bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chemotherapy for urothelial tract malignancies: Breaking the deadlock
Authors: Scher Howard I. , Norton Larry 
Published: February 2007

AbstractChemotherapy treatments for urothelial tract tumors have improved to the point that some patients are enjoying long‐term disease‐free survival. Moreover, with currently available agents and combinations, and with our increased application of clinical and biologic prognostic factors, we are refining our ability to select appropriate therapies for individual patients. We have learned that once the decision is made to use combination chemotherapy, adequate doses should be used. This can be facilitated by the coadministration of hematopoeitic growth factors. Recently completed phase II trials have confirmed that higher doses and dose rates may increase response proportions of and in particular, the proportion of complete responses. The finding that granulocyte colony stimulating factor enhances the sensitivity of tumor cells to methotrexate in vitro and to other agents studied against urothelial tumors implanted in nude mice implies an expanded role for these compounds. However, because non‐hematologic toxicities are still important, it is unlikely that simple escalation of all components a four drug regimen such as of M‐VAC (cisplatin, methotrexate, vinblastine, and doxorubicin) will have a significant impact on survival.In addition, as more is learned about the pharmacokinetic and pharmacodynamic relationships of the active agents, it appears that better schedules can be designed to improve the therapeutic index of the compounds. Ultimately we will be able to determine drug sensitivities, both at the start of therapy and as it evolves during treatment, that will allow a better selection of a particular chemotherapeutic regimen. For example, mdr1 induction appears to play a significant role in the therapy for treatment‐resistant tumors. The availability of a number of active salvage regimens that are not constrained by this mechanism hints that changes in drug sequencing and drug scheduling may provide a significant improvement in outcome.While established combination chemotherapy regimens should be considered standard therapy in appropriately selected patients, promising strategies and new agents need to be investigated if we are to “break the deadlock” that has appeared in the treatment of urothelial tumors. These investigations can be performed safely in a well‐controlled fashion to enable the identification of new regimens and to compare promising strategies with appropriate control populations in randomized trials.
Cellular and molecular biology of melanoma
Authors: Porta Giuseppe Della 
Published: February 2007

AbstractMelanoma cells have surface markers that are expressed differently than in normal melanocytes and nevus cells. Monoclonal antibodies may define a phenotypic map of the various melanocytic lesions and can be used in immunohistopathology and immunoscintigraphy. Monoclonal antibodies directed against melanoma‐associated glycoproteins and glycolipids are being tested for therapy. Rearrangements or deletions on chromosome 1, 6, and 7 are the most frequently observed cytogenetic abnormalities. Molecular studies have not given a clear picture. A subset of HRAS alleles has been reported to be associated with melanoma. NRAS activation by point mutation has been found in one fourth of the cases. Allele losses at different loci have been reported. Genetic linkage studies have given conflicting results on the presence of a gene for the melanoma‐dysplastic nevus syndrome on the short arm of chromosome 1.
Precursor lesions of melanoma: Do they exist?
Authors: Mihm Martin C. , Barnhill Raymond L. , Sober Arthur J. , Hernandez Manuel Howe 
Published: February 2007

AbstractThe question of whether definite precursors to melanoma exist is answered in the affirmative. Three cutaneous lesions likely to be such precursors are described and discussed as to their clinical and histologic appearance and incidence. Additionally, a type of conjunctival melanosis that has been associated with malignant melanoma of the conjunctiva is discussed and an attempt is made to define it; a proposed classification of this entity is reviewed. Basic approaches to management and analysis of precursor lesions are elaborated.
Treatment of regional nodes
Authors: Cascinelli Natale , Belli Filiberto 
Published: February 2007

AbstractThe appearance of nodal metastases from cutaneous melanoma represents a poor prognosis. Surgery is the only possible treatment for these patients since chemotherapy or immunotherapy have no confirmed specific efficacy in adjuvant or therapeutic schedules. If, for clinically metastatic regional nodes, there is complete agreement on the opportunity of dissection, in the case of clinically uninvolved nodes some controversy exists. For melanomas of the extremities, two different randomized studies have demonstrated no difference in the long‐term outcome of patients with stage I melanoma, whether immediate or delayed node dissection is performed. For axial melanomas, although definitive data are not available, there are preliminary statistical results as well as anatomical and technical reasons, suggesting an identical surgical approach to that performed for primaries of other sites. Therefore, apart from specific cases, there is good evidence that node dissection should be planned only for patients with clinically involved regional nodes.
Systemic therapy in disseminated melanoma
Authors: Rümke Ph. 
Published: February 2007

AbstractThere is no standard treatment for advanced melanoma. As long as metastases are satellites or in‐transit metastases localized in a leg or arm, the prospects for curative treatment by isolation perfusion are good. But as soon as metastases have spread via the circulation, curative treatment with cytotoxic agents becomes virtually impossible. When the tumor burden is not too extensive, however, palliative treatment can be of clinical value. Some combinations of cytotoxic agents or combinations of biologic response modifiers have been shown to induce worthwhile remissions. Toxicity remains a problem, however. The advantages of the newer immunological approaches, especially with interleukin‐2 (IL‐2) and T‐cell lymphocytes, is that treatment for a short period may result in good remissions at an early stage. Much clinical research is still needed to improve these costly approaches.
Cutaneous melanoma: Prognosis and treatment results worldwide
Authors: Balch Charles M. 
Published: February 2007

AbstractThis first metanalysis of melanoma from treatment centers worldwide consisted of 15,798 patients with localized melanoma (stages I and II) and 2,116 stage II melanoma patients with nodal metastases. Comparisons of dominant prognostic variables showed consistent results from center to center, despite the heterogeneity of the patient population. Six of eight centers that performed a multivariate analysis ranked ulceration among the first three most dominant prognostic factors. Men had a higher proportion of ulcerated lesions than did women. There was a positive correlation between ulceration and thickness. Patients with melanoma of the scalp had a worse prognosis than did those with lesions of the face and neck; those with melanomas on the hands had a significantly worse prognosis than did those with lesions on the arms or legs. In this study, women had a statistically significant survival advantage over men. Their melanomas arose in more favorable sites, were thinner, and less ulcerative and had a lower stage of disease at presentation. Stage 111 melanomas were more common in males, thicker, and more ulcerated and had a nodular growth pattern. Patients with clinically occult nodal metastases detected by pathological examination and those with a single metastatic node fared the best. Five of six centers identified the number of metastatic nodes to be the most significant prognostic factor. Distant metastases (stage IV were analysed at only two centers, which found that the number and site of metastases appeared to be the dominant prognostic features of stage IV melanoma. When all factors were analyzed in a Cox regression analysis, the dominant factors for stage IV melanoma patients were (I) the number of metastatic sites, and (2) the remission duration. There were no histologic criteria of the primary melanomas that predicted the patient's clinical course once distant metastases had developed.
Will multimodality therapy solve the enigma of long‐term survival for squamous cell carcinoma of the esophagus?
Authors: Locicero Joseph 
Published: February 2007

AbstractSquamous carcinoma of the esophagus is a disease with a poor prognosis which fortunately occurs seldom in the United States. Because patients present with more advanced disease here, surgical therapy has not equaled results reported from Asia. Although, claims of equality have appeared in the literature, radiation therapy alone has not been very effective for this disease. There are a myriad of small reports which extol a variety of combined approaches. Based upon a review of these series it is obvious that a Phase III trial is required to establish the best multimodality therapy for management of squamous carcinoma of the esophagus. Components of such a trial are reviewed and suggestions are made for design and reporting of such a trial.
Efficacy of multimodality therapy in gastric adenocarcinoma
Authors: Jessup J. M. , Posner M. , Huberman M. , Loclcero J. , Stone M. , Stele G. 
Published: February 2007

AbstractMultimodality therapy has not reproducibly improved the survival of patients with gastric adenocarcinoma. This is largely because the staging of disease has been imprecise and because the current regimens have only limited efficacy against advanced disease. Until staging is improved and active regimens are found, it will be difficult to identify synergism between surgery and other treatment modalities.
Laparoscopy/thoracoscopy for staging: II. Pretherapy nodal evaluation in carcinoma of the esophagus
Authors: Locicero Joseph 
Published: February 2007

AbstractMany surgical studies show a significant stratification of survival following resection of esophageal cancer based upon accurate pathologic staging. However, investigators are moving away from single modality therapy toward multimodality trials for the treatment of this disease. This presents a problem in staging of patients before therapy is begun. Chemotherapy and/or radiation therapy may alter the local tumor characteristics and nodal metastases, thus confounding evaluation of treatment results. Although CT scanning and transesophageal ultrasound help in assessing nodal status, they have not reached the precision necessary for study purposes. Pretherapy nodal staging using video‐assisted exploration may provide the same level of accuracy as mediastinoscopy does for lung cancer.
Laparoscopic surgery for colon and rectal cancer
Authors: Bleday Ronald , Babineau Timothy , Forse R. Armour 
Published: February 2007

AbstractLaparoscopic techniques are now being applied to increasing numbers of general surgical procedures. Technical feasibility, margins, number of lymph nodes, and recurrence rates need to be assessed with the application of this new technique to colon or rectal malignancies.Technically, the right colon, sigmoid, and proximal rectum appear to be the most amenable to laparoscopic assisted or complete laparoscopic resection. Early results from a registry of laparoscopic assisted colectomies shows that there is no significant difference in the number of lymph nodes in the lymphovascular bundle compared to conventional colon resections. Early retrospective reports indicate that there may be a significant decrease in post op length of stay.We conclude that the technique of laparoscopic assisted colectomy for colon or rectal cancer needs to follow the same oncologic principles as that of conventional surgery, and ultimately a trial will be needed to compare conventional and laparoscopic cancer resections of the large bowel.
Relevance of quality of life assessment to the evaluation of combined‐modality therapy
Authors: Shapiro Charles L. 
Published: February 2007

AbstractQuality of life (QOL) assessment is a research tool which is incorporated into clinical trials to provide information about the ways in which the treatment affects the individuals sense of well‐being and his physical, psychologic, and social functions. In the appropriate setting QOL assessment offers additional endpoints, beyond the traditional response rates and survival durations, to evaluate cancer treatments in ways which can be particularly meaningful to patients. Selected aspects of QOL methodology and the application of QOL assessment to the evaluation of combined‐modality therapies for gastrointestinal cancers are discussed.
Diagnostic imaging and staging of primary lung cancer
Authors: Rubin Eva , Sanders Colleen , Harvey James C. , Beattie Edward J. 
Published: February 2007

AbstractImproved diagnostic imaging has the potential to guide the surgeon in choice of invasive procedures required for staging and treatment of lung cancer.In the evaluation of a solitary pulmonary nodule, absence of growth for 2 years or certain typical calcifications are strong evidence of benignity, but we do not advocate following indeterminate nodules without a diagnosis because even small nodules may be carcinomas. In assessing chest wall invasion, computed tomography has no greater predictive value than a history of localized pain. The absence of nodes greater than 1.0 cm in short axis diameter on computed tomograms of the thorax is associated with low risk of tumor in mediastinal nodes, but tissue diagnosis is required for certainty. The finding of nodes larger than 1.0 cm may be useful in guiding the surgeon during staging procedures. Currently, there is no advantage of magnetic resonance imaging over computed tomography in evaluation of mediastinal nodes.Complete history and physical examination with routine serum chemistries will identify patients at high risk for metastases and will guide selection of appropriate special studies.It is emphasized that accurate staging requires histologic diagnosis and that CT and thorough surgical evaluation of the mediastinum are complementary procedures in staging of lung cancer.
Intraoperative brachytherapy in non‐small cell lung cancer
Authors: Nori Dattatreyudu 
Published: February 2007

AbstractThe lung cancer incidence and mortality rates have risen steadily each year. Survival rates during the same period have improved marginally even by the best treatment approaches. A small proportion of patients with limited disease can be offered surgical resection as the primary curative treatment. In a significant number of cases, complete resection of cancer is not possible either because the patient could not tolerate radical surgical approach or because the tumor is attached to important structures in the mediastinum precluding any surgical intervention. Intraoperative brachytherapy by various techniques offers the greatest advantage in these patients to deliver higher doses of radiation to the tumor without damage to the normal lung. Numerous intraoperative brachytherapy techniques are described to adapt to different clinical situations.Experience over the past 30 years has shown that these procedures are safe and well tolerated and can be used alone or as a boost in conjunction with external beam radiation. Published data show encouraging local control rates and survival compared with treatment by external radiation to higher doses.
Multidisciplinary approach to the treatment of locally and regionally advanced non‐small cell lung cancer: University of Miami experience
Authors: Sridhar K. S. , Thurer R. J. , Markoe A. M. , Chatoor H. T. , Fountzilas G. , Raub W. J. , Savaraj N. , Beattie E. J. 
Published: February 2007

AbstractAn intensive multimodality therapy protocol incorporating neoadjuvant chemotherapy was initiated in July 1985 for patients with either borderline resectable or unresectable non‐small cell carcinoma of the lung. Thirty‐five patients, 21 men and 14 women were entered till March 1991. The median age was 58 years (27–74). Histology was squamous in 15, adenocarcinoma in 11, large cell in 6, and adenosqua‐mous carcinoma in 3. Initial stages were IIIA in 19 patients, IIIB in 14 and II in 2. All patients tolerated preoperative chemotherapy with 5‐FU, etoposide and cisplatin (FED). The response to chemotherapy was complete response in 2 (6%), and partial response in 22 (63%). Thirty‐two patients underwent surgery. 26 patients were rendered disease free including two found disease free at surgery. Fifteen underwent pneumonectomy, 14 lobectomy and 3 biopsy only. Interstitial radiation therapy was used in 7 patients. The median survival of all patients was 19 months, those who underwent incomplete surgical resection was 12 months and patients rendered disease free at operation 21 months. Thirteen patients are alive and free of disease, including 6 patients alive longer than 5 years. Only patients who responded to chemotherapy and also had compete resection survived more than 2 years. Aggressive neoadjuvant therapy with FED, followed by resection, brachytherapy, postoperative radiation therapy, and adjuvant chemotherapy can be safely accomplished with encouraging survival in Stage III patients.
Simultaneous chemoradiation in advanced non‐small cell lung cancer
Authors: Pisch Julianna , Malamud Stephen , Harvey James , Beattie Edward J. 
Published: February 2007

AbstractWe designed our study to evaluate the safety and efficacy of simultaneous chemoradiation therapy in an accelerated, twice‐a‐day schedule to improve local control and survival in advanced lung cancer patients. Forty‐one patients were entered into the study. Twenty‐three had stage IIIB and 18 had stage IIIA disease. They received cisplatin 30 mg/m2, VP‐16 80 mg/m2, and 5‐Fluorouracil (5‐FU) 900 mg/m2 in iv infusion. Radiation therapy consisted of 2G twice a day for 5 days, followed by a 2‐week rest. This cycle was repeated 3 times. Patients were evaluated for surgical resection after the second cycle.Acute toxicity was acceptable: 3 patients expired (1 congestive heart failure, 1 sepsis, 1 pulmonary embolism). The 1‐year actuarial survival was 60.3%; the 2‐year actuarial survival was 55.3%. Our results show that this regimen is well tolerated and that the 2‐year actuarial survival appears to be comparable to that reported in the literature.
Small‐cell lung cancer: An overview of issues in therapy
Authors: Wittes Robert E. 
Published: February 2007

AbstractAs one of the few chemo‐ and radiosensitive neoplasms among the common epithelial solid tumors of adults, small‐cell lung cancer has long tantalized clinical investigators. Although for the last 15‐20 years therapy has yielded high remission rates, including substantial complete remission rates, results have not improved very much over nearly two decades of intensive therapeutic research, and long‐term disease‐free survival remains an elusive goal for the large majority of patients. At this point the number of promising untested hypotheses in therapy is quite small, and major advances will probably have to await either the serendipitous discovery of much more active drugs than we now possess, or else the purposeful development of new approaches based on insights into the nature of the transformed state and the biology of SCLC itself.
Initial and reoperative pulmonary metastasectomy: Indications, technique, and results
Authors: Pogrebniak Helen W. , Pass Harvey I. 
Published: February 2007

AbstractThe ability to predict which patients will derive a survival benefit from pulmonary metastasectomy is limited. Most patients remain asymptomatic until the disease becomes advanced, and therefore computerized tomography (CT) of the chest has become the standard of care for follow‐up of patients at risk for pulmonary metastases. The most important predictor of post‐thoracotomy survival in patients at the National Cancer Institute with soft tissue, osteogenic, and pediatric sarcomas as well as melanoma and renal cell carcinoma has been the ability to render the patient disease‐free. Tumor histology, disease‐free interval, and possibly number of nodules are also determinants of survival. Median sternotomy is the preferred approach for initial and repeat metastasectomies and every effort should be made to preserve pulmonary parenchyma. Resection of pulmonary metastases has become an accepted therapeutic modality, but selection of surgical candidates, and operative planning needs to be individualized.
Surgery for small liver cancers
Authors: Makuuchi Masatoshi , Kosuge Tomoo , Takayama Tadatoshi , Yamazaki Susumu , Kakazu Tohoru , Miyagawa Shinichi , Kawasaki Seiji 
Published: February 2007

AbstractDuring the last 16 years, we have resected small hepatocellular carcinomas (HCCs) measuring 5 cm or less from 362 patients, 266 of whom also had liver cirrhosis. The operative and hospital mortality rate were 1.7% and 1.9%, respectively. These showed a gradual decrease year by year in parallel with reduction of intraoperative blood loss achieved by the selective vascular occlusion technique and Pringle method. In 1989, 87% of hepatectomy patients were discharged without the need for whole blood transfusion, and 5‐year survival was 43.7%. Tumor size, number of tumors, intrahepatic metastasis, vascular invasion, and capsular invasion were significant prognostic factors. Edmondson grade and the operative procedure employed were significantly related to outcome. Our standard policy for selection of operative procedures and perioperative care is described, and the selection of treatment modalities is discussed.
Postoperative chemoimmunotherapy for the treatment of liver cancer
Authors: Uchino Junichi , Une Yoshie , Kawata Akira , Wakisaka Yoshitaka , Hosokawa Masuo 
Published: February 2007

AbstractA randomized study using spleen‐derived lymphokine‐activated killer (LAK) cells in hepatocellular carcinoma (HCC) is reported. We induced cytotoxic lymphocytes from resected spleen of HCC. The effect of recombinant interleukin‐2 (rIL‐2)‐activated spleen cells for prevention of recurrence of HCC after hepatic resection was studied. Enough mononuclear cells could be harvested from the resected spleens. The induction of activated spleen cells was carried out by culture in fresh medium containing 1,500 JU/ml of IL‐2. The cytotoxicity of the activated spleen cells maintained high levels during the culture period ranging from 3‐30 days. These autologous activated spleen cells were administered to patients 2 days after the intra‐arterial infusion of Adriamycin. A randomized study using these spleen LAK cells resulted in lower recurrence rates in the LAK IL‐2‐treated group. No severe side effects were observed.The lymphocytes derived from resected spleens were useful as the source of effector cells in clinical adoptive immunochemotherapy for HCC, because of their higher cytotoxicity and the simplicity of gaining a large amount of Cells. 0 1993 Wiley‐Liss, Inc.