Cancer
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Multicenter Study
Primary cutaneous melanoma. Optimized cutoff points of tumor thickness and importance of Clark's level for prognostic classification.
Maximum tumor thickness and level of invasion are known to be the most important prognostic factors for patients with primary cutaneous melanoma. However, the classification of tumor thickness and the question of whether the combination of tumor thickness and level of invasion provides a better prognostic classification than tumor thickness alone are still matters of debate. The present study examined the relationship between tumor thickness and survival probability to define cutoff points of tumor thickness. Secondly, it investigated the prognostic value of the combination of tumor thickness and level of invasion as proposed in the current TNM classification system. ⋯ The proposed stratification of tumor thickness with cutoff points at 1, 2, and 4 mm was supported by multivariate statistical analysis. The analysis of the current TNM staging system indicates the precedence of tumor thickness for the staging of patients with primary cutaneous melanoma in the case of discordance between tumor thickness and level of invasion.
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Multicenter Study
Prediction of survival of patients terminally ill with cancer. Results of an Italian prospective multicentric study.
The individualization of prognostic factors in the various stages of cancer facilitates the planning of a therapeutic assistance program aimed at various subsets of patients. The prognostic factors for survival in patients terminally ill with cancer have been investigated in case studies that are often retrospective, monocentric and/or include a mixture of patients in advanced disease stages. The aim of this prospective multicentric study was to verify those clinical factors predictive of survival in a population of patients with terminal cancer. ⋯ The importance of certain clinical parameters as prognostic indicators for patients with terminal cancer (clinical experience, physical activity level, clinical symptoms relating to and unrelated to nutritional state) were confirmed; some others possible factors, such as treatment with corticosteroids and hospitalization, also were noted. These may be useful factors in the therapeutic, assistance decision-making process and may eliminate overtreatment and undertreatment resulting from philosophically preconceived attitudes, rather than from considering the patient's true pathologic condition.
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Clinical Trial
A phase II trial of interferon alpha-2A, 5-fluorouracil, and cisplatin in patients with advanced esophageal carcinoma.
The combination of 5-fluorouracil (5-FU) and cisplatin has moderate antitumor activity in the treatment of metastatic epidermoid carcinoma of the esophagus. The authors have recently shown activity for the combination of 5-FU and interferon-alpha 2a (IFN-alpha) in both esophageal epidermoid and adenocarcinoma. A Phase II trial, therefore, was undertaken to evaluate the antitumor activity of the three-drug combination of IFN-alpha, 5-FU, and cisplatin in unresectable or metastatic esophageal carcinoma. ⋯ In this Phase II trial, the combination of IFN-alpha, 5-FU, and cisplatin had substantial antitumor activity in esophageal carcinoma with apparently greater antitumor activity in epidermoid carcinoma than adenocarcinoma. A larger confirmatory trial comparing this treatment to conventional 5-FU and cisplatin is warranted for epidermoid carcinoma. In future chemotherapy trials, the response assessment for epidermoid and adenocarcinoma should continue to be stratified.
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Multicenter Study Clinical Trial
Concurrent hyperfractionated irradiation and chemotherapy for unresectable nonsmall cell lung cancer. Results of Radiation Therapy Oncology Group 90-15.
Clinical trials of hyperfractionated radiation therapy and induction chemotherapy followed by standard radiation therapy have shown improved survival in patients with unresectable nonsmall cell lung cancer (NSCLC). Radiosensitization may improve local tumor control when chemotherapy is given concurrently with hyperfractionated radiation therapy, but also may increase toxicity. A Phase I/II trial, Radiation Therapy Oncology Group 90-15, was designed to evaluate whether this strategy could improve survival with acceptable toxicity and be part of a Phase III trial of chemoradiation sequencing. ⋯ For patients with unresectable nonsmall cell lung cancer, who were not selected on the basis of weight loss, concurrent hyperfractionated irradiation and chemotherapy had more intense acute toxicity than hyperfractionation alone, but late toxicity was acceptable. One and 2-year survival rates were 54 and 28%, respectively.
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Because results of retropubic I-125 implantation for prostate cancer have been poor, external beam radiation was added postimplant. Serum prostate specific antigen (PSA) was used to assess this approach of combined irradiation. ⋯ The PSA-monitored disease free survival rate after combination irradiation appears comparable with that after radical prostatectomy and perhaps superior to that after external-beam radiation. This effect was achieved even though lower-than-usual doses of radiation from both sources were administered. The combination of an I-125 implant followed by external-beam radiation produces high doses within the prostate and, to a lesser extent, in the periprostatic tissue. Additive and synergistic effects from simultaneous irradiation may be responsible for these results.