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Biomedical subjects

S Monfardini

Publications and source records attributed to S Monfardini.

At least 181 records · Page 10Linked to original sources
PubMed1986

Combination chemotherapy with fluorouracil, adriamycin, cis-platinum and VM-26 in advanced transitional cell carcinoma of the urinary tract.

From October 1981 to October 1984, 42 consecutive patients with locally advanced unresectable or metastatic transitional cell carcinoma of the urinary tract were treated with cis-Platinum 50 mg/m2 i.v. and Adriamycin 50 mg/m2 i.v. day 1, and Fluorouracil 500 mg/m2 i.v. and VM26 100 mg/m2 days 1 and 8, every 3 weeks. In the 36 evaluable patients, 4 complete remissions and 15 partial remissions were noted (52.7% response rate). Of the 12 patients with previously untreated, locally advanced bladder carcinoma, 8 responded, with 3 pathologically confirmed complete remissions. Toxicity was moderate. Median survival was 44 weeks. This 4-drug combination had significant palliative activity in our patient population. Its role in the preoperative setting deserves further evaluation.

Adult↗
PubMed1986

Chemotherapy with adriamycin and vincristine alternated with cyclophosphamide and actinomycin D in testicular germ cell tumors refractory to cisplatin, vinblastine and bleomycin.

Eighteen patients with testicular cancer refractory to cisplatin, vinblastine and bleomycin (PVB) were treated with a non-cross-resistant regimen including adriamycin, 60 mg/m2 i.v. on day 1, and vincristine, 1.2 mg/m2 i.v. on days 1 and 8, alternated q 3 weeks with cyclophosphamide, 600 mg/m2 i.v. on days 1 and 8, and actinomycin D, 1 mg/m2 i.v. on days 1 and 8. The median number of administered cycles was 8 (range 3-14). The results were analyzed according to previous response to PVB. One of two patients relapsing after the first-line therapy obtained a transient second complete response (CR) (duration 7 months). None of seven patients who showed no response to PVB obtained a CR; in 3/9 patients with a partial response (PR) after PVB, the achievement of CR could not be definitely attributed to salvage therapy. Toxicity was mild; no cardiac failure or drug-related deaths were observed. In conclusion, these two alternating regimens were well tolerated, but this treatment was not found to be useful in patients not responsive to PVB, for whom new and alternative therapies are required. The favorable impact on prognosis, evident only in the subgroup of patients with PR, was probably attributable to PVB rather than to this salvage regimen.

Adult↗
PubMed1986

Persistent generalized lymphadenopathy: clinical characteristics of a lymphadenopathy syndrome in intravenous drug abusers.

Persistent generalized lymphadenopathy (PGL) is the most frequent AIDS related manifestation in homosexual men. From May 1984 to March 1985, 45 (38%) out of 117 intravenous (iv) drug abusers evaluated had PGL. Thirty-two were males and 13 females (median age 25 years). All patients referred to the frequent sharing of syringes. The median duration of lymphadenopathy was 3 months (range 3-60) with a median number of involved extrainguinal sites of 4 (range 2-7). Systemic symptoms and energy to skin tests were common, whereas splenomegaly and past infections were less frequently encountered. Hypergammaglobulinemia and an inverted T helper/suppressor ratio and lymphopenia were found in 78%, 43%, and 20% of the patients, respectively; the presence of HTLV-III antibodies was demonstrated in 12 (46%) of the 26 tested patients. Histologically, excised lymph nodes from 14 patients exhibited a marked follicular hyperplasia, diffuse plasmacytosis, and a conspicuous capillary proliferation. All patients are followed on a regular basis with clinical examination and laboratory tests; in no case has AIDS or a malignant lymphoma so far developed.

AIDS-Related Complex↗
PubMed1985

Early resection of residual tumor during cisplatin, vinblastine, bleomycin combination chemotherapy in stage III and bulky stage II nonseminomatous testicular cancer.

Sixty consecutive patients with Stage III or bulky Stage II nonseminomatous germinal testis tumors were treated with cisplatin, vinblastine, bleomycin combination chemotherapy (PVB). One patient died of acute toxicity after the first course of therapy, 16 entered complete remission (CR) after two or three inductions, and 36 underwent surgery for removal of residual masses after the third cycle. No residual tumor was found in 16 cases, 10 had mature teratoma, and residual malignant tumor was completely resected in 8 of 10 patients. On the whole, 52 of 59 cases (88%) who completed the therapy entered CR, 34 (58%) with PVB and 18 (30%) with PVB and resection of the residual disease. The major beneficiaries of surgery were patients with bulky metastases (17 of 45, 38%) and those with primary teratocarcinoma (13 of 24, 54%). All of the patients who entered CR received two additional inductions and no maintenance. After a median follow-up period of greater than 3 years, 40 patients (68%) remain continuously disease-free, 1 died in CR, and 3 of the 11 who had relapse were salvaged. All of the 32 patients with lung deposits less than 5 cm and/or lymph node metastases less than 10 cm entered CR after the combined treatment modality, and 29 (91%) are alive disease-free. Also, 20 of 27 patients (74%) with far-advanced disease (lung and lymph node metastases larger than 5 and 10 cm, respectively, extrapulmonary disease) entered CR after PVB and surgery, but only 11 (41%) are continuously disease-free. Early resection of the residual tumor during PVB combination chemotherapy greatly increased the CR rate, but relapses were very frequent in patients with far-advanced disease.

Adolescent↗
PubMed1985

Single agents known to be active in head and neck cancer.

Despite good results of polychemotherapy in head and neck cancer, monochemotherapy retains a valuable role in managing patients with advanced disease. In a palliative setting, lower toxicity and simpler handling of therapy with single agents are outlined by the Authors, who review results of most active drugs in their different schedules.

Antineoplastic Agents↗
PubMed1984

Retroperitoneal lymphadenectomy and aggressive chemotherapy in nonbulky clinical Stage II nonseminomatous germinal testis tumors.

In a former series of 60 resected Stage II nonseminomatous germinal testis tumors the authors succeeded in demonstrating that adjuvant cisplatin, vinblastine, and bleomycin (PVB) was able to significantly improve survival (100% in 11 treated versus 28.5% in 7 historical controls, P less than 0.01) only in patients with retroperitoneal metastases greater than 5 cm, macroscopic extranodal spread, tumor invasion into retroperitoneal veins (pathologic Stage II-C). Forty-eight evaluable patients with clinical nonbulky Stage II nonseminomatous testis cancer underwent retroperitoneal lymphadenectomy as primary treatment. Four courses of postoperative PVB were administered only to 18 clinically understaged patients (14 pathologic Stage II-C, and 4 postoperatively reclassified as Stage III). The remaining 30 patients were followed at monthly intervals. After a median follow-up of 25 months, relapses were: 1 (10%) in 10 pathologic Stage I patients; 8 (40%) in 20 pathologic Stage II-A and II-B; null in the 18 treated. Eight of the nine patients (89%) who had relapse entered continuous complete remission following salvage therapy. The overall 2-year disease-free survival in this case series is 98%. Retroperitoneal lymphadenectomy followed by compulsive follow-up and selective use of aggressive chemotherapy is an alternative to remission induction chemotherapy as primary treatment in clinical nonbulky Stage II nonseminomatous testis cancer, and to immediate adjuvant chemotherapy in all patients with resected Stage II disease.

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↗
PubMed1984

No adjuvant chemotherapy in selected patients with pathologic stage II nonseminomatous germ cell tumors of the testis.

In a previous report on patients with resected stage II nonseminomatous germinal cell testis tumors the findings of retroperitoneal metastases larger than 5 cm., macroscopic extranodal spread and tumor invasion into retroperitoneal veins (pathologic stage IIC) almost invariably were associated with relapse and poor survival in the absence of adjuvant chemotherapy, while postoperative cisplatin, vinblastine and bleomycin therapy was effective in preventing relapses in all cases. From February 1980 to January 1982, 40 consecutive patients underwent retroperitoneal lymphadenectomy for stage II disease. Only patients with pathologically assessed stage IIC cancer received 4 cycles of adjuvant cisplatin, vinblastine and bleomycin, while those with pathologic stages IIA and IIB disease, with or without microscopic extracapsular extension of the tumor, received no further therapy and were followed carefully at monthly intervals. After a median followup of 26 months or more relapses were noted in none of the 14 treated patients compared to 9 of 26 untreated patients (35 per cent). Of the latter 9 patients 8 (89 per cent) had continuous complete remission after salvage therapy and 39 of 40 patients (97.5 per cent) currently are free of disease. No difference was observed in the relapse rate and survival between patients with stages IIA and IIB disease. We conclude that patients with pathologic stages IIA and IIB disease can be treated safely only at the time of relapse, while the usefulness of adjuvant chemotherapy has been confirmed in those with stage IIC cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

Adjuvant chemotherapy in resected stage-II nonseminomatous germ cell tumors of testis. In which cases is it necessary?

In an attempt to reduce the recurrence rate and to improve survival in resected stage-II nonseminomatous testicular cancer, two consecutive series of patients were treated with adjuvant vinblastine-bleomycin (VB) continuous infusion, or cisplatin, vinblastine, bleomycin (PVB). 11 former patients who received no adjuvant chemotherapy and 5 who refused the adjuvant treatment were considered historical controls. After a median follow-up of 5 years, relapses were 4 in 15 patients treated with VB (27%), 1 in 29 treated with PVB (3%) and 8 in the untreated (50%). Adjuvant PVB significantly reduced the recurrence rate (p less than 0.001), while VB did not (p = 0.4). However, the advantage of adjuvant PVB was evident only in patients with retroperitoneal metastases larger than 5 cm, macroscopic extranodal spread, and tumor invasion into retroperitoneal veins, who were classified as pathologic stage II-C: no relapse and 100% survival following adjuvant PVB in 11 cases, versus 86% relapses and 28.5% survival in 7 untreated patients (p less than 0.01); 2 relapses and 2 survivors in 3 treated with VB. On the other hand, only 1 of the 39 patients with less extensive retroperitoneal disease died of testicular cancer, and he was in the VB adjuvant treatment group. We conclude that only aggressive adjuvant chemotherapy significantly reduces the recurrence rate and improves survival in resected stage-II nonseminomatous testis cancer. However, it is mandatory only in the very high risk subset II-C of patients, while the others could be carefully followed at monthly intervals and safely treated with aggressive chemotherapy only in the event of relapse.

Adolescent↗
PubMed1984

Transient left homonymous hemianopsia during treatment of testicular carcinoma with cisplatinum, vinblastine, and bleomycin.

This is the third case, reported in the literature, of transient cortical blindness that occurred during treatment of testicular carcinoma with cisplatinum, vinblastine and bleomycin. The presence of transiently pathological computerized tomography and brain scan suggests that this alarming event may not only be a toxic side effect of chemotherapy, but also a symptom related to eradicable subclinical metastases.

Adult↗
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↗
PubMed1982

[Approach to the problem of economic costs of the medical therapy of tumors].

The use of antitumoral drugs is increasing constantly. The economic cost pro capite of the commonest oncotherapeutic treatments has been analysed. The calculation is carried out on the basis of out-patient as well as in-patient treatment. The costs were identical in the hospital where the study was carried out due to the application of the recent regional health legislation. A number of considerations are made regarding the implications of unqualified use of the medical treatment of cancer.

Breast Neoplasms↗
PubMed1980

Primary malignant neoplasms associated with chronic lymphocytic leukemia.

Over the past 2 decades there has been an almost exponential increase in the frequency with which cases of leukemia associated with another primary malignant lesion have been reported. In this study we reported the occurrence of a second primary neoplasm to 82 consecutive cases of chronic lymphocytic leukemia (CLL) admitted to the Istituto Nazionale Tumori of Milan from September 1962 to December 1978. In 16 of these (19.5%), an assoicated neoplasm was diagnosed subsequently (8 cases) or concurrently (8 cases) to CLL. Head and neck carcinomas and breast cancer had the highest incidence (5 and 3 cases, respectively). The results of this study further support the hypothesis that patients with CLL are prone to develop subsequent cancer. The defective cellular and humoral immunity in CLL may have an etiological role in the development of an additional primary malignancy. Although alkylating agents are known carcinogens in experimental animals and man, our results support the lack of a correlation between treatment with alkylating agents and incidence of second primary neoplasms, as demonstrated by Greene et al. (10).

Breast Neoplasms↗