This is the first prospective randomized study of ASI in a large population of patients with renal carcinoma after radical nephrectomy. Our data clearly indicate that ASI can increase the reactivity to autologous tumor, as measured by the DTCH test, but it appears unable to affect DFS and OS of patients.
Our study confirms the activity of IL-2 based immunotherapy in renal cell carcinoma. Moreover, ECOG performance status, clinical response, hypotension and oliguria toxicity resulted as independent survival prognostic factors.
From February 1984 to February 1987, 29 patients with advanced, hormone-resistant prostatic carcinoma were treated with mitomycin-C at a dose of 20 mg/m2 every 6 weeks (15 mg/m2 in patients greater than 75 years old and in those who had undergone previous radiotherapy). In the 27 evaluable patients, there were no complete remissions (CR), 2 partial remissions (PR), 14 stabilizations (STAB), and 11 cases of progressive disease (PRO). Ten stabilized patients showed significant pain reduction. Toxicity was minimal. The actuarial median survival was 10.8 months. In this study, mitomycin C was not active in terms of CR + PR; however, a beneficial symptomatic effect was frequently observed.
The treatment of metastastic disease to the brain requires integration of neurosurgical, radiotherapeutic and oncological principles. Surgical resection is mandatory if a brain tumor manifests as an apparently unifocal lesion of a newly discovered neoplastic disorder. Furthermore, surgery is to be selected to alleviate signs and symptoms of increased intracranial pressure which can be caused by a mass effect and/or by obstruction of the CSF pathways. With regard to local tumor control of a single brain metastasis, resection followed by whole brain irradiation has proven superior to radiotherapy alone. Alternatively, a brain metastasis with a diameter of less than 3 cm can also be treated with Gamma-knife radio-surgery, a therapeutic modality that has also proven valuable in the control of multiple brain metastases and for local control following resection. Sometimes, local control can also be improved with a boost of conventional external beam radiotherapy onto a pre-irradiated site. Multiple brain metastases with lesions displaying a diameter of more than 3 cm not well suited for resection can also be treated with whole brain radiotherapy. Occasionally, a chemoresponsive tumor can be controlled with cytotoxic drugs. In conclusion, a carefully tailored therapeutic strategy can be very rewarding for both the patient and the specialists involved that definitively improves the quality of life by extending progression-free survival.
From September, 1978, to November, 1980, 69 consecutive patients with locally advanced (T3-T4) prostatic adenocarcinoma, with or without distant metastases, were treated with oral estramustine phosphate. Dosage was 15 mg/kg/day for 2 months, followed by 5 mg/kg/day until progression. In the 48 evaluable patients with progressive disease that entry in the study, 1 complete response, 7 partial responses, 31 disease stabilizations, and 9 progressions were encountered (81.2% NPCP response rate). Karnofsky performance status equal to or less than 50 was predictive of poor response to estramustine phosphate. In the 10 evaluable patients with stabilized disease at entry in the study after orchiectomy, 2 complete responses, 4 partial responses, 3 disease stabilization, and 1 progression were noted. The major side effects observed were gynecomastia, nausea, and vomiting.
From August 1986 to September 1988, 76 eligible patients with advanced prostatic carcinoma, measurable or evaluable disease, no previous hormonal treatment, were treated with Buserelin at a dosage of 500 micrograms every 8 h for 7 days, followed by 400 micrograms intranasally three times a day. No concomitant antiandrogens were administered. In the 63 evaluable patients (11 patients not yet evaluable because of short treatment time, two lost to follow-up), three complete remissions, 28 partial remissions, 30 stable disease and two progressions were obtained (National Prostatic Cancer Project criteria). Median duration of response was 55+ weeks. Side effects were modest, mostly related to the endocrinological effects of Buserelin. Transient increase in serum testosterone levels was found in 37% of the evaluable patients, but transitory 'flare-up' was present in seven patients only. With a median follow-up time of 11.5 months, median survival has not been reached. In conclusion, this study confirmed the activity of Buserelin and the feasibility of its middle-term administration.
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