at a median of 3.5 months (2-46 months) after orchiectomy; all of these were treated with chemotherapy and are in complete remission at a median of 55 months (27-69 months) after diagnosis of recurrence. Eighteen other (75%) who did not relapse are without evidence of disease at a median of 39 months (24-112 months) after orchiectomy. Orchiectomy alone followed by close observation in clinical stage I NSGCT is a reasonable approach in reliable patient populations at well-equipped centers where adequate follow-up is possible.

Adolescent↗
PubMed1989

Extended experience with surgical treatment of stage D1 adenocarcinoma of prostate. Significant influences of immediate adjuvant hormonal treatment (orchiectomy) on outcome.

Concepts regarding the surgical treatment of cancer of the prostate have changed significantly at the Mayo Clinic. Rather than emphasizing radical prostatectomy only for low-grade (grade less than or equal to 2) and low-stage (less than or equal to T1/B1) lesions--which may be equally well treated at less than ten years, in regard to crude survival, by radiotherapy--we believe that radical prostatectomy is particularly suitable for lesions of higher local stages, including those with regional node extension. This view is based on a large experience (less than 2,000 cases) with the radical surgical treatment of cancer of the prostate and on the realization that conservative single-modality treatment (hormonal or radiotherapy) for advanced local Stages (C and D1) provides poor cause-specific survival and nonprogression rates and may lead to high local morbidity. The treatment of Stage D1 prostate cancer was thought to be not amenable to surgical treatment, and many have recommended observation only. In 266 patients (mean age, 64 years) followed one to twenty-one years (mean, 4.7 years), immediate adjuvant orchiectomy at the time of radical prostatectomy performed in 162 patients (61%) resulted in a highly significant (P less than 0.0001) decrease in progression compared with no immediate orchiectomy in 104 patients (39%). The ten-year overall and local nonprogression rates for those undergoing immediate orchiectomy were 80 percent and 98 percent, respectively; median time to progression for the no-immediate-orchiectomy group was less than 4.5 years, and the local recurrence rate was 25 percent at ten years. Of all the pathologic variables, only DNA ploidy pattern had a significant influence on progression and cause-specific survival. Also, in patients with D1 disease and a nuclear DNA diploid pattern, immediate adjuvant orchiectomy resulted in a nonprogression rate of 100 percent at ten years compared with virtually 0 percent in those with a nondiploid tumor and no immediate orchiectomy. Because 42 percent of the patients with D1 disease in the Mayo Clinic experience have DNA diploid tumors, adjuvant orchiectomy in this group results in no progression or prostate cancer death. Patients with Stage D1 prostate cancer and DNA nondiploid pattern undergoing prostatectomy should be entered in prospective adjuvant innovative treatment protocols since these tumors do not seem to respond to early hormonal manipulation.

Adenocarcinoma↗
PubMed1989

Pelvic lymphadenectomy and transperineal interstitial implantation of IR 192 combined with external beam radiotherapy for bulky stage C prostatic carcinoma.

From January 1983 until June 1987, 51 patients with locally advanced prostatic carcinoma (47 Stage C, 4 bulky B2) were treated at Mayo Clinic (33 patients) and at William Beaumont Hospital (18 patients) with (a) 5 Gy delivered pre-operatively in one fraction, (b) pelvic lymphadenectomy and (c) interstitial implantation of the prostate with Ir 192 seeds via a perineal template (the Martinez Universal Perineal Interstitial Template) to deliver 35 Gy, and (d) 30.6 Gy external beam therapy in 17 fractions to prostate only fields. Initial clinical response has been excellent. Local control, with a median follow-up of 45 months, has been 100% by clinical exam and 84.5% pathologically in the subset biopsied. Disease-free actuarial survival at 5 years is 89%. Major toxicity has been limited to the rectum, but a modification of the brachytherapy technique has reduced this sharply. We conclude that bulky Stage C prostatic carcinoma can be successfully treated by this aggressive combination of modalities with acceptable toxicity.

Adult↗
PubMed1989

Pattern of failure after radical retropubic prostatectomy for clinically and pathologically localized adenocarcinoma of the prostate: influence of tumor deoxyribonucleic acid ploidy.

From 1966 to 1980, 315 patients underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy without adjuvant treatment for clinically and pathologically localized adenocarcinoma of the prostate. Followup was 5 to 21 years, with a median of 8 years. The disease was pathological stage A in 24 patients (8%) and pathological stage B in 291 (92%). A total of 45 patients (14.2%) experienced progression. Over-all, 28 patients (8.9%) suffered local recurrence at a mean of 6.6 years postoperatively (median 5.5 years). Local recurrence was noted as late as 15 years postoperatively. Over-all, systemic progression was observed in 25 patients (8%) after a mean of 4.7 years (median 6 years). Eight patients (2.5%) experienced local and systemic failure. The projected local and systemic failure rates at 15 years were 22% and 15%, respectively. Disease-specific survival at 15 years was 93%, since only 11 patients (3.4%) died of prostate cancer. In an age-matched case control analysis, after all prognostic variables were analyzed (Mayo grade, Gleason score, capsule involvement, number of foci, volume of tumor and deoxyribonucleic acid tumor ploidy), progression was related to nondiploid deoxyribonucleic acid tumor ploidy (p less than 0.0004) as determined by flow cytometry in 63% of the patients who evidenced progression versus 8% of the nonrecurrent group.

Adenocarcinoma↗
PubMed1989

Impact of endourology on diagnosis and management of upper urinary tract urothelial cancer.

The technique of transurethral ureteropyeloscopy was used in 43 patients with upper urinary tract urothelial tumors. Diagnosis was confirmed in 19 of 22 renal pelvic tumors (86 per cent) and 19 of 21 ureteral tumors (90 per cent). The major complication rate in this series is low (7 per cent) and did not appear to influence unfavorably subsequent management or outcome. A total of 21 patients underwent conservative endourological management of the upper tract tumor. The local recurrence rate was 20 per cent (1 of 8) for renal pelvic tumors and 15 per cent for distal ureteral tumors (2 of 13). The technique of ureteropyeloscopy should be added to the standard diagnostic regimen for the investigation of upper tract filling defects and conservative endourological techniques can be used safely for management of selected cases of upper tract urothelial tumor.

Aged↗
PubMed1989

Stage C prostatic adenocarcinoma: flow cytometric nuclear DNA ploidy analysis.

Flow cytometric nuclear DNA ploidy analysis was used to study pathologic stage C prostatic adenocarcinoma (pT3, N0, M0) in 146 patients who underwent radical retropubic prostatectomy and bilateral pelvic lymphadenectomy between 1967 and 1981. Of these tumors, 46% had a DNA diploid pattern, 47% had a DNA tetraploid pattern, and 7% had a DNA aneuploid pattern. Abnormal ploidy patterns were associated more frequently with histologic high-grade tumors than with low-grade tumors. Considered alone, DNA ploidy pattern showed a strong association with subsequent prognosis. The median interval to progression for tumors with DNA tetraploid and DNA aneuploid patterns was 7.8 and 3.5 years, respectively. For the DNA diploid tumors, only 23% progressed within 18 years, the longest follow-up. At 10 years, only 10% of patients with DNA diploid tumors had died of prostatic cancer, in comparison with 28% of the DNA tetraploid and 36% of the DNA aneuploid groups (P less than 0.01). By analysis of a combination of histologic tumor grade and nuclear DNA ploidy pattern, an even stronger association with prognosis was demonstrated. For the 38 patients with histologic low-grade and DNA diploid tumors, progression-free survival was 92% at 10 years, in comparison with 57% for 23 patients with low-grade DNA nondiploid tumors. Patients with high-grade tumor had a poorer prognosis whether the DNA ploidy pattern was diploid or nondiploid. Nuclear DNA ploidy pattern is an important and independent prognostic variable for patients with pathologic stage C prostatic cancer treated by radical prostatectomy.

Adenocarcinoma↗
PubMed1988

Radical cystectomy for historical and pathologic T1, N0, M0 (stage A) transitional cell cancer. Need for adjuvant systemic chemotherapy?

Of 695 patients who, in a five-year period, underwent cystectomy for bladder cancer, 32 (4.6%) proved to have historical and pathologic Stage T1 (Stage A) transitional cell cancer. Of these, 23 (72%) had grade 3 disease or higher. Overall, in 17 (53%) progression developed after follow-up of greater than or equal to 5 years. Moreover, in 10 (31%) of the patients systemic progression developed during follow-up; less than 50 per cent of the patients were projected to be free of systemic progression at ten years. DNA ploidy pattern analysis did not prove helpful in predicting disease outcome. Because effective systemic chemotherapy has become available in the form of M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin), it seems justifiable that patients who are considered to be candidates for cystectomy because of high-grade, multifocal T1 transitional cell cancer of the bladder also could be candidates for effective neo-adjuvant chemotherapy, in addition to those who usually are part of these protocols--namely, those with greater than or equal to T2 disease.

Adult↗
PubMed1988

Experience with extracorporeal surgery and autotransplantation for renal cell and transitional cell cancer of the kidney.

Of 21 patients who underwent bench surgery for renal malignancies (renal cell carcinoma in 16 and transitional cell carcinoma in 5) 15 also had autotransplantation and 6 did not. In 5 patients the contralateral kidney was removed simultaneously for synchronous bilateral renal malignancy, and 16 had cancer in a solitary kidney. In the 3 patients who underwent nephrectomy for complications after autotransplantation no evidence of residual tumor was noted on histopathological examination. Of 9 patients 1 (11 per cent) had local recurrence after successful autotransplantation (renal cell carcinoma). Two patients with transitional cell carcinoma died of metastatic disease. Treatment failed in 31 per cent of the 16 patients with renal cell carcinoma (metastatic disease in 4 and metastatic disease with local recurrence in 1). Removal of solitary or synchronous bilateral renal cell cancer by bench surgery with subsequent autotransplantation is effective. For high grade transitional cell carcinoma of a solitary kidney its value is doubtful without adjuvant systemic treatment.

Adult↗
PubMed1988

Malignant melanoma of the penis.

Malignant melanoma of the penis is rare and accounts for only a small percentage of penile carcinomas. We report the largest series and the longest followup of patients with this disease. The tumor usually presents as a small, brown or black lesion, often ulcerating, on the glans penis. Stage I disease (confined to the penis) can be treated conservatively by distal penectomy and results in excellent survival. Palpable inguinal lymph nodes and nodes associated with thick cutaneous lesions require surgical exploration. Stages II (node positive) and III (metastatic) diseases carry a poor prognosis, mainly because of the lack of effective adjuvant systemic therapy.

Aged↗
PubMed1988

Radical prostatectomy after radiation therapy for cancer of the prostate: feasibility and prognosis.

A total of 30 patients underwent an operation (radical prostatectomy in 27 and cystoprostatectomy in 3) for prostate cancer. In 17 patients radiotherapy with curative intent (range 5,700 to 7,500 cGy., mean 6,130 cGy.) had failed locally at 7 to 150 months (mean 48.8 months) later; 13 underwent the operation 2 months or less after planned radiotherapy (4,000 to 7,000 cGy., mean 5,431 cGy.). Followup was 1 to 16 years (mean 6.7 years). There was no perioperative death. The most significant complications were vesical neck contracture (17 per cent), lymphedema (10 per cent) and incontinence (10 per cent). Pathological staging revealed 8 patients with stage D1 disease. Of tumor grade, stage, adjuvant hormonal treatment and ploidy pattern only the last was associated with progression and survival. An increasing number of patients with local, albeit often symptomatic, radiation failure may present during the next years and they must be treated. Salvage prostatectomy is feasible and its associated morbidity seems to be acceptable; alternative (nonoperative) treatment modalities have proved not to be effective. Deoxyribonucleic acid ploidy pattern can provide valuable prognostic information in this difficult patient population for decision-making regarding radical surgery and adjuvant hormonal treatment.

Adult↗
PubMed1988

Metastatic renal cell cancer and radical nephrectomy: identification of prognostic factors and patient survival.

Between January 1, 1970 and December 31, 1980 (followup 2 years or more) 158 patients with histologically proved metastatic renal cell cancer and no prior therapy were seen. Statistical analyses identified variables that significantly influenced survival, including grade of the primary lesion (p equals 0.002), weight loss of more than 10 per cent (p less than 0.0001) and multiple versus single metastases (p equals 0.0001). Cell type, soft tissue versus bone metastasis, age, sex, site and size of primary lesion, and delay in the diagnosis did not influence survival significantly. Adjuvant nephrectomy markedly influenced survival only in patients with solitary metastasis, low grade primary tumor and weight loss of less than 10 per cent (p equals 0.06). Based on this analysis a score system was constructed to help predict survival and the impact of new forms of therapy in the future.

Adult↗
PubMed1988

Neoadjuvant chemotherapy for locally advanced transitional cell carcinoma of the bladder: do local findings suggest a potential for salvage of the bladder?

Sixteen patients with locally advanced transitional cell carcinoma of the bladder were given two to four cycles of combination chemotherapy with methotrexate, vinblastine, doxorubicin hydrochloride (Adriamycin), and cisplatin (M-VAC) in an effort to reduce tumor size and enhance the potential for surgical resection. All patients had initial clinical staging (based on cystoscopy and cystoscopic biopsy, urine cytology, computed tomographic scanning, and excretory urography). Before each cycle, all patients had repeat clinical staging tests. Ten patients underwent postchemotherapy bilateral pelvic lymphadenectomy and radical cystoprostatectomy, and their bladders were examined histopathologically by step-sectioning techniques. One patient underwent abdominal exploration, bilateral pelvic lymphadenectomy, and ipsilateral partial cystectomy. Five patients had repeat clinical staging only without removal of their bladders. Of the 16 patients, 5 (31%) had residual invasive tumor and no tumor response. Three patients (19%) had a partial response, two of whom had only carcinoma in situ (one with prostatic duct involvement) and one of whom had stage pT1, NO, MO disease. Five patients (31%) had normal findings on computed tomographic scans, cystoscopy, biopsy, and urine cytology and thus had complete responses. In addition, 3 of 11 patients who underwent pathologic staging had no residual tumor on clinical and surgical staging and were complete responders. The overall (partial + complete) response rate was 69%, and the overall complete remission rate (pathologic + clinical staging) was 50%. These results suggest that the concept of possible salvage of the bladder with the current treatment program might be premature and must be applied selectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Stage D1 prostatic adenocarcinoma: significance of nuclear DNA ploidy patterns studied by flow cytometry.

Flow cytometric analysis of nuclear DNA ploidy pattern was performed on 91 samples of prostatic adenocarcinoma from patients with stage D1 disease (metastatic deposits in pelvic lymph nodes). All patients had undergone radical retropubic prostatectomy and bilateral pelvic lymphadenectomy. Clinical follow-up ranged from 5 to 19 years. Nuclei were extracted from paraffin-embedded archival material. Isolated nuclei were stained with propidium iodide. The DNA ploidy pattern was diploid (normal) in 42% of tumors, tetraploid in 45%, and distinctly aneuploid in 13%. Only 15% of DNA diploid tumors progressed locally or systemically, whereas 75% of tumors with an abnormal DNA ploidy pattern (tetraploid or aneuploid) subsequently progressed (P less than 0.0001). Among low-grade tumors, ploidy analysis detected a subgroup associated with a poor prognosis; among high-grade tumors, a subgroup associated with a favorable prognosis was detected. None of the patients with a DNA diploid tumor died of prostatic cancer during the period of observation. In contrast, 43% of patients with DNA tetraploid tumors and 44% of those with DNA aneuploid tumors had died of prostatic cancer 10 years after surgical treatment (P less than 0.001). Determination of nuclear DNA ploidy pattern by flow cytometry provides objective, highly significant, prognostic information for patients with stage D1 prostatic carcinoma.

Adenocarcinoma↗
PubMed1988

Bilateral pelvic lymphadenectomy and radical retropubic prostatectomy for stage C or D1 adenocarcinoma of the prostate: possible beneficial effect of adjuvant treatment.

Limited clinical stage C (T3 NX M0) disease can be treated surgically, and morbidity can be acceptable. When appropriate adjuvant therapy (orchiectomy and/or radiation) is administered, residual cancer can be controlled locally for at least a limited period. The incidence of local progression in pathologic stage C or D1 disease may be negligible after early adjuvant orchiectomy and/or radiation treatment. The combination of immediate orchiectomy and radical prostatectomy has been shown to limit progression significantly (P = .0009) in many patients with D1 (T0-3 N1,2 M0) disease. However, some patients do not respond to this combination treatment, which suggests that systemic dissemination of heterogeneous tumor cells is unresponsive to adjuvant androgen ablation therapy. The DNA ploidy pattern may be a valuable predictor of disease outcome after treatment in stage D1 disease. Other pathologic variables (including acid phosphatase levels) have not been useful in predicting disease outcome or treatment response. Finally, patients with limited clinical stage C disease and those with pathologic C or D1 disease should be enrolled in a prospective randomized protocol so that the possible beneficial effects of adjuvant treatment programs can be evaluated. Apart from the usual pathologic variables and prostate-specific antigen testing, the DNA pattern should be included as a stratification factor.

Acid Phosphatase↗