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PubMed1992

Angiographically occult brainstem vascular malformation: a longitudinal comparison of magnetic resonance imaging (MRI) and multimodal evoked potential (EP) recordings.

Over a period of several years, a patient with angiographically occult vascular malformation (AOVM) involving the brainstem was longitudinally studied by means of serial Magnetic Resonance Imaging (MRI) and multimodal Evoked Potential (EP) recordings (visual-VEP, brainstem auditory-BAEP, somatosensory--SEP--by stimulating median and peroneal nerves). MRI did contribute to an accurate definition of AOVM features. In particular, it was able to follow over time the AOVM size, and to discriminate between recent and old bleedings. Multimodal EP recordings displayed different pathological BAEP and peroneal SEP values, which documented a transient segmental brainstem involvement (related to the presence of hemorrhage), along with persistent and probably irreversible signs of diffuse brainstem dysfunction. Thus, MRI and EP assessment is useful in monitoring the clinical course of brainstem occult vascular malformations.

Brain Neoplasms↗
PubMed2005

Response of S 180 murine tumor to bleomycin in combination with radiation and hyperthermia using micronucleus assay: a multimodality approach for therapeutic augmentation.

Response of a transplantable tumor, S180, grown intradermally in inbred Balb/c mice, was assessed by using micronucleus assay after treating the solid tumors with bleomycin (BLM), radiation (RT) and hyperthermia (HT) vis-a-vis multimodality approach. The frequency of micronuclei (MN) though did not vary greatly during the one week of observation in untreated tumors, it significantly increased in the drug and RT groups at 24 hr post-treatment. However, MN frequency was non-significant in the HT group from the control. A drug dose dependent linear increase in the frequency of MN induction was evident in 10, 15 and 20 mg/kg body weight BLM alone treated groups. Combination of radiation with BLM or HT further increased the MN counts in the bimodality groups. But, MN induction at 24 hr post-treatment in the trimodality group (BLM + RT + HT) was non-significant from that of the bimodality treatments. However, the tumors treated with trimodality treatment presented severe tumor necrosis, indicating increased cell loss, and resulting in immediate tumor regression. In all the bi-modality groups MN counts though declined 3 or 5 days post-treatment, the values remained significantly higher than the control, on day 7 post-treatment. Micronucleus assay could be used as a predictive parameter for the assessment of post-irradiation tumor regression response. However, the tumor response assessment with MN assay alone may not be sufficient and the role of other parameters, such as apoptosis and necrosis, in immediate tumor regression, especially radiosensitive/thermosensitive tumors can not be ignored while taking multimodality approach into consideration for cancer therapy.

Animals↗
PubMed2005

Aggressive multimodality treatment for intra-hepatic recurrence of hepatocellular carcinoma following hepatic resection.

BACKGROUND: Intra-hepatic recurrence following hepatic resection is the primary challenge for patients with hepatocellular carcinoma (HCC). The aim of this investigation was to evaluate the long-term results of multimodality treatment of patients with intra-hepatic recurrent HCC following hepatic resection. METHODS: From January 1995 through December 2001, a total of 846 patients who underwent hepatic resection for primary HCC at the Chang Gung Memorial Hospital (Taoyuan, Taiwan) were analyzed through long-term follow-up; intra-hepatic recurrence of HCC was identified in 444 (52.5%) patients. Patients with intra-hepatic recurrence were categorized into two groups based on whether they underwent regional treatment. A comparison analysis of the survival rates of these two groups following treatment for recurrent intra-hepatic HCC was performed. RESULTS: Patients treated with multiple modalities exhibited significantly better survival results, both after initial hepatectomy and intra-hepatic recurrence compared with patients in the non-regional-treatment group. (p < 0.001) The 1-, 3-, and 5-year survival rates of patients in the regional-treatment group after initial hepatic resection were 88.1%, 60.1%, and 35.8%, respectively. The 1-, 3-, 5-year survival rates after treatment of intra-hepatic recurrence in the regional-treatment group were 74.8%, 39.3%, and 25.2%, respectively. CONCLUSION: The incidence of intra-hepatic recurrence following hepatic resection for HCC remains high. Aggressive multimodality treatment could extend the survival for patients with recurrent postoperative intra-hepatic HCC.

Adult↗
PubMed2006

[Long-term survival following multimodality treatment of metachronous metastases (parotid gland, adrenal gland, brain and mediastinal lymph node) after resection of non-small cell lung cancer; report of a case].

We describe a case of long-term survival following multimodality treatment of metachronous metastases (parotid gland, adrenal gland, brain and mediastinal lymph node) after resection of non-small cell lung cancer. A 72-year-old man had a past history of right upper lobectomy for pT3N0M0 tubular adenocarcinoma of the lung 12 years ago and left lower lobectomy for pT3N1M0 papillary adenocarcinoma of the lung 42 months ago, and left parotidectomy and irradiation to the neck for parotid metastasis 20 months ago. A progressive increase in serum CEA level during the follow-up period revealed a 5 cm left adrenal mass and small (1 cm or less) multiple brain metastases, and a 2 cm mediastinal lymph node. He underwent adrenalectomy and gamma knife surgery and received irradiation to the mediastinum, and was administered gefitinib as first-line chemotherapy for about a year. Brain metastases recurred despite 4 more rounds of gamma knife surgery and 4 cycles of docetaxel hydrate as second-line chemotherapy, and 1 cycle of vinorelbine ditartrate as third-line chemotherapy. He died of multiple brain metastases 65 months postoperatively. We confirm the possibility of long-term survival following multimodality treatment even though multiple organ metastases were found after resection of non-small cell lung cancer.

Adrenal Gland Neoplasms↗
PubMed2006

Management of malignant glioma: steady progress with multimodal approaches.

Despite recent successes in the treatment of cancer with multidisciplinary multimodal treatment approaches, the duration of survival for patients with malignant glioma remains limited. Malignant gliomas represent a class of infiltrative, aggressive neoplasms that are generally resistant to combination therapies. The basic approach to treatment has involved a combination of surgery and radiotherapy. The use of chemotherapy has been met with skepticism because of its limited efficacy and the significant side effects demonstrated in clinical trials. Nevertheless, based on findings in randomized trials of new agents, it has been suggested that further evaluation of the role of chemotherapy is warranted. Temozolomide and Gliadel (carmustine wafers) are generally well tolerated due to their limited systemic toxicity. These agents appear particularly well suited for incorporation into multimodal treatment strategies. Proposed investigations and ongoing clinical trials will be conducted to assess the use of these agents in novel combination therapies. Future treatment strategies may include a wide variety of biological response modifiers, but will need to continue to address local control with surgery, radiation, and adjuvant chemotherapy.

Antineoplastic Agents↗
PubMed2006

A prospective clinical feasibility study for multimodal "fast track" rehabilitation in elective pancreatic cancer surgery.

INTRODUCTION: Surgery on the pancreas is a major abdominal procedure leading to a number of pathophysiological alterations during the early post-operative period. Novel approaches to perioperative care including shortened pre-operative starving periods, pre-operative glucose load, sophisticated pain management and early enteral feeding have resulted in major improvements of surgical results after major colorectal surgery. These alterations of perioperative care have been introduced to visceral surgery as so-called fast track surgery or multimodal rehabilitation (multimodal rehabilitation, ERAS = enhanced recovery after surgery). So far it is not known whether or not these approaches can also be applied in pancreatic cancer surgery. METHODS: Twelve patients underwent fast track rehabilitation after pancreatic cancer surgery and their clinical course was compared with age-, sex-, and disease-matched control patients. In addition to clinical parameters (resumption of gastrointestinal function, complication rates, postoperative length of stay) we compared leukocyte counts and C-reactive protein serum levels of both patient groups. Patients recruited for this prospective study received clear carbohydrate rich fluid until two hours before surgery. Bowel preparation was reduced to one-time administration of a laxative and pain treatment consisted of thoracic epidural analgesia in combination with COX-II inhibitors. Intraoperative fluid administration was restricted to 500 cc of colloids and 500 cc of electrolytes. Oral food intake started on the day of surgery with clear fluids and was increased to a small amount of solid food on day 3 after surgery. Complete enteral nutrition was initiated on day 5 after surgery following opaque media examination of the upper gastrointestinal tract. Demission from hospital was planned on day 10 after surgery. RESULTS: The clinical course of patients undergoing fast track rehabilitation was significantly faster regarding resumption of bowel function and complete enteral nutrition. Furthermore, postoperative length of hospital stay was significantly shorter in fast track patients. CONCLUSION: While routine laboratory parameters showed similar changes during the postoperative course after pancreatic surgery, the clinical outcome parameters clearly indicated that the concept of fast track rehabilitation can be even beneficially applied to these high-risk patients undergoing elective surgery for pancreatic cancer.

Adult↗
PubMed2006

Mucoepidermoid carcinoma of the thymus treated by multimodality therapy: a case report.

A case report of mucoepidermoid carcinoma of the thymus, aggressively treated by multimodality therapy including surgery, radiotherapy, chemothermotherapy, and systemic chemotherapy is presented. The patient, a 53-year-old man, underwent potentially complete resection for an anterior mediastinal tumor, histologically diagnosed as a mucoepidermoid carcinoma of the thymus with Masaoka stage II disease. However, because of local recurrences in the left chest wall and pleura, re-resection was twice performed 4 years and 5 months, and 5 years and 7 months after the initial surgery, in combination with intrathoracic chemothermotherapy and irradiation. Seven years and 1 month after the initial operation, in vitro chemosensitive test based-chemotherapy using vinorelbine for pleural disease was performed, resulting in maintenance of good quality of life (QOL) due to dramatic decrease in pleural effusion. He died of tumor progression, 7 years and 9 months after the initial treatment. Although the clinical aspects of thymic mucoepidermoid carcinoma are little known, it is assumed that such aggressive therapeutic multimodalities as repeated surgical resection, irradiation and chemothermotherapy, and chemotherapy based on in vitro chemosensitivity tests contributed to long-term survival for this unusual disease.

Carcinoma, Mucoepidermoid↗
PubMed2002

Interventions for detrusor overactivity: the case for multimodal therapy.

Viable therapeutic alternatives for the management of overactive bladder (OAB) have recently evolved that provide satisfactory symptomatic control for the majority of patients. However, the presupposition that interventions exist as stand-alone entities is not representative of experience in unique populations with the therapeutic benefit of combination therapy, using components drawn from behavioral, physiotherapeutic, neuromodulatory, and, if necessary, surgical alternatives. Even in populations relatively refractory to therapy, the use of multimodal therapy yields additive benefits for patients with OAB symptoms. Herein is detailed the evidence supporting the concept that multimodal therapy provides optimal benefit to patients suffering from this symptom complex.

Journal Article↗
PubMed2002

Treatment approaches for interstitial cystitis: multimodality therapy.

Interstitial cystitis is an increasingly common disease characterized by urgency, frequency, and pelvic pain. Its etiology is poorly understood but is likely to be multifactorial. A proposed pathophysiology describing a cascade of events, including epithelial dysfunction, mast cell activation, and neurogenic inflammation, is presented. Using this model, multimodality therapy regimens have been developed that treat all components of this cascade. Multimodality therapy appears more effective than single agents in the treatment of interstitial cystitis.

Journal Article↗
PubMed1991

[Experience of multimodal therapy for advanced neuroblastoma].

The prognosis of advanced neuroblastoma is extremely poor. We treated 5 patients with advanced neuroblastoma, older than 3 years, with multimodal therapy including intraoperative irradiation and autologous bone marrow transplantation. Elevated serum NSE and ferritin level and unfavorable histology according to the Shimadas histological classification, all of which are indicators of poor prognosis, were found in all of them. N-myc oncogene was amplified in 3 cases. After preoperative intensive induction chemotherapy, delayed primary operation and intraoperative irradiation (10-15 Gy) were performed. The postoperative lethal dose chemotherapy and total body irradiation (33 Gy x 3 days) were followed by autologous bone marrow transplantation. Tumor cells were purged using immunomagnetic beads method. Two cases showed recurrence (brain; 1, bone and bone marrow; 1) and a metastatic brain tumor was extirpated completely. All of them are alive during the follow up period from 6mo. to 4y8mo. (mean; 2y5mo.) with no evidence of disease except one. It may be concluded that our multimodal therapy is effective in achieving better results for advanced neuroblastoma.

Bone Marrow Purging↗
PubMed1990

Primary mediastinal nonseminomatous germ cell tumors. Results of a multimodality approach.

Before cisplatin-based chemotherapy, long-term survival after resection of primary mediastinal nonseminomatous germ cell tumors was unusual. We reviewed the case histories of 48 patients who underwent multimodality treatment for mediastinal nonseminomatous germ cell tumor between 1976 and 1988. Twenty-eight patients received initial therapy at Indiana University and 20 were referred after having had unsuccessful initial therapy elsewhere. In 44 patients (92%) the levels of either one or both serum tumor markers were elevated at the time of diagnosis. Five patients had choriocarcinoma, three embryonal carcinoma, 12 yolk sac carcinoma, four teratocarcinoma, 22 mixed cell type, and two had an unclassified type. Twenty-two of the 28 patients in our initial therapy group had a complete response to treatment, as defined by normal serum tumor markers and absence of residual tumor. In this group, 16 patients had resection of residual disease after chemotherapy, four had total or near total resection before chemotherapy, and only two had chemotherapy alone. Seventeen patients are surviving after this treatment with a median survival of 64 months and a 57% 5-year Kaplan-Meier survival rate. Only two of the 20 patients who were referred for salvage chemotherapy had a complete response. Both required resection of residual disease after salvage chemotherapy. Only one patient survived after this treatment. There was no significant treatment morbidity or mortality. A multimodality approach to primary mediastinal nonseminomatous germ cell tumor with intensive cisplatin-based chemotherapy, emphasis on normalizing serum tumor markers, and aggressive resection of residual disease now offers survival to a significant number of patients.

Adolescent↗
PubMed1989

[Effects of early multimodal stimulation on preterm newborn infants].

During the last trimester of pregnancy, newborns are deprived of both maternal biorhythms, tactile, kinesthetic and auditory stimulation which characterize the intrauterine environment. The purpose of this study is to determine if supplemental multimodal stimulation improves neurobehavioral performance, increases weight gain and shortens hospital stay. Nine neonates with the following characteristics were included in an early multimodal stimulation program: 1) gestational age less than or equal to 34 weeks, 2) feeding through orogastric tubing, 3) hemodynamically stable, with no signs of hemorrhaging, infections, or any suggestion of neurological damage, convulsions or congenital malformations. A control group with the same characteristics was also included in the study. Risk factors for each patient were evaluated and their evolution was closely watched while still in the hospital. Both the postural reflexes and neurobehavioral performance were assessed at the time the child left the hospital and a month afterwards. Statistically significant differences were found in the neurobehavioral performance and postural reflexes of those included in the study group.

Acoustic Stimulation↗
PubMed1989

[Multimodality treatment of malignant brain tumors].

The outcome of treatment for malignant brain tumors has remarkably improved in recent years by applying multimodal therapeutic procedures. This conclusion was made by analysis of accurate data consisting 22,600 cases of completely followed brain tumor patients accumulated under the All Japan Brain Tumor Registry. The 5-years survival rates of malignant brain tumors have much improved in these 15 years, in which the most significant improvements were noticed in cases of medulloblastoma and intracranial germ cell tumors. The 5-year survival rate of medulloblastoma was improved from about 30% to more than 80%, and the number of cured patients are increasing. These favorable results are due to many factors, such as advanced imaging diagnosis of CT scan and MRI, radical surgical removal of tumors under operating microscope, and combined radiotherapy with chemotherapy. The synchronized chemoradiotherapy using vincristine and ACNU or ACNU and interferon has significantly improved the outcome of treatment for malignant gliomas. The administration of calcium entry blocker before the injection of vincristine has improved the effectiveness rates of chemoradiotherapy. Germinoma can completely be cured by chemoradiotherapy. The 5-year survival rates of germinoma have reached to 100% in female and more than 93% in male cases. The effectiveness of surgical removal, sensitivity for radiotherapy and chemotherapy were analyzed in various histological types of brain tumors and the significant effect of multimodal treatment for these tumors were discussed.

Brain Neoplasms↗
PubMed1989

[Use of plasmapheresis in multimodality correction of hemostasis disorders in patients with calculous pyelonephritis].

As many as 142 patients with calculous pyelonephritis were examined for the system of hemostasis. It is shown that pyelonephritis is characterized by hypercoagulation shifts according to the echitox test, by the high content of fibrinogen and its degradation products, thrombinemia, a decrease of the antithrombin III level, and by high heparin resistance of plasma. At the same time there was a reduction of fibrinolysis. Thirty-six patients with the most pronounced disorders of hemostasis underwent multimodality treatment including plasmapheresis which favoured an improvement of the patients' status. The body temperature declined, the signs of intoxication disappeared, and the well-being improved. Hypercoagulation tended to disappearance, whereas the content of fibrinogen and its degradation products decreased. The level of antithrombin III rose and plasma resistance to heparin disappeared. At the same time the characteristics of the paracoagulation tests identifying thrombinemia remained unchanged. No noticeable changes in fibrinolysis were recorded. It is suggested that plasmapheresis should be widely used in multimodality treatment of pyelonephritis.

Adult↗
PubMed1988

Multimodality evoked potentials in sarcoidosis.

Neurosarcoidosis is suspected on clinical grounds and then confirmed by radiography, by spinal fluid examination, or by biopsy. To determine whether evoked potential testing may also be of value in diagnosing and following the course of neurosarcoidosis, multimodality evoked potentials were obtained in 12 men with sarcoidosis, including two with neurosarcoidosis. Seven of 12 subjects, one of whom had neurosarcoidosis, manifested abnormal evoked potentials. Visual evoked potentials were abnormal in one patient and somatosensory evoked potentials were abnormal in one patient. Five additional patients, including one with neurosarcoidosis, had abnormal auditory evoked potentials suggestive of auditory nerve or low pons involvement. These data indicate that multimodality evoked potentials, especially auditory potentials, may show central nervous system involvement in patients with sarcoidosis in the absence of clinically apparent disease.

Adrenal Cortex Hormones↗
PubMed1986

Biofeedback, cognitive training and relaxation techniques as multimodal adjunct therapy for hospitalized adolescents: a pilot study.

Modifications and adjuncts to traditional therapy techniques appear to be necessary for successfully treating hospitalized adolescents with impaired social and verbal skills, and a history of acting-out behavior. Modified therapy groups were combined with a structured biofeedback and cognitive training program to help these adolescents control anger and modify their behavior. Used in conjunction with training and practice in relaxation techniques, this multimodal treatment approach appeared to be helpful in both reducing incidents of acting out on residential units, and in reaching individualized therapeutic goals. The present paper describes use of this multimodal approach within selected residential settings, and outlines the structured materials developed by the authors.

Acting Out↗
PubMed1985

Utility of multimodality evoked potentials in cerebral injury.

With technical rigor and a few modifications, reliable recordings of multimodality evoked potentials can be obtained in patients suffering head injury. The integrity or complexity of the EP waveform appears to be the best indicator of the reversibility of injury to the CNS. A multimodality approach is recommended in head trauma to enhance the sample of brain tissue evaluated, as a single pathway courses a very limited region of brain. In head injury, the EP and clinical findings do not correlate perfectly, although they are generally in agreement. In most cases, the EPs are accurate prognostic indicators and the rate of error of prediction is actually slightly lower than that of the clinical examination in head trauma. Serial evaluations are often necessary as a patient's course and prognosis may change. These changes may not be readily apparent on clinical examination. The information provided by MEP studies is quite helpful when the clinical examination is incomplete or inconsistent. Even when clinical data are available, the EP results, when combined with other indicators of neurologic integrity, afford a firmer basis for diagnostic and prognostic decisions.

Auditory Pathways↗
PubMedDate not supplied

Recent progress in multimodal therapy for resectable breast cancer.

Operable breast cancer with histologically positive axillary lymph nodes has been subjected to a number of prospective randomized trials with multimodal therapy in Milan since 1973. Available results indicate that the scientific and biological hypotheses that formed the basis of multimodal therapy were correct. In fact, five years after radical mastectomy, women who had received adjuvant chemotherapy with cyclophosphamide, Methotrexate and fluorouracil (CMF) showed significant improvement in relapse-free and total survival rates. The results were related to the level of drug administered as well as to the number of axillary nodes, but not to menopausal or estrogen receptor status. Future analyses will better define the optimal duration of CMF chemotherapy (12 vs. 6 cycles) as well as the efficacy of sequential noncross-resistant regimens.

Antineoplastic Agents↗