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Biomedical subjects

T Szepesi

Publications and source records attributed to T Szepesi.

At least 37 records · Page 2Linked to original sources
PubMed1985

[Male breast cancer].

Between 1974 and 1982 inclusive 18 male patients were treated for breast carcinoma. 12 patients had postoperative radiotherapy whereas 4 were referred for treatment of recurrent or metastatic disease. One patient showed signs of inflammatory breast cancer and was treated with chemo-radiotherapy and one was being followed up in our department after radiotherapy for prostatic cancer in 1970. Median overall survival was 52 months and the median disease-free interval was 21 months.

Aged↗
PubMed1985

[Prognostic factors in the treatment of inoperable orofacial tumors with simultaneous radiotherapy and intra-arterial chemotherapy].

Between January 1973 and April 1982 66 evaluable patients with advanced inoperable orofacial tumours underwent intraarterial Bleomycin and Methotrexate with simultaneous radiotherapy in a prospective study. 32 patients had no previous treatment, 34 patients had initial surgery, radiotherapy and/or chemotherapy. 15 mg Bleomycin were administered through a catheter into the arteria externa carotis daily in the morning. 25 mg Methotrexate were given in the same way at night followed by 3 mg Calcium-Leucovorin i.m. every 8 hours. The cumulative dose was 300 mg Bleomycin and 500 mg Methotrexate. Four hours after the administration of Bleomycin the target volume was irradiated (single fraction 2 Gy, total dose 60 to 65 Gy). The overall response rate was 65% containing 17% complete and 48% partial remission. Destruction of the bone appeared to be the most important index at the start of the therapy. Further prognostic determinants as previous treatment, localisation of the primary tumours (maxilla and mandibula respectively oral cavity and oropharynx) and local regional lymphnode stage missed statistically significance in the survival time, may be due to a possible radiosensitizing effect of the simultaneous chemotherapy. Complete remission turned out to be the most important prognostic factor after the end of treatment. Patients responding with complete remission show a median disease free survival of 56+ months and a median survival time of 82 months. Acute reactions were reversible. Only in 14% of the patients the treatment could not be finished. Better results could be obtained by electron-affinic radiosensitizers and high LET radiation.

Antineoplastic Agents↗
PubMed1984

Misonidazole and irradiation in the treatment of high-grade astrocytomas: further report of the Vienna Study Group.

A randomized study investigating the value of misonidazole in patients irradiated for grade III and IV supratentorial astrocytomas was started in June 1977. With a minimum follow-up time of 6 months, 45 patients who completed therapy are available for analysis. All patients received the same radiation treatment (66.5 Gy in 31 fractions over 7.5 weeks, field size reduction after 45 Gy). In the first, second and eighth week, a 4 Gy tumor dose was given on Monday and Thursday. Misonidazole was given 4 hours before irradiation to 18 randomized patients on those 6 treatment days (2.1-2.7 g/m2 per treatment day). Daily tumor doses of 1.7 Gy were administered Monday through Friday from the third until the seventh week. Median survival for patients treated with misonidazole is 13.8 months; for those treated by irradiation alone it was 9.8 months. The corresponding 1 year survival rates are 64 and 25%, respectively. Survival plots indicate some advantage for the patients treated with misonidazole, however statistically there is no significant difference observed (p greater than 0.08). There are no significant differences in Karnofsky performance status, sex and in histological grade or in age distribution between the groups. However, the type of surgery (complete or subtotal) influenced survival markedly: patients with complete surgery lived significantly longer (p less than 0.0009). Neurotoxic side effects of misonidazole were minimal.

Brain Neoplasms↗
PubMed1984

Small bowel double-contrast enema in stage III ovarian cancer.

The efficiency of small bowel double-contrast enema in the detection and localization of tumor- or therapy-induced lesions of the intestine was studied retrospectively in 43 patients with stage III ovarian carcinoma. The radiographic findings in 62 examinations were verified by operative and autopsy findings and by the clinical course. Postoperative changes in the small bowel were noted in 69% of the patients (63% moderate, 6% severe). Signs of acute radiation enteritis were found in 36% (all moderate). Signs of chronic radiation enteropathy were detected in 71% (53% moderate, 18% severe). Small bowel obstruction due to recurrent tumor was correctly identified in 9%. Nonobstructing peritoneal implants were detected in 27% of the patients. The small bowel double-contrast enema is accurate in localizing lesions resulting from adhesions, acute and chronic radiation enteritis, or obstructing tumor; it is less efficient in detecting nonobstructive peritoneal metastases. The major clinical value of this examination is its ability to differentiate "dysfunctional intestine," which is managed conservatively, from focal obstruction requiring surgery. The radiographic features of chronic radiation enteritis on double-contrast enema examination are discussed in detail.

Barium Sulfate↗
PubMed1983

[First clinical experiences with the radiosensitizer MTDQ in advanced primary and recurrent tumors].

Between April 1981 and February 1983 55 patients with advanced tumours or recurrences in preirradiated fields with different localizations and histology underwent radiotherapy in a pilot I study with MTDQ, a radiosensitizer developed in Hungary, at the University Clinic for Radiotherapy and Radiobiology of Vienna. The prognostically unfavourable group with recurrences following complete irradiation of the target volume shows the same response rate and frequency of complete remissions as the prognostically favourable group without pretreatment (73% versus 61% and 27% versus 29%). The best results are noted in epithelial and mesenchymal tumours of head and neck and in gynaecological malignancies. Furthermore, the side-effects of the drug MTDQ, which are clinically acceptable, are comprehensively described and discussed. The authors have come to the conclusion that MTDQ accomplishes the clinical prerequisites of a radiosensitizer, and propose a prospective randomized study for head and neck tumours.

Adolescent↗
PubMed1983

[Treatment of advanced ovarian cancer as an interdisciplinary task: surgery, histopathology, radiotherapy, and chemotherapy].

From February 1977 to February 1981 we treated 55 patients with ovarian cancer (45 stage III and 10 stage IV) with simultaneous radio-chemotherapy; 34 of these patients underwent a therapeutic second-look operation. The overall response rate was 94%, comprising 63% complete and 31% partial remissions. In the group with residual tumours exceeding 2 cm in diameter after primary operation 52% complete remissions were observed. In the stage III group there were 74% complete and 26% partial remissions. Cytoreductive surgery to less than 2 cm was achieved by means of an early second-look operation in 74% of these cases. These patients have as good a prognosis as those with an equivalent residual tumour after primary resection. Unlike the cases with tumour spread to the retroperitoneal area, macroscopic tumour spread to the surface of the liver or diaphragm indicated a worse prognosis. The survival time of patients who prove to be tumour-free at the time of the diagnostic operation is significantly longer than of those with residual tumours. Neither the age of the patients nor the histological findings after primary operation have any significant influence on survival time. Late intestinal complications made us change the therapeutic strategy employed since March 1981 to sequential radio-chemotherapy. Possible cure for stage III patients can be achieved only by way of interdisciplinary cooperation. In stage IV patients the prognosis is so bad that local therapy is possible only in selected cases.

Adenocarcinoma, Mucinous↗
PubMed1983

[Role of radiotherapy in inflammatory local recurrence of breast cancer : first experiences with combined radio-chemotherapy].

Between June 1976 and October 1981 ten patients with extended inflammatory recurrent mammary carcinoma of the chest wall and distant metastases underwent sequential chemo- and radiotherapy at the University Clinic for Radiotherapy and Radiobiology in Vienna. Five of these patients had received local treatment of recurrent mammary carcinoma of the chest wall before. Eight of ten patients responded to therapy, 5 showed complete remission. The mean remission period of 8.8 months for the chest wall area is significantly longer than that of distant metastases with 6.1 months (p less than 0.05). Local megavolt therapy has no influence on the mean survival time, but improves the quality of life considerably. All patients under treatment achieved at least 80% on the Karnofsky score. After a comprehensive study of recent international literature the authors have come to the conclusion that local and regional recurrence after initial treatment obviously prove an advanced stage. For this very reason the prevention of local regional recurrence by means of postoperative megavolt therapy is of great significance.

Adult↗
PubMed1982

[Hormones and tumor therapy: the rational basis of endocrine therapy in breast cancer].

Since endocrine therapy has gained great importance in curative and palliative radiotherapy, the hormone-therapy of breast cancer owing to the relevance of the receptor contents in the tumour, has had to be reconsidered over the past decade. Accordingly, this paper deals with endocrine pathophysiology both in relation to the central and cellular mechanisms of hormone action; in addition it presents recent findings on biosynthesis of the different hormones. Furthermore, important treatment criteria with regard to patient selection will be listed. The discussion of these criteria is based both on clinical findings ("empirical criteria") and on the receptor status ("objective criteria") with a view to a better assessment of risk and prognosis at the time of surgery.

Adrenal Cortex↗
PubMed1982

[Hormones and tumor therapy: current clinical status and future developments in endocrine therapy of breast cancer].

Postoperative adjuvant hormone therapy and hormone therapy in disseminated breast cancer will be discussed systematically. The classical ablative and additive endocrine therapeutic measures--with the exception of ovarectomy and gestagen therapy--are increasingly being replaced by antagonists. Individual chapters discuss recent experience with combined hormone-radiotherapy or hormone-chemotherapy. In addition, a successful therapy scheme for the treatment of disseminated breast cancer will be presented.

Adrenal Cortex Hormones↗
PubMed1982

[Optimum surgical staging and rational use of radiodiagnostic methods in case of ovarian carcinomas (stages III and IV)].

Pretherapeutic informations furnished by surgery and histopathology are of special importance for the local high voltage therapy of the operated ovarial carcinoma. The intraoperative state does not only confirm the diagnosis, but also reveals the full biologic extension of the tumor and, thus, the correct staging. Extensive supplementary radiodiagnostic examinations are necessary if the informations furnished by the surgeon are not complete. Between February 1977 and February 1981, we treated 55 patients suffering from ovarial carcinomas with a combined simultaneous radio-chemotherapy (45 patients with stage III and 10 with stage IV). The first operations had been performed at gynecologic departments of other hospitals in 60% of all cases, at surgical departments of other hospitals in 20% of all cases and at the II. Gynecologic Clinic of the University of Vienna in only 20% of all cases. The definitive staging was established by postoperative analyses of X-ray views of the chest, liver-spleen scintigrams, ultrasonic examination, computed tomography, lymphoscintigraphy and lymphography. 36 women were submitted to an early therapeutic second operation. It turned out that in most of all cases the retroperitoneal manifestations were correctly recognized by the different radiodiagnostic methods; histopathology was superior in only 8% of all cases. The rate of retroperitoneal metastases is 45% out of the total collective and 40% out of patients in stage III. With the therapy method applied, the survival time does not depend upon the retroperitoneal state as long as there are no tumor manifestations with a maximum diameter of more than 2 cm. The liver metastases described after the first operation do not necessarily correspond to such manifestations; often they are rather tumorous peritoneal layers. More attention should be given to the state of the subdiaphragmatic region, because manifestations in this region are an unfavorable diagnostic factor. Patients in stage III have possibly still curative chances. A careful surgical exploration and a close co-operation between surgery, histopathology, radiodiagnosis and clinical examination are not only a basis for a rational treatment but will also exempt patients from unnecessary or cumbersome examinations.

Adult↗
PubMed1982

[Interdependence of response rates, survival rates, stage and histology after radio-/chemotherapy in patients with advanced ovarian carcinoma].

Between February 1977 and February 1981, 55 patients with ovarian cancer (45 at stage III and 10 at stage IV) underwent simultaneous radio-/chemotherapy and early therapeutic second-look operation. The overall response rate amounts to 94%, 63% of which are complete and 31% are partial remissions. Stage III comprises 74% complete and 26% partial remissions. Patients with complete remission at stage III have a significantly longer tumor-free survival time than patients with partial remission (median 16 vs. 8 months). A longer overall survival time (median 30 vs. 16 months) is also significant. At stage III there have been 74% successful therapeutic second operations. In all patients with residual tumors above 2 cm in diameter after primary operation a response rate of 92% could be achieved, 52% showed complete remissions. The survival time proved to be independent of both histological parameter and age. The remaining residual tumor above or under 2 cm in diameter in any single location is, however, a significant prognostic factor for long-time survival. Possible curative chances for patients with stage III disease are only to be expected through interdisciplinary oncological cooperation.

Adult↗
PubMed1981

[The moving-strip technique in the treatment of ovarian cancer (author's transl)].

A critical analysis of the latest results in the treatment of epithelial ovarian carcinomas indicates significant progress. Postoperative radiotherapy using the moving-strip technique is the treatment of choice in stages I a (grade 2 and 3 lesions and/or tumour rupture), Ib, II and III (asymptomatic) with residual tumours less than 2 cm in size. In the stages Ic, IIc and III (symptomatic) with residual tumours larger than 2 cm, radiotherapy may be curative following successful initial combination chemotherapy. This combined modality treatment is being investigated in our department in a prospective trial. The importance of prognostically significant factors (completeness of operation, age, histology, histological grade and adequate treatment) is discussed. The moving-strip technique is described in particular with regard to its practical application as basis of the modern therapeutic regimen for ovarian cancer.

Castration↗
PubMed1981

[Simultaneous radio-chemotherapy of advanced epithelial ovarian cancer--results after three years (author's transl)].

An interdisciplinary prospective, non-randomized study was performed at the University Clinic for Radiotherapy and Radiobiology of Vienna in 26 patients with advanced epithelial ovarian cancers (FIGO stage III and IV) from February 1977 until February 1980. All patients underwent a combined radiotherapy-chemotherapy programme. In those 12 patients in whom at the time of the first operation only a biopsy was possible, the aim was to achieve early operability for a second-look operation (with removal of the internal reproductive organs, the omentum and remaining tumour masses). In 8 of theses 12 patients it was technically possible to perform radical surgery or to reduce tumour masses to under 2 cm. Of 20 evaluable patients 14 had stage III and 6 had stage IV cancer. In patients with stage III the response rate was 100% and the complete remission rate (with or without second-look operation) was above 70%. The duration of complete remission exceeded 10 months, median survival is at present 17 months. Patients with stage IV had a response rate of 66% (but mainly partial remissions), with significantly shorter survival times. Bowel complications occurred in one quarter of the patients and led to a revision of our therapeutic concept and the time sequence of the combined modality treatment. The importance of significant prognostic factors is stressed. The study indicated the superiority of the combined treatment approach in patients with stage III cancer. Patients with stage IV cancer, are, on the other hand, best managed primarily by chemotherapy; palliative irradiation and a second-look operation should be reserved only for selected patients.

Adult↗
PubMed1981

[Current status and future developments in chemotherapy of advanced epithelial ovarian cancers (author's transl)].

In the management of advanced epithelial cancers of the ovary the importance of prognostically significant factors is well established. The remission rates with the drugs most commonly used are stated. Patients with a complete remission show a marked increase in survival time. The importance of prior chemotherapy in relation to a second or third line of treatment is discussed. Immunological test series in combination with chemotherapy are undergoing controlled investigations.

Adenocarcinoma, Mucinous↗