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At least 829 records · Page 46Linked to original sources
PubMed1986

Prediction of outcome after curative resection for large bowel cancer.

Prospectively collected information on 2524 patients who had undergone "curative" resection for colorectal cancer was analysed to establish the rank-order of importance of both clinical and pathological factors affecting outcome. The patients were divided into two groups. In the first, a statistical weighting was established for each prognostic factor and those that influenced long-term survival were, in order of importance, lymph node status, tumour mobility, number of lymph nodes positive for tumour, presence of bowel obstruction, and depth of primary tumour penetration. Factors that influenced in-hospital mortality were cardiopulmonary complications, intraabdominal sepsis (without anastomotic leak), presence of bowel obstruction, and age. In the second group these mathematical weightings were applied, and the predicted and observed outcomes were in close agreement. Statistical techniques of this kind will be of value in prognosis and in analysis of the results of new treatment regimens.

Adult↗
PubMed1989

Factors influencing mortality after curative resection for large bowel cancer in elderly patients.

Mortality rates from the Large Bowel Cancer Project are presented with special reference to patients older than 70 years. The in-hospital mortality rate among those who underwent curative resection for colorectal carcinoma was 7%. Unlike long-term prognosis, which is influenced by pathological features, in-hospital mortality is influenced largely by clinical factors. Age was an adverse factor (78% of deaths occurred among those aged over 70, who formed 46% of the study population), as was obstruction or perforation. 55% of deaths were due to cardiopulmonary complications. Educating patients to seek treatment early, careful preoperative assessment and postoperative monitoring of cardiopulmonary function, and, in selected patients, use of local treatments rather than wide resections may help to reduce mortality in elderly patients.

Age Factors↗
PubMed2003

Evolution of non-pharmacological curative therapy for atrial fibrillation. Where do we stand today?

The present review aims at giving a comprehensive synthesis regarding not only the epidemiological aspects but also the evolution, over the last decades, of the curative surgical and catheter-based ablative treatments for atrial fibrillation (AF), with particular emphasis on the experience of Milan working group which has always been committed to the on-going and fascinating therapeutic challenges inherent in this type of cardiac arrhythmia. After discussing the surgical treatment of AF we report the rationale basis of current pulmonary vein (PV) ablation techniques. In particular, we report on circumferential PV ablation, an intellectually appealing strategy, aimed at creation of RF lesions around each PV ostia using a non-fluoroscopic electro-geometric mapping system to reconstruct the anatomy of venous-atrial junction, allowing to tailor number and size of lesions to the complex morphology of the PV-LA junction in each patient. This purely anatomic approach not only disconnects PVs (as demonstrated by elimination of PV ostial potentials and absence of discrete electrical activity inside the lesion during pacing outside the ablation line), but also, like surgery, reduces the "electrically active" atrial tissue, involving substantial parts of the posterior LA wall, with a profound atrial electroanatomic remodeling, as expressed by voltage abatement (<0.1 mV) inside and around the encircled areas.

Atrial Fibrillation↗
PubMed2000

Cellular radiosensitivity and complication risk after curative radiotherapy.

PURPOSE: To test for an association between in vitro fibroblast radiosensitivity and complication risk in a case-control study of breast cancer patients treated under standard conditions in a clinical trial of radiotherapy dose fractionation. PATIENTS AND METHODS: A cohort of patients participating in a randomised clinical trial of radiotherapy dose fractionation was selected on the basis of treatment-induced changes in the breast several years later. Thirty-nine cases with marked normal tissue changes were matched on several variables with 65 controls with no changes attributable to radiotherapy. Dermal fibroblast strains were established from duplicate skin biopsies, and clonogenic cell survival assays performed in triplicate after both high ( approximately 1.6 Gy/min) and low ( approximately 1 cGy/min) dose-rate irradiation. Laboratory studies were blind to patient identity, treatment outcome and radiotherapy schedule. RESULTS: Analysis of 1128 clonogenic survival curves confirmed significant inter-patient variation in fibroblast radiosensitivity as measured by clonogenic survival. However, no association between fibroblast radiosensitivity and the development of late radiotherapy normal tissue effects was detected. CONCLUSIONS: Inter-individual variation in cellular radiosensitivity may not be the main determinant of complication risk in patients undergoing radiotherapy for breast cancer. Other biological and technical factors may be more important in explaining the marked inter-patient differences in normal tissue damage evident several years after curative radiotherapy.

Case-Control Studies↗
PubMed2002

Expression of transforming growth factor-alpha, epidermal growth factor receptor and platelet-derived growth factors A and B in oropharyngeal cancers treated by curative radiation therapy.

BACKGROUND AND PURPOSE: Epidermal growth factor receptor (EGFR) has been implicated in cellular responses to ionizing radiation and represents a major target for current radiosensitizing strategies. We wished to ascertain whether a correlation existed between the expression of EGFR, transforming growth factor-alpha (TGFalpha) and platelet-derived growth factors A and B (PDGF-A and PDGF-B) and treatment outcome in a group of patients with oropharyngeal cancer who had undergone curative radiation therapy. We also assessed the relationship existing between each of the aforementioned proteins and intratumoral microvessel densities (IMD) which have been previously reported (Int J Radiat Oncol Biol Phys 2000;48:17-25. MATERIALS AND METHODS: Pretherapeutic tumor biopsies from 95 patients were immunohistochemically stained and their immunoreactivities evaluated semi-quantitatively. The statistical analyses included Cox regression for calculating risk ratios of survival endpoints and logistic regression for determining odds ratios for the development of distant metastasis. RESULTS: Local tumor control as well as disease-free and overall survival were independent of protein expression levels, whereas combined TGFalpha and EGFR immunoreactivities were closely related to IMD (P = 0.003). The expression levels of these two proteins were also correlated to each other (P = 0.015). Expression of PDGF-B occurred in 54% of cases and was associated with an increase in the risk of developing distant metastasis (P = 0.011). CONCLUSIONS: Tumoral levels of TGFalpha, EGFR and PDGF-A/B are not predictive of radioresponsiveness in oropharyngeal cancers. The association between IMD and immunoreactivity for TGFalpha and EGFR indicates the involvement of these proteins in the promotion of angiogenesis in these tumors. PDGF-B should be further evaluated as a prognostic marker for squamous cell cancer of the head and neck.

Disease-Free Survival↗
PubMed1998

Age has no impact on acute and late toxicity of curative thoracic radiotherapy.

BACKGROUND AND PURPOSE: Radiotherapy is a treatment method frequently employed in the management of thoracic tumours. Although the highest incidence of these tumours is found in elderly people, tolerance to radiotherapy is not well documented in older age groups. Many physicians are tempted to alter the radiotherapy planning in a population with a supposed lower life expectancy in order to prevent acute reactions whereas late reactions are often ignored. The current study aimed to determine the influence of age on the frequency and severity of acute and late side-effects and also whether the prognosis of tumours sufficiently differed between ages to justify different attitudes towards their management. MATERIALS AND METHODS: Data from 1208 patients receiving chest irradiation and included in arms designed with RT of six EORTC randomized trials were evaluated. Data were extracted by a computer program elaborated for each study and were merged in a single database for analysis. Patients were split into six age ranges from 50 to 70 years and over. Survival and late toxicity were calculated with the Kaplan-Meier method and comparison between age groups was performed with the logrank test. The gamma-statistic test was used to test the impact of age on acute toxicity occurrence. RESULTS: Survival adjusted for the primary location of the tumour was comparable in each age group (P = 0.82). Data regarding age and acute toxicity were available for 1208 patients who experienced 640 grade > or =1 toxicities. The difference in distribution over age was not significant for acute nausea, dyspnea, oesophagitis, weakness and WHO performance status alteration. Weight loss was significantly different with regards to age with a trend toward increased weight loss in older age groups (P = 0.002). To minimize actuarial bias, only patients surviving more than 90 days were analyzed for late effect risks. Late toxicities were examined only if they occurred before an eventual tumour failure in order to avoid confusion between effects of first and second line treatments. In such conditions, 1082 grade > or =1 late toxicities were recorded in 935 patients of 1106 available for analysis. The mean time to complication was 13 months and was similar in all age groups. Forty percent of patients were free of complication at 4 years, the logrank test showing no significant difference between age groups (P = 0.57). For grade >2 side-effects, the calculation did not show any difference between each age group (P = 0.1). A detailed analysis of late dyspnea and late weakness studied with the same method did not demonstrate any difference between age groups. Only grade >2 late oesophagitis demonstrated a significant trend to be more frequent in older patients (P = 0.01), but this difference disappeared after adjustment on study (P = 0.32). CONCLUSION: The absence of toxicity observed in the current study regardless of age reinforces the conviction that age per se is not a sufficient reason to exclude patients in good general condition with thoracic tumour from curative radiotherapy when medically indicated.

Actuarial Analysis↗
PubMed1999

Curative-intent radiation therapy in anal carcinoma: quality of life and sphincter function.

In 22 colostomy-free survivors of curative-intent radiation therapy or chemoradiation for anal carcinoma, measurement of the Gastrointestinal Quality of Life Index (GIQLI) revealed a mean 114 of a maximum 144 points, as compared to 121 in healthy volunteers (n = 150) and 113 in patients with benign anorectal diseases (n = 325). Sixteen patients underwent anorectal manometry to determine anal sphincter length (SL), resting pressure (RP), maximum squeeze pressure (MSP), rectal compliance (RC) and relaxation of the internal anal sphincter (RIAS). SL, RP and MSP were significantly lower in anal carcinoma patients than in healthy volunteers. Complete continence was detected in 56% of patients.

Adult↗
PubMed2000

Neoadjuvant photodynamic therapy before curative resection of proximal bile duct carcinoma.

BACKGROUND: Hilar bile duct carcinoma has an 80% probability of local recurrence after curative resection, which might be reduced if neoadjuvant photodynamic therapy is feasible. CASE AND TREATMENT: After intravenous injection of sodium porfimer we treated an adenocarcinoma of the proximal common bile duct (T2 N0 M0, Bismuth type II) in a 72-year-old man with red laser light (applied from the lumen at a dose 250 Joules/cm2), and the adjacent right and left hepatic and common bile duct at a dose of 125 Joules/cm2. After 23 days the tumor was completely resected (adenocarcinoma pT2 pNO; G2). RESULTS: In the lumenal, 4-mm-thick layer the bile duct specimen exhibited complete tumor necrosis with pigmentation of photodegraded porfimer and no viable tumor cells, while in the outer layer of the wall (at 5-8-mm depth) viable cancer cell nests without degraded porfimer were seen. The bile duct tissue showed little damage. Eighteen months after surgery, neither tumor recurrence nor stricture formation was found at the pretreated bilioenteric anastomoses. CONCLUSIONS: a) Photodynamic therapy with sodium porfimer seems to be confined to the superficial 4-mm layer of bile duct cancer. b) Neoadjuvant photodynamic therapy is feasible for hilar bile duct carcinoma.

Adenocarcinoma↗
PubMed2005

Seeking improved outcome in the curative treatment of non-small-cell lung cancer.

Progress is being made in the treatment of patients with early (stage I-III) and unresectable locally advanced (stage III) non-small-cell lung cancer (NSCLC). The primary modality of treatment is complete surgical resection of the malignant growths. However, not all patients are appropriate candidates for surgery, and the majority who undergo surgical resection have a poor survival. Recurrence and death are most commonly due to systemic failure, indicating micrometastatic disease. Treatments targeted at eradicating micrometastatic disease, such as adjuvant therapy, induction chemotherapy, concurrent chemoradiotherapy, and intensified radiotherapy, are currently being explored as a means to improve outcome in the curative treatment of NSCLC.

Antineoplastic Agents↗
PubMed2002

Cushing's syndrome during pregnancy: curative adrenalectomy at 31 weeks gestation.

A case of Cushing's syndrome due to benign adrenal adenoma (Ad) arising in pregnancy is described. Accurate tumour localisation with magnetic resonance imaging facilitated definitive surgical intervention. Curative adrenalectomy was performed via a posterior approach in the third trimester with subsequent uncomplicated delivery of a healthy infant.

Adenoma↗
PubMed1999

Contribution of myeloid and lymphoid host cells to the curative outcome of mouse sarcoma treatment by photodynamic therapy.

Selective depletion or inactivation of specific myeloid populations (neutrophils, macrophages) and lymphoid populations (helper T cells, cytolytic T cells) in EMT6 sarcoma-bearing mice was used to determine the contribution of each of these host immune cell types to the curative outcome of Photofrin-based photodynamic therapy (PDT). Immunodepletion of neutrophils and cytolytic T cells initiated immediately after PDT resulted in a marked reduction in PDT-mediated tumor cures. Significant reduction in the cures of EMT6 tumors was also achieved by immunodepletion of helper T cells and inactivation of macrophages by silica treatment. The initial tumor ablation by PDT was not affected by any of the above depletion treatments. These results provide direct evidence that the contribution of neutrophils, macrophages and T lymphocytes is essential for the maintenance of long-term control of PDT-treated tumors.

Animals↗
PubMed1999

DNA mismatch repair deficiency in curatively resected sextuple primary cancers in different organs: a molecular case report.

A male patient synchronously or metachronously underwent six curative resections after diagnoses of cancers in the rectum, urinary bladder, stomach, colon, liver and lung. Five cancers, excluding early colon cancer, were analyzed for instability in seven microsatellite markers and in transforming growth factor beta type II receptor, insulin-like growth factor II receptor and BAX. All analyzed cancers had replication errors and instability in at least one target gene. These results suggest that abnormal DNA mismatch repair system plays a major role in the occurrence of multiple primary cancers in this case.

Adenocarcinoma↗
PubMed2003

Homeopathic use of modern medicines: utilisation of the curative rebound effect.

Homeopathy is a therapeutic method based on the application of the similitude principle, utilising medicinal substances that produce effects that are similar to the symptoms being treated. In this process, the organism is stimulated to react against its own disturbances through a vital (paradoxical, secondary or homeostatic) reaction, oriented by the primary effect of the used drug. This effect should have properties that are similar to the symptom that is being treated. This secondary reaction of the organism to a medicinal stimulus is observed in hundreds of modern drugs, and is referred to as a rebound effect. In this study we propose the utilisation of modern drugs according to the principle of homeopathic cure, employing the rebound effect as a curative reaction. For that we suggest the compilation of a Common Materia Medica that would group all symptoms produced by the medications in human individuals (therapeutic, adverse and side effects), utilising them, a posteriori, following a partial or total similitude, in minimal or ponderous doses. By doing that, we can take advantage of the numerous modern pharmacological compendiums, amplifying the spectrum of homeopathic cure with a wide range of new symptoms and medications.

Complementary Therapies↗
PubMed2000

The need for long-term surveillance for patients treated with curative radiotherapy for Hodgkin's disease: University of Minnesota experience.

PURPOSE: To examine the long-term outcome of Stage I, II, and III patients treated with curative radiotherapy for Hodgkin's disease at the University of Minnesota Hospital, with particular focus on long-term treatment-related complications and the need for long-term surveillance after treatment. METHODS AND MATERIALS: A total of 210 Stage I, II, and III patients (98 female, 112 male) treated at the University of Minnesota since 1970 were included in this study. All patients were laparotomy staged. Between 1970 and 1974, 35 high-risk patients (i.e., patients with large mediastinal mass, and/or hilar disease, and/or splenic involvement) and 40 low-risk patients were treated with standard field radiotherapy. From 1975 on, 67 high-risk patients received radical radiotherapy because of poor outcomes with standard radiotherapy, and 68 low-risk patients received standard radiotherapy. Salvage chemotherapy was given to 62 patients who recurred. Median follow-up for all patients was 15.6 years (range 0. 35-26.5 years). Long-term complications after treatment were assessed using standardized incidence ratios (SIR) and mortality ratios (SMR), with particular focus on cardiac complications and secondary malignancies. RESULTS: By study end, 70% of the patients are alive and 70% had never recurred. Complications included 33 second malignancies and 75 cardiovascular events. Patients treated for Hodgkin's disease had about 7 times the risk of dying from cardiac problems (SMR = 7.2) and 10 times the risk of dying from a second malignancy (SMR = 10.3) compared to the general population. In terms of absolute risk, Hodgkin's disease would cause seven additional deaths from secondary malignancies per year among 1000 patients and four additional deaths from cardiac problems. CONCLUSION: Hodgkin's disease patients treated successfully with radiotherapy are at an increased risk for developing long-term treatment-related cardiac disease and/or second malignancies. Careful monitoring of these patients is essential to manage morbidity and minimize mortality from these complications. Suggestions for the establishment of worldwide surveillance programs for these patients are proposed.

Adolescent↗
PubMed1997

Is comprehensive lymphatic irradiation for low-grade non-Hodgkin's lymphoma curative therapy? Long-term experience at a single institution.

PURPOSE: This study reports 21 patients with Stage I-III low-grade non-Hodgkin's lymphoma who were treated with comprehensive lymphatic irradiation (CLI) at the University of Florida between 1966 and 1992. METHODS AND MATERIALS: Sites clinically involved with disease were treated with 30 Gy, whereas clinically uninvolved sites were treated with 25 Gy. Median follow-up for the group was 14 years (24.5 years for Stage III patients). RESULTS: Overall absolute survival rates at 5, 10, and 15 years were 84%, 68%, and 34%. Cause-specific survival rates at 5, 10, and 15 years were 84%, 68%, and 56%. Freedom-from-relapse rates at 5, 10, and 15 years were 75%, 58%, and 58%, with no relapses noted after 10 years. Bulky disease (>6 cm) was a significant indicator of poor prognosis for cause-specific survival (p = .01). CONCLUSION: These data support findings from other institutions suggesting a role for CLI as potentially curative therapy with acceptable toxicity and a short treatment time for patients with Stages I and II and limited Stage III disease.

Adult↗
PubMed2000

Regrowth delay analysis of irradiated tumors in the curative dose region.

PURPOSE: To develop a method to analyze regrowth delay times, including cured tumors. METHODS AND MATERIALS: Regrowth delay measured in the in vitro squamous cell carcinoma megacolony system following fractionated irradiation was analyzed using two different approaches. A conventional regrowth delay analysis based on means or medians of dose groups was contrasted with a one-step procedure using the inverse of individual regrowth delay times, where cured tumors are represented by an infinite delay time. Two data sets with different proportions of cured tumors were compared in this way. In addition, for both approaches, confidence limits were also generated by the bootstrap technique. RESULTS: The parameter estimated was the alpha/beta ratio. The inverse analysis yielded similar results as the conventional analysis, but with much smaller confidence limits. When the dataset was stripped by stepwise removal of lower dose groups with no cures, the estimates of the alpha/beta ratio remained definitely more robust in inverse analysis. Results of the bootstrap procedure confirmed the accuracy of the calculated confidence intervals. CONCLUSION: Regrowth delay analysis using reciprocal regrowth delay times is a useful tool, especially when the data shows large variations, or a substantial fraction of the dataset falls into the curative dose region.

Animals↗
PubMed2000

Studies on preventive and curative effects of berberine on chemical-induced hepatotoxicity in rodents.

Berberis aristata is an edible plant employed in the South Asian Traditional Medicine, particularly its fruits being used as a tonic remedy for liver and heart. In this investigation, berberine, a known compound from this plant, was studied for its possible antihepatotoxic action in rats. Pretreatment of animals with berberine (4 mg/kg; orally twice daily for 2 days) prevented the acetaminophen- or CCl4-induced rise in serum levels of alkaline phosphatase (ALP) and aminotransaminases (AST and ALT), suggestive of hepatoprotection. Post-treatment with three successive oral doses of berberine (4 mg/kg every 6 h) reduced the hepatic damage induced by acetaminophen, while CCl4-induced hepatotoxicity was not modified, suggesting a selective curative effect against acetaminophen. Pretreatment of animals with a single oral dose of berberine (4 mg/kg) induced prolongation of the pentobarbital (60 mg/kg, i.p.)-induced sleeping time as well as increased strychnine (0.3 mg/kg; i.p.)-induced toxicity, suggestive of inhibitory effect on microsomal drug metabolizing enzymes, cytochrome P450s (CYPs).

Acetaminophen↗
PubMed2001

Effects of information supply on satisfaction with information and quality of life in cancer patients receiving curative radiation therapy.

In order to test the efficacy of various information inputs, 210 consecutive cancer patients were randomized to one of three information conditions before the start of curative radiation treatment: (1) standard information plus group and repeated individual information (n=70), (2) standard information plus brochure (n=70), and (3) standard information only (n=70). Patients completed questions regarding satisfaction with information, anxiety, depression, subjective distress and quality of life at inclusion, and 1h before the start of the radiation therapy treatment (approximately 4 weeks later). Patients receiving standard information plus group and repeated individual information were significantly more satisfied with the information than were patients in the remaining two groups. There were no differences with respect to any of the other outcome measures. This study has shown that the nurses group and individual information was of significant importance in preparing the patients for the procedure of receiving radiation therapy.

Female↗