OBJECTIVES: To evaluate whether, in patients with carcinoma in situ (CIS) of the urinary bladder, alternating instillation therapy with mitomycin C (MMC) and bacillus Calmette-Guerin (BCG) was more effective and less toxic than conventional BCG monotherapy. METHODS: Patients were stratified prospectively for primary, secondary, and concomitant CIS and randomized to one of two regimens. Patients in the alternating group received six weekly intravesical instillations of MMC 40 mg, followed by alternating monthly instillations of BCG 120 mg and MMC for one year. In the monotherapy group, only BCG was instilled on the same schedule. RESULTS: Of 323 enrolled patients, 304 were eligible for analysis. After an overall median follow-up of 56 months, the Kaplan-Meier disease-free estimate for BCG monotherapy was significantly better than that for alternating therapy (p=0.03; log rank test). Risk for progression appeared lower in the BCG monotherapy group (p=0.07), but no differences existed in survival. Besides the regimen, CIS category also predicted outcome to some extent. BCG monotherapy caused significantly more local side-effects and premature cessation of instillation treatment than did the alternating therapy. However, no differences were observed in the number of serious side-effects. CONCLUSION: One-year BCG monotherapy was more effective than the alternating therapy for reducing recurrence and compared well with the best regimens reported from substantially smaller series. The alternating therapy was better tolerated.
To evaluate treatment results, elucidate whether national guidelines were followed, and identify areas demanding further treatment optimization.
Between July 2000 and June 2007, 328 patients were treated with curatively intended chemoradiotherapy (CRT) for nonmetastatic squamous cell carcinoma of the anal region, according to national treatment guidelines based on tumor stage.
Complete response after CRT was obtained in 87% of patients, rising to 93% after salvage surgery. Chemotherapy, elective irradiation of the groin and salvage surgery were performed to a lesser extent in elderly patients, mainly because of frailty and comorbidity. Recurrence occurred in 24% of the patients, resulting in a 3- and 5-year recurrence-free survival (RFS) of 79% and 74%, respectively. Locoregional recurrences dominated, most commonly in the primary tumor site. Recurrence was treated with curative intent in 45% of the cases. The 3- and 5-year overall survival were 79% and 66%, and cancer-specific survival (CSS) were 84% and 75%, respectively. The risk of adverse outcome increased significantly with more locally advanced tumors and for male gender in multivariable analyses for RFS and CSS.
The treatment results are in accordance with similar cohorts. The primary treatment control rate was high, but there was a significant risk of locoregional recurrence in advanced tumors. The loyalty to national guidelines was broad, although individual adjustments occurred. However, caution to avoid toxicity must not lead to inadequate treatment. Male gender seems to have inferior outcome.
The prognosis in gastric cancer has been almost unchanged for the last 20 years. At the time of diagnosis the majority of patients have disseminated disease. The 5-year survival is only about 15%. Several efforts with numerous antineoplastic regimens have been studied. The most widely used regimen has been the FAM (5-fluorouracil, adriamycin, mitomycin C) regimen. Because of the cardiotoxicity and dose intensity of the FAM regimen, a low toxicity regimen, the ELF (etoposide, leucovorin, 5-fluorouracil) regimen, has been introduced. We present the data from the treatment of 26 patients (17 FAM, 9 ELF) with advanced gastric cancer at the University Hospital of Tromsø. The monthly costs of FAM and ELF treatment were calculated to a price of 553 pounds and 2976 pounds (British pounds). The median survival of 5 months (FAM) and 6 months (ELF) is in accordance with other studies. Assuming that the median survival in our study is correct, the cost of one year saved was 123,834 pounds, while the cost of one QALY (quality adjusted life year) employing the ELF compared to the FAM regimen was 104,334 pounds. We conclude that the standard ELF regimen too expensive in the treatment of gastric cancer.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can offer long-term survival to patients with resectable peritoneal metastasis (PM) from colorectal cancer (CRC), a condition with otherwise dismal prognosis. This study describes short- and long-term outcome in a national patient cohort and aims to identify prognostic factors.
All patients treated with CRS-HIPEC for non-appendiceal PM-CRC in Norway 2004-2013 were included (n?=?119), and outcome and potential prognostic factors were examined using survival- and ROC-curve analysis.
Five-year overall survival (OS) and disease-free survival (DFS) were 36% and 14%, respectively, with 45 months median follow-up. The only factor associated with OS in multivariable analysis was peritoneal cancer index (PCI), with HR 1.05 (1.01-1.09) for every increase in PCI-score (P?=?0.015). Peritoneal relapse was associated with shorter OS than distant metastasis (P?=?0.002). ROC-curves identified PCI?>?12 as a marker with 100% specificity for prediction of disease relapse. Severe postoperative complications (Clavien-Dindo?=?3) occurred in 15% of patients and there was no 100-day mortality.
Long-term outcome was in line with published results, morbidity was acceptable and there was no 100-day mortality. The results reemphasize CRS-HIPEC as an important treatment option in PM-CRC, with particularly good results in patients with PCI?
To study the epidemiology and risk factors of early- and late-onset postoperative endophthalmitis (PE) and severe blebitis following trabeculectomy.
Retrospective, single-centre, observational study with a case-control design in part. Patients sustaining PE and severe blebitis following trabeculectomy or a combined trabeculectomy with a cataract extraction procedure performed from 1990 through 2008 and diagnosed from 1990 through 2012 were recorded at St Erik Eye Hospital. Incidence data were calculated with help from the hospital records. Notes data of cases and of six randomly selected but procedure matched control patients for each case were compared.
The joint rate of infection was 0.46% or 34 incidents in 7402 procedures. The frequency of early (occurring
The effectiveness of arterial embolization using DSM (Degradable Starch Microspheres, Spherex, Sweden) combined with hyperthermia were investigated in the treatment of VX2 carcinoma in rabbits and also in human hepatic tumors. These microspheres temporarily obstructed the blood flow at the precapillary level. The blood flow in the tumor was inhibited to a greater extent and for a longer period than in normal muscle. The rise in temperature at the tumor site during heating was shown to be significantly higher than in muscle. The pH in the tumor clearly showed a stronger degree of inhibition than that achieved with hyperthermia alone. Histological examination demonstrated no marked damage to the muscle following DSM + hyperthermia. In the patients with hepatic tumor, hyperthermia was performed using an RF Thermotron 8 (8 MHz) externally, followed by injection of 15 ml of DSM combined with anti-cancer drugs via a catheter. The rise of temperature in DSM + chemo-hyperthermia during heating showed a higher value than that with hyperthermia alone and effective cases (PR) totalled 5 from among 8 cases treated. It was concluded that the heating efficiency may be improved by arterial chemo-embolization in the treatment of hepatic tumors.
In non-resectable liver malignancies, concurrent administration of degradable starch microspheres (DSM) and anticancer drugs via hepatic artery has been suggested as a method to increase the concentration of drugs in tumor tissue. DSM also has been known to increase the temperature of tissue when administered at the time of hyperthermia. In the light of these findings we have studied the effect of hepatic arterial infusion of 5-FU and mitomycin C and local hyperthermia in combination with hepatic arterial flow arrest with DSM for the treatment of hepatoma in 11 patients and metastatic liver cancer in 38 patients. Of the 8 patients having hepatoma with increased AFP, all the patients showed a decrease of AFP following the therapy with an average ratio of 65% decrease. Of the 33 patients with hepatic metastasis with increased CEA, 32 patients (96%) showed a decrease of CEA following the therapy (control group with infusion chemotherapy and hyperthermia without DSM: 58%) with an average decrease ratio of 59% (control group: 43%). Of the 26 patients with increased CA 19-9, 22 patients (84%) showed a decrease of CA 19-9 (control group: 75%) with an average decrease ratio of 52% (control group: 29%). This pilot study suggests that the concurrent hepatic arterial infusion of 5-FU, mitomycin C and DSM with local hyperthermia may have the potential to improve selective regional drug effect.
In non-resectable liver malignancies, concurrent administration of degradable starch microspheres (DSM) and anticancer drugs via hepatic artery has been suggested as a method to increase the concentration of drugs in tumor tissue. DSM also has been known to increase the temperature of tissue when administered at the time of hyperthermia. In the light of these findings, we have studied the effect of hepatic arterial infusion of 5-FU and mitomycin C and 2450 MHz microwave local hyperthermia in combination with hepatic arterial flow arrest with DSM for the treatment of hepatoma in 10 patients and metastatic liver cancer in 20 patients. Of the 8 patients with hepatoma with increased AFP, all the patients showed a decrease of AFP following therapy with an average decrease ratio of 64%. Of the 17 patients with hepatic metastasis with increased CEA, 16 patients (94%) showed a decrease of CEA following the therapy (control group with infusion chemotherapy and hyperthermia without DSM: 66%) with average decrease ratio of 50% (control group: 27%). Of the 15 patients with increased CA 19-9, 13 patients (86%) showed a decrease of CA 19-9 (control group: 62%) with an average decrease ratio of 52% (control group: 21%). This pilot study suggests that the concurrent hepatic arterial infusion of 5-FU, mitomycin C and DSM with local hyperthermia may have the potential to improve selective regional drug effect.
BACKGROUND AND OBJECTIVES: There is only limited and somewhat controversial information available on hepatic artery infusion of cytotoxic agents in gallbladder cancer. We report the results of 5-year follow-up of all gallbladder cancer patients treated with surgery and intra-arterial mitomycin C or mitomycin C alone in our hospital during 15 years. METHODS: Thirty-five patients with gallbladder cancer were treated with superselective intra-arterial chemotherapy (SIAC) with mitomycin C during 1981-1996. Survival was measured from diagnosis, and all patients were followed up until death or the end of January 2002. Cumulative survival rates and median survival times were calculated for all patients, according to response to treatment and staging. The data are presented as 5-year survival. RESULTS: Median survival times after SIAC for all patients, responders, and non-responders were 48, 60+, and 8.5 months, respectively. Overall response rate was 60%. Survival was significantly better for tumors limited to the gallbladder wall, as expected. Drug toxicity occurred in half of the patients, requiring cessation of chemotherapy in 25% of the cases. CONCLUSIONS: The median survival of gallbladder cancer patients treated with surgery and SIAC seems to be significantly better compared to the previously reported outcome of surgical treatment alone. Drug toxicity limits the use of i.a. chemotherapy and requires careful monitoring for early side-effects.