Search PubMed⌕ Search

Biomedical subjects

Jacek Jassem

Publications and source records attributed to Jacek Jassem.

54 records · Page 3Linked to original sources
PubMed2003

Factors determining acute normal tissue reactions during postoperative radiotherapy in endometrial cancer: analysis of 317 consecutive cases.

BACKGROUND AND PURPOSE: Acute radiotherapy reactions are commonly underestimated and under-reported in the literature. Our aim was to evaluate the incidence and risk factors for acute reactions during postoperative radiotherapy in endometrial cancer patients. MATERIAL AND METHODS: Performed was detailed retrospective analysis of 317 endometrial cancer patients given postoperative radiotherapy. Two hundred forty seven patients (78%) received both intracavitary (BRT) and external beam irradiation (EBRT), 49 patients (15%) received only BRT and 21 patients (7%) - only EBRT. BRT included radium (Ra) or cesium (Cs). The mean total dose at 0.5 cm for Ra and Cs was 50.5+/-10.3 Gy and 48.4+/-15.0 Gy, respectively, and the mean dose rate - 0.47+/-0.06 Gy/h and 1.42+/-0.41 Gy/h, respectively. Mean EBRT dose in the ICRU reference point was 49.0+/-3.7 Gy given in fractions of 1.54-2.49 Gy (mean 2.0+/-0.17 Gy). Radiotherapy and Oncology Group classification system was employed to score acute reactions. The impact of patient- and treatment-related factors on the risk of acute bowel and urinary bladder reactions was assessed with uni- and multivariate tests. RESULTS: Acute radiotherapy reactions of any grade occurred in 265 patients (84%) including bowel complications in 66% and urinary bladder complications in 36%. There were 21 severe (grade 3 or 4) reactions, all but one seen in the patients treated with combined EBRT and BRT. Higher total dose (P=0.024), higher EBRT dose (P=0.022) and higher age (P=0.026) were correlated with increased acute bowel toxicity in univariate analysis. Multivariate analysis showed that higher EBRT dose (P=0.015) and older age (P=0.016) were independently correlated with the risk of acute bowel events. Higher total dose (P=0.009), BRT dose (P=0.029), BRT dose rate (P=0.004), EBRT fraction size (P=0.007), the use of Cs BRT (P=0.001) and lower parity (P=0.041) were correlated with increased risk of acute bladder toxicity in univariate test. Multivariate analysis demonstrated that the independent risk factors for acute bladder events were BRT dose rate (P=0.002) and low parity (P=0.042) and there was a trend for EBRT dose (P=0.076). In multivariate analysis there was no impact of other clinical factors (FIGO stage, diabetes mellitus, hypertension, prior abdominal surgery) on the risk of acute bowel and/or bladder reactions nor was the impact of surgery-to-radiotherapy interval, overall radiotherapy time and overall treatment time. CONCLUSIONS: The risk of acute reactions depends both on treatment-related (BRT dose rate, EBRT dose) and patient-related factors (age, parity). Precise treatment prescription, planning and verification are of paramount concern. Further studies are warranted to evaluate the impact of extrinsic and intrinsic factors associated with acute normal tissue injury.

Adult↗
PubMed2003

The risks and benefits of hormonal replacement therapy in healthy women and in breast cancer survivors.

For many years hormonal replacement therapy (HRT) has been considered to offer not only effective relief of climacteric symptoms but also a reduction in the risk of osteoporosis and cardiovascular disease, plus a possible prevention of cognitive decline. Randomised trials of HRT in women with preexisting coronary heart disease have not confirmed, however, cardiovascular benefits of HRT and have even suggested increased cardiac risk associated with this management. Numerous retrospective studies demonstrated that the risk of breast cancer is higher in HRT-users and is related to therapy duration. More recent studies suggested that breast cancer risk increases further if oestrogen is coupled with progestogen. On the other hand, some data show that breast cancers diagnosed in women during HRT administration may be less aggressive. Typically, tumours in these patients are smaller and better differentiated. HRT also increases the relative risk of endometrial cancer, particularly if oestrogen alone is administered. Currently, the indications for HRT in healthy subjects should include only reduction of menopausal symptoms and prevention of osteoporosis. The use of HRT in breast cancer survivors is controversial, and until the results from prospective randomised trials are available, cannot be recommended in this group as a standard care.

Aged↗
PubMed2003

Gemcitabine and anthracyclines in breast cancer.

Anthracyclines are among the most active drugs in breast cancer. Gemcitabine is a novel agent that has also shown good antitumor activity in advanced breast cancer. This compound has a favorable toxicity profile, no apparent multidrug resistance, and retains its activity in anthracycline-pretreated patients. Therefore, it was logical to combine gemcitabine with anthracyclines. The combinations of gemcitabine and anthracyclines (doxorubicin, liposomal doxorubicin, epirubicin) have been tested in a few phase I and II studies. Generally, these combinations have been shown to be feasible and well tolerated. The pharmacokinetics of gemcitabine and anthracyclines was not affected by their combined use. Myelosuppression was the most common adverse event; neutropenia was easily reversible. Data from phase II clinical studies suggest that gemcitabine/anthracycline combinations are relatively effective in first- or second-line therapy for women with locally advanced and metastatic breast cancer. Future randomized clinical trials are warranted to further elucidate the role of these regimens in breast cancer care.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

[Efficacy and feasibility evaluation in long term pamidronate treatment of bone metastases].

UNLABELLED: The aim of our study was to evaluate the efficacy and feasibility of long-term pamidronate treatment. MATERIAL AND METHODS: Thirty-six patients (pts) undergoing long-term (> 9 months) pamidronate treatment for bone metastases of breast cancer (30 pts), prostate cancer (3), multiple myeloma (2) and renal carcinoma (1) were retrospectively analyzed. The indication for pamidronate treatment were appearance of bone metastases (21 pts), progression of bone lesions (13) or intolerance of clodronate (2). Pamidronate was administered as an intravenous infusion, most commonly at a dose of 90 mg monthly. Skeletal complications including pathologic fractures, the need for palliative radiotherapy or bone surgery, spinal cord compression and hypercalcemia as well as occurrence of new bone or visceral lesions were assessed. The use of analgesics and subjective bone pain relief were used to evaluate the analgetic effect of pamidronate therapy. Adverse events of pamidronate treatment were noted. RESULTS: Patients received a median of 15 pamidronate infusions (range 9-35). Complete pain control was observed in 7 pts (19%), partial in 21 (58%) and stabilization in 8 (22%). Mean time to maximal effect was 5 months (range 0-17). There were 5 cases (14%) of fever and 6 cases (17%) of flu-like syndrome after pamidronate administration. New bone lesions appeared in 16 pts (44%) after a median of 12 months (range 1-28). Other skeletal complications included pathologic fractures (9 pts, 25%) and hypercalcemia (2 pts, 5.6%); 13 pts (36%) required radiotherapy. Symptomatic progression occurred in 27 pts (75%), with a median progression-free time of 14 months (range 5-35) from the beginning of pamidronate treatment. CONCLUSIONS: Long-term treatment with pamidronate in patients with bone metastases is well tolerated and effective in decreasing bone pain, thus maintaining considerably high quality of life.

Adult↗
PubMed2002

Relationship between acute and late normal tissue injury after postoperative radiotherapy in endometrial cancer.

PURPOSE: To evaluate the relationship between acute and late normal tissue reactions in 317 consecutive endometrial cancer patients treated with surgery and adjuvant radiotherapy (RT). METHODS: The data of 317 patients (staging according to the International Federation of Gynecology and Obstetrics) treated with postoperative RT were analyzed. Both low-dose-rate brachytherapy and external beam RT were applied in 247 patients (78%); brachytherapy only in 49 (15%) and external beam irradiation only in 21 (7%). The median follow-up was 7.3 years (range 4-21). The European Organization for Research and Treatment of Cancer, Radiation Therapy Oncology Group system with elements of the late effects of normal tissue, subjective, objective, management, analytic (LENT/SOMA) scale was used to score the RT reactions. The correlation between the occurrence and severity of acute and late bowel and bladder toxicity, as well as the relationship between the severity of acute effects and time to occurrence of late reactions, were assessed using linear and logistic regression analyses. RESULTS: Of the 317 patients, 268 (85%) experienced acute RT reactions of any grade. Severe acute bowel reactions were observed in 15 patients (5%), urinary bladder complications in 1 patient (0.5%), cutaneous in 1 patient (0.5%), and vaginal in 1 patient (0.5%). Severe acute hematologic toxicity was seen in 3 patients (1%). A total of 158 patients (51%) experienced late RT reactions of any grade. Severe late bowel reactions were observed in 19 patients (6%), urinary bladder in 5 (2%), vaginal in 3 (1%), and bone in 10 (4%). When all toxic events were considered, there was a highly significant correlation between the acute and late bowel reactions (p <0.001), but the acute and late urinary bladder reactions did not correlate (p = 0.64). The grade of acute toxicity was found to predict the grade of late toxicity for the bowel but not for the bladder (p <0.001 and p = 0.47, respectively). The severity of acute bowel and bladder toxicity did not correlate with the time to occurrence of late toxicity in these locations (p = 0.34 and p = 0.47, respectively). CONCLUSION: Patients with increased acute bowel toxicity during postoperative RT for endometrial cancer have an increased risk of late bowel injury. A higher grade of acute bowel complications correlated with more severe late events, but was not predictive for its latency time. These findings suggest the possibility of an early indication of patients with an increased risk of late toxicity in whom preventive measures might be attempted.

Adult↗
PubMed2002

Salvage hemipelvis radiotherapy with fertility preservation in an adolescent with recurrent vulvar carcinoma.

BACKGROUND: To preserve fertility, hemi-pelvis irradiation was chosen for locoregional groin recurrence of vulvar cancer in an adolescent. CASE: A case of squamous cell vulvar carcinoma in uncommonly young patient is presented. First surgical management (local excision of T1N0M0 tumor of the right labia minora) was performed at the age of 16.5 years. Further therapy included wide local resection of recurrent local lesion, two subsequent ipsilateral groin dissections of nodal metastases (with extranodal spread at the first instance), and ipsilateral pelvic lymphadenectomy. The patient was administered external beam irradiation of 45 Gy to the hemi-pelvis followed by 10.8 Gy boost to the right inguinal region. After 6.5 years from the completion of radiotherapy the patient is free of disease. She managed to conceive but the labor was premature and the infant died in its 7th week of life. CONCLUSION: In this case salvage hemi-pelvic irradiation for groin metastases of vulvar cancer has proved to be an effective treatment, allowing preservation of hormonal and obstetric functions. Partial post-irradiation damage of the uterus might have caused premature labor. Thus, special obstetric care is advisable in such situations.

Adult↗
PubMed2002

A phase II study of gemcitabine plus cisplatin in patients with advanced non-small cell lung cancer: clinical outcomes and quality of life.

The aim of the present phase II study was to assess the activity and safety of gemcitabine-cisplatin combination in advanced NSCLC, and to evaluate the impact of this regimen in terms of symptom benefit and quality of life (QOL). Eighty patients with pathologically confirmed advanced (stage IIIB and IV) NSCLC were enrolled into this study. Gemcitabine was administered on days 1, 8 and 15 at a dose of 1000 mg/m(2), and cisplatin was given on day 2 at a dose of 100 mg/m(2). The cycles were repeated every 4 weeks. The impact of treatment on QOL and on tumor-related symptoms was evaluated with the validated EORTC forms (QLQ-C30 and LC-13). The regimen was relatively well tolerated. Myelosuppresion was the principal toxicity. Grade 3/4 neutropenia, thrombocytopenia and anemia occurred in 58, 65 and 30% of patients respectively. In 143 cycles (35%) the administration of gemcitabine on day 15 was omitted due to myelosuppresion. Non-hematological toxicities were generally mild. Among the 76 patients available for response evaluation, there were 5 complete responses (7%) and 26 partial responses (34%); an overall response rate of 41%. The median duration of response was 8.0 months. The median survival for all 80 patients was 11.0 months and the actuarial 1-year survival probability 45%. During therapy global QOL improved in 22% of patients and particular functional domains increased in 19-37% of patients. Dyspnea was released in 36% of patients, fatigue in 45%, chest pain in 38%, shoulder pain in 27%, cough in 44%, and hemoptysis in 75%. The mean intensity scores of the last three symptoms decreased significantly with therapy. Our study confirmed relatively high efficacy of the gemcitabine-cisplatin combination in patients with advanced NSCLC. Of particular importance was that treatment with gemcitabine-cisplatin combination in a large proportion of patients was also associated with remarkable symptomatic release and with improvement of QOL. However, the high frequency of myelotoxicity-related gemcitabine omissions on day 15 of the cycle indicates that modification of the schedule should be considered in standard care.

Adenocarcinoma↗
PubMed2002

Combined chemotherapy and radiotherapy in inoperable non-small cell lung cancer.

Despite its low efficacy, radiotherapy has traditionally been considered the mainstay of treatment in inoperable stage III NSCLC. One of the attempts to improve the outcome is combining radiation with chemotherapy. This strategy is expected to increase the cure rate not only by improved locoregional tumor control but also by elimination of micrometastases outside the radiotherapy field. Chemotherapy and radiation may be applied in sequence or concurrently. The results of randomized studies testing these two strategies have been inconsistent, however a series of recent trials and the metaanalysis demonstrated a survival benefit of chemoradiation over radiotherapy alone. Recently, concurrent chemotherapy and radiation was found to be superior to sequential application but toxicity of the former is higher. The value of new agents (taxanes, vinorelbine, gemcitabine and topoisomerase inhibitors) in combined modality therapy of NSCLC seems to be promising, but warrants further clinical evaluation.

Carcinoma, Non-Small-Cell Lung↗
PubMed2002

Cancer clinical trials in Central and Eastern Europe: historical review.

Prospective clinical trials on cancer started in Central and Eastern Europe in the early 70s under the auspices of the Council of Mutual Economic Assistance (CMEA). The objective of the CMEA Chemotherapy Group was to conduct prospective phase III studies with particular focus on drugs developed in the member countries. The main organizational problems were insufficient contact with the Trial Center and the excessive formalism of the cooperation. In the mid-80s most of the clinical research was taken over by the new structure: the South and East European Oncology Group (SEEOG), later renamed the Central and East European Oncology Group (CEEOG). CEEOG is a drug-oriented group consisting currently of over 30 institutions from eight countries. Its major interests have included breast cancer, ovarian cancer, lung cancer and head and neck cancer. Most of the studies have been phase II trials carried out in cooperation with various international companies. Most recently another regional cooperative group has been created: the Central European Cooperative Oncology Group (CECOG), whose main objectives are to conduct phase III studies on new chemotherapy combinations.

Clinical Trials as Topic↗
PubMed2002

Chemoradiotherapy of non-small cell lung cancer.

The efficacy of radiotherapy in locally advanced unresectable non-small cell lung cancer is low. This method does not provide effective eradication of bulky disease in the thorax, neither does it prevent uncontrolled systemic disease. The addition of chemotherapy to radiation results in increased cure rate by both improving tumor control in the thorax and by eliminating or delaying the emergence of metastatic disease. The two most frequently tested strategies of combining chemotherapy and radiation include primary chemotherapy followed by radiation and concurrent application of both methods. This review provides the rationale for this strategy and presents the results of major Phase III studies. Discussed are advantages of chemoradiation, its limitations in clinical practice and prospects for the future.

Antineoplastic Agents↗
PubMed2002

[P53 and P16 gene mutations in non-small cell lung cancer].

The aim of this study was to assess prospectively the occurrence of p53 and p16 mutations (considered separately and together) in NSCLC in terms of their clinical and prognostic relevance. Study group included 87 patients who underwent pulmonary resection for cure. p53 and p16 mutations were found in 22 (25%) and 14 (16%) cases, respectively. In eight patients (9%) both mutations were present, and the tendency for their common occurrence was significant (p = 0.02). There was no relation between mutation and clinical characteristics. Median survival in the entire group was 17 months and the 3-year survival probability--41%. There was no correlation between the occurrence of any mutation (considered separately or together) and survival. These results indicate that p53 and p16 gene mutations tend to occur together in NSCLC, however these alterations seem not to have noteworthy clinical and prognostic significance.

Adult↗
PubMed2002

[Serum anti-P53 antibodies (AB-anti-P53) in patients with advanced non-small cell lung cancer (NSCLC)].

The aim of the study was to assess the frequency of serum Ab-anti-p53 in 39 patients with advanced NSCLC and to evaluate the predictive value of the test. Antibodies were present in 10 (25.6%) of patients. There was no correlation between Ab-anti-p53 and clinical characteristics including age, gender, and histological type of tumor. In 17 patients response to chemotherapy (CT) was obtained (in one patient--complete, and in 16--partial response). The percentage of patients responding to CT in group with and without serum antibodies did not differ significantly (33% and 48%, respectively; p = 0.48). The results of the study indicate that serum Ab-anti-p53 are relatively often present in advanced NSCLC patients, however the clinical value of this test needs further evaluation.

Adult↗
PubMedDate not supplied

Loss of heterozygosity at chromosomes 3p and 17p in primary non-small cell lung cancer.

BACKGROUND: Loss of heterozygosity (LOH) of selected regions at chromosomes 3p and 17p in non-small cell lung cancer (NSCLC) and the association of these abnormalities with major clinical parameters and prognosis were studied. MATERIALS AND METHODS: The study group included 92 consecutive primary NSCLC tumours and four microsatellite markers from chromosome 3p and three markers from 17p were analyzed. RESULTS: LOH of at least one locus was found in 83% of all analyzed tumours. Most frequently deletion (58%) was found at locus D3S1481 (3p14.2). Sequence deletions of D17S520 (17p12) and TP53 (17p13.1) occurred in 52% of tumours. LOH occurrence at 3p and 17p was more frequent in squamous cell carcinomas compared to adenocarcinomas (89% vs. 75%), but this difference was not significant. CONCLUSION: No significant association was found between LOH on any analyzed loci and tumour stage (TNM) and grade (G). There was no correlation between LOH and survival.

Carcinoma, Non-Small-Cell Lung↗