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Biomedical subjects

K W Brunner

Publications and source records attributed to K W Brunner.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Immunoscintigraphy with 99mTc marked melanoma antibody in patients with malignant melanoma].

In 38 patients with malignant melanoma 44 radioimmunoscintigraphies (RIS) with 99mTc labeled F(ab')2 fragments of an anti-melanoma monoclonal antibody (225.28S, Tecnemab-K, Sorin Biomedica) have been performed. No side effects have been observed even in the patients with repeated RIS. Overall 81% (35/43) of all lesions were detected by imaging and 9 lesions have been previously unknown. Sensitivity and specificity was highest for lymphnode metastases with 100% each. Poor imaging was observed in lung and mediastinal metastases (2/7) as well as small skin metastases. RIS has to be studied for its clinical value in staging of lymphnode metastases preoperatively in patients undergoing regional lymphnode dissection.

Antibodies, Monoclonal↗
PubMed1988

[Loco-regional recurrence following surgery of breast carcinoma: prognostic factors and therapeutic consequences].

The course following local relapse after mastectomy was studied prospectively in 225 women. Factors significantly influencing the further course were determined. On the whole the prognosis was relatively good, with a projected 5-year relapse-free survival of 47%, a median time interval of 53 months until development of distant metastases, and an estimated death rate of 41% after 5 years. The most important factor influencing the incidence and time interval until appearance of distant metastases is the axillary lymph node status at the time of mastectomy. N0 patients have a much better prognosis than N+ patients in univariate as well as multivariate analysis. Other factors in univariate analysis which play a role in either the incidence of distant metastases or overall survival include estrogen receptor content, site of the local relapse (skin or regional lymph nodes), time interval between mastectomy and the occurrence of the local relapse, and number of tumor nodules in the local relapse. In multivariate analysis virtually the only really independent prognostic factors are primarily the initial axillary lymph node status for survival free of distant metastases and the time interval from mastectomy to local relapse for overall survival.

Breast Neoplasms↗
PubMed1988

Treatment of advanced ovarian cancer with surgery, chemotherapy, and consolidation of response by whole-abdominal radiotherapy.

Between April 1981 and June 1985, 195 patients with ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) Stages IIB, IIC, III, and IV, entered a trial that consisted of surgery and chemotherapy with cisplatin (P) and melphalan (PAM) with or without hexamethylmelamine (HexaPAMP or PAMP regimens) every 4 weeks for 6 cycles. Because the intent was to study the outcome by treatment after evaluation of first-line chemotherapy, patients were evaluable only if the response was assessed by a second-look operation or if measurable disease progression was documented. One hundred fifty-eight patients (81%) were evaluable for response. Forty-five (28%) achieved pathologically confirmed complete remissions (pCR), and 24 of these patients received whole-abdominal radiation (WAR) for consolidation of response. Five patients with complete remission after WAR relapsed, as did nine of the 21 with complete remission who had not undergone WAR. The 3-year time to progression percentage (TTP +/- SE) from second-look operation was 70% +/- 7% for all patients who achieved pCR, 83% +/- 8% for those who received WAR, and 49% +/- 15% for those who did not receive WAR (this was not a randomized comparison). The 3-year TTP percentage for the 49 partial responders was 21% +/- 6%, identical for the 19 who had WAR and the 30 who had no radiation therapy. Additional or alternative methods for consolidation of pCR are needed since patients continue to relapse despite optimal initial response to therapy.

Abdomen↗
PubMed1988

Unexpected high toxicity in a phase II study of teniposide (VM-26) in elderly patients with untreated small cell lung cancer (SCLC).

Teniposide (VM 26) as a single agent has shown promising results in the treatment of patients with small cell lung cancer. We treated 32 (30 evaluable) non-pretreated elderly and poor prognosis patients with small cell lung cancer with teniposide 100 mg/day (30 min infusion) days 1-5, every 3-4 weeks. Overall initial performance status was poor (WHO 2 or 3 in 62%). Extensive disease (ED) was documented in 50% including five patients with CNS metastases all of whom received simultaneous cranial irradiation. There was an unexpected high early death rate of 30% (9/30) including five patients with early toxic death due to severe bone marrow suppression leading to fatal septicaemia. The overall response rate was only 33% with no complete response. Where appropriate non-responding or relapsing patients received second line treatment with multidrug regimens +/- radiotherapy. The overall median survival was 5.6 months [ED: 1.7, limited disease (LD): 7.5 months]. Median response duration was 5.4 months (ED: 5.1, LD: 6.7 months). For responding patients median survival was 8.8 months (ED) and 11.5 months (LD). We conclude that in elderly and poor performance status patients single agent teniposide as used in this study has an unacceptable high early death rate and that the response rate is inferior to modern standard multidrug regimens.

Aged↗
PubMed1987

Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer.

Between 1979 and 1984, 195 evaluable patients were entered in an international multicenter study comparing two regimens for patients with completely resected pathological Stage II testicular cancer (that is, with positive retroperitoneal lymph nodes). All patients had undergone orchiectomy and dissection of the retroperitoneal lymph nodes. They were randomly assigned to be treated with two cycles of immediate adjuvant cisplatin-based chemotherapy or to be observed monthly with treatment at relapse. The median follow-up period was four years. Of the 97 patients assigned to adjuvant chemotherapy, 6 (6 percent) had a recurrence; however, only 1 had received adjuvant chemotherapy before the recurrence. Three died (one of testicular cancer), and 94 of the 97 survived. Of the 98 patients who were observed, 48 (49 percent) had a relapse. However, almost all patients with relapses were effectively treated, and 93 of the 98 are alive and disease-free; 3 have died of testicular cancer. No identifiable factors were strongly associated with the risk of relapse. We conclude that two courses of cisplatin-based adjuvant chemotherapy will almost always prevent relapse in pathological Stage II testicular cancer treated with orchiectomy and retroperitoneal-lymph-node dissection. However, when surgery, follow-up, and chemotherapy are optimal, observation with chemotherapy only for relapse will lead to equivalent cure rates.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

[Hodgkin's disease in a Swiss family].

Hodgkin's disease was found in five members of the same generation in a large Swiss family. At presentation, the patients were between 20 and 30 years old. The histological diagnosis was confirmed in three patients. In one woman the differential diagnosis of histiocytic non-Hodgkin's lymphoma was considered. The patient history did not provide any conclusive evidence for environmental factors shared by all patients. Three siblings had grown up in the same household. They had never been in contact with the other pair of affected sisters. No clustering of cases in time occurred, as individual cases were diagnosed at least two years apart. Antibodies against Epstein-Barr viral capsid antigen were found in four patients (IgG: 1:10 to 1:160). There was no single HLA-haplotype common to all patients. However, two affected sisters were HLA-identical (paternal haplotype: Aw24(9), Bw62(15), DRw6; and maternal haplotype: A2, B7, DR2). Their brother with Hodgkin's disease was homozygous for A-, B- and DR-antigens. He shared all these antigens with his two affected sisters (A2, Bw62(15), DR2). A genetic predisposition in combination with environmental factors, in particular subclinical Epstein-Barr virus infection, may have been responsible for the development of Hodgkin's disease in this family.

Adult↗
PubMed1987

[Palliative tumor chemotherapy and quality of life: what is optimal?].

In antitumor chemotherapy the combinations of drugs, dose and schedule are determined by the basic aims of the anticancer treatment. This also applies to the severity of side effects: their acceptability is different for different treatment aims. Where cancer chemotherapy is potentially curative, more side effects and transient reversible impairment of the quality of life must be accepted in comparison to tumor stages where treatment is purely palliative. The final aim of any palliative anticancer therapy must be to improve the quality of remaining life. An increased lifespan of poor quality is undesirable. These important criteria must be the guidelines in designing any palliative anticancer treatment. The criteria are different for different tumors, and within the same tumor for different risk groups. All these factors must be considered in selecting palliative chemotherapy. Examples of risk-adapted palliative chemotherapy are presented for three of the most frequent malignant tumors and their subgroups. For many tumors and their metastatic subgroups the criteria for optimal combinations of drugs, their dose, schedule and duration are being progressively refined. If this knowledge is applied properly in each case this should minimize the danger of unnecessary or even pointless impairment of life quality in the management of cancer patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Complete remission following endocrine or combined cytotoxic and hormonal treatment in advanced breast cancer. A retrospective analysis.

Among 422 patients with advanced breast cancer treated in a randomized trial we observed 60 complete responses (CR). Sixteen were achieved among 206 patients treated with endocrine therapy alone and 37 among 216 patients treated with concomitant chemotherapy and endocrine therapy. The incidence of CR in women treated with the concomitant modality was higher in those with dominant soft tissue disease, intermediate in those with osseous or pulmonary involvement, and low in patients with liver metastases. Bone was shown to be the organ most responsive to therapy among patients treated with hormonotherapy, while patients with soft tissue metastases had an unexpectedly low rate of complete remission with this modality. The probability of achieving a CR was inversely proportional to the tumor burden in the patients treated with concomitant chemotherapy and endocrine therapy. For complete responders on hormone treatment alone and for those on combined endocrine and cytotoxic therapy, both median time to progression (26 and 29 months, respectively) and survival (52 and 53 months, respectively) were similar and statistically significantly longer than in partial or minor responders. This observation leads us to the conclusion that the hormonal component is the determinant for the length of a CR.

Actuarial Analysis↗