Background. Surgery and radiotherapy mainstays in the management of advanced head and neck cancer, although historically, only 20–30% of patients survive. Therefore, in an attempt to improve locoregional control and survival, a multimodal protocol using cisplatin as a radiosensitizer was implemented. Methods. Between 1984 and 1990,68 patients with advanced head and neck cancer (Stages III and IV) were treated with a regimen consisting of an induction phase of 4500 cGy and two cycles of cisplatin followed by an eradicative phase of either radical surgery (Group A, 27 patients) or radical radiotherapy (Group B, 41 patients). The maintenance phase chemotherapy consisted of adjuvant 5‐fluorouracil (5‐FU) and cisplatin after completion of locoregional treatment. Of the 68 patients, 19 had Stage III disease, and 49 had Stage IV; 21 had no regional lymph node metastases (No), and 47 had regional lymph node metastases (N+). Results. The induction phase yielded a 26% (18 patients) complete response (CR) rate and a 57% (39 patients) partial response (PR) rate (response > 50%), yielding an overall response rate of 83%. Eleven patients (16%) had stable disease (ST) (i. e., < 50% response). The 2‐year survival rates by initial treatment response for patients who had a CR, a PR, and stable disease were 53%, 56%, and 36%, respectively; for Groups A and B, 63% and 45%, respectively; for Stages III and IV, 68% and 43%, respectively; and for NO and N+, 69% and 43%, respectively. In Group A, 14 of 27 patients (52%) had no viable tumor in the surgical specimen (i. e. had pathologic complete tumor clearance [CTC]); this subgroup had a 5‐year survival rate of 58%. Ten patients (37%) who had gross total resection of tumor with negative margins but had tumor present in the specimen had a 5‐year survival of 22%. In Group B, the 5‐year survival rate was 43% for 27 patients who achieved CR after completion of radical radiotherapy (total tumor dose, 6480–7020 cGy). The 5‐year survival rate of the 14 patients who had a PR and stable disease after radical radiotherapy and 3 patients whose resection was incomplete was 0%. The overall 2‐ and 5‐year survival rates for all patients were 53% and 32%, respectively. Of 21 patients in whom treatment failed, most (90%) had a locoregional recurrence: 13 local recurrences (62%), 5 regional (24%), and 1 locoregional (5%). Two patients (10%) experienced failure at distant sites (the lung). Major treatment‐related morbidity developed in two patients. Conclusions. Although induction chemotherapy‐radiotherapy produces a high clinical response rate, this does not translate into improved survival compared with historical controls. A subgroup that showed complete tumor clearance (CTC or pathologic complete response) at surgery had an apparent improved survival and merits further study. Patient selection did not appear to be a factor for the CTC group, because the majority of patients in this group had partial responses to induction therapy, nodal disease and advanced tumor stage, and tumor presence in ...
Twenty coronary patients with a median age of 76 years were treated in the coronary care unit with tiapamil, a new Ca2+ antagonist, by intravenous infusion (until December, 1979, the generic name was dimeditiapramine). The following arrhythmias were identified: atrial fibrillation with ventricular rate >95 beats/min (5 patients); supraventricular premature complexes (SVPC) (4 patients); and ventricular premature complexes (VPC), Lown grades 2-4 (1 5 patients). Electrocardiograms and hemodynamic parameters were continuously monitored prior to, during, and after the therapy. In patients with atrial fibrillation, sinus rhythm was not restored, but tiapamil decreased the ventricular rate by 54%.In patients with VPC, the median frequency of VPC decreased from 310.5 before tiapamil to 32.5 beats/h at the fourth hour of therapy (p
18 patients with acute myocardial infarction and sustained arrhythmias were treated with a new Ca2+ antagonist, Ro 11-1781, at the dose of 1.0 mg/kg i.v. The drug was effective in reducing heart rate to less than 90 beats/min in 9/10 patients with atrial fibrillation, in 3/4 patients with atrial flutter and in 3/4 patients with supraventricular tachycardia. The peak effect was observed within 2--5 min after the intravenous administration of Ro 11-1781. In cases with recurring tachyarrhythmias, the drug was also effective in repetitive administration. Systolic blood pressure was reduced, but severe hypotension (less than 90 mm Hg) was not observed. The atrioventricular conduction in these patients remained unimpaired and asystole did not occur. The drug appears to be an effective and a well tolerated antiarrhythmic agent.
Several gender-specific differences in cardiovascular diseases are known and pharmacokinetics of β-blockers shows relevant sex-specific differences. The plasma levels of metoprolol, for example, are higher in women compared to men. However, randomized studies have shown that metoprolol has little or no greater reduction in the mortality of women following myocardial infarction. We tested the hypothesis that metoprolol might have significant gender-specific effects in patients with chronic angina pectoris. Body weight of women was slightly (–9%) less than that of men and the daily dose of metoprolol was similar in both groups. Thus, according to pharmacokinetics women should have obtained higher plasma levels of this drug and the ensuing pharmacologic effects of metoprolol should have been greater. Our results do not confirm this assumption. Metoprolol reduced the frequency of angina episodes and the consumption of nitroglycerin tablets to a similar extent in both sexes. However, the pretreatment hemodynamic profiles confirmed the existence of gender-specific differences: women had significantly higher heart rate and blood pressure both at rest and during exercise. Since both groups were comparable in age, comorbidities, and medications, the existing difference is likely to be due to gender-specificity. The hemodynamic differences persisted during therapy with metoprolol: resting heart rate, blood pressure and rate pressure product were reduced to a greater extent in men. During cycloergometry, there was a slight difference in the time of onset of ST depression and time of onset of angina, which were slightly higher in men, but probably because of the limited number of cases, the difference between men and women did not reach significance. On the other hand, with metoprolol the duration of exercise and, in parallel, the number of metabolic equivalents was significantly greater in males than in females. Thus in spite of a presumed greater plasma concentration of metoprolol in women, we found a significant difference in anti-ischemic effect in favor of men. We conclude that metoprolol might exert a significantly greater therapeutic effect on stress-induced angina pectoris in men than in women and this difference should be taken into account when prescribing this β-blocker.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.