Treatment of germ cell tumors of the ovary.
Explore the source record for details and available documents.
Antineoplastic Combined Chemotherapy Protocols↗
Biomedical subjects
S D Williams
Publications and source records attributed to S D Williams.
High dose carboplatin/VP-16 plus ifosfamide with autologous bone marrow support in the treatment of refractory germ cell tumors.
We report seven patients with germ cell tumors which either recurred following a minimum of two regimens of platinum-based chemotherapy or were refractory to cisplatin. The patients were treated with one or two courses of high dose carboplatin (CBDCA) and etoposide (VP-16) plus ifosfamide (IFX) with mesna uroprotection and autologous bone marrow support. The doses given were CBDCA 500 mg/m2 every other day x 3 and VP-16 400 mg/m2 every other day x 3. IFX was given in a dose of 2 g/m2 daily x 5 days with mesna. The original intent of the protocol was to explore escalating doses of IFX, but excessive renal toxicity at the first dose level prevented escalation. Of the seven patients treated, four developed a marked decline in their renal function and three of the four required hemodialysis or hemofiltration. Six of seven patients treated had a decline in their serum markers indicating a response to therapy, but all have relapsed. Our conclusion is that while the combination of CBDCA/VP-16/IFX with ABMT is active in this group of patients, it is associated with excessive renal toxicity which is probably due to underlying renal dysfunction secondary to extensive prior cisplatin-based chemotherapy.
Adolescent↗
Chemotherapy of ovarian germ cell tumors.
The development of modern surgical staging and effective chemotherapy regimens has markedly improved outcome of treatment of ovarian germ cell tumors. Almost all patients with completely resected tumors will survive their disease. Those with tumors other than dysgerminoma should all receive adjuvant chemotherapy. Patients with stage IA dysgerminoma can safely be observed, whereas those of higher stage should probably receive chemotherapy, although radiotherapy may be an option in selected patients, particularly older ones or those with other serious illness. Patients with advanced disease should all be treated with chemotherapy. Cisplatin-based regimens as developed for testicular cancer are more effective than VAC or VAC-type regimens. With such treatment, most dysgerminoma patients will be cured, as will many with other cell types. However, there is room for improvement in the latter group and continued investigation is appropriate.
Adolescent↗
Mediastinal yolk sac tumor. The Indiana University experience, 1976 to 1988.
Mediastinal yolk sac tumor (endodermal sinus tumor) is an extremely rare extragonadal germ cell neoplasm that has been associated with a grave prognosis. Twenty-one male patients with mediastinal yolk sac tumor received treatment at Indiana University between 1976 and 1988. Fourteen were seen after initial diagnosis, and their disease was treated with cisplatin-based chemotherapy in association with complete surgical resection if possible. Five are currently alive and disease free (36%). Seven were referred for salvage chemotherapy after relapse of their disease. Despite aggressive chemotherapy, these patients all died; they had a median survival time of 6 months. Our experience suggests that an aggressive combined modality approach with cisplatin-based chemotherapy followed by surgical resection of residual disease is the optimal management of this tumor. New regimens need to be explored for relapse of the disease after initial chemotherapy.
Adolescent↗
Primary mediastinal nonseminomatous germ cell tumors. A modern single institution experience.
Between 1976 and 1988, 31 patients with mediastinal nonseminomatous germ cell tumors (MNGCT) received initial cisplatin-based chemotherapy of uniform intensity. Eighteen of these patients (58%) obtained disease-free status; 11 with chemotherapy alone and seven with adjunctive surgery. Eleven have remained continuously free of disease. Two have had recurrence of teratoma and are disease-free after resection of teratoma at 12+ and 68+ months. Three patients developed recurrence of germ cell tumor. Three patients developed a hematologic malignancy. Of the 18 patients who obtained disease-free status, 15 remain alive and disease-free. Overall, 13 of the 31 patients and 24 other patients received salvage chemotherapy at Indiana University, Indianapolis, Indiana. Of these 37 patients, six obtained a disease-free status and four (11%) remain alive at 13+, 56+, 78+, and 122+ months, respectively. This series represents the largest series of patients with MNGCT ever reported. Analysis of these data and results from other recent series suggest that approximately 50% of patients with MNGCT will be cured with modern, intense cisplatin-based chemotherapy coupled with adjunctive surgery if needed.
Adult↗
Review of the rapid normalization of serum albumin with modified total parenteral nutrition solutions.
The theoretical basis for the rapid normalization of hypoalbuminemia is contingent on recognition of those clinical circumstances requiring rapid and prolonged repair of colloid oncotic pressure. Standard total parenteral nutrition (TPN) solutions repair serum protein only after prolonged periods of therapy. Nutritionists have empirically observed that adding albumin to TPN solutions can quickly normalize hypoalbuminemia for sustained periods. Infusion of similar quantities of albumin without TPN results in no prolonged normalization. The mechanism of the rapid normalization of serum albumin with albumin-modified TPN solutions has yet to be determined, as has its relationships to prevention of hypoalbuminemia-associated morbidity and mortality.
Digestive System↗
Cyclophosphamide and ifosfamide: role of uroprotective agents.
Explore the source record for details and available documents.
Acetylcysteine↗
Postneonatal circumcision: population profile.
Because postneonatal circumcision includes the risk of general anesthesia and costs more than elective neonatal circumcision, a retrospective study was performed to describe the population currently undergoing postneonatal circumcision and to identify the factors influencing decisions that lead to this procedure. A chart review and follow-up telephone survey were done to gather information concerning patients admitted for postneonatal circumcision to two Salt Lake City hospitals during a 2-year period. From the 135 patients eligible for analysis, two distinct groups emerged: the "sick" group (n = 52)--those who had neonatal complications, and the "well" group (n = 83)--those with no neonatal complications. The median age at circumcision was 5.5 months for the boys in the sick group and 35 months for the boys in the well group (P less than .001, Student's t test). During the neonatal period, 32% of families in the well group received anticircumcision advice from their primary care physician. The decision in favor of circumcision was made by two thirds of the families of sick infants before their sons were 6 weeks of age. Other surgery was performed concurrent with the circumcision in 44% of patients in the sick group and 24% of patients in the well group (P less than .0001, chi 2). Balanitis, phimosis, or a physician's recommendation were listed as the primary reason for post-neonatal circumcision by 50% of patents in the well group. Phimosis was listed by the surgeon as an indication for postneonatal circumcision in 65% of all patients' charts, although only 13% of parents listed phimosis as an indication for their children's circumcision.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Cisplatin, vinblastine, and bleomycin in advanced and recurrent ovarian germ-cell tumors. A trial of the Gynecologic Oncology Group.
STUDY OBJECTIVE: To evaluate the efficacy of cisplatin-based combination chemotherapy in patients with advanced ovarian germ-cell tumors. DESIGN: Nonrandom prospective trial with endpoints of tumor response, results of repeat surgical exploration, progression-free interval, and survival. SETTING: Cooperative university-based cancer study comprising 27 participating institutions. PATIENTS: Ninety-seven patients were treated and all were evaluable. Of these, 8 had dysgerminoma and 89 had other cell types. INTERVENTIONS: Patients received 3 to 4 courses of cisplatin. vinblastine, and bleomycin (PVB). After chemotherapy, suitable patients had re-staging laparotomy. Maintenance vinblastine therapy was originally given but was discontinued for all patients in 1981. Patients with persistent or recurrent disease were treated with vincristine, dactinomycin, and cyclophosphamide (VAC) or etoposide plus cisplatin (EP). RESULTS: Of 35 patients with tumors other than dysgerminoma who had clinically measurable disease, 15 (43%; CI, 26% to 61%) had complete responses. Forty of fifty-six second-look laparotomies (71%; CI, 58% to 83%) revealed no tumor or mature teratoma. Forty-seven patients are still disease-free and 59 are alive. The survival rate is 71% (CI, 62% to 89%) and the disease-free rate is 51% (CI, 41% to 62%) at 2 years. Eight patients had durable remissions with second- or third-line therapy. Seven of eight patients with dysgerminoma are also disease-free. CONCLUSIONS: Cisplatin-based chemotherapy is effective for patients with ovarian germ-cell tumors, is superior to previous regimens, and will cure a substantial number of patients.
Adult↗
The dmfs and dmft of young South African children.
As part of a series of frequent epidemiological field studies to determine caries prevalences in the primary dentition of young South African children, 1436 children of 1-4 yr of age from five ethnic groups were examined. Using WHO diagnostic criteria decayed, missing, and filled surfaces were determined with mirror and probe and caries free, dmfs, dfs, ds, mfs, and dmft scores were calculated. The investigation has shown that urban coloured and Indian children have the highest caries prevalences and urban white children have the lowest. It is suggested that the percentage of caries-free children should be used to set goals for reduction in caries.
Black or African American↗
Hypocalcification and hypoplasia in primary teeth of pre-school children from different ethnic groups in South Africa.
A study was completed in 1985/86 which examined the dental health of pre-school children from different ethnic groups and communities in South Africa: rural black, urban black, urban colored, urban Indian, and urban white. Enamel defects were recorded in primary teeth by use of the HHI, an index developed to measure hypocalcification and hypoplasia of enamel. The findings showed that colored children had the greatest number of enamel defects. The teeth most commonly affected were the maxillary anterior teeth and mandibular molar teeth. It is suggested that further epidemiological studies utilizing the HHI should be undertaken in pre-school children, especially from developing countries, to gain more information on the causes of enamel defects in the primary dentition and the possible use of such findings to predict nutritional health of individuals.
Child, Preschool↗
Hypocalcification and hypoplasia in permanent teeth of children from different ethnic groups in South Africa assessed with a new index.
A new descriptive index, the HHI (hypocalcification-hypoplasia index), is described for comparing enamel defects in groups of people. The index was used in a study completed in 1986, in which 1251 11-year-old children from different ethnic groups resident in South Africa were examined: 210 rural black, 203 urban black, 206 urban colored, 426 urban Indian, and 206 urban white. The index can be used as a screening examination, and the results from these different ethnic groups are presented.
Child↗
Management of postchemotherapy residual mass in patients with advanced seminoma: Indiana University experience.
Thirty-six patients with advanced seminoma treated with cisplatin combination chemotherapy were evaluated to assess the significance of postchemotherapy residual radiographic mass. All patients had a minimum follow-up of 2 years. Of the 36 patients 21 had an evaluable residual radiographic mass after completion of chemotherapy. Twelve of these patients had a less than 3 cm maximal transverse diameter residual mass, and nine had a greater than 3 cm persistent mass postchemotherapy. Only three of these 21 patients underwent postchemotherapy retroperitoneal lymph node dissection, and the histopathology revealed only necrotic fibrous tissue. The remaining patients were followed by close observation including repeat abdominal computed tomography (CT) every 3 months the first year and every 6 months the second year (or until normal); further therapeutic intervention was given only on evidence of progressive disease. Nineteen of these 21 patients have no evidence of disease, including eight of nine with greater than 3 cm persistent radiographic abnormality. The optimal management for advanced seminoma patients with a persistent radiographic mass postchemotherapy remains unresolved. However, based on this small series, we feel that observation is a viable option, reserving radiotherapy or chemotherapy for those patients who subsequently develop progressive disease.
Adult↗
Evaluation of optimal duration of chemotherapy in favorable-prognosis disseminated germ cell tumors: a Southeastern Cancer Study Group protocol.
Four courses of PVP16B (cisplatin plus etoposide [VP-16] plus bleomycin) has been standard chemotherapy for disseminated germ cell tumors at Indiana University and the Southeastern Cancer Study Group (SECSG) since 1984. We began a random prospective phase III study in patients with favorable-prognosis (minimal and moderate extent) disseminated germ cell tumors comparing four courses of PVP16B over 12 weeks to the identical dose PVP16B administered in three courses over 9 weeks. The categories of minimal and moderate disease constitute approximately two thirds of all disseminated germ cell tumors that require chemotherapy. One hundred eighty-four patients entered this trial, and all patients have a minimal follow-up of 1 year. Overall, 106 of 107 (99%) minimal extent and 73 of 77 moderate patients (95%) achieved an initial disease-free status (NED), confirming the favorable prognostic categories. Eighty-six of 88 patients (98%) randomized to three courses and 93 of 96 randomized to four courses (97%) of PVP16B achieved disease-free status. There have been ten relapses (5%), with five on each arm. Currently, 81 of 88 (92%) and 88 of 96 (92%) patients randomized to three v four courses of PVP16B are continuously disease-free. This study confirms the high cure rate with PVP16B in favorable-prognosis germ cell tumors. The deletion of the fourth course of PVP16B significantly reduces the toxicity, cost, and inconvenience of this curative regimen. We conclude that three courses of PVP16B is the preferred regimen for favorable-prognosis germ cell tumors.
Antineoplastic Combined Chemotherapy Protocols↗
Dose-intensive chemotherapy in refractory germ cell cancer--a phase I/II trial of high-dose carboplatin and etoposide with autologous bone marrow transplantation.
Between September 1986 and March 1988, 33 patients with refractory germ cell cancer were entered on a phase I/II trial of two courses of high-dose carboplatin plus etoposide with autologous bone marrow support. All patients had extensive prior treatment and had either cisplatin-refractory disease (67%) defined as progression within 4 weeks of the last cisplatin dose or failed at least two cisplatin-based regimens (35%) including a cisplatin-ifosfamide salvage regimen. Patients received a fixed total dose of etoposide of 1,200 mg/m2 with each cycle. The carboplatin dose ranged from 900 mg/m2 to 2,000 mg/m2. Twenty of the 33 patients received the second cycle of therapy. Despite extensive prior therapy with cisplatin, neurotoxicity, nephrotoxicity, or hearing impairment with high-dose carboplatin and etoposide was unusual. The most common nonhematologic toxicity was moderate enterocolitis. The hematologic toxicity of this regimen was substantial at each dose level. All 53 courses were accompanied by granulocytopenic fevers. Seven of the 33 patients (21%) died from treatment. All of these deaths occurred during the granulocyte nadir, and five were related to documented sepsis. Overall, 14 of 32 patients (44%) evaluable for response obtained an objective response, including eight complete remissions. Four patients remain in complete remission, with three patients being continuously free of disease in excess of 1 year. Eight responders (including four complete remissions) had progressed while receiving cisplatin. We conclude that carboplatin and etoposide can be administered in combination at high dosages and this regimen may have curative potential for patients with germ cell tumors resistant to conventional-dose cisplatin-based therapies.
Adolescent↗
Nutritional management of decubitus ulcers in the elderly.
Explore the source record for details and available documents.
Aged↗
Ifosfamide in testicular cancer: the Indiana University experience.
The systemic treatment of patients with metastatic germ cell tumors has improved dramatically during the past 15 years. Nonetheless, a cohort of patients are candidates for salvage chemotherapy. Having ruled out the possibility of pseudoprogression (eg, false elevated serum markers, teratoma, bleomycin lung disease), salvage therapy is indicated. Numerous trials in Europe and at Indiana University have confirmed single-agent activity of ifosfamide in patients with refractory germ cell tumors. As a consequence, a trial evaluating VeIP (vinblastine, ifosfamide, cisplatin) and VIP (etoposide, ifosfamide, cisplatin) was undertaken in 57 patients previously not cured with cisplatin, vinblastine, and etoposide regimens. Twenty patients achieved disease-free status with chemotherapy alone (n = 12) or chemotherapy plus surgical resection of residual carcinoma or teratoma (n = 8). Fifteen of these 20 patients remained free of recurrent disease from 18 to 53 months, including seven patients in continuous remission for over 2 years. Ifosfamide combination chemotherapy has curative potential in this heavily pretreated population. Further work to determine the role of ifosfamide in initial therapy is under way.
Antineoplastic Combined Chemotherapy Protocols↗
Disseminated testicular cancer: current chemotherapy strategies.
Disseminated testis cancer is a landmark adult solid tumor because of its high curability. In the last decade and a half, a number of clinical trials have been completed or are ongoing. In addition, long-term follow-up of some earlier trials is now available. This report summarizes the current treatment approaches, paying particular attention to the role of cisplatin.
Adult↗