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Biomedical subjects

P Valagussa

Publications and source records attributed to P Valagussa.

At least 145 records · Page 8Linked to original sources
PubMed1985

Prognosis of bulky Hodgkin's disease treated with chemotherapy alone or combined with radiotherapy.

The medical records of 396 consecutive patients with a histological diagnosis of Hodgkin's disease were reviewed to assess the prognostic importance of bulky and non-bulky lymphomas. The presence of large lymphadenopathy failed to affect significantly the seven-year results in terms of complete remission (bulky 81.1% v. non-bulky 86.2%), freedom from progression (60.7% v. 65.6%), relapse-free survival (75.1% v. 76.5%) and overall survival (62.7% v. 68.9%). It is noteworthy that in all subsets, ABVD (Adriamycin + bleomycin + vinblastine + dacarbazine), either combined with irradiation or alternated with MOPP (mechlorethamine + vincristine + procarbazine + prednisone), yielded superior results compared with MOPP with or without irradiation. Given the prognostic importance of various bulky sites, the presence of large lymphadenopathy in anatomic regions other than the mediastinum failed to affect results adversely. On the contrary, in patients in stages IIB-IIIA-IIIB, treated with combined modality, the presence of bulky mediastinal involvement did influence prognosis compared with patients with positive but non-bulky mediastinum. At seven years the results were 60.2% v. 79.9% for freedom from progression, 73.2% v. 89.9% for relapse-free survival and 64.8% v. 87.1% for total survival, respectively (P less than 0.03). By contrast, in patients with stage IV disease the extent of mediastinal involvement did not affect results. Nonetheless, the frequency of intrathoracic relapses was higher (26.7%) in patients given chemotherapy alone compared with patients treated with combined modality (11.5%).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Third-line salvage chemotherapy in Hodgkin's disease.

CEP (CCNU, etoposide, and prednimustine) was tested as third-line chemotherapy in 40 patients resistant to both MOPP and ABVD. The observed response rate (complete remission, 35%, and partial remission, 25%) is encouraging. Treatment was generally well tolerated and all acute side effects were reversible.

Adolescent↗
PubMed1984

A clinicopathologic study in advanced non-Hodgkin's lymphomas treated with sequential non-cross-resistant regimens: comparison of the working formulation with the Rappaport and Kiel classifications.

One-hundred and ninety-four adult patients with histologically proven stage III and IV non-Hodgkin's lymphomas, treated with CVP (cyclophosphamide, vincristine and prednisone) alternated with ABP (adriamycin, bleomycin and prednisone), were analyzed to test the validity of the clinicoprognostic correlation offered by the working formulation in comparison with the Rappaport and Kiel classifications. Actuarial overall survival at 5 yr showed a significant difference among the three prognostic subgroups of the working formulation (low grade, 53.3%; intermediate grade, 47.5%; high grade, 27.7%). Overall survival of favorable subgroups of the Rappaport and Kiel classifications was superior to that of unfavorable prognostic groups. The percentage of systemic symptoms and bulky disease increased in patients with low-grade compared to those with intermediate-grade and intermediate-to-high-grade malignancy. The achievement of complete remission was not related to any of the prognostic groups of the Working Formulation, and no difference could be detected within the various prognostic groups of the Rappaport and Kiel classifications. Within the diffuse histiocytic lymphomas of the Rappaport classification, two groups with a different prognostic outcome were evidenced by the working formulation (G, with an overall survival of 50%, and H, with an overall survival of 26.7% at 5 yr) and by the Kiel classification. The possibility of reporting results in the three different groups of the working formulation instead of two can be considered a step forward. Within the diffuse histiocytic histology, the working formulation allows separation, as does the Kiel classification, into two main different prognostic subgroups.

Adolescent↗
PubMed1983

Non-Hodgkin's lymphomas of Waldeyer's ring.

From 1970 to 1980, 171 consecutive cases with non-Hodgkin's lymphomas (NHL) of Waldeyer's ring were admitted to this Institute. The cases were reviewed to evaluate whether involvement of Waldeyer's ring might represent a distinct clinicopathologic entity. Adequate pathologic staging was performed in 86% of cases. All slides were reviewed, and the histologic diagnosis given according to the Rappaport classification, the Kiel classification, and the recent Working Formulation of NHL for Clinical Usage. Waldeyer's ring alone was involved in 12.3% of the cases at presentation; regional nodes were positive in one-third (35.7%), and distant involvement was detected in half of the patients (52%). The tonsils represented the most frequent site of involvement by NHL within Waldeyer's ring. Treatments employed were heterogeneous, but most of the patients with stage I-II received radiotherapy alone. The present series shows that the association of involvement of Waldeyer's ring and the stomach by NHL occurs in less than 10% of the cases. Treatment results and patterns of recurrence fail to differentiate NHL involving Waldeyer's ring from those of other sites. Prognosis remains related to the classical variables and is independent of the site of onset.

Humans↗
PubMed1983

Clinical staging and therapeutic results in multiple myeloma.

The validity of the Durie and Salmon's clinical staging system for multiple myeloma has been tested in 81 consecutive patients studied at the Istituto Nazionale Tumori of Milan from January 1970 to June 1982. Median survival from diagnosis was 48 months for stage I, 41 months for stage II and 23 months for stage III (P = 0.02). Median survival of patients with normal renal function (A) was 35 months and of those with abnormal kidney function (B) 7 months. Almost all early deaths were observed in patients with stage III disease associated with renal failure. No statistically significant difference was found in the median survival in patients with kappa and those with lambda light chains. The analysis of survival according to the three main combinations of chemotherapy used in this study (melphalan-prednisone vs melphalan-procarbazine-prednisone vs adriamycin-prednisone) could not disclose any significant difference. Prognosis was, however, closely related to the response to combination chemotherapy: median survival was 72 months in responders, 36 months in patients with improvement and 25 months in non-responders (P less than 0.01). A lower incidence of response was obtained in patients with stage III myeloma compared to patients with stage I-II. The myeloma staging system used in this study is simple to employ and allows identification of truly comparable patient groups in the evaluation of therapeutic results. Our therapeutic results confirm the effectiveness of melphalan plus prednisone and fail to demonstrate any advantage in the administration of adriamycin as first-line therapy.

Adult↗
PubMed1983

Chemotherapy of breast cancer: current views and results.

The paper critically reviews major accomplishments achieved with the use of chemotherapy in the treatment of various stages of breast cancer. In spite of innumerable clinical trials, there is no evidence that in advanced breast cancer the addition of more drugs, either in concomitant, sequential or alternating fashion, to known effective combinations, was able to significantly improve the incidence and the magnitude of objective response or its median duration or survival. The addition of endocrine therapy to chemotherapy has failed so far to improve the most important end-point, i.e. total survival. Second-line chemotherapy is only moderately effective for a fairly short period of time. Thus, in women with advanced breast cancer excessive tumor cell burden and permanent drug resistance remain the major obstacles to obtaining complete remission and long-term disease free survival. In the adjuvant setting, the initial trials with combination chemotherapy have achieved consistent results, particularly in women with minimal axillary node involvement. Unless a woman has undergone a surgical breast-saving procedure, postoperative radiotherapy does not appear to play an important therapeutic role, either with or without concomitant or sequential chemotherapy. Present results would suggest that in advanced breast cancer little progress can be expected in the near future. Therefore, medical oncologists should focus on the correct application of established drug regimens, using a sequential flow of hormonal manipulations and cytotoxic chemotherapy. In high-risk groups, full dose adjuvant polydrug therapy given for a relatively short period of time appears to be at present the only means able to significantly decrease the failure rate following local regional treatment. Present consistent achievements, which appear devoid of important delay morbidity (e.g. cancerogenesis, chronic organ damage) will require further clinical research to identify more effective and less toxic treatments.

Antineoplastic Agents↗
PubMed1983

Adjuvant CMF in breast cancer: comparative 5-year results of 12 versus 6 cycles.

We report the 5-yr results of a prospective randomized study comparing 12 versus 6 cycles of CMF (cyclophosphamide, methotrexate, fluorouracil) with the aim to evaluate the possibility of reducing the duration of adjuvant treatment without compromising the therapeutic effect of the multimodal approach. At 5-yr from mastectomy, both relapse-free survival (CMF 12: 59%; CMF 6: 65.6%) and total survival (CMF 12: 72.7%; CMF 6: 76.9%) were not significantly different in the two treatment groups. Within the two series, no difference was detected between pre- and postmenopausal patients (CMF 12: 59.3% versus 57.6%; CMF 6: 66.5% versus 63.1%), while findings were inversely related to the number of involved axillary nodes. The analysis of relapse-free survival confirmed that in both menopausal groups, relapse-free survival was not significantly affected by estrogen receptor status. Acute toxic manifestations were moderate and reversible. In particular, no drug-induced leukemia nor increased incidence of solid tumors other than breast cancer were documented in this series. Present results after 12 CMF cycles are almost identical to those of our first CMF adjuvant study. Current findings are sufficiently mature to indicate that the maximum tumor cytoreduction with CMF occurs within a relatively short period of time. To improve the results achieved with a single multidrug regimen, more intensive forms of treatment, i.e., utilizing non-cross-resistant combinations, warrant careful evaluation.

Adult↗
PubMed1982

Alternating drug combinations in the treatment of advanced Hodgkin's disease.

Of 75 consecutive patients with Stage IV Hodgkin's disease, we assigned 38 to receive MOPP alone (mechlorethamine, vincristine, procarbazine, and prednisone) and 37 to receive MOPP alternating monthly with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) - a combination of drugs not cross-resistant with MOPP. Complete remission was documented in 71 percent of the patients receiving MOPP alone and in 92 per cent of those receiving the alternating regimen (P = 0.02). At five years, there was no progression of disease in 37 per cent of the MOPP group and in 70 per cent of the MOPP-plus-ABVD group (P less than 0.0001). After chemotherapy, the median relapse-free survival period was 20 months in the MOPP group and over 31 months in the MOPP-plus-ABVD group (P less than 0.01). Five-year survival with no evidence of disease was 84 per cent in patients given MOPP and ABVD and 54 per cent in those given MOPP alone (P less than 0.005). We conclude than alternating non-cross-resistant combinations appear promising in the management of advanced Hodgkin's disease and are worthy of trial in other malignant diseases.

Adult↗
PubMed1982

Evaluation of lung ventilation and carbon monoxide-diffusing capacity in patients with nonseminomatous testicular tumors treated with bleomycin.

Spirometric tests and CO transfer tests were systematically employed before, during, after the therapy and in the follow-up of 33 patients affected by seminomatous testicular tumours treated with 4-5 Einhorn courses (PVB). The aim was to demonstrate possible bleomycin-induced pulmonary toxicity and its relationship with the cumulative dose of the drug. Our patients, who never had clinical or radiological signs of pulmonary toxicity, did not show significant change in the functional respiratory tests throughout therapy, except for 6 patients who had a reduction in CO transfer of about 30% after the 2nd or 3rd course which persisted up to the end and during the follow-up. We did not find any correlation of such a reduction with predisposing factors.

Adolescent↗