1,720,995 research outputs found
The role of the nonsurgical oncologist in the management of advanced transitional cell cancer. Part II: metastatic disease
No full textTCC may arise at any site in the urinary tract, and when advanced or metastatic can be regarded by the nonsurgical oncologist as a single tumour type. TCCs commonly develop histologically and may be admixed with areas of squamous carcinoma, adenocarcinoma or peripheral neuro-ectodermal tumour. In most cases this does not alter the therapeutic approach, although it might alter the outcome.TCCs arise most commonly in the bladder, where they are the fourth most common cancer in men and eighth most common in women, responsible for >5000 deaths annually in the UK. They occur increasingly commonly with age, and advanced disease in the elderly is a common clinical management problem, which necessitates adjustment to treatment regimens.Locally advanced disease is routinely managed by cystectomy, with the possibility of bladder reconstruction for selected patients. However, more recently there has been renewed interest in bladder-sparing approaches, including radiotherapy and chemo/radiotherapy. Neoadjuvant chemotherapy has been evaluated in large randomized trials and similar international studies are ongoing, testing the usefulness of adjuvant chemotherapy after chemotherapy. These nonsurgical approaches to this group of cancers will be considered in this review, with an emphasis on data obtained from prospective randomized trials.</p
ABVD for Hodgkin's lymphoma: full-dose chemotherapy without dose reductions or growth factors
No full textBackground: We investigated whether administration of full-dose ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine) chemotherapy without growth factors, and irrespective of the granulocyte count, caused treatment delays or increased the number of infective episodes, in patients with Hodgkin's lymphoma (HL). Patients and methods: Thirty-eight patients with confirmed predominantly early-stage HL were treated with ABVD outside clinical trial protocols over a 5-year period on an outpatient basis. Results: Ninety-five per cent of patients completed their scheduled ABVD regimen without adverse effects despite the development of neutropenia. Anaemia and thrombocytopenia did not present problems. Febrile neutropenia complicated 0.57% of combination chemotherapy injections. No growth factors were used and no dose modifications were carried out apart from the omission of bleomycin in one patient for the last two cycles of treatment due to the development of lung toxicity. All patients are currently disease-free, although three (7.8%) required salvage high-dose therapy (one relapsed and two with refractory disease). Conclusions: ABVD administration irrespective of granulocyte counts allowed the treatment to be given at full dose without delays or significant number of infective episodes. There was no need for growth factor support, minimising treatment costs. The use of full-dose ABVD irrespective of granulocyte count should be evaluated in future protocols for H
Management of spinal cord and cauda equina compression secondary to epidural metastatic disease in adults with malignant germ cell tumours
No full textAim: to review the management and clinical outcome of 10 patients, presenting to a single centre with symptoms and signs of spinal cord or cauda equina compression secondary to epidural metastatic disease from a testicular germ cell cancer.Methods: clinical data regarding presenting history, physical examination, staging investigations, treatment and clinical outcome were retrospectively obtained from patient records.Results: eight patients exhibited neurological deficits at the time of initial presentation of germ cell cancer or as a first manifestation of relapse following dog leg irradiation. Four of these cases were managed with chemotherapy alone, with excellent neurological recovery, whilst four underwent decompressive laminectomy – in three cases prior to referral and in one case after commencing chemotherapy. Five of the eight patients relapsed. Four required further chemotherapy (high dose in two cases). The remaining patient underwent thoracic surgery, with resection of teratoma differentiated. Six of the eight patients are currently alive and disease free. Two patients had chemorefractory disease and died, though one was treated in the pre-cisplatin era. Two patients presented with cord compression as a feature of disease relapse following chemotherapy, and were managed with radiotherapy alone in an attempt to achieve local disease control and limit neurological dysfunction. However, both subsequently died with progressive disease.Conclusion:epidural spinal cord or cauda equina compression is a rare complication of metastatic germ cell cancer, which can be successfully managed in chemo-naive patients with good neurological outcome
Brain as sanctuary site of relapse in germ cell cancer patients previously treated with chemotherapy
No full textBackground: Post chemotherapy isolated relapse to the brain of germ cell cancer is potentially curable.Patients and methods: We reviewed the experience of germ cell cancer with cerebral metastases at the CRC Wessex Medical Oncology Unit in Southampton. Patients were classified according to their presentation (initial diagnosis, solitary relapse or widespread). Treatment and outcome of these patients is presented and compared with previous series.Results: Of 1049 patients treated for metastatic germ cell cancer, 15 were diagnosed with cerebral metastases. Six patients had cerebral sanctuary site relapse, and underwent resection and cranial irradiation. Four of these are continuously disease free after treatment at 2, 67, 96, and 145 months from therapy, another is receiving chemotherapy for limited systemic relapse and the sixth has relapsed and died. Three further patients relapsed with cerebral disease in the presence of active disease elsewhere and each progressed and died. The final six patients had cerebral disease at presentation of whom five have progressed and died.Conclusions: Isolated cerebral metastases occurring after successful systemic chemotherapy for germ cell cancer are curable. An aggressive salvage approach with surgery followed by radiotherapy is indicated
Case series: Adult testicular dermoid tumours - mature teratoma or pre-pubertal teratoma?
No full textAdult testicular dermoid tumours are rare tumours with no reported potential for recurrent or metastatic spread. Despite this they are currently classified as mature teratoma and managed as if they have equivalent malignant potential. This report describes two cases of adult mature teratoma of dermoid type and questions the classification and pathogenesis of this disease. In one of the cases there was a clear history of a testicular lump arising pre-pubertally, raising the possibility that some adult dermoid tumours may in fact be pre-pubertal teratomas that have persisted into adulthood. Classification as a mature teratoma carries with it a follow-up regimen that includes numerous radiological investigations with their attendant radiation exposure. A positive histological diagnosis and separate classification of adult dermoid tumours would allay clinical fears of recurrence and metastasis and negate the need for repeated radiological investigation
The continued value of central histopathological review of testicular tumours
No full textAims: Central histopathological review of testicular tumours prior to definitive treatment can have an important impact on patient management. This study was designed to assess the continued value of central review in the light of increasing subspecialization and increased numbers of consultant histopathologists.Materials and results: The original and review reports of 291 testicular cancer specimens from 1998 to 2002 were analysed, looking particularly at major diagnosis, vascular invasion and the tumour elements within non-seminomatous germ cell tumours (NSGCT). When a diagnosis was altered any effect on subsequent patient management was assessed. There was a discrepancy in tumour type in 11 cases (4%) compared with 6% in 1992–1997. The commonest change was from seminoma to NSGCT or combined germ cell tumour (5/11). There was also diagnostic difficulty with spermatocytic seminoma (3/11). The clinical management of all 11 cases was influenced as a result of the review diagnosis. Discrepancies in vascular invasion were noted in 13 of the 126 NSGCTs (10%) compared with 20% in 1992–1997. Differences in NSGCT tumour elements, though clinically less important, were frequent in both groups.Conclusions: There continues to be a small number of significant and clinically important errors identified following central histopathological review of testicular tumours. This study highlights the value of central review and supports its continued practice in the management of testicular tumours
Recombinant factor VIIa in the management of pulmonary hemorrhage associated with metastatic choriocarcinoma
No full textA 25-year-old man presented in September 2005 with relapsed
metastatic germ cell tumor and a rapidly rising serum human beta chorionic gonadotropin (HCG; from 10,000 to 40,000 U/L over the preceding 10 days). He had been diagnosed 18 months earlier with International Germ Cell Cancer Collaborative Group (IGCCCG) poor prognosis extragonadal retroperitoneal metastatic germ cell cancer. He had presented then with lower back pain, hemoptysis, and weight loss. A computed tomography (CT) scan of the brain, chest, abdomen,andpelvis hadshowna large retroperitoneal mass with a left hydronephrosis, multiple pulmonary deposits, and multiple brain metastases. Blood markers showed HCG 522,442 U/L, alphafetoprotein 5 KU/L, and lactate dehydrogenase 1,500 U/L. Testicular examination and ultrasound were unremarkable
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