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PubMed2000

A phase III randomized study comparing oral doxifluridine and oral 5-fluorouracil after curative resection of gastric cancer.

To investigate the usefulness of oral doxifluridine (5'-DFUR), an active intermediate metabolite of capecitabine (XELODA), in gastric cancer patients after curative resection, we conducted a phase III randomized controlled study to compare oral 5'-DFUR and oral 5-fluorouracil (5-FU). 485 gastric cancer patients with Stage II or III operative findings at curative resection were registered and administered 5'-DFUR (460 mg/m2/day, daily, for two years) or 5-FU (115 mg/m2/day, daily, for the same period). Although no differences in overall survival or disease-free survival were detected, subset analysis showed 5'-DFUR was more effective in reducing peritoneal recurrence than 5-FU (p = 0.047), and in patients with Stage III or stage IIIb (histologic findings) in the 5'-DFUR group had more favorable disease-free survival curves and survival curves than the 5-FU group with similar stages.

Administration, Oral↗
PubMed2001

Effect of initial tumor stage on patient follow-up after potentially curative surgery for cutaneous melanoma.

The optimal follow-up strategy after completion of therapy for melanoma is not known. We evaluated the effect of TNM stage on the self-reported surveillance strategies employed by practicing plastic surgeons caring for otherwise healthy patients subjected to potentially curative treatment for cutaneous melanoma. Hypothetical patient profiles and a detailed questionnaire based on these profiles were mailed to a random sample (N=3,032) of the 4,320 members of the American Society of Plastic and Reconstructive Surgeons. The effect of TNM stage on the surveillance strategies chosen was analyzed by repeated-measures ANOVA. There were 1,142 responses to the 3,032 surveys; 395 were evaluable. Plastic surgeons often do not provide postoperative follow-up themselves; this was the most frequent reason for non-evaluability. Surveillance of patients after resection of melanoma relies most heavily on office visits, chest X-ray, CBC, and liver function tests. All other surveillance modalities are used infrequently. Most respondents modify their surveillance practices slightly according to the patient's initial TNM stage. Most commonly used modalities are employed significantly more frequently with increasing TNM stage. This effect persists through ten years of follow-up, but the differences across stages are tiny. We conclude that most plastic surgeons performing surveillance after potentially curative surgery in otherwise healthy patients with melanoma use similar follow-up strategies for patients of all TNM stages. These data permit the rational design of a controlled clinical trial of high-intensity vs. low-intensity follow-up.

Adult↗
PubMed1981

Comparative efficacies of quinine and chloroquine as companions to primaquine in a curative drug regimen.

A comparison has been made of the capacities of chloroquine and quinine to serve as companions to primaquine in curing established infections with sporozoites of the M or B strains of Plasmodium cynomolgi in rhesus monkeys. The results indicated that chloroquine was slightly but consistently more effective than quinine in this role. This finding provides support for use of chloroquine as the companion blood schizonticide in the current experimental animal-based search for improved tissue schizonticidal drugs, and bolsters the rather tenuous base for clinical use of this 4-aminoquinoline, rather than quinine, as a companion to primaquine in suppressive-curative and radical-curative regimens.

Animals↗
PubMed1993

Causal prophylactic and radical curative activity of WR182393 (a guanylhydrazone) against Plasmodium cynomolgi in Macaca mulatta.

Primaquine is the only currently available drug effective against persistent tissue stages of relapsing malaria in humans. Causal prophylactic and radical curative properties of WR182393 (a guanylhydrazone) were investigated as part of an effort to evaluate alternatives to primaquine in the rhesus monkey (Macaca mulatta)/Plasmodium cynomolgi test model. The drug was suspended in dimethylsulfoxide for intramuscular (im) injection. A pilot study indicated causal prophylactic activity in a regimen of 40 mg base/kg/day im for three days beginning the day before intravenous challenge with 1 x 10(6) P. cynomolgi sporozoites. Regimens of 31, 10, 3.1, and 0 mg base/kg/day im for three days were then tested in groups of two monkeys given a similar challenge. The two animals given 31 mg base/kg/day remained parasite-free. Average time to parasitemia for the lower dosage groups was 38, 18, and 8 days respectively. Groups of two monkeys with sporozoite-induced P. cynomolgi infections were also treated for seven days with 31, 10, 3.1, and 0 mg base/kg/day im in combination with 10 mg base/kg/day of chloroquine orally. Both monkeys given 31 mg base/kg/day did not relapse. The average time to relapse following treatment was 48, 29, and 8 days, respectively, for the lower dosage groups. Compound WR182393 is the first non-8-aminoquinoline class of drug to exhibit both causal prophylactic and radical curative properties against a relapsing primate, vivax-like malaria.

Animals↗
PubMedDate not supplied

Prognostic factors in ambulatory patients with inoperable locoregionally recurrent rectal cancer following curative surgery.

BACKGROUND: The optimal treatment for locoregionally recurrent rectal cancer after curative surgery has not yet been defined. The definition of prognostic factors could lead to the selection of an aggressive therapeutic approach in patients with favourable prognosis alone. PATIENTS AND METHODS: The records of thirty-nine ambulatory pts, 15 female and 24 male, with diagnosis of locoregionally recurrent rectal cancer (LRRC) after curative surgery and treated with radiotherapy were retrospectively analyzed. The following factors were analyzed for their ability to predict the clinical response and outcome for LRRC: age, sex, initial tumor grading, primary surgical approach, initial primary tumor stage according to Dukes' classification, disease free survival (time to primary surgery and detection of a LRRC), pelvic-perineal structure affected by recurrence, total radiation dose, chemotherapy with fluorouracil, symptomatic response to the therapy, locoregional symptomatic re-recurrence, systemic progression disease. RESULTS: In the univariate analysis, predictive factors for survival, were graded (G1-2 vs G3 p = 0.04), Dukes' stage at first diagnosis (A-B vs C p = 0.01), and site of pelvic-perineal recurrence (Pelvic mass alone yes vs no p = 0.01; Nerve and/or Osseous involvement yes vs no p < 0.001). Following therapy for LRRC, a better survival was observed in pts with a complete symptomatic response (complete remission vs partial remission vs no change p < 0.001), without a further locoregional symptomatic re-recurrence (re-recurrence, yes vs no p = 0.001) and/or appearance of metastatic disease (yes vs no p < 0.001).

Adult↗
PubMedDate not supplied

Post-operative chemotherapy in non-curative gastrectomy for advanced gastric cancer.

BACKGROUND/AIMS: The definitive effects of post-operative chemotherapy for prolonging survival in patients with non-curative gastrectomy for advanced gastric cancer have not been established. METHODOLOGY: Eighty-three patients with advanced gastric cancer who underwent non-curative gastrectomy were divided into 49 patients with post-operative chemotherapy (chemotherapy group) and 34 patients without post-operative chemotherapy (control group). Chemotherapy regimens were as follows: oral 5-fluorouracil (5-FU) alone (n = 22), intravenous mitomycin (MMC) plus 5-FU (n = 20), intravenous methotrexate (MTX) plus 5-FU (n = 3), intravenous cisplatin plus 5-FU (n = 2), and hepatic arterial infusion of 5-FU plus oral 5-FU (n = 2). No prior chemotherapy or radiation therapy was given. RESULTS: Although the age in the control group (mean: 71.9 years) was significantly older than in the chemotherapy group (mean: 66.1 years), there were no significant differences in the other clinical and pathological background data between the two groups. The 1-year survival rate in the chemotherapy group (71.4%) was significantly higher than in the control group (50.0%). However, the 3-year and 5-year survival rates did not significantly differ in the chemotherapy group versus the control group, 30.6% vs. 32.4% and 24.5% vs. 32.4%, respectively. Although a significant difference did not exist between the two groups, median survival after operation in the chemotherapy group (20.5 months) was longer than that in the control group (16.2 months). Furthermore, median survival of patients with peritoneal dissemination in the chemotherapy group (16.4 months) was significantly longer than that in the control group (7.7 months). CONCLUSIONS: Post-operative chemotherapy may contribute to prolonged survival in patients with non-curable advanced gastric cancer, even when patients had peritoneal dissemination. However, the long-term survival rate was not improved by post-operative chemotherapy. More aggressive chemotherapy may be needed to improve the long-term prognosis for such patients.

Adenocarcinoma↗
PubMed1999

Recurrence and survival after potentially curative surgery for colorectal cancer.

AIMS: To measure long-term outcomes in an unselected consecutive series of patients undergoing potentially curative surgery for colorectal cancer at Dunedin Hospital and identify risk factors for disease recurrence and mortality. METHOD: A retrospective study of 241 patients operated on between January 1990 and December 1992, and followed up to January 1996. RESULTS: Overall five-year actuarial survival was 55 percent, and 66, 56 and 43 percent respectively for Dukes' stage A, B and C disease. Factors associated with increased overall mortality were advanced Dukes' stage, perioperative blood transfusion and smoking, whereas factors associated with disease recurrence were advanced Dukes' stage, large tumour size and presentation with obstruction. CONCLUSIONS: Mortality following potentially curative surgery for colorectal cancer in Dunedin has not changed significantly since the previous study 15 years earlier and is similar to more recently published data from other New Zealand centres.

Aged↗
PubMedDate not supplied

Peritoneal recurrence of ampullary carcinoma following curative pancreatoduodenectomy.

A 72 year-old Japanese man with peritoneal recurrence of carcinoma of the ampulla of Vater after curative pancreatoduodenectomy is presented. He was treated by percutaneous transhepatic biliary drainage (PTBD) for obstructive jaundice. The PTBD catheter dislodged 14 days later. He underwent emergency open peritoneal lavage and external choledochal drainage for diffuse bile peritonitis. Cytologic examination of bile obtained from the T-tube revealed malignant cells. He underwent pancreatoduodenectomy with regional lymph node dissection 2 months later for ampullary carcinoma. Pathologic examination showed a macroscopic protruding, 8 x 7 x 10 mm, papillary adenocarcinoma of the ampulla of Vater. The tumor was classified as stage II with pT2, pN0, and pM0. Eight months later, cytologic examination of ascites demonstrated adenocarcinoma cells. The patient died with peritoneal recurrence 10 months after curative pancreatoduodenectomy.

Adenocarcinoma, Papillary↗
PubMed1999

[Demographic and curative factors of need for rehabilitation--possibilities and limits of simple time series models].

Regarding rehabilitation demands, macro-analytical time-series models outline a method for the estimation of effective rehabilitation needs and for explaining the magnitude of the requirements. Their range is limited, in so far as they are unable to clarify the rehabilitation requirement regarding individual micro-level behavioural aspects. For the moment the rehabilitation requirements are hidden units in the models. Differing macro-dimensions have been gradually included in the analysis. The demographic parameters of the potential patients in need of rehabilitation are the fundamental starting point. Rehabilitation requirements are increasingly modelled by the magnitude of the curative requirements. These are characterised in the rehabilitation as "preliminary or follow up". Two examples of simple time-series models in rehabilitation--for the development of rehabilitation demand--illustrate empirically, which possibilities and boundaries are set in view of demographic and curative requirements by the interpretative range of the macro-concepts. What is methodically interesting with it, is how the analytical borders of such time-series models can experience a recognisable theoretical broadening, through a projection in real logistical facts--here in the interaction between prognosis and retrospection.

Coronary Disease↗
PubMed1997

[Primary curative incision in the treatment of perianorectal abscess].

More than 50% of the patients with perianorectal abscess treated with traditional incisional drainage will lead to fistula formation postoperatively. We present a procedure of primary curative incision for treatment with perianorectal abscess without fistula formation. The result of primary curative incision in comparison with traditional incisional drainage in a randomized control study showed that the incidence of postoperative fistula formation and recurrent abscess was 2.56% in the former and 56.25% in the latter. The key points of the procedure were discussed in detail and the causes and prevention of the disease occurred after injection of sclerotic drugs for hemorrhoids were also discussed.

Abscess↗
PubMedDate not supplied

Prediction of survival period for patients with postoperative recurrence after curative resection for advanced gastric carcinoma.

BACKGROUND/AIMS: Although many studies have attempted to clarify the prognostic indicators for gastric carcinoma, there have been few studies regarding the factors that correlate with the survival period of patients with postoperative recurrence. METHODOLOGY: Among 504 advanced gastric adenocarcinoma patients who had undergone curative gastrectomy, 188 patients who had died of recurrence were used in this study. RESULTS: Univariate analysis indicated that age, the presence of lymph node metastasis and blood vessel invasion, the number of positive lymph nodes, and gastrectomy significantly correlated with the survival period. Multivariate analysis indicated that the length of the survival period was independently influenced by the number of positive lymph nodes and blood vessel invasion. The survival time of patients with less than 3 positive lymph nodes and no accompanying blood vessel invasion was significantly longer than that of other patients. CONCLUSIONS: The number of positive lymph nodes and the presence of blood vessel invasion are the most important factors predicting the survival period of patients with postoperative recurrence after curative resection for advanced gastric carcinoma.

Adenocarcinoma↗
PubMed2001

Curative resection of both primary and second primary lung cancer.

Curative resection of a second primary lung cancer in a patient who survived small-cell lung cancer is reported. Small-cell cancer had been treated with chemotherapy followed by surgical resection 12 years before. The patient developed squamous cell cancer as the second primary tumor and underwent lobectomy with mediastinal node dissection. Patients who undergo two curative pulmonary resections of both primary and second primary lung cancer are extremely rare. The patient is alive 176 months after the initial diagnosis of small-cell lung cancer and 28 months after resection for his second primary lung cancer. Careful follow-up at an interval of 3-6 months beyond 10 years is very important because adequate treatments could lead to longer survival of patients with primary small-cell lung cancer.

Carcinoma, Small Cell↗
PubMed2001

[Effects of interferon-alpha on recurrence and metastasis of hepatocellular carcinoma after curative resection in nude mice].

OBJECTIVE: To study the effect of interferon-alpha (IFN-alpha) on the recurrence and metastasis of hepatocellular carcinoma (HCC) in nude mice, and to clarify if there is synergistic effect treated by combination of IFN-alpha and all-trans retinoic acid (ATRA). METHODS: The effect of IFN-alpha and/or ATRA on the proliferation of HCC cell lines was measured in vitro. The metastatic model of human HCC in nude mice LCI-D20 was used in present study. Curative resection was performed at 10th day after implantation in 44 nude mice. Drugs were given at the next day after resection. IFN-alpha was administered subcutaneously at doses of 3+/-10(5) U/day, 6+/-10(5) U/day, respectively. ATRA was administered p.o. at a dose of 20 mg/kg/day, and IFN-alpha 6+/-10(5)U/day combined with ATRA 20 mg/kg/day. The mice were sacrificed 35 days after treatment. The recurrent tumor size was measured and the presence of intrahepatic dissemination and lung metastases were recorded. RESULTS: The effect of IFN-alpha and/or ATRA on the proliferation of HCC cells SMMC7721, BEL-7402, BEL-7405, and MHCC97 was not obvious. The combination of IFN-alpha and ATRA had no synergistic effect in vitro. The lung metastatic rate, the liver recurrent rate, the size of main recurrent lesions, the number of intrahepatic disseminating nodules and the largest disseminating nodule of the controlled group was 100%(12/12), 100%(12/12), (1346.3+/-4.2 ) mm(3), 8.2+/-4.4, 864 mm(3), respectively; whereas it was 0, 87.5%(7/8), (8.7+/-2.9) mm(3), 2.3+/-0.6, and 7.8mm(3), respectively in the IFN-alpha 3+/-10(5) U/day treated group(P<0.05); 0, 12.5%(1/8), 0.5mm(3), 2, 0.5 mm(3) in the IFN-alpha 6+/-10(5)U/day treated group(P<0.05); 0, 12.5%(1/8), 1 mm(3), 2.5+/-0.7, 8 mm(3) in the IFN-alpha 3+/-10(5) U/day and ATRA treated group(P<0.05); 87.5%, 100%, (1472.6+/-5.6) mm(3), 7.3+/-3.8, 768.5 mm(3) in the ATRA treated group (P>0.05). CONCLUSIONS: IFN-alpha has an inhibitory effect on intrahepatic recurrence and lung metastasis of human HCC after curative resection in nude mice, and the effect is enhanced with increasing dose. IFN-alpha and ATRA have no synergistic effect according to in vivo and in vitro test. ATRA has no effect on recurrence and metastasis of HCC.

Animals↗
PubMed2001

Preoperative serum levels of sialyl Lewis(a), sialyl Lewis(x), and sialyl Tn antigens as prognostic markers after curative resection for colorectal cancer.

In this study, we examined the preoperative serum levels of sialyl Lewisa, sialyl LewisX, sialyl Tn, and carcinoembryonic antigen in 243 colorectal cancer patients in order to clarify the role of these antigens as prognostic factors after curative surgery. The patients were divided into two groups: low and high antigen groups (lower and higher than a selected diagnostic-based cut-off value). Patients with high serum levels of sialyl Lewisa and carcinoembryonic antigen had shorter disease-free intervals than those with low serum levels of the respective antigen, although sialyl Lewisx and sialyl Tn showed no significant differences. Multivariate analysis revealed that three independent prognostic variables, including depth of tumor invasion, lymph node metastasis, and serum sialyl Lewisa level, did prove to have value in predicting disease-free interval. In conclusion, among the four antigens examined in this study, the preoperative serum level of sialyl Lewisa is the only independent prognostic variable for recurrence after curative resection of colorectal cancer.

Adult↗
PubMed1979

[Prognostic criteria and clinical prerequisites of curative therapy of esophageal cancer by radiotherapy alone (author's transl)].

Survey of 289 patients with squamous cell carcinoma of the esophagus treated solely by irradiation between 1961 and 1973. All patients fit for radiotherapy -- uniformly without further selection -- received a local dose of at least 6500 rads. This resulted in a 18% one year survival rate; only one patient lived more than five years. All patients were compared using different criteria to correlate the initial findings at the time of diagnosis with the type of therapy and the prognosis. Three treatment plans were established according to the initial clinical findings: a) palliative therapy, b) locally curative therapy and c) radical curative therapy. The treatment plan which seems to show the best results consists of preoperative irradiation with adjuvant chemotherapy followed by surgical removal of the tumor. This plan should be pursued in all appropriate patients.

Adult↗
PubMed2001

[Curative effect of radical gastrectomy combined with peritoneal lavage with thermal hypoosmotic solution in treatment of gastric cancer].

OBJECTIVE: To evaluate the curative effect and indications of radical gastrectomy combined with peritoneal lavage with thermal hypoosmotic solution, double distilled water (DDW) or DDW plus chlorhexidine acetate, in treatment of gastric cancer. METHODS: Five hundred cases of gastric cancer who underwent radical gastrectomy from January 1986 to December 1995 were divided into three groups: group A with 198 cases who underwent radical gastrectomy and peritoneal lavage for 10 minutes with 400 ml of DDW at 43 degrees C, group B, with 89 cases who underwent radical gastrectomy and peritoneal lavage for ten minutes with 4 000 ml of DDW plus 0.6 g chlorhexidine acetate, and group C, with 213 cases who underwent radical gastrectorny and peritoneal lavage for four minutes with 4 000 ml of normal saline at normal temperature as controls. RESULTS: The group A and group B (called lavage group as a whole) had almost the same curative effects. The one-year survival rates and three-year survival rates were similar among the cases in different stages in no matter what group. The five-year survival rate was 63.8% in the lavage group and 51.2% in the control group, most of the cases with a good effect being at the mid-stage (II and III A stages). CONCLUSION: Peritoneal lavage, helpful in killing the exfoliated cancer cells in peritoneal cavity of patients with gastric cancer at II and III A stages, should be conducted in the treatment of gastric cancer by radical gastrectomy before closing the abdomen.

Adult↗
PubMedDate not supplied

The prognosis of stage IV gastric carcinoma patients after curative resection.

BACKGROUND/AIMS: In the UICC staging system, stage IV contains not only those patients with distant metastasis but also patients with far-advanced T and N status but without distant metastasis. We investigated the prognostic factors of stage IV gastric carcinoma patients, without distant metastasis after curative resection and the role of surgery. METHODOLOGY: One hundred and ninety stage IV gastric carcinoma patients, without distant metastasis were reviewed after curative resection in our hospital from January 1987 to December 1996. RESULTS: Male sex, distal third location, diffuse or infiltrative type and histologically undifferentiated type were common. Of the 190 patients, 52 (27.4%) patients lived more than 3 years. The lymph node ratio (positive lymph node/retrieved lymph node) and combined resection independently affected survival (P = 0.0013, 0.0061, respectively). The perigastric lymph node ratio was well correlated with overall lymph node ratio (r = 0.794, P < 0.001). CONCLUSIONS: With the involvement of an adjacent organ and knowing the perigastric lymph node ratio, the surgeon can decide upon the extent of dissection and postoperative treatment. However, a prospective study is warranted.

Female↗
PubMed2002

[Inappropriate prescription of heparin at curative doses in the hospital. Can the information to prescribing physicians decrease misuse?].

OBJECTIVES: To control whether prescriptions of curative doses of heparin (non fractioned heparins, enoxaparin, tinzaparin) in the hospital complied with the official recommendations; to provide the physicians with information adapted to the recorded misuse and to evaluate the influence of this information. METHODS: A prospective study was conducted between May and October 1999 on the prescriptions of 20 residents from 6 services in 3 phases: phase P1 with initial evaluation (particularly on the indications for heparin, the molecule administered, initial dose and monitoring), phase P2 with analysis and diffusion of an adapted information and phase P3 with final evaluation. RESULTS: 111 inpatients were included in the phase P1 (66.7% aged over 75 years, 18.9% with creatinin clearance below 30 ml/mn) and 101 inpatients were included in the phase P3 (56.4% aged over 75 years, 10.8% with renal failure). During phase P1: among the prescriptions of low molecular weight heparin (LMWH) 54.3% did not comply with the official recommendations; initial doses were too high in 15.3% of patients; mean initial doses of LMWH were not adapted to age, weight or creatinin clearance. Only 58.5% of patients had their platelets monitored. On the other hand, 15.3% of patients exhibited heparin side effects. During phase P3, the main modifications in prescriptions were a reduction in inappropriate indications for LMWH, reduction in LMWH prescriptions in patients aged over 75 or with excessive body weight or with renal failure, and increased platelet monitoring, but without significant difference. On the other hand, mean initial doses of each heparin were not modified. Heparin complications decreased but not significantly. CONCLUSION: This study highlights a real context of heparin prescription at curative doses, often differing from clinical studies, particularly with regards to age, renal failure and comorbidity; prescriptions often unadapted to official recommendations on indications, dose and monitoring; a real but limited influence of appropriate information for the physicians, which partially depends on the accuracy of official recommendations, particularly in patients with increased hemorrhagic risk.

Adult↗