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S Ous

Publications and source records attributed to S Ous.

At least 37 records · Page 2Linked to original sources
PubMed1991

Long-term morbidity and quality of life in testicular cancer patients.

Today about 90% of patients with testicular cancer can be cured. The consideration of treatment-related long-term morbidity has, therefore, become an important issue. Cisplatin-based chemotherapy induces long-lasting Raynaud-like phenomena and/or peripheral sensoric, usually mild, neuropathy in 30-40% of the patients. Irreversible reduction of renal function is a frequent finding after chemotherapy, especially if high doses of cisplatin are given. Abdominal radiotherapy is generally well tolerated but may lead to slight chronic meteorism and dyspepsia. 'Dry ejaculation' represents the principal sequelae after retroperitoneal surgery. The frequency of this side effect can be reduced by nerve-sparing surgery. Both chemotherapy and radiotherapy reduce spermatogenesis transiently. About 2 years after discontinuation of treatment, sperm production has recovered in most of the patients with normal pretreatment gonadal function. At least half of the patients with a desire for post-treatment paternity are able to father a child after their treatment. Assisted fertilization may reduce post-treatment infertility problems for individual couples. In general, cured testicular cancer patients are more satisfied with life than an age-matched control group, but may present a greater fluctuation of their mood and affect. In conclusion, most cured testicular cancer patients enjoy a normal life if precaution is taken to reduce therapy-related side effects to a minimum. However, reduction of the complication rate would not lead to a decrease of the present high cure rate of this malignancy.

Adult↗
PubMed1990

Prognosis in patients with metastatic non-seminomatous testicular cancer.

155 patients with metastatic non-seminomatous testicular cancer were treated with cisplatin-based chemotherapy which in most cases was combined with surgery. The 5 year crude survival was 90% for all patients (98 patients with small volume disease: 97%; 32 patients with large volume disease: 91%; 25 patients with very large volume disease: 64%). High pre-chemotherapy serum tumour marker levels (AFP greater than 500 micrograms/l; and/or HCG greater than 1000 U/l) decreased the survival rates in all groups. Only 4 of 17 relapsing patients were rendered tumour-free by salvage chemotherapy. In a multivariate analysis, a pre-chemotherapy alpha-foetoprotein (AFP) level greater than 500 micrograms/l was associated with poor survival as was the presence of a retroperitoneal tumour greater than 10 cm, lung metastases greater than 3 cm and/or extrapulmonary hematogenous metastases. It is concluded that easily assessable clinical pre-treatment variables can be used to define high risk or low risk patients with metastatic testicular cancer. Treatment intensity should be adjusted in accordance to such prognostic factors.

Adolescent↗
PubMed1990

Is routine primary retroperitoneal lymph node dissection still justified in patients with low stage non-seminomatous testicular cancer?

We present 8 years' experience of primary retroperitoneal lymph node dissection (RLND) in 190 patients with low stage non-seminoma; 154 patients had clinical stage I (CSI) and 36 had clinical stage IIa (CSIIa) disease. Of the 154 patients with CSI tumours, 33 had increased serum AFP and/or HCG before RLND (CSIM+) and 121 had normal tumour markers (CSIM-). Retroperitoneal lymph node metastases (pathological stage II) (PSII) were found in 38 of 121 patients with CSIM-, in 19 of 33 patients with CSIIM+ and in 26 of 36 patients with CSIIa. In a multivariate analysis, the presence of small vessel infiltration (demonstrated in histological sections of the primary tumour) and a prolonged tumour marker half-life were predictive factors for PSII. These 2 factors enabled a group of non-seminoma patients with CSI disease to be identified who had a 15% risk of retroperitoneal tumour growth (low risk group) as compared with a high risk group where 60 to 70% of patients had retroperitoneal lymph node metastases. Relapses occurred in 7 of 107 patients with PSI and in 6 of 83 patients with PSII disease; in the latter group, 5 relapses developed before the start of routine adjuvant chemotherapy; 6% of patients developed major post-operative complications. In addition, "dry ejaculation" was the principal side effect following RLND (unilateral RLND: 20/132 patients; bilateral RLND: 50/54 patients). The comparative cost to the health service during the first year of follow-up was estimated for low risk non-seminoma patients with CSI subjected to RLND and for those in whom a surveillance policy was adopted. The latter approach was preferable. It was concluded that a surveillance policy should be followed in low risk non-seminoma CSI patients provided that frequent follow-up is possible. A more active policy is recommended in high risk patients (e.g. adjuvant chemotherapy without RLND). Nerve-sparing RLND may be considered in patients with CSIIa disease and negative tumour markers.

Adolescent↗
PubMed1990

Management of patients with poor-prognosis nonseminomatous germ cell cancer.

The treatment and outcome of 57 patients with poor-prognosis metastatic nonseminomatous germ cell cancer were reviewed. The patients were treated between 1980 and 1986. Poor-prognosis patients were characterized by the presence of at least one of the following findings: (1) retroperitoneal tumor mass greater than 10 cm; (2) greater than 3 lung metastases, the largest being greater than 2 cm; (3) extrapulmonary, extralymphatic, metastases; and (4) extragonadal primary tumor. The intended treatment consisted of cisplatin-based combination chemotherapy followed by secondary surgery. From 1980 to 1983 a modified Einhorn regimen was used (cisplatin 100 mg/m2 per cycle; CVB). In case of unacceptable vinblastine toxicity, this drug was substituted by VP-16 (500 mg per m2 per cycle; BEP20). From October 1983 the intention was to replace at least 3 of the CVB/BEP20 cycles by BEP60 cycles (days 1-3: cisplatin 60 mg/m2, days 1-3: VP-16 120 mg/m2; days 1, 5, 15: bleomycin 30 mg). There were 33 patients in the CVB/BEP20 group and 24 patients in the BEP60 group. Two patients of the CVB/BEP20 group and 6 patients of the BEP60 group were not evaluable for response, but are included in the survival analysis. The reasons for exclusion from response evaluation were that these patients could not receive the intended chemotherapy in appropriate doses due to severely reduced pretreatment general condition or due to early death. Fourteen patients with multiple lung metastases but no other poor-prognosis criteria had a 93% survival indicating that they did not represent poor-prognosis germ cell cancer. After excluding these 14 patients, the 4-year survival was 58% for 19 CVB/BEP20 patients and 72% for BEP60 patients. This difference did not reach the level of statistical significance in this limited series. The introduction of high-dose cisplatin had thus not led to clearly superior treatment results as compared to CVB/BEP20.

Adolescent↗
PubMed1990

Distribution of retroperitoneal lymph node metastases in patients with non-seminomatous testicular cancer in clinical stage I.

118 Patients with non-seminomatous testicular cancer (NSTC) in clinical stage I (CSI = no metastases by clinical, radiological and biochemical evaluation) underwent retroperitoneal lymph node dissection (RLND). The operation was done unilaterally (95 patients) in peroperatively tumor-free patients or in those with limited metastatic growth. In 23 patients with more extensive metastases, bilateral RLND was performed. Metastatic lymph nodes were found in 36 patients, and these patients received 3-4 cycles of a cisplatin-based combination chemotherapy. If no metastases were detected the patients had no further treatment. The 5-year disease-free survival rate was 100%. 8 of 82 patients without detected metastases in the operation specimen relapsed (all outside the retroperitoneal space), but were cured by salvage chemotherapy. Solitary metastases were found in 11 patients, whereas 25 patients had more than 1 metastatic lymph node. The size of the largest metastasis ranged from 0.3 to 40 mm. Metastases from right-sided tumors were detected at all levels of the lumbar region, predominantly to the right of the inferior vena cava and/or within the interaortocaval space. Left-sided tumors metastasized to the upper two thirds of the lumbar space, only rarely crossing the midline. This anatomical distribution of metastatic lymph nodes indicates that the presacral sympathetic nerve plexus and the sympathetic nerve fibers around the aortic bifurcation can be spared from extensive resection in the majority of patients with NSTC in CSI. Unilateral RLND or other nerve-sparing techniques are thus possible, preserving antegrade ejaculation in greater than 80% of the patients. This RLND represents a reasonable alternative to the 'surveillance' policy in NSTC.

Adult↗
PubMed1990

Cisplatin and medium dose methotrexate in advanced transitional cell carcinoma of the urinary tract.

Twenty-seven patients with advanced transitional cell carcinoma of the urothelium were studied. The area of each tumour was measured by computed tomography. Twenty-four of the 27 patients were evaluated after treatment with the following course of chemotherapy given intravenously: day 1-cisplatin 50 mg/m2; day 2-methotrexate 250 mg/m2; and folinic acid rescue treatment 24 hours after the methotrexate infusion. Each cycle of treatment was given three times, with two weeks between cycles. There were two complete and 11 partial responses, and the primary tumour responded as often as the distant metastases. The toxicity of the regimen was acceptable, even given the advanced age of most of the patients. Most of whom found that their disturbances of micturition and sleeping problems were improved by the treatment. Cisplatin combined with methotrexate achieves a response rate of about 50% in advanced transitional cell carcinoma. When combinations of chemotherapy are being chosen for these often elderly patients the curability and palliation effects must be balanced against the toxicity and morbidity.

Adult↗
PubMed1989

[Testicular cancer. A challenge to the health services taking care of young males].

About 130 Norwegian men (15-45 years old) develop testicular cancer each year. Men with a history of undescended testes, atrophic testes and/or fertility problems probably represent a high risk group. Typical symptoms are tumour, harder consistency and discomfort in the testes, low back pain and gynecomastia. Testicular ultrasonography often helps to establish the correct diagnosis. Seminoma is separated from non-seminoma histologically. Adjuvant radiotherapy to the retroperitoneal lymph nodes is the most frequent treatment in seminoma patients with early disease and is combined with chemotherapy in patients with advanced disease. Chemotherapy and surgery are the main therapeutic modalities in non-seminoma patients. In clinical trials a "wait and see" policy is applicable in selected patients with non-seminoma without metastases, provided that frequent follow-up examinations are feasible. Gastrointestinal side effects, alopecia, peripheral neuropathy and azoospermia are the most frequent acute and reversible side effects of treatment of testicular cancer. Post-treatment paternity can be achieved by at least half of the patients who wish to father a child after treatment. The 5-years' survival rate for young patients with testicular cancer is 95%. Young men should perform testicular self-examination regularly. Medical officers in the Armed Forces and doctors at schools and universities and in occupational health should be aware of testicular cancer in young adults with suspicious clinical findings.

Adolescent↗
PubMed1989

T2/T3 bladder carcinomas treated with definitive radiotherapy with emphasis on flow cytometric DNA ploidy values.

From 1972 through 1982, 124 patients with muscle invasive T2/T3 bladder carcinoma without evidence of distant metastases were treated with definitive radiotherapy (60 Gy in 6 weeks) to the pelvis at The Norwegian Radium Hospital. Sections from paraffin embedded biopsies taken prior to the start of treatment were prepared for DNA flow cytometry, and 121 histograms were considered interpretable for DNA ploidy values. Significantly improved survival was seen in patients with the following characteristic, univariate analysis: T2 tumor, macroscopically complete removal of the tumor prior to radiotherapy, clinically complete response to radiotherapy, normal serum creatinine, absence of hydronephrosis, tetraploid tumor, WHO performance status 0 or 1, age below 65 years. In a multivariate analysis the following pretreatment variables turned out with prognostic power in this order: normal serum creatinine, T2 tumor, tetraploidy, and absence of small vessel invasion. When including response to therapy, the following factors were significantly predictive of a beneficial survival: clinically complete response after radiotherapy, normal creatinine, T2 tumor and tetraploidy. Tetraploidy was associated with response to radiotherapy when compared to diploid tumors (p = 0.07). This relationship alone did not explain the better survival of patients with tetraploid tumors, and other factors concerned with "tumor aggressivity" may be additional explanatory parameters. DNA ploidy values provide valuable information in the pretreatment situation concerning the prognosis for patients with T2/T3 bladder carcinoma.

Carcinoma↗
PubMed1989

Histology of tumor residuals following chemotherapy in patients with advanced nonseminomatous testicular cancer.

A total of 111 patients with advanced nonseminomatous testicular cancer underwent cisplatin-based combination chemotherapy, followed by surgical removal of residual masses in 101. Surgery included retroperitoneal lymph node dissection in 92 patients, thoracotomy in 19 and hepatic resection in 1 (11 patients underwent 2 operations). Complete necrosis and/or fibrosis was found in 52 operative specimens, mature teratoma in 37 and vital malignant tumor in 12. Of the 11 patients who underwent 2 operations 4 had complete necrosis and/or fibrosis in both histological specimens. After a median observation of 55 months 83 of 89 patients with complete necrosis and/or fibrosis or mature teratoma were without evidence of disease. Only 7 of 12 patients with vital malignant tumor in the operative specimen survived without evidence of disease. Relapses were observed in 16 patients, 4 of them in the retroperitoneal space. Of the 16 relapses 5 were in 12 patients with residual vital malignant tumor, 5 in 37 patients with post-chemotherapy mature teratoma and 4 in 52 patients with complete necrosis and/or fibrosis after chemotherapy. Two patients with recurrence did not undergo an operation. In patients in whom post-chemotherapy retroperitoneal lymph node dissection is considered complete necrosis and/or fibrosis can be predicted by the combination of several factors, including absence of teratomatous elements in the testicular tumor, complete response on post-chemotherapy computerized tomography, and normal alpha-fetoprotein and human chorionic gonadotropin levels after chemotherapy (sensitivity 83%, specificity 76% and correctly predicted 79%). With the knowledge of these factors it seems possible to omit post-chemotherapy retroperitoneal lymph node dissection in approximately 20% of the patients with advanced metastatic nonseminomatous testicular cancer with initial retroperitoneal tumors.

Adolescent↗
PubMed1989

Post-chemotherapy lymph node histology in radiologically normal patients with metastatic nonseminomatous testicular cancer.

A total of 37 patients with initially advanced metastatic nonseminomatous testicular cancer underwent retroperitoneal lymph node dissection after cisplatin-based combination chemotherapy. Abdominal computerized tomography was negative at retroperitoneal lymphadenectomy (lymph nodes not exceeding 10 mm. in the transverse computerized tomography plane). Complete necrosis and fibrosis were found in 25 patients. In 11 patients the retroperitoneal lymphadenectomy specimen showed a mature teratoma. Residual vital malignant tumor was observed in 1 patient. Neither the initial size of the retroperitoneal mass nor the histological status of the primary tumor was predictive of the histological findings in the retroperitoneal lymphadenectomy specimen. The high frequency of mature teratoma raises the question whether omitting post-chemotherapy surgery is a safe routine policy in patients with negative computerized tomography, especially if long-term followup is not feasible. We recommend a post-chemotherapy retroperitoneal operation as routine treatment even in patients with negative computerized tomography.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Chemotherapy of advanced seminoma: clinical significance of radiological findings before and after treatment.

The predictive significance of the mass detected following chemotherapy was assessed in 46 patients with advanced seminoma. Patients with residual viable seminoma in the post-chemotherapy operation specimen or who developed recurrent disease were regarded as chemotherapy failures. This group included 1 of 20 patients in whom the retroperitoneal masses were less than or equal to 10 cm2 3 to 4 weeks after chemotherapy and 4 of 15 patients whose residual masses were greater than 10 cm2. Four of 11 patients with mediastinal tumours achieved a complete remission (mediastinal masses less than or equal to 1 cm2). However, 2 of these 4 patients relapsed, as did 2 of the 4 who achieved a partial remission. In no case was the original size of the tumour significantly related to treatment failure. Three patients had residual lung masses; 1 of these contained histological evidence of viable tumour. In one-third of the irradiated relapse-free patients, slightly enlarged masses were visible on follow-up computed tomography scans taken several years after treatment, even in patients without tumour activity. There is a 25% risk of relapse in patients with advanced seminoma who have retroperitoneal masses greater than 10 cm2 following cisplatin-based chemotherapy. They should be followed up regularly for many years.

Adult↗
PubMed1989

Non-seminomatous testicular cancer clinical stage I: prediction of outcome by histopathological parameters. A multivariate analysis.

The clinical course of 186 orchiectomized patients with testicular non-seminoma clinical stage I (CSI) was reviewed together with a reevaluation of the haematoxylin-eosin-stained histological sections of the primary tumour. Treatment (1970-1980) was as follows: abdominal radiotherapy (group 1): 132 patients; observation only (group 2): 23 patients; retroperitoneal lymph node dissection (group 3): 31 patients. Failure of the management (diagnostic error/relapse after treatment) was defined as demonstration of retroperitoneal lymph node metastases (group 3) or relapse during follow-up (group 2 and 3). Ten of the 31 primarily operated patients had retroperitoneal lymph node metastases. (These patients received 3-4 cycles adjuvant cisplatin based on chemotherapy.) Forty-six patients relapsed after a median time of 6 months (range: 2-113). The 10-year cancer-related survival rates for group 1 and 2 were 85 and 73%, respectively. No cancer-related death occurred in group 3 within the first 5 years. In a univariate analysis the following parameters were significantly (p less than 0.05) correlated with management failure: vascular invasion (blood, lymphatic), the presence of syncytiotrophoblasts, the demonstration of the histological subtype MTU. In a multivariate analysis both lymphatic and blood vessel invasion significantly predicted management failure. In 80% of the non-seminoma patients with CSI and both lymphatic and blood vessels invasion in the primary tumour failure of the primary management must be expected. In the multivariate analysis the demonstration of MTU was a predictive factor only if no differentiation was made between lymphatic and blood vessel invasion. The presence or absence of endodermal sinus tumour was not correlated with the failure rate in non-seminoma CSI. Based on easily assessable histopathological parameters of the primary tumour (small vessel invasion in particular) it is possible to define subgroups of patients with non-seminoma CSI who have a high or a low risk of relapse or who are likely to have microscopic retroperitoneal lymph node metastases. Such a differentiation should have therapeutic consequences.

Humans↗
PubMed1988

Changes in ploidy distributions in human liver carcinogenesis.

Cellular and nuclear DNA content was measured by flow cytometry and the fraction of binucleated cells by fluorescence microscopy in normal adult human livers, hepatocellular carcinomas, cirrhotic livers surrounding tumors, and in some benign liver conditions. In five normal livers about one-half of the hepatocytes were polyploid; the majority of these were binucleated tetraploids containing two diploid nuclei. Thus, polyploidization in human liver does not progress as far as, for example, in the rat, where 80%-90% of adult hepatocytes are polyploid, mostly with tetraploid or octoploid nuclei. In five human euploid hepatocellular carcinomas and one investigated case of focal nodular hyperplasia, the percentage of polyploid cells was significantly reduced. Four other carcinomas exhibited a prominent aneuploid (hypotetraploid) peak in addition to the diploid peak. An abnormally low fraction of binucleated cells was also indicated in these tumors. Liver tissue surrounding the tumors had a ploidy distribution similar to that of normal liver. The results suggest that, like in several models of experimental hepatocarcinogenesis, human hepatocellular tumor growth is associated with a decreased polyploidization tendency and a corresponding increase in diploid, divisional growth, which may give the tumors a growth advantage relative to the surrounding liver.

Adolescent↗
PubMed1988

Late recurrence of testicular cancer.

The aim of this study is to draw attention to important points concerning the clinical management of late relapses in testicular cancer. From 1972 to 1982 The Norwegian Radium Hospital (NRH) has treated 1,008 patients with testicular cancer. Fifteen (1.5%) of these patients relapsed 36 months or more after their primary treatment. The patients' medical records were reviewed in this retrospective study, and all available histological sections were reevaluated. Six patients had pure seminoma initially and relapsed after an average of 54.5 months. Five of them had subjective symptoms due to recurrent tumor. Four patients relapsing in the supradiaphragmatic lymph nodes only are alive with no evidence of disease after an observation time of 17 to 30 months after treatment. Nine nonseminoma patients relapsed after an average of 85 months (36 to 194 months). Eight of these were aware of subjective signs or symptoms due to recurrent tumor leading to the diagnosis of the relapse. Four of these patients are alive with no evidence of disease after an observation time of 4 to 46 months after treatment. Two of these patients relapsed with pure mature teratoma. Late relapses do occur although they are rare events. Seminoma patients relapsing in the lymph nodes only have a good prognosis, and nonseminoma patients have a slightly poorer prognosis. Active follow-up for relapse detection is not justified. All testicular cancer patients should instead be informed of typical signs and symptoms that can be related to a relapse and encouraged to seek medical help for further investigation.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Evaluation of response by CT in patients with advanced bladder cancer treated with cisplatinum/methotrexate.

Nine patients with locally advanced bladder cancer were examined by CT to evaluate the response of chemotherapy with Cisplatinum/Methotrexate. A CT technique with a fat emulsion in the bladder lumen was used. Two series were performed, before and after intravenous contrast medium injection. The measurements of two perpendicular diameters were less applicable for response evaluation of primary bladder tumours. Area measurements by encircling the area should be used. The use of intravenous contrast was mandatory. When area measurements were used the CT examination showed complete remission in one patient, partial remission in five patients and no change in three patients. The evaluation of the response by clinical examination and CT showed the same result in five patients. In four patients CT and clinical evaluation did not correspond.

Aged↗
PubMed1987

Definitive radiotherapy of prostatic cancer: the Norwegian Radium Hospital's experience (1976-1982).

During the years 1976 to 1982 definitive curatively aimed radiotherapy to the primary tumor was given to 53 patients with prostatic cancer confined to the true pelvis (T0, 2; T1-2, 19; T3, 24; T4, 8; N0, 18; N+, 2; Nx, 33); all patients were of the Mo-category. The pelvic lymph nodes received a total dose of 2 Gy X 25 by means of an anterior and posterior radiation field. The prostatic gland was irradiated by an additional booster dose of 2 Gy X 10 given to a perineal field. Twenty-four patients have relapsed after their prostatic radiotherapy, only three of them within the irradiated area. For the patients with T0-T2 tumors, the 5-year crude survival was 69%, whereas it was only 37% for patients with T3 tumors. Thirty-five patients developed intestinal (26 patients) and/or urogenital (23 patients) radiation side effects. In three patients a colostomy had to be performed owing to rectal stricture or fistula. The poor survival after radiotherapy in the present series is probably due to a high incidence of unrecognized pelvic lymph node metastases. In the future only prostatic cancer patients without pelvic lymph node spread will be considered candidates for definitive radiotherapy. An optimal radiation technique is mandatory in order to avoid major radiotherapy-induced toxicity.

Aged↗