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Glimelius B.; Kalkner M.; Enblad G.; Gustavsson A.; Jakobsson M.; Branehog I.; Lenner P.; for the Swedish Lymphoma Study Group 《Annals of oncology》1994,5(9):809-816
PURPOSE: Since 1985 a Swedish National Care Programme has provided tailoredprinciples for the staging, treatment and follow-up of patientswith Hodgkin's disease (HD). This report presents treatmentresults for all patients below 60 years of age who were diagnosedwith early and intermediate stages, between 1985 and 1989. PATIENTS AND METHODS: During that period, 210 patients with supradiaphragmatic HDin clinical (CS) and pathological (PS) stages IA + IIA, PS IB+ IIB, and PS III1, A were diagnosed in five Health Care Regionsin Sweden. In patients with CS IA, staging laparotomy was notrecommended provided that the radiological assessment of theabdomen was adequate, whereas this procedure was recommendedin stages CS IB, IIA and IIB in order to minimize treatment.In the absence of bulky mediastinal disease, patients with CS+ PS IA and PS IIA were treated with mantle (occasionally mini-mantle)irradiation alone, while patients with bulky disease, as wellas those with stages PS IB + IIB + III1A, were treated withone cycle of MOPP/ABVD prior to mantle (PS III1, A sub-totalnodal) irradiation. Full chemotherapy followed by radiotherapy to initial siteswith bulky disease was recommended for patients with CS IIAwho did not undergo laparotomy. RESULTS: After a median follow-up in excess of five years, treatmentresults are favourable for all stages, providedthe recommendations were followed. In patients with CS + PSIA treated according to the recommendations, recurrence rateswere 14% (9/65) with all but one patient (64/65, 98%) remainingin continuous first or second remission. These figures wereworse in patients treated inadequately (9/26 [35%] and 22/26[85%], respectively). In PS IIA, adequately-treated patientshad a recurrence rate of 13% (7/52) whereas 5/7 (71%) of thosewith bulky disease who received only mantle irradiation developedrecurrences. Similar patterns also emerged in patients withCS IIA, PS IB + IIB and PS III, A. CONCLUSIONS: The tailored principles, which usually entail less staging and/ortreatment than is generally the case, produced favourable resultswhen applied to an entirely un-selected group of patients withearly and intermediate stages of HD. Hodgkin's disease, combined-modality treatment, radiotherapy 相似文献
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Kalkner KM Acosta S Thorsson O Frederiksen H Nilsson A Gustavsson B Elingsbo M Stridsberg M Abrahamsson PA 《Prostate cancer and prostatic diseases》2006,9(1):92-98
In this pilot study, the predictive value of Octreotide scintigraphy (Octreoscan) and/or Chromogranin-A (CgA) was investigated in patients with hormone-refractory prostate cancer treated with Octreotide acetate. In total, 20 patients with progressive disease and bone metastases entered the trial. At baseline Octreoscan, CgA, PSA, alkaline phosphates (ALP) and two self-administered questionnaires (EORTC QLQ C-30 (v3) and brief pain index) were performed and a diary of the pharmaceutical was started. The treatment consisted of Octreotide (Sandostatin LAR) acetate 30 mg intramuscular injection every month. The blood samples and questionnaires were repeated every month until 3 months. Clinical responder was defined as a patient with increased global health score more than 10 units and stable or decreased pain score without an increase in analgesic. In all, 17 patients were treated per protocol, and four were assessed as clinical responders. Six patients developed a reduction in ALP (median -26%, range -5 to -78%). All patients increased in PSA. At baseline, three patients had a negative Octreoscan and the patients with positive lesions, demonstrated uptake of low intensity. At baseline the CgA was elevated above the normal range in 15 of the patients, and during treatment five patients decreased their CgA to the normal range. Neither baseline Octreoscan nor CgA could identify the clinical reponders. A minority of patients improves their health-related quality of life. The decrease and normalization of CgA levels in five patients during therapy indicates therapeutic activity but Octreoscan and CgA could not identify clinical responders. 相似文献
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Raija Ristamki Heikki Joensuu Hans Hagberg Karl M. Kalkner Sirpa Jalkanen 《International journal of cancer. Journal international du cancer》1998,79(3):221-225
Soluble isoforms of various adhesion molecules have recently been observed in the blood circulation, but the physiological effects of such molecules remain unsettled. Our earlier results indicate that soluble CD44 can be detected in sera of healthy individuals and that significantly higher levels of serum CD44 (s-CD44) can be found in lymphoma patients. The serum level of the standard form of CD44 parallels the clinical treatment response in patients with lymphoma. In the present study, we have investigated the clinical significance of s-CD44 in non-Hodgkin's lymphoma measured at the time of the diagnosis. S-CD44 was measured from the sera of 123 patients with non-Hodgkin's lymphoma by dot blotting High levels of s-CD44 were associated with high serum levels of lactate dehydrogenase and thymidine kinase, high histological grade of malignancy and poor overall survival. However, s-CD44 level did not have independent prognostic value in a multivariate analysis. In conclusion, a high s-CD44 level at the time of diagnosis was associated with poor survival and several other adverse prognostic factors. Our previous and present studies taken together suggest that measurement of s-CD44 is a valuable tool to monitor treatment response in lymphoma patients. However, it may not be an improved prognostic marker. Int. J. Cancer (Pred. Oncol.) 79:221–225, 1998.© 1998 Wiley-Liss, Inc. 相似文献
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Antibodies against double-stranded DNA and development of polymyositis during treatment with interferon 总被引:6,自引:0,他引:6
Kalkner KM; Ronnblom L; Karlsson Parra AK; Bengtsson M; Olsson Y; Oberg K 《QJM : monthly journal of the Association of Physicians》1998,91(6):393-399
Alpha interferons have become effective palliative treatments for patients
with neuroendocrine tumours such as carcinoids and endocrine pancreatic
tumours. However, several reports indicate an increased incidence of both
autoantibodies and autoimmune diseases in patients treated with
interferon-alpha (IFN-alpha). We studied the development of antibodies
against double-stranded DNA (dsDNA) and clinical signs of autoimmune
disease in 214 patients with malignant carcinoids or endocrine pancreatic
tumours consecutively admitted for treatment with IFN-alpha. Seventeen
patients (8%) developed antibodies against dsDNA, predominantly females (12
females and 5 males). One patient had clinical and laboratory signs of
polymyositis. Among the other 16 patients, three developed hypothyroidism
and in six patients the anti- dsDNA autoantibodies normalized despite
continuing therapy. Although a significant number of patients developed
autoantibodies against dsDNA, overt autoimmune disease related to these
antibodies is a rare event and many patients spontaneously normalize these
titres despite continuing IFN-alpha treatment.
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