RESUMEN
BACKGROUND: Combinations of anthracyclines, taxanes and gemcitabine have shown high activity in breast cancer. This trial was designed to evaluate a modified combination regimen as primary chemotherapy. Non-pegylated liposomal doxorubicin (NPLD) was used instead of conventional doxorubicin to improve cardiac safety. Gemcitabine was given 72 h after NPLD and docetaxel as a prolonged infusion over 4 h in order to optimize synergistic effects and accumulation of active metabolites. PATIENTS AND METHODS: Forty-four patients with histologically confirmed stage II or III breast cancer were treated with NPLD (60 mg/m(2)) and docetaxel (75 mg/m(2)) on day 1 and gemcitabine as 4-h infusion (350 mg/m(2)) on day 4. Treatment was repeated every 3 weeks for a maximum of six cycles. All patients received prophylactically recombinant granulocyte colony-stimulating factor. Patients with axillary lymph node involvement after primary chemotherapy received adjuvant treatment with cyclophosphamide, methotrexate and fluorouracil. RESULTS: The clinical response rate was 80%, and complete remissions of the primary tumor occurred in 10 patients (25%). Breast conservation surgery was performed in 19 out of 20 patients (95%) with an initial tumor size of less than 3 cm and in 14 patients (70%) with a tumor size Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico
, Neoplasias de la Mama/tratamiento farmacológico
, Adulto
, Neoplasias de la Mama/patología
, Neoplasias de la Mama/cirugía
, Desoxicitidina/administración & dosificación
, Desoxicitidina/análogos & derivados
, Docetaxel
, Doxorrubicina/administración & dosificación
, Femenino
, Factor Estimulante de Colonias de Granulocitos
, Humanos
, Infusiones Intravenosas
, Liposomas
, Mastectomía Segmentaria
, Persona de Mediana Edad
, Taxoides/administración & dosificación
, Resultado del Tratamiento
, Gemcitabina
RESUMEN
PURPOSE: To assess the efficacy and safety of primary systemic treatment with doxorubicin and paclitaxel in patients with early breast cancer. PATIENTS AND METHODS: Forty patients with newly diagnosed, histologically confirmed breast cancer (T2, N0-1, M0) received primary chemotherapy with doxorubicin (60 mg/m2) and paclitaxel (200 mg/m2) in 3-week intervals for up to four courses. RESULTS: A total of 151 cycles were administered. The clinical response rate as assessed by sonographic measurement was 70%, and complete remissions of the primary tumor occurred in two patients. Eight patients (20%) had histologically confirmed complete responses. Predominant toxicity was myelosuppression with grade 3/4 neutropenia in 70% of patients. Non-hematological toxicity was generally moderate. Grade 4 non-hematological toxicities were not observed and grade 3 toxicity was reported with alopecia (98%) and stomatitis (10%). CONCLUSIONS: The combination of doxorubicin and paclitaxel is safe and highly active in patients with early breast cancer. The evaluated schedule is suitable for phase III studies.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/patología , Doxorrubicina/administración & dosificación , Esquema de Medicación , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Neutropenia/inducido químicamente , Paclitaxel/administración & dosificación , Estomatitis/inducido químicamente , Resultado del TratamientoRESUMEN
Carcinoma of the cervix is the fourth most common cancer in women. Accurate staging of the disease is essential in selecting optimal therapy. The clinical staging based on the criteria of the FIGO is inaccurate. With MRI an excellent imaging of the tumour spread within the cervix can be achieved, also tumour extension to the parametria and infiltration of the neighbouring structures as bladder and rectum. MRI is the method of choice in the preoperative staging of cervical cancer. Computed tomography and sonography have lower staging value compared to the MRI. An advantage of CT, compared with MRI, is the high accuracy in investigations of patients with ureteral obstruction and hydronephrosis. Both methods MRI and CT are comparable in assessing pelvic and paraaortic lymph node metastases.
Asunto(s)
Carcinoma/diagnóstico , Cuello del Útero/patología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Neoplasias del Cuello Uterino/diagnóstico , Carcinoma/diagnóstico por imagen , Carcinoma/patología , Cuello del Útero/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Estadificación de Neoplasias , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodos , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias del Cuello Uterino/patologíaRESUMEN
Thirty-two patients with histologically confirmed cervical carcinoma were preoperatively investigated using MRI; in addition, a CAT-scan was performed on 15 of these patients. The diagnostic results using both modalities were compared with the histological findings (after hysterectomy according to Wertheim-Meigs, including lymph node dissection in the pelvic and, in part, in para-aortal regions). Determination of tumour volume was possible with high accuracy using MRI. Accuracy in assessing the parametria was 86%, vagina 90%, bladder and rectum 97%. The shortcoming of MRI is still the detection of infiltrated lymph nodes. The accuracy of 69% achieved for lymph nodes is equal to results with computed tomography. The general accuracy for our patients in staging was 81% for MRI versus 47% for CT. MRI-based diagnosis enables us to determine a correct tumour staging preoperatively, and is therefore very helpful in planning an adequate therapy. If MRI were used more widely it would contribute to simplification and shortening of the preoperative diagnostic procedure in patients with cervical carcinoma.
Asunto(s)
Carcinoma/patología , Carcinoma/cirugía , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/cirugía , Adulto , Anciano , Carcinoma/diagnóstico por imagen , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias/métodos , Cuidados Preoperatorios , Pronóstico , Recto/patología , Vejiga Urinaria/patología , Neoplasias del Cuello Uterino/diagnóstico por imagen , Vagina/patologíaRESUMEN
The investigation of cervix carcinoma with magnetic resonance tomography (MRT) is still controversially discussed with regard to its diagnostic value as well as for planning radiation therapy. The purpose of this article is to present and discuss papers published between 1993 and 1997 in this field with respect to the technique used, the contrast media applied and its clinical value. A literature search using three different databases (Medline, Embase, Cancerlit) identified 39 publications, which were then analysed. Despite the partially suboptimal presentation of results in these papers MRT proved superior to other imaging modalities. Due to better demarcation of cervix carcinoma with MRT, it was possible to calculate tumor value as well as to correctly judge the infiltrative character. This allows for a more precise treatment and staging of the patient's prognosis. In the future, MRT might be useful in diagnosing recurrence at relatively early stage. Unfortunately lymphatic nodes can only be insufficiently verified using MRT.