Biomedical subjects

L Petruzelka

Publications and source records attributed to L Petruzelka.

36 records · Page 2Linked to original sources

PubMed2001

[Tamoxifen or tamoxifen in combination with chemotherapy in adjuvant therapy of breast carcinoma. Results of a multicenter randomized study].

UNLABELLED: Between April 1994 and May 1997 103 breast cancer patients (pts), pT1c-3a, pN0-1, M0, were randomised after surgery to adjuvant tamoxifen (20 mg per day) or to tamoxifen plus CMF (C 500 mg/m2, M 40 mg/m2 and F 600 mg/m2 on days 1st and 8th q 28 day) in 6 cycles. The median age (49-72 years, median 58), tumour size, number of involved lymphnodes (0-3), estrogens receptor status, grade (I-III) and type of operation were well balanced among the 50 pts on tamoxifen and the 53 pts on tamoxifen plus CMF pts, preferably postmenopausal. RESULTS: Grade of toxicity according to WHO criteria was not higher then two in both arms. Toxicity both haematological and non-haematological was higher in the group treated with chemotherapy (0 vs 32 resp. 20%) except weight gain (52% in both group). After median follow-up of 42 mos five recurrences in tamoxifen and seven in tamoxifen plus CMF pts were observed (p = NS). The projected 3-y DFS is 92% for tamoxifen and 88% for tamoxifen plus CMF (p = NS). The 3-y OS is 88% for tamoxifen and 80% for tamoxifen plus CMF pts (p = NS). CONCLUSIONS: Both regimens are equally effective with higher toxicity in the group with combined chemo- and hormonal therapy.

Aged↗

PubMed2001

[Diagnosis and treatment of tumor metastases].

More than half the patients with malignat tumours have at the time of diagnosis already remote metastases or they develop remote dissemination after different intervals following termination of local treatment. Organ complications in case of metastatic dissemination are for the majority of patients the most life threatening condition. In therapeutic decisions the approach to some solid tumours is the same as in systemic diseases. The possibility to achieve a long-term therapeutic effect during conventional systemic therapy are limited in metastatizing solid tumours of adult age. Assessment of the extent of the disease incl. detection of metastatic dissemination is of decisive importance for the selection of therapeutic strategy. Imaging methods such as computed tomography, ultrasonography and nuclear magnetic resonance provide basic structural anatomic information. The limitating factor is obtaining functional information on tumor tissues and the possibility to differentiate the residual disease from non-viable or necrotic tumor masses. These data can be provided by radiopharmacological imaging methods such as positron emission tomography. Introduction of new imaging methods is becoming increasingly important when new therapeutic methods are used where the effect of the therapeutic result does not mean necessarily reduction of the tumour volume. Research of the metastatic process involved revolutionary changese lucidating individual stages linked in a cascade pattern. The metastatic potential of human tumours correlates with the expression of a number of genes regulating tumour growth (EGF - epidermal growth factor, IGF - insulin like growth factor) motility of tumour cells (AMF - autocrine motility factor) the process of angiogenesis (VEGF vascular endothelial growth factor, bFGF - basal fibroblastic growth factor, interleukin-8) and the invasiveness (genes for the matrix of metalloproteinase MMP-2/MMP-9). Expression of the surface glycoporotein E-cadherin which influences the cohesiveness of cells is in an inverse relationship with the invasiveness and metastatic potential. Identification of the appropriate genes in a heterogeneous tumour population calls for multiparametric, multivariation analysis of gene expression. Understanding of this complex problem opened new possibilities of therapeutic action and improved curability of neoplastic diseases in all stages of the disease. Gradual more detailed understanding of individual stages of a multigrade process of metastatizing helped to reveal new potential target structures for treatment. In the process of angiogenesis these are metalloproteinases, angiogenic growth factors, endothelial cells and vascular structures of tumours. Practical use for therapeutic purposes will develop on the basis of results of clinical studies which are underway.

Humans↗

PubMed2000

[Malignant mucosal melanoma of the head and neck].

Mucosal melanoma comparison to cutaneous melanoma of the head and neck are rare and do poorly. Approximately 0.5-2% of all melanomas occur from the mucous membranes of aerodigestive tract. Most common site of the tumor are the nasal cavity and paranasal sinuses but melanoma of the oral cavity are described too. Therapy usually consists of surgical resection with or without postoperative radiotherapy and immunochemotherapy eventually. The definite role of a kind of therapy in the treatment of mucosal melanoma is not remains to be defined as the small number of cases make prospective study challenging. This article reviews 19 patients with mucosal melanoma of the head and neck treated at the Department of ENT and Head and Neck Surgery Charles University of Prague since 1980 to 1999. Clinical data were obtained from the patient's charts. Analysis of the metastatic disease, type of therapy and follow-up was retrospectively reviewed. The site of the tumor was the lateral wall of the nasal cavity (five cases), nasal septum (four cases), maxilar cavity (two cases), and ethmoidal cavity, orbitoethmoidal complex, nasopharynx, saccus lacrimalis to ethmoidal sinuses diffused, tonsilla (one case each) and hypopharynx (two cases). Primary treatment was surgical resection in ten cases, in one case with radiation therapy, and in seven cases chemotherapy. In three cases were diagnostic surgery only and one patient was without therapy. Three patients received radical neck dissection more. Four patients were treated radiation therapy and three chemotherapy after surgery. In two cases were surgery after primary radiotherapy. For nine cases of recurrence of the disease were surgery (in five cases) and chemotherapy (in four cases). Overal and disease free interval was from 2 to 22 month, approximately 9.3 month and 3-year survival was 41.18%.

Adult↗

PubMed1998

[Treatment of febrile neutropenia in patients with solid tumors].

BACKGROUND: Febrile neutropenia (FN) is one of the most serious complications of anti-tumourous treatment calling for early diagnosis and intensive treatment. The objective of the trial was to recommend a standard procedure for the treatment of febrile neutropenia at their Oncological Clinic, based on analyses of attacks of febrile neutropenia and the current microbial situation. METHODS AND RESULTS: In 1995-1997 in 30 patients (24 women, 6 men) 39 attacks of febrile neutropenia were treated. The age distribution of patients was within the range of 20-68 years, the mean age being 50 years. In the group patients with breast cancer predominated (14), soft tissue sarcomas (4), colorectal carcinoma (3), other diagnoses participated with 9 episodes. The analysis of the microbial situation was based on cultivation findings made in patients with attacks of FN. For empirical treatment of FN the authors use at combined treatment piperacillin-gentamicin or sultamicillin-cefpodoxim/or ciprofloxacin. If empirical treatment fails, therapy is based on the results of cultivation and the patient's clinical condition. Growth factors are indicated for treatment only in FN complicated by mycotic infection, inflammatory pulmonary infiltrates or cardiopulmonary failure. CONCLUSIONS: The standard procedure in the treatment of FN should be broad spectrum bactericidial antibiotics. The use of growth factors is reserved for complicated episodes of FN.

Adult↗

PubMed1998

Gemcitabine in locally advanced and metastatic non-small cell lung cancer: the Central European phase II study.

The efficacy and toxicity profile of gemcitabine was evaluated in this phase II study of chemonaive patients with locally advanced and metastatic non-small cell lung cancer (NSCLC). Eighty patients (62 males, 18 females) were entered into this study. The disease stage was IIIA in ten patients, IIIB in 32, and IV in 38 patients. The median age was 61 (range 41 - 78). Karnofsky performance status was > or = 80 in 88% of patients. All patients were chemonaive, but five patients had received prior radiotherapy and 34 patients had undergone prior surgery. Gemcitabine 1250 mg/m2 was given as a 30-min intravenous infusion on days 1, 8, and 15 of a 28-day cycle. Patients received up to nine cycles (median three cycles). Of 872 doses 815 (93%) were administered without dose delay or modification. Of the 80 patients enrolled, 76 were evaluable for efficacy analysis, and 16 patients had a partial response for an overall response rate of 21.1% (95% CI, 11.9-30.3%). A further 47 patients (61.8%) had stable disease. Partial responses were seen in eight of 41 stage III patients (19.5%) and in eight of 35 stage IV patients (22.9%). The median time to progressive disease was 4.6 months. Median survival for all 80 patients was 7.1 months. Haematological toxicity was mild with grade 3 4 neutropenia in 6.3% of patients, grade 3 thrombocytopenia in 3.8% of patients, and grade 3 anaemia in 2.5% of patients. Grade 3 non-laboratory toxicity was: somnolence (1.3% of patients), infection (1.3%), nausea and vomiting (6.4%) and dyspnoea (5.1%). This study confirms that single-agent gemcitabine is active in advanced NSCLC and its well-tolerated safety profile makes it particularly suited to outpatient use.

Adenocarcinoma↗

PubMed1998

[Comparison of adjuvant chemotherapy in breast carcinoma with a combination of cyclophosphamide, methotrexate, 5-fluorouracil (CMF) and AC (doxorubicin, cyclophosphamide). Initial results of a national cooperative study].

The aim of this multicentric, prospective randomized trial is to evaluate and to compare, effects and toxicities of two chemotherapeutic combinations (AC and CMF) in adjuvant treatment of breast cancer. Both combinations were given in equitoxic doses and number of cycles was only four. There are 106 women treated for breast cancer T1c-3a, N0-1, M0 in the study. After surgery the patients were randomized, 54 for AC combination and 52 for CMF. We evaluate toxicity of this treatment in all patients in the study. Hematological and nonhematological side effects were comparable in both groups except alopecia (in the group AC was 100%). The study is not finished yet. Preliminary analysis does not show any difference between these two groups.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1996

[Recombinant erythropoietin (r-HuEPO) in the treatment of anemia in multiple myeloma].

BACKGROUND: Anemia is common complication in multiple myeloma (MM). Its etiology is multifactorial-bone marrow infiltration, cytokines production, renal failure and effect of chemotherapy are main contributing factors. The red cell substitution therapy, which is administrated in 34 - 53% of patients, is frequently associated with the risk of well-known side effects. The use of recombinant erythropoietin (r-HuEPO) is a novel therapy in patients with MM. METHODS AND RESULTS: We have investigated the effect of r-HuEPO (Eprex. Cilag) in the group of 8 patients with MM. The growth factor was administrated in the dose of 150 U/kg. 3 times/ week s.c. The criterium of response was the increase of Hb levels of 20 g/L. All patients responded to r-HuEPO treatment. The medium period of response was 6,5 weeks. In two patients the doses of r-HuEPO could be reduced due to excellent effect of therapy. The energy level, ability to daily activities and overall quality of life significantly improved during the course of therapy. Neither effect of growth factor on thrombopoiesis and/or leukopoiesis nor serious adverse events due to r-HuEPO therapy were observed. The activity of underlying disease did not seem to be affected by r-HuEPO. In one patient the disease rapidly progressed after the end of study. The progression had some features of plasmablastic leukemia and leads to the death of patient. CONCLUSIONS: According to our experience, r-HuEPO is highly effective in the treatment of anemia in MM. The stimulation of erythropoiesis was associated with significant improvement of quality of life of patients. The effect of r-HuEPO treatment on activity of MM was not found, however, in one patient rapid progression of disease was observed after the end of study.

Aged↗

PubMed1996

Oral ifosfamide/mesna versus intravenous ifosfamide/mesna in non-small-cell lung cancer: a randomized phase II trial of the EORTC lung cancer cooperative group.

BACKGROUND: Chronic oral administration of anticancer drugs may offer therapeutic advantages. PATIENTS AND METHODS: A total of 68 patients with advanced non-small-cell lung cancer, not previously treated by chemotherapy, were randomized to receive either ifosfamide given orally (OSI) at a dose of 1 g/day for 14 days every 4 weeks, or as a 1-hour intravenous infusion (IVI) at a dose of 1.6 g/m2/day for 5 days every 4 weeks. According to the route of ifosfamide administration, patients received either mesna i.v. or mesna film-coated tablets for uroprotection. RESULTS: Eight patients were found to be ineligible for the study and therefore excluded for all analyses. Thirty-three patients received IVI, and 27 patients OSI. One patient randomized to OSI died before treatment was initiated, leaving 59 patients fully evaluable for toxicity. Hematological toxicity was less severe for patients on OSI, but CNS toxicity was reported more frequently on OSI (39%; 12% grade III/IV), than on IVI (15%; 9% grade III/IV), which caused the premature close of the study. Other non-hematological adverse events were of modest clinical significance and comparable in both arms. Forty-nine patients were considered evaluable for response: in the IVI arm, 5 (17%) of the 29 evaluable patients obtained a partial remission, and 7 patients a no change (24%). In the OSI arm, 2 (10%) of the 20 evaluable patients obtained a partial remission, and 11 (52%) a stable disease. CONCLUSIONS: Both arms have some activity in non-small-cell lung cancer; while OSI was less myelosuppressive than IVI, it was associated with a higher incidence of CNS toxicity. Oral administration of ifosfamide, in the schedule and daily dose tested here cannot be recommended.

Administration, Oral↗

PubMed1996

[Recombinant human erythropoietin in the treatment of anemia associated with lymphoproliferative diseases--chronic lymphadenosis and multiple myeloma].

UNLABELLED: The etiology of anaemia associated with tumours is multifactorial. One of the mechanisms of development of anaemia in tumours are so-called chronic diseases anaemias, the main feature of which is inadequate production of endogenous erythropoietin (EPO). The objective of the investigation was to test the effect of recombinant human erythropoietin (rHuEPO) in the treatment of anaemia (rise of haematocrit, Hb) in patients with chronic lymphatic leukaemia (CLL) and multiple myeloma (MM) and the effect of this treatment on the quality of life. The authors evaluated at the same time the impact of the endogenous EPO level before treatment and its predictive value as regards the therapeutic response. PATIENTS: The investigation comprised a total of 14 patients (6 CLL, 8 MM). The basic criterion for inclusion in the group was a Ht value lower than 0.32 and Hb less than 105 g/l. The examination protocol was focused on elimination of other causes of anaemia. During the 12-week investigation the patients completed a questionnaire "Quality of life" which reflected their subjective evaluation of the effect of treatment. The patients themselves administered r-HuEPO three times a week by the s.c. route--an initial dose of 150 U/kg with the possibility to increase the dose to 300 U/kg. RESULTS: A therapeutic response was obtained in four patients with CLL and eight patients with MM. Respondents with CLL had endogenous EPO values lower than 300 U/l, seven MM respondents lower than 200 U/l, one 400 U/l. The Hb level of the patients rose and the quality of life improved. All patients tolerated treatment very well and the authors did not observe any serious undesirable effects. CONCLUSION: The investigation confirmed the therapeutic effect of r-HuEPO in patients with a lower baseline value of EPO. Subjective evaluation (questionnaire) correlated with objective evaluation (Ht, Hb). Assessment of the endogenous EPO level before treatment is according to the authors one of the important primary predictive parameters and EPO values between 200 and 300 U/l are the upper range where a therapeutic effect can be expected with the highest probability. The authors conclude also that a secondary predictive criterion of the response is evaluation of the therapeutic effect after 4-5 weeks treatment when a rise of Hb by at least 20 g/l is an argument for further treatment.

Aged↗

PubMed1996

[Palliative radiotherapy in patients with advanced non-small cell bronchogenic carcinoma].

The efficacy of palliative radiotherapy of NSCLC was evaluated. 70 patients with histologically and cytologically confirmed advanced NSCLC were palliativelly irradiated in Department of Oncology I. Medical Faculty Charles University, Prague, in the period 1/93-12/94. 46 patients were evaluable for response (32 men, 14 women, median age 66.1, range 46-82). Median survival was 24.5 weeks. The most frequent intrathoracal symptoms were: cough 54%, chest pain 41%, dyspnoe 54%, hemoptysis 13%, VCS sy 7%. Palliation of the main symptoms has been achieved in 68% for cough, in 83% for hemoptysis, in 89% for chest pain, in 60% for dyspnoe and in 100% for VCS sy (in combination with chemotherapy). The median duration of palliation was 14.7 weeks for all the main symptoms, e.g. more than 50% of overall survival. Two fractionations schedules for the chest radiotherapy were used: 30 Gy/10 fr/2 wks (67%) or short regimens 8-20 Gy/1-2 fr/1-2 wks (33%). The results of palliation and survival are similar for both treatment schedules. Side effects has been infrequent, only 6 patients (13%) had dysphagia during the treatment. Radiation myelopathy has been not observed in any case. The therapeutical effect has been achieved in the more than 80% cases of pain, hemoptysis and VCS syndrome.

Aged↗

PubMed1991

[Prognostic factors in non-Hodgkin's malignant lymphoma].

A group of 271 patients with non-Hodgkin's malignant lymphomas from years 1975-1989 was tested using multivariant statistical analysis, from the point of view of the prognostic value their basic clinical and laboratory data. In the group of low grade malignancy lymphomas, the following factors showed a prognostic validity: clinical stage, general status, centrocytic histological subtype, and anaemia. In the group of high grade malignant lymphomas following one were set as prognostically important: general status, clinical stage and age. In particular histological subtypes of low grade malignancy statistically valid difference of survival was not proved, the centrocytic type excluded. However, the difference was found between these types and particular subtypes of high malignancy grade. Based on these results, the Cox's risk model was made, enabling us to define 4 risk groups according to the histological subtype and clinical stage: group A (risk less than 0.5), group B (risk = 0.5-1.0), group C (risk = 1.0-2.0), group D (risk greater than 2.0).

Female↗

PubMed1987