[Recent development in the chemotherapy of metastasizing teratocarcinomas of the testis].
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Biomedical subjects
Publications and source records attributed to U Bruntsch.
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In 21 patients with acute leukaemia not or no longer responsive to conventional chemotherapy, and in four patients with chronic myeloid leukaemia in the blast phase, intensive combination treatment was started with thioguanine, daunomycine, cytarabine, methotrexate, prednisone, cyclophosphamide, and vincristine. Six patients with acute leukaemia went into complete remission, three into partial remission. The mean duration of remission was relatively short at 11 weeks. Of the four patients in the blast phase of chronic myeloid leukaemia two had objective and subjective remission. The toxicity of the combined treatment was not marked and subjective tolerance good. Such combined treatment is a realistic means of managing treatment-resistant acute leukaemia and chronic myeloid leukaemia in the blast phase.
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In a prospective study 18 patients with metastasizing testicular teratomas were treated with adriamycin, bleomycin and vincristin. Sixteen could be fully evaluated: 12 in stage IV (visceral metastases), three in stage III (lymphondular involvement beyond the diaphragm) and one with advanced stage II (iliac, para-aortic and inguinal nodes). None of the patients had previously received chemotherapy. Toxic side-effects were not severe enough to prevent 12 patients from being treated on an outpatient basis. Complete remission occurred in five, with four of them still in remission two, eight, ten and eleven months later. Partial remission (50% decrease in tumour size for at least four weeks) occurred in three, with one still improving. No change was noted for 11 months in a patient with advanced pulmonary disease. Progression under therapy occurred in seven patients and in some of them there was an initial response which did not, however, meet the criteria of partial remission. The therapeutic results as well as toxicity suggest that this regime is superior to actinomycin D montherapy and various previously used combinations.
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Acquired erythroblastic aplasia of adults is a rare disease characterised by the absence of red cell precursors in the bone marrow. In a 34-year-old female patient the disease has been known for seven years. A partial remission had at first been achieved with glucocorticoids but regular transfusions had been necessary since 1971. Treatment with cyclophosphamide produced a remission which has lasted for over twelve months up to now. Histology of the bone marrow biopsy shows the appearance of active erythropoiesis after cyclophosphamide treatment which reflects well the clinical course.
Combined treatment with three or five chemotherapeutic drugs was given to 115 women with metastasizing breast cancer. These were unselected cases. Three drugs (cyclophosphamide, methotrexate and prednisone) were given to 49 patients, with remissions occurring in 28, arrest in a further five. Five drugs (additional to the three mentioned ones: vincristine and 5-fluorouracil) were given to 66, with remission in 45 and arrest of the disease in another eight. There was no certain difference between the response to the two forms of treatment. Mean survival time for both forms was 13 months in the remission group and six months in the failure group.
We report about a group of 11 patients with primary lympho- or reticulosarcoma of the stomach in a group of 94 patients with Non-Hodgkin-Lymphomas. There were 5 patients with reticulosarcoma of the stomach among 44 patients with reticularsarcoma (11 percent) and 6 patients with primary lymphosarcoma of the stomach among a total of 50 patients with lymphosarcoma (12 percent). In most instances the diagnosis was made during surgery. At the time of diagnosis only 4 of the 11 patients had Stage IE disease. All patients who received intensive chemotherapy are living. Patients who died during the observation period had reticulosarcomas. They had not received any chemotherapy or treatment was discontinued early for varying reasons. Results are discussed in view of the diagnosis and treatment, suggestions for therapy are made.
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