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T Berghmans

Publications and source records attributed to T Berghmans.

72 records · Page 4Linked to original sources
PubMed1998

Maintenance chemotherapy for small cell lung cancer: a critical review of the literature.

Maintenance chemotherapy after induction therapy is a controversial topic in small cell lung cancer. We carried out a critical review of the literature on this topic. Since 1980, 13 randomized trials have been published. One shows a statistically significant difference in survival in favor of maintenance, five obtain some survival advantages in subgroups of patients, one shows a significantly shorter survival with maintenance and in six studies, there is no difference between both arms. A quantitative overview or meta-analysis was unpracticable because of the lack of data for calculation of the odds ratio in the publications and because of the heterogeneity of the studies' designs. A qualitative overview was carried out using two scales: the Chalmers scores and the European Lung Cancer Working Party (ELCWP) score. Correlation between both scores was excellent. There was no significant difference in quality scores with both methods between negative trials and those who showed some survival advantage for survival. The overall quality of the publications was not good, with important methodological aspects missing, such as a clear definition of the primary objective or an a priori estimate of the sample size necessary to conduct the trial. We concluded that maintenance chemotherapy could have some indications and that good quality trials, as reflected by very high quality scores, need to be carried out in the future.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

[Maintenance chemotherapy in the treatment of small cell lung cancer: the advocate's view].

The role of maintenance chemotherapy in the treatment of small cell lung cancer remains controversial. We have collected the arguments in favor of that approach by performing a quantitative and qualitative overview of the studies published on this topic in the French and English literatures since 1980. On the thirteen prospective randomized trials reported, six demonstrated a significant survival advantage in favor of maintenance, no difference was observed in 6 and 1 study had a significant survival advantage for no maintenance. Due to the heterogeneity of the study designs and to the lack of published data, no meta-analysis could be performed. A qualitative overview of the different trials showed that the quality scores of the positive trials was similar to the negative ones, allowing us to conclude that they could be considered at the same level. No negative trial with a similar design can be opposed to each particular positive trial that is thus not conterbalanced. Moreover the trials not in favor of maintenance could be falsely negative by a lack of power, the publications mentioning no statistical consideration. There are thus a series of arguments in favor of maintenance chemotherapy for small-cell lung cancer, which require to be confirmed by randomised trials of adequate quality.

Antineoplastic Agents↗
PubMed1998

[Critical review of the randomized trials assessing the role of adjuvant thoracic irradiation and chemotherapy in the treatment of limited-stage small cell lung cancer].

The role of chest irradiation in the treatment of small cell lung cancer remains controversial. Two meta-analyses have shown a significant improvement of survival when this therapy is associated to chemotherapy but the controlled studies individually lead to contradictory conclusions. We have performed qualitative and quantitative evaluation of the literature on this topic in order to try to clarify this problem. On 15 published trials, 8 only give sufficient data allowing a meta-analysis. This does not show that chest irradiation improves statistically significantly survival in comparison to chemotherapy alone (odds ratio = 0.82; 95% CI: 0.63-1.07). The qualitative evaluation has been performed with the Chalmers and ELCWP scales. The scores obtained by both methods are highly correlated. There is no significant difference between the scores obtained by studies showing a survival improvement with irradiation or by negative studies. Very few trials report important criteria like definition of the primary end-point or the a priori estimate of the population size, attesting important methodological deficiencies. In conclusion, the quantitative aggregation of studies seems difficult to interpret because of the non optimal quality of the studies.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Epidemiology of infections in the adult medical intensive care unit of a cancer hospital.

A prospective collection of positive antimicrobial cultures was performed over 12 consecutive months in the medical intensive care unit of a cancer hospital. In all, 144 infections and 163 pathogens were documented during 87 of the 528 admissions. Lung, urinary, ENT (ear, nose and throat) infections and bacteraemia were the most frequently documented. Staphylococcus species, Streptococcus species, Escherichia coli, Klebsiella species and Pseudomonas species were the most common pathogens. Gram-positive strains were observed predominantly during monomicrobial bacteraemia (48.9%). Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) were found in 58% and 92% of the isolated strains respectively. No particular outbreak was identified. A further prospective study will be necessary to evaluate the impact of the antibiotic use on the selection of resistant strains in our ICU.

Adult↗
PubMed1997

[Current topics in pulmonary oncology].

Thoracic oncology practice is changing with the end of the century. New diagnostic tools like photodetection allow to diagnose at a white light undetectable level. Preneoplastic lesions or very early cancers that can be locally treated by photochemotherapy, cryotherapy or brachytherapy. The natural history of lung cancer will also be better known. Concerning advanced disease, cisplatin chemotherapy improves survival of patients with stage III non-small cell lung cancer in combination with surgery or chest irradiation and of those with stage IV in comparison with best supportive care alone. New approaches in small cell lung cancer seem promising like accelerated chemotherapy, early chest radiotherapy and maintenance treatment. Moreover, a series of new active cytotoxic agents has been recently identified. The complexity of these modalities makes more and more necessary a integrated pluridisciplinary approach of the lung cancer patient.

Bronchial Neoplasms↗
PubMed1997

[Diagnosis and treatment of early-stage bronchial cancer: current status].

Lung cancer is the cancer with the largest mortality in Belgium. Nowadays, the most potent risk factor for lung cancer, tobacco smoking, is increasing, principally in teenagers. It is therefore necessary to intervene more efficiently in the natural history of the disease. This aim can be achieve by the early detection and the local treatment of small size lung cancer and in situ carcinoma. Interestingly, pulmonary preneoplastic lung lesions have been identified and characterized in the central airways as well as in the peripheral lung parenchyma. These preneoplastic lesions can evolve to invasive cancer or regress after tobacco smoking cessation or chemoprevention treatment. A new autofluorescence based endoscopy technique is described, that allows to detect preneoplastic pulmonary lesions and radio-occult lung cancer. These small sized lesions can be cured with endoscopic local treatment such as photodynamic therapy.

Adolescent↗
PubMed1996

Hyponatremia related to medical anticancer treatment.

Hyponatremia is a common potential complication in cancer patients. It can be related to anticancer medical therapy. Vincristine, vinblastine, cisplatin and cyclophosphamide are the chemotherapeutic agents most frequently associated with hyponatremia. More recently, analogs such as carboplatin and ifosfamide have also been incriminated. Hyponatremia is also associated with new immunomodulators (interferon, interleukin-2 and levamisole) and monoclonal antibodies. The mechanism by which all these drugs act on the sodium steady state is only partially known. The syndrome of inappropriate antidiuretic hormone secretion is described secondary to vinca alkaloids and cisplatin and possibly with alkylating agents. Renal salt wasting is described with platinum compounds.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Combined fractional excretion of sodium and urea better predicts response to saline in hyponatremia than do usual clinical and biochemical parameters.

BACKGROUND: The treatment of hyponatremic patients requires physicians to make a therapeutic choice between saline infusion and water restriction. Therefore, they need readily available and reliable parameters to facilitate making that choice. This study was designed to determine whether the use of clearance ratios can help clinicians recognize saline-responding hyponatremic patients. PATIENTS AND METHODS: Thirty-five nonedematous, hospitalized, hyponatremic patients were classified according to their history and saline response into four groups: diuretic-taking patients, polydipsic patients, saline responders, and saline nonresponders. Within these four groups, clinical and biochemical volume-related parameters, including clearance ratios, were prospectively evaluated before infusion of 2 L isotonic saline. Clearance ratios as well as usual clinical and biochemical parameters were tested for their accuracy in predicting saline responsiveness. RESULTS: Both positive (70%) and negative (54.5%) predictive values for hypovolemia were unsatisfactory; clinical prediction of hypovolemia was also characterized by low sensitivity (41.1%), but acceptable specificity (80%). In the polydipsia and saline-nonresponder groups, plasma urea and uric acid values tended to be lower than in the diuretic and saline-responder groups. However, the usefulness of these parameters was limited by too large an overlap among the different groups. In both polydipsic patients and saline responders, urinary sodium concentration was low. The combined amount of urinary sodium and potassium in relation to plasma sodium did not discriminate among the different groups. Most helpful in distinguishing among the groups was a combination of several clearance ratios (fractional excretions of sodium, potassium, urea, and uric acid), since the predictive use of each parameter on its own was restricted. The best indicator of saline responsiveness was a low fractional excretion of filtered sodium (< 0.5%) combined with a low fractional excretion of urea (< 55%). CONCLUSION: The accuracy of clinical evaluation for predicting the state of extracellular fluid volume in hyponatremia is low. The combination of low fractional sodium excretion (< 0.5%) and low fractional urea excretion (< 55%) is the best biochemical way to predict saline response, whereas high fractional potassium excretion (> 20%) indicates diuretic intake.

Aged↗
PubMed1992

[Small-cell lung cancer: survival analysis over the last 10 years: 1980-1990].

A review of 269 papers published between 1980 and 1990 has been performed in order to evaluate the median survival (MS) of patients with small cell lung cancer (SCLC) in relationship with different therapeutic modalities. We found that therapies with cisplatin and etoposide were associated with a significantly longer MS than those without these drugs. Alternating regimens, short therapies (< or = 6 months) and maintenance treatments have a similar MS. Initial and late intensification does not significantly prolong the MS as compared to conventional treatments. Neither radiation therapy to the chest and/or to the brain does increase the MS. Overall, MS of patients with limited SCLC is significantly longer than that of patients with extensive disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Phase II and III studies with new drugs for non-small cell lung cancer: a systematic review of the literature with a methodology quality assessment.

We carried out a systematic review of new drugs active in non-small cell lung carcinoma (NSCLC). Fifty five phase II and III trials were reviewed (vinorelbine (19 trials), paclitaxel (15), gemcitabine (11), docetaxel (6), topotecan (2) or irinotecan (2)). The first four ones could be considered as active drugs when given as single agent. More information is required for the camptothecin derivatives. Four phase III randomised studies were available, all concerning vinorelbine. They showed that in combination with cisplatin, vinorelbine improved the response rate and perhaps survival, in comparison to vinorelbine alone and that vinorelbine was better than 5 fluorouracil and vindesine. A quantitative overview was impracticable, because of too few randomised trials. A qualitative overview was carried out using the European Lung Cancer Working Party score. The overall median quality score was 65.3%. There was no statistically significant difference between the drugs, but there was a positive correlation between the score and the number of patients. There was also an improvement of the quality score in favour of the randomised trials. Some important methodological aspects were often missing in the articles. In conclusion, gemcitabine, vinorelbine, paclitaxel and docetaxel are active against NSCLC but more good-quality data are required to define their exact role in the routine.

Antineoplastic Agents↗
PubMedDate not supplied

Cisplatin-carboplatin-gemcitabine or ifosfamide-gemcitabine in advanced non-small cell lung carcinoma: two pilot studies.

Gemcitabine has been demonstrated active in non-small cell lung cancer (NSCLC). The objective of this trial was to evaluate the feasibility of combinations of gemcitabine (1 g/m2 dl,8,15) with cisplatin (60 mg/m2 dl) and carboplatin (200 mg/m2 dl) (CCG; n = 12) or ifosfamide (4.5 g/m2 dl) (IG;n = 4) in patients with advanced NSCLC, in order to prepare a phase III randomised trial. Toxicity, mainly haematological, was tolerable. It consisted in neutropenia (IG) and both thrombopenia and neutropenia (CCG). The administration of carboplatin according to the AUC (AUC = 3) resulted in a significant reduction of haematological toxicity. A good number of responses were documented. These acceptable results urged our group to compare these regimens to the combination of cisplatin, carboplatin and if osfamide.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Docetaxel as salvage treatment for non-small cell lung cancer: implementation study].

Salvage treatment with docetaxel after failure of cisplatin-based chemotherapy in non-small cell lung cancer (NSCLC) has already been tested in the context of clinical prospective trials but only dealing with selected patients. The aim of the present study is to assess the generalizability of these results in an unselected population. We retrospectively analysed the data of all patients not included in clinical studies and treated at the Jules Bordet Institute between September 1996 and July 2003 by docetaxel after a previous chemotherapy containing platinum. Patients were separated in two groups: eligible or not studies according to the selection criteria of the published phase II and III prospective trials. There were 27 patients treated by docetaxel after relapse or failure of prior first-line platinum-based chemotherapy. Among them, 15 were ineligible according to the criteria of published phase II and III trials. The global response rate was 7.41%. All responders had a partial response to first line chemotherapy. Toxicity consisted mainly in grade III/IV neutropenia and was similar between the two group of patients. The median survival time was 25 weeks. In conclusion, our implementation study confirms the activity of docetaxel as salvage therapy after failure of first line cisplatin-based chemotherapy in an unselected population of patients with NSCLC, with a response rate similar to that obtained in propective trials.

Adult↗
PubMedDate not supplied

Correction of hyponatremia by urea in a patient with heart failure.

A 84 year-old woman presenting with evolving breast cancer was admitted in the intensive care unit for malaise. Profound hyponatremia in the context of symptomatic heart failure was documented. Intravenous infusion of NaCl 0.9% was unsuccessful. Treatment with oral urea was begun and sodium level returned to nearly normal values 5 days later.

Adenocarcinoma↗
PubMedDate not supplied

[Paraneoplastic gastroparesis].

A 53-years-old woman with bilateral untreated breast cancer is admitted for intractable vomiting. No obstructive gastric disease is found but a marked delayed gastric emptying, suggesting the diagnosis of gastroparesis. No classical cause being demonstrated, the diagnosis of paraneoplastic gastroparesis is proposed. Treatment with cisapride and chemotherapy lead to regression of digestive symptoms and of breast tumor. This uncommon entity, usually described in association with small cell lung cancer, may involve the whole gastrointestinal tract, sometimes in association with abnormalities of the autonomous nervous system. Destruction of the myenteric plexuses by auto-antibodies could be responsible for this pathology.

Breast Neoplasms↗