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Panday VRN, Huizing MT, van Tellingen O, Hakvoort RA, Willemse PHB, De Graeff A, Vermorken JB, Beijnen JH. Pharmacologic study of Cremophor EL in cancer patients with impaired hepatic function receiving paclitaxel. J Oncol Pharm Pract 2016. [DOI: 10.1177/107815529900500204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims. Cremophor EL (CrEL) (polyoxyethylene glycerol triricinoleate 35) is used as a pharmaceutical vehicle for the formulation of several drugs, including the anticancer agent paclitaxel (Taxolt). This excipient has been associated with hypersensitivity reactions and affects the pharmacokinetic properties of paclitaxel, especially in patients with hepatic dysfunction. In this study, we investigated the pharmacokinetics of CrEL in a specific population of patients. Methods. Patients were stratified in five cohorts based on hepatic function, received paclitaxel for metastatic disease, and were monitored pharmacokinetically during course 1 and course 2. CrEL levels were measured and related to the extent of hepatic dysfunction. Results. A total of 46 courses were measured from 27 patients. CrEL pharmacokinetic parameters in patients with mild hepatic dysfunction (cohorts I-III) were not significantly different from patients with normal hepatic function, whereas the patients with moderate to severe hepatic dysfunction (cohorts IV and V) displayed a different pharmacokinetic profile. Conclusions. The results indicate a nonlinear pharmacokinetic behavior of CrEL. No differences were found for CrEL pharmacokinetics when course 1 was compared with course 2 per cohort. A possible influence of the specific characteristics of patients with severe hepatic dysfunction, such as altered physiologic and metabolic states, could play a role in the deposition of CrEL.
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Affiliation(s)
- Vinodh R Nannan Panday
- Department of Medical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands, Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, Amsterdam, The Netherlands
| | - Manon T Huizing
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, Amsterdam, The Netherlands
| | - Olaf van Tellingen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, Amsterdam, The Netherlands
| | - Robert A Hakvoort
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, Amsterdam, The Netherlands
| | - Pax H B Willemse
- Department of Medical Oncology, Academic Hospital Groningen, Groningen, The Netherlands
| | - Alexander De Graeff
- Department of Medical Oncology, Academic Hospital Utrecht, Utrecht, The Netherlands
| | - Jan B Vermorken
- Department of Medical Oncology, University Hospital Antwerpen, Edegem, Belgium
| | - Jos H Beijnen
- Department of Medical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands, 2Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, Amsterdam, The Netherlands, Department of Pharmaceutical Analysis and Toxicology, Faculty of Pharmacy, State University of Utrecht, Utrecht, The Netherlands
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De Munck L, De Bock GH, Otter R, Reiding D, Broeders MJM, Willemse PHB, Siesling S. Abstract P6-02-05: Digital versus screen-film mammography in population-based breast cancer screening: Performance indicators and tumor characteristics of screen-detected and interval cancers. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-02-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose:
To evaluate whether the introduction of full-field digital mammography (FFDM) in screening has resulted in any changes in performance indicators compared to screen-film mammography (SFM), including tumor characteristics and incidence rates of interval cancers.
Materials and Methods
Data of the Dutch National Cancer Screening Programme, region North (2004-2010) were linked to the Netherlands Cancer Registry (N=902,868). Screening performance indicators (recall rate, detection rate, positive predictive value, sensitivity and specificity) and tumor characteristics of screen-detected cancers were compared between FFDM and SFM, as were incidence rates and tumor characteristics of interval cancers. Analyses were stratified by initial and subsequent examinations. Differences were compared using chi-square.
Results
Initial examinations: After initial examinations recall rates were 2.1% for SFM and 3.0% for FFDM (p<0.001). The positive predictive value was 25.6% for SFM and 19.9% for FFDM (p=0.002) and detection rates were similar. The detection rate for DCIS was 0.86 per 1000 women for SFM compared to 1.18 per 1000 women for FFDM (p=0.137). Similar percentages of low grade DCIS were found for SFM and FFDM (18% vs. 14%;p=0.860). No difference were found in tumor size, morphology, grade and nodal status of invasive screen-detected cancers.
Subsequent examinations: After subsequent examinations performance indicators were similar. Detection rates for DCIS were 0.74 per 1000 women for SFM versus 0.81 per 1000 women for FFDM (p=0.298). For invasive cancers, detection rates were 4.54 per 1000 women for SFM versus 4.33 per 1000 women for FFDM (p=0.210). The percentages of low grade DCIS were similar for SFM and FFDM (12% vs.9%; p=0.524). Invasive cancers diagnosed with FFDM were more often of high grade (p=0.024) and ductal type (p=0.030).
No difference was found in the incidence rates of interval cancers for SFM and FFDM after initial examinations (2.69/1000 vs.2.51/1000; p=0.787). The sensitivity after initial examinations was 66.1% for SFM and 69.1% for FFDM (p=0.657), specificity was 98.5% and 96.9% for SFM and FFDM, respectively (p<0.001). After subsequent examinations the incidence rates of interval cancer were 2.30/1000 for SFM and 2.41/1000 for FFDM (p=0.652), sensitivity was 69.7% for SFM and 66.7% for FFDM (p=0.232). Specificity was 99.4% SFM and 99.2% for FFDM (p<0.001). No differences were found in tumor size, morphology, grade or nodal status of interval cancers diagnosed after FFDM compared to SFM after initial or after subsequent examinations.
Conclusions
Compared to SFM, FFDM resulted in similar rates of screen-detected and interval cancers, indicating that FFDM performs as well as SFM in a breast cancer screening program, with more invasive cancers of high grade and ductal type found after subsequent screens. FFDM resulted in a higher recall rate and lower PPV. No signs of an increase in low-grade DCIS (which might connote possible overdiagnosis) were seen. Tumor characteristics of interval cancers were similar.
Citation Format: De Munck L, De Bock GH, Otter R, Reiding D, Broeders MJM, Willemse PHB, Siesling S. Digital versus screen-film mammography in population-based breast cancer screening: Performance indicators and tumor characteristics of screen-detected and interval cancers. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-02-05.
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Affiliation(s)
- L De Munck
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; National Cancer Screening Programme, Region North, Groningen, Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - GH De Bock
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; National Cancer Screening Programme, Region North, Groningen, Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - R Otter
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; National Cancer Screening Programme, Region North, Groningen, Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - D Reiding
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; National Cancer Screening Programme, Region North, Groningen, Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - MJM Broeders
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; National Cancer Screening Programme, Region North, Groningen, Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - PHB Willemse
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; National Cancer Screening Programme, Region North, Groningen, Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - S Siesling
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; National Cancer Screening Programme, Region North, Groningen, Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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de Munck L, Kwast A, Reiding D, de Bock GH, Otter R, Willemse PHB, Siesling S. Attending the breast screening programme after breast cancer treatment: a population-based study. Cancer Epidemiol 2013; 37:968-72. [PMID: 24075800 DOI: 10.1016/j.canep.2013.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 08/27/2013] [Accepted: 09/02/2013] [Indexed: 01/05/2023]
Abstract
INTRODUCTION In the Netherlands, breast cancer patients are treated and followed at least 5 years after diagnosis. Furthermore, all women aged 50-74 are invited biennially for mammography by the nationwide screening programme. The relation between the outpatient follow-up (follow-up visits in the outpatient clinic for 5 years after treatment) and the screening programme is not well established and attending the screening programme as well as outpatient follow-up is considered undesirable. This study evaluates potential factors influencing women to attend the screening programme during their outpatient follow-up (overlap) and the (re-)attendance to the screening programme after 5 years of outpatient follow-up. METHODS Data of breast cancer patients aged 50-74 years, treated for primary breast cancer between 1996 and 2007 were selected from the Netherlands Cancer Registry and linked to the National Breast Cancer Screening Programme in the Northern region. Cox regression analyses were used to study women (re-)attending the screening programme over time, possible overlap with the outpatient follow-up and factors influencing this. RESULTS In total 11227 breast cancer patients were included, of whom 19% attended the screening programme after breast cancer treatment, 4.4% within 5 years and 15.4% after more than 5 years. Factors that independently influenced attendance within 5 years as well as more than 5 years after treatment were: interval tumours (HR 0.77; 95%CI 0.61-0.97 and HR 0.69; 95%CI 0.53-0.88, ref: screen-detected tumours), receiving adjuvant radiotherapy (HR 0.65; 95%CI 0.47-0.90 and HR 0.66; 95%CI 0.47-0.93; ref: none) and diagnosis of in situ tumours (HR 1.67; 95%CI 1.25-2.23 and HR 1.39; 95%CI 1.05-1.85; ref: stage I tumours). Non-screen related tumours (HR 0.41; 95%CI 0.29-0.58) and recent diagnosis (HR 0.89 per year; 95%CI 0.86-0.92) were only associated with attendance within 5 years after treatment. CONCLUSION The interrelation between outpatient follow-up and screening should be improved to avoid overlap and low attendance to the screening programme after outpatient follow-up. Breast cancer patients should be informed that attending the screening programme during the outpatient follow-up is not necessary.
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Affiliation(s)
- Linda de Munck
- Department of Research, Comprehensive Cancer Centre the Netherlands, P.O. Box 19079, 3501 DB Utrecht, The Netherlands.
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Reyners AKL, de Munck L, Erdkamp FLG, Smit WM, Hoekman K, Lalisang RI, de Graaf H, Wymenga ANM, Polee M, Hollema H, van Vugt MATM, Schaapveld M, Willemse PHB. A randomized phase II study investigating the addition of the specific COX-2 inhibitor celecoxib to docetaxel plus carboplatin as first-line chemotherapy for stage IC to IV epithelial ovarian cancer, Fallopian tube or primary peritoneal carcinomas: the DoCaCel study. Ann Oncol 2012; 23:2896-2902. [PMID: 22689176 DOI: 10.1093/annonc/mds107] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND In ovarian cancer, cyclooxygenase-2 (COX-2) overexpression is prognostic for poor survival. We investigated the efficacy of celecoxib (C), a selective COX-2 inhibitor, added to docetaxel (Taxotere)/carboplatin (DC) in advanced ovarian cancer. PATIENTS AND METHODS In a phase II, randomized study, 400 mg celecoxib b.i.d. was added to first-line DC treatment (DCC). Celecoxib was to be continued after DC termination up to 3 years. Study end points were tolerability, progression-free survival (PFS) and overall survival (OS). RESULTS 151 of 196 eligible patients were diagnosed with stage IIIC/IV disease. Median follow-up for patients alive was 32.3 months. Celecoxib was used during a mean of 8.5 months. Twenty-three of 97 DCC patients stopped celecoxib prematurely, mainly due to skin reactions. Complete biochemical response was achieved in 51/78 DC patients (65%) versus 57/78 DCC patients (75%, not significant). In both study arms, median PFS was 14.3 months and median OS 34 months. COX-2 was expressed in 82% of 120 tumor samples retrospectively recovered. The PFS and OS of patients with intermediate/high COX-2 expression were similar to that in the other patients. CONCLUSION Celecoxib did not influence PFS and OS, but interpretation of results is hampered by premature celecoxib discontinuation.
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Affiliation(s)
- A K L Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen.
| | - L de Munck
- Department of Research, Comprehensive Cancer Center The Netherlands, Utrecht
| | - F L G Erdkamp
- Department of Internal Medicine, Orbis Medical Center, Sittard
| | - W M Smit
- Department of Internal Medicine, Medical Spectrum Twente, Enschede
| | - K Hoekman
- Department of Medical Oncology, VU University Medical Center, Amsterdam
| | - R I Lalisang
- Department of Medical Oncology, University Medical Center, Maastricht
| | - H de Graaf
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden
| | - A N M Wymenga
- Department of Internal Medicine, Medical Spectrum Twente, Enschede
| | - M Polee
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden
| | - H Hollema
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen
| | - M A T M van Vugt
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen
| | - M Schaapveld
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P H B Willemse
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen
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de Munck L, Schaapveld M, Siesling S, Wesseling J, Voogd AC, Tjan-Heijnen VCG, Otter R, Willemse PHB. Implementation of trastuzumab in conjunction with adjuvant chemotherapy in the treatment of non-metastatic breast cancer in the Netherlands. Breast Cancer Res Treat 2011; 129:229-33. [PMID: 21431871 DOI: 10.1007/s10549-011-1451-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 03/10/2011] [Indexed: 11/26/2022]
Abstract
Trastuzumab in conjunction with adjuvant chemotherapy markedly improves outcome. In the Netherlands, a national guideline was released in September 2005 stating that trastuzumab should be given in conjunction with adjuvant chemotherapy in women with HER2-positive breast cancer. Aim of this study was to identify the number of women with HER2-positive breast cancer and to evaluate the level of implementation of adjuvant trastuzumab in clinical practice nationwide. Women diagnosed with primary breast cancer between September 2005 and January 2007 were selected from the Netherlands Cancer Registry (NCR). HER2 status, adjuvant treatment and reasons to withhold trastuzumab were registered. 14,934 Breast cancer patients were diagnosed in this period of whom 1,928 (13%) had a HER2-positive tumour. Of all HER2-positive women receiving adjuvant chemotherapy, 66 (6%) did not receive trastuzumab. This percentage decreased from 10% at the time of introduction of the guideline to 4% in the study period September 2005-December 2006. Most common reasons to withhold trastuzumab were cardiovascular disease (29%) and patient refusal (21%). Of all HER2-positive patients who received adjuvant chemotherapy, 94% received trastuzumab. The implementation of trastuzumab in clinical practice was realized within 8 months after introduction of the new guideline.
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Affiliation(s)
- L de Munck
- Department of Research, Comprehensive Cancer Centre North East, Groningen, The Netherlands.
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Leffers N, Lambeck AJA, Gooden MJM, Hoogeboom BN, Wolf R, Hamming IE, Hepkema BG, Willemse PHB, Molmans BHW, Hollema H, Drijfhout JW, Sluiter WJ, Valentijn ARPM, Fathers LM, Oostendorp J, van der Zee AGJ, Melief CJ, van der Burg SH, Daemen T, Nijman HW. Immunization with a P53 synthetic long peptide vaccine induces P53-specific immune responses in ovarian cancer patients, a phase II trial. Int J Cancer 2009; 125:2104-13. [PMID: 19621448 DOI: 10.1002/ijc.24597] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The prognosis of ovarian cancer, the primary cause of death from gynecological malignancies, has only modestly improved over the last decades. Immunotherapy is one of the new treatment modalities explored for this disease. To investigate safety, tolerability, immunogenicity and obtain an impression of clinical activity of a p53 synthetic long peptide (p53-SLP) vaccine, twenty patients with recurrent elevation of CA-125 were included, eighteen of whom were immunized 4 times with 10 overlapping p53-SLP in Montanide ISA51. The first 5 patients were extensively monitored for toxicity, but showed no > or = grade 3 toxicity, thus accrual was continued. Overall, toxicity was limited to grade 1 and 2, mostly locoregional, inflammatory reactions. IFN-gamma producing p53-specific T-cell responses were induced in all patients who received all 4 immunizations as measured by IFN-gamma ELISPOT. An IFN-gamma secretion assay showed that vaccine-induced p53-specific T-cells were CD4(+), produced both Th1 and Th2 cytokines as analyzed by cytokine bead array. Notably, Th2 cytokines dominated the p53-specific response. P53-specific T-cells were present in a biopsy of the last immunization site of at least 9/17 (53%) patients, reflecting the migratory capacity of p53-specific T-cells. As best clinical response, stable disease evaluated by CA-125 levels and CT-scans, was observed in 2/20 (10%) patients, but no relationship was found with vaccine-induced immunity. This study shows that the p53-SLP vaccine is safe, well tolerated and induces p53-specific T-cell responses in ovarian cancer patients. Upcoming trials will focus on improving T helper-1 polarization and clinical efficacy.
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Affiliation(s)
- Ninke Leffers
- Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Van Der Horst-Schrivers ANA, Slot MHEB, Willemse PHB, Kema IP, De Vries EGE, Wymenga ANM. Effect of interferon and 5-fluorouracil on serum VEGF levels in neuroendocrine tumours. Acta Oncol 2009; 47:153-5. [PMID: 17851877 DOI: 10.1080/02841860701449403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Buijs C, Willemse PHB, de Vries EGE, Ten Hoor KA, Boezen HM, Hollema H, Mourits MJE. Effect of Tamoxifen on the Endometrium and the Menstrual Cycle of Premenopausal Breast Cancer Patients. Int J Gynecol Cancer 2009; 19:677-81. [DOI: 10.1111/igc.0b013e3181a47cbe] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Engelen MJA, Snel BJ, Schaapveld M, Pras E, de Vries EGE, Gietema JA, van der Zee AGJ, Willemse PHB. Long-term morbidity of adjuvant whole abdominal radiotherapy (WART) or chemotherapy for early stage ovarian cancer. Eur J Cancer 2009; 45:1193-1200. [PMID: 19201598 DOI: 10.1016/j.ejca.2009.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 12/18/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
Abstract
UNLABELLED The aim of the study was to evaluate long-term toxicity of adjuvant treatment in early stage ovarian cancer survivors. Data from all patients treated in one hospital for early stage ovarian cancer diagnosed between 1980 and 1990 were collected using a structured data form. In 93 FIGO stages I and II patients, cytoreductive and staging surgery was performed; 15 received no adjuvant treatment (controls), 39 whole abdominal radiotherapy (WART) and 39 platin-based chemotherapy. Median age at diagnosis was 54 years (range 21-83 years). During follow-up, 49/93 (53%) patients have died with a median overall survival of 18.4 years (95% CI 12.8-23.9). In both the radiotherapy and the chemotherapy group, 50% of patients reported long-term side-effects (all grades) versus 13% of controls. Two patients in the WART group died from bowel complications. Secondary malignancies were observed in 16 patients. Of all patients alive at the last follow-up, 12/17 (71%) patients treated with radiotherapy and 11/18 (61%) treated with chemotherapy experienced long-term morbidity versus 2/9 (22%) controls (P=0.03). IN CONCLUSION Long-term follow-up of early stage ovarian cancer patients showed lasting GI morbidity in the survivors treated with adjuvant radiotherapy, which has therefore become obsolete. Cisplatin-based chemotherapy caused peripheral neuropathy versus virtual absence of problems in the survivors of just surgery, emphasising the need for strict criteria before instigating adjuvant treatment.
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Affiliation(s)
- M J A Engelen
- Department of Gynaecologic Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - B J Snel
- Department of Gynaecologic Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - M Schaapveld
- Department of Epidemiology and Statistics, Comprehensive Cancer Centre North Netherlands, P.O. Box 330, 9700 AH Groningen, The Netherlands
| | - E Pras
- Department of Radiotherapy, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - E G E de Vries
- Department of Medical Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - J A Gietema
- Department of Medical Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - A G J van der Zee
- Department of Gynaecologic Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - P H B Willemse
- Department of Medical Oncology, University of Groningen and University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
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van der Zee AGJ, de Vries EGE, Schaapveld M, Willemse PHB. [The limitations of observational research]. Ned Tijdschr Geneeskd 2009; 153:102; author reply 102. [PMID: 19235351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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van der Zee AGJ, Engelen MJA, Schaapveld M, Karim-Kos HE, de Vries EGE, Willemse PHB, Otter R. [Primary surgery by a gynecological oncologist improves the prognosis in patients with ovarian carcinoma]. Ned Tijdschr Geneeskd 2009; 153:15-19. [PMID: 19198207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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van der Horst-Schrivers ANA, van Ieperen E, Wymenga ANM, Boezen HM, Weijmar-Schultz WCM, Kema IP, Meijer WG, de Herder WW, Willemse PHB, Links TP, de Vries EGE. Sexual function in patients with metastatic midgut carcinoid tumours. Neuroendocrinology 2009; 89:231-6. [PMID: 19033719 DOI: 10.1159/000178754] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 07/15/2008] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sexual dysfunction is a poorly studied aspect of quality of life in patients with midgut carcinoid tumours. We investigated whether carcinoid patients experience sexual problems. METHODS Patients with metastatic midgut carcinoid tumours filled in a validated questionnaire for sexual dysfunction. The prevalence of dysfunction on the subscales arousal, erection, lubrication, orgasm and dyspareunia was compared to a Dutch reference population. Plasma concentration of gonadal hormones, tryptophan and urinary 5-hydroxyindolacetic acid concentrations were measured. RESULTS 43 patients were studied, 27 men and 16 women. Sexual dysfunction was present in 29.6% of men and 6.3% of women. The prevalence of sexual dysfunction on the different subscales did not differ from the reference population. Patients with a sexual dysfunction had, compared to those without a sexual dysfunction, a longer duration of disease, 95.3 months (range 5.4-314.5) versus 18.6 months (range 0.6-167.9) (p = 0.024), lower plasma tryptophan concentration (+/-SD) of 31.5 +/- 16.1 and 48.9 +/- 14.5 micromol/l (p = 0.031), and more often used interferon-alpha, 50% of patients versus 10.5% of patients (p = 0.044). CONCLUSION Patients with metastatic midgut carcinoid tumours do not experience sexual problems more often than a reference population. Male patients with sexual dysfunction are characterised by more long-standing disease and lower tryptophan concentration.
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Buijs C, Mom CH, Willemse PHB, Marike Boezen H, Maurer JM, Wymenga ANM, de Jong RS, Nieboer P, de Vries EGE, Mourits MJE. Venlafaxine versus clonidine for the treatment of hot flashes in breast cancer patients: a double-blind, randomized cross-over study. Breast Cancer Res Treat 2008; 115:573-80. [PMID: 18670875 DOI: 10.1007/s10549-008-0138-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Accepted: 07/14/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Ciska Buijs
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Buijs C, de Vries EGE, Mourits MJE, Willemse PHB. The influence of endocrine treatments for breast cancer on health-related quality of life. Cancer Treat Rev 2008; 34:640-55. [PMID: 18514425 DOI: 10.1016/j.ctrv.2008.04.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 04/15/2008] [Accepted: 04/16/2008] [Indexed: 11/19/2022]
Abstract
UNLABELLED Many hormonal modalities are available for breast cancer treatment, such as selective oestrogen receptor modulators (SERMs), aromatase inhibitors, progestins and luteinising hormone-releasing hormone (LHRH) agonists. The long-term impact of these endocrine manipulations is an issue, because the duration of adjuvant treatment is still increasing, as is the number of breast cancer survivors. Premature menopause is induced at a young age, and may often be permanent after chemotherapy. The purpose of this review is to provide a literature-based overview of the side effects of endocrine treatment in pre- and postmenopausal breast cancer patients and the influence on HRQoL, especially on sexual functioning. The collection of health-related quality of life (HRQoL) data can result in better treatment recommendations during endocrine therapy. METHODS This review was limited to prospective randomised studies in English literature from between 1977 and 2007 and provides an overview of the effects on HRQoL and sexuality of various hormonal treatment in pre- and postmenopausal breast cancer patients, both in the adjuvant and palliative setting. Relevant clinical studies were identified by using the Medline database. RESULTS HRQoL mostly is severely influenced by chemotherapy and part of these symptoms may be lasting, especially when associated with the induction of premature menopause. Similar symptoms may be encountered during ovarian suppression therapy by LHRH analogs, but they will usually prove to be reversible. The varying side effect profiles of tamoxifen and aromatase inhibitors did not lead to significant difference in overall HRQoL. HRQoL during progestins and the SERM fulvestrant has been compared to this during aromatase inhibitors, and a large number of studies on HRQoL during endocrine therapy will be discussed.
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Affiliation(s)
- Ciska Buijs
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
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Joerger M, Huitema ADR, Huizing MT, Willemse PHB, de Graeff A, Rosing H, Schellens JHM, Beijnen JH, Vermorken JB. Safety and pharmacology of paclitaxel in patients with impaired liver function: a population pharmacokinetic-pharmacodynamic study. Br J Clin Pharmacol 2008; 64:622-33. [PMID: 17935602 DOI: 10.1111/j.1365-2125.2007.02956.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS To assess quantitatively the safety and pharmacology of paclitaxel in patients with moderate to severe hepatic impairment. METHODS Solid tumour patients were enrolled into five liver function cohorts as defined by liver transaminase and total bilirubin concentrations. Paclitaxel was administered as a 3-h intravenous infusion at doses ranging from 110 to 175 mg m(-2), depending on liver impairment. Covariate and semimechanistic pharmacokinetic-pharmacodynamic (PK-PD) population modelling was used to describe the impact of liver impairment on the pharmacology and safety of paclitaxel. RESULTS Thirty-five patients were included in the study, and PK data were assessed for 59 treatment courses. Most patients had advanced breast cancer (n = 22). Objective responses to paclitaxel were seen in four patients (11%). Patients in higher categories of liver impairment had a significantly lower paclitaxel elimination capacity (R2 = -0.38, P = 0.05), and total bilirubin was a significant covariate to predict decreased elimination capacity with population modelling (P = 0.002). Total bilirubin was also a significant predictor of increased haematological toxicity within the integrated population PK-PD model (P < 10(-4)). Data simulations were used to calculate safe initial paclitaxel doses, which were lower than the administered doses for liver impairment cohorts III-V. CONCLUSIONS Total bilirubin is a good predictor of paclitaxel elimination capacity and of individual susceptibility to paclitaxel-related myelosuppression in cancer patients with moderate to severe liver impairment. The proposed, adapted paclitaxel doses need validation in prospective trials.
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Affiliation(s)
- M Joerger
- Department of Pharmacy & Pharmacology, the Netherlands Cancer Institute/Slotervaart Hospital, Amsterdam, The Netherlands.
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Schaapveld M, Visser O, Louwman MJ, de Vries EGE, Willemse PHB, Otter R, van der Graaf WTA, Coebergh JWW, van Leeuwen FE. Risk of new primary nonbreast cancers after breast cancer treatment: a Dutch population-based study. J Clin Oncol 2008; 26:1239-46. [PMID: 18323547 DOI: 10.1200/jco.2007.11.9081] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess the risk of secondary nonbreast cancers (SNBCs) in a recently treated population-based cohort of breast cancer patients focused on the association with treatment and prognostic implications. PATIENTS AND METHODS In 58,068 Dutch patients diagnosed with invasive breast cancer between 1989 and 2003, SNBC risk was quantified using standardized incidence ratios (SIRs), cumulative incidence, and Cox regression analysis, adjusted for competing risks. RESULTS After a median follow-up of 5.4 years, 2,578 SNBCs had occurred. Compared with the Dutch female population at large, in this cohort, the SIR of SNBCs was increased (SIR, 1.22; 95% CI, 1.17 to 1.27). The absolute excess risk was 13.6 (95% CI, 9.7 to 17.6) per 10,000 person-years. SIRs were elevated for cancers of the esophagus, stomach, colon, rectum, lung, uterus, ovary, kidney, and bladder cancers, and for soft tissue sarcomas (STS), melanoma, non-Hodgkin's lymphoma, and acute myeloid leukemia (AML). The 10-year cumulative incidence of SNBCs was 5.4% (95% CI, 5.1% to 5.7%). Among patients younger than 50 years, radiotherapy was associated with an increased lung cancer risk (hazard ratio [HR] = 2.31; 95% CI, 1.15 to 4.60) and chemotherapy with decreased risk for all SNBCs (HR = 0.78; 95% CI, 0.63 to 0.98) and for colon and lung cancer. Among patients age 50 years and older, radiotherapy was associated with raised STS risk (HR = 3.43; 95% CI, 1.46 to 8.04); chemotherapy with increased risks of melanoma, uterine cancer, and AML; and hormonal therapy with all SNBCs combined (HR = 1.10; 95% CI, 1.01 to 1.21) and uterine cancer (HR = 1.78; 95% CI, 1.40 to 2.27). An SNBC worsened survival (HR = 3.98; 95%CI 3.77 to 4.20). CONCLUSION Breast cancer patients diagnosed in the 1990 s experienced a small but significant excess risk of developing an SNBC.
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Affiliation(s)
- Michael Schaapveld
- Comprehensive Cancer Center North-Netherlands (CCCN), P.O. Box 330, 9700 AH Groningen, The Netherlands.
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Engelen MJA, Bongaerts AHH, Sluiter WJ, de Haan HH, Bogchelman DH, Tenvergert EM, Willemse PHB, van der Zee AGJ. Distinguishing benign and malignant pelvic masses: The value of different diagnostic methods in everyday clinical practice. Eur J Obstet Gynecol Reprod Biol 2008; 136:94-101. [PMID: 17118522 DOI: 10.1016/j.ejogrb.2006.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Revised: 09/17/2006] [Accepted: 10/05/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To optimize referral to specialized gynaecologists for surgical treatment of ovarian cancer by improving preoperative discrimination between benign and malignant pelvic tumours. STUDY DESIGN In a prospective multicentre study 143 patients with a pelvic mass were included. At several occasions during the diagnostic work-up the gynaecologist estimated the chance of malignancy (educated guess/expert opinion). MRI in the local setting was suggested for uncertain cases. All MRI images were reviewed by an expert radiologist. The datasheet designed for the study further allowed for determining the risk of malignancy index (RMI). RESULTS The diagnostic accuracy of the gynaecologist's final estimation of the chance of malignancy and the calculated RMI were comparable (area under the ROC curve of 0.87 and 0.86). MRI did not improve the accuracy of the diagnostic work-up for the study population as a whole. Subgroup analysis did however show improved diagnostic accuracy in cases with an estimated chance of malignancy between 20 and 80% when the MRI was read by an expert radiologist. CONCLUSION Patient selection for surgery of a pelvic mass should be based on the chance of malignancy as assigned by the referring gynaecologists. In case of uncertainty MRI improves diagnostic accuracy, when judged by an expert.
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Affiliation(s)
- Mirjam J A Engelen
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
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Buijs C, Rodenhuis S, Seynaeve CM, van Hoesel QGCM, van der Wall E, Smit WJM, Nooij MA, Voest E, Hupperets P, TenVergert EM, van Tinteren H, Willemse PHB, Mourits MJE, Aaronson NK, Post WJ, de Vries EGE. Prospective study of long-term impact of adjuvant high-dose and conventional-dose chemotherapy on health-related quality of life. J Clin Oncol 2007; 25:5403-9. [PMID: 18048822 DOI: 10.1200/jco.2007.11.2813] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate and compare health-related quality of life (HRQOL) after conventional- and high-dose adjuvant chemotherapy in patients with high-risk breast cancer. PATIENTS AND METHODS Patients were randomly assigned to either a conventional or high-dose chemotherapy regimen; both regimens were followed by radiotherapy and tamoxifen. HRQOL was evaluated until disease progression using the Short Form-36 (SF-36), Visual Analog Scale, and Rotterdam Symptom Checklist and assessed every 6 months for 5 years after random assignment. For the SF-36, data from healthy Dutch women with the same age distribution served as reference values. RESULTS Eight hundred four patients (conventional-dose chemotherapy, n = 405; high-dose chemotherapy, n = 399) were included. Median follow-up time was 57 months. Directly after high-dose chemotherapy, HRQOL decreased more compared with conventional chemotherapy for all SF-36 subscales. After 1 year, the reference value of healthy women was reached in both groups. Small differences were observed between the two groups in the role-physical and role-emotional subscales, but 1 year after treatment, these differences were minor and not clinically relevant. During follow-up, patients with a lower educational level and many complaints before chemotherapy experienced a worse HRQOL. CONCLUSION Shortly after high-dose chemotherapy, HRQOL was more affected than after conventional-dose chemotherapy. One year after random assignment, differences were negligible. Identifying patients who have a higher chance of persistent impaired quality of life after treatment (which, in the present study, included patients with a lower educational level and many complaints before chemotherapy) is important and may open the way for better patient-tailored prevention strategies.
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Affiliation(s)
- Ciska Buijs
- University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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Mourits MJE, de Vries EGE, ten Hoor KA, van der Zee AGJ, Willemse PHB. Beware of amenorrhea during tamoxifen: it may be a wolf in sheep's clothing. J Clin Oncol 2007; 25:3787-8; author reply 3788-9. [PMID: 17704431 DOI: 10.1200/jco.2007.11.1633] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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van der Horst-Schrivers ANA, Post WJ, Kema IP, Links TP, Willemse PHB, Wymenga ANM, de Vries EGE. Persistent low urinary excretion of 5-HIAA is a marker for favourable survival during follow-up in patients with disseminated midgut carcinoid tumours. Eur J Cancer 2007; 43:2651-7. [PMID: 17825550 DOI: 10.1016/j.ejca.2007.07.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 07/16/2007] [Accepted: 07/26/2007] [Indexed: 11/22/2022]
Abstract
Survival of patients with disseminated midgut carcinoid tumours varies. We investigated which factors predict survival at referral and during follow-up, with emphasis on urinary 5-hydroxyindolacetic acid (5-HIAA) levels. Between 1992 and 2003, 76 patients were studied; urine was prospectively collected over a 24 h period every 3 months in order to measure 5-HIAA levels. Uni- and multivariate analyses were performed. Median follow-up was 55 months with a median survival of 54 months. Prognostic factors for poor survival were high age, high gamma-glutamyltransferase levels and greatly increased 5-HIAA levels (>20 mmol/mol creatinine) The Hazard Ratio (HR) of a greatly increased 5-HIAA level was 3.33 (95% confidence interval (CI) 1.66-6.66, p=0.001). In a multivariate survival analysis with the 5-HIAA level as time dependent covariable, the HR for the 5-HIAA level was 1.007 (95% CI 1.004-1.010, p=0.000). In conclusion, patients with persistent moderately increased urinary 5-HIAA levels (< or =20 mmol/mol creatinine) have favourable outcome.
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Affiliation(s)
- Anouk N A van der Horst-Schrivers
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
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Martens HA, Schröder CP, van der Eerden PJM, Willemse PHB, Posthumus MD. Severe disabling tendinopathy caused by anastrazole. Rheumatology (Oxford) 2007; 46:1619-21. [PMID: 17726034 DOI: 10.1093/rheumatology/kem213] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schaapveld M, Visser O, Louwman WJ, Willemse PHB, de Vries EGE, van der Graaf WTA, Otter R, Coebergh JWW, van Leeuwen FE. The impact of adjuvant therapy on contralateral breast cancer risk and the prognostic significance of contralateral breast cancer: a population based study in the Netherlands. Breast Cancer Res Treat 2007; 110:189-97. [PMID: 17687645 PMCID: PMC2440941 DOI: 10.1007/s10549-007-9709-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 07/20/2007] [Indexed: 12/31/2022]
Abstract
Background The impact of age and adjuvant therapy on contralateral breast cancer (CBC) risk and prognostic significance of CBC were evaluated. Patients and Methods In 45,229 surgically treated stage I–IIIA patients diagnosed in the Netherlands between 1989 and 2002 CBC risk was quantified using standardised incidence ratios (SIRs), cumulative incidence and Cox regression analysis, adjusted for competing risks. Results Median follow-up was 5.8 years, in which 624 CBC occurred <6 months after the index cancer (synchronous) and 1,477 thereafter (metachronous). Older age and lobular histology were associated with increased synchronous CBC risk. Standardised incidence ratio (SIR) of CBC was 2.5 (95% confidence interval (95% CI) 2.4–2.7). The SIR of metachronous CBC decreased with index cancer age, from 11.4 (95% CI 8.6–14.8) when <35 to 1.5 (95% CI 1.4–1.7) for ≥60 years. The absolute excess risk of metachronous CBC was 26.8/10,000 person-years. The cumulative incidence increased with 0.4% per year, reaching 5.9% after 15 years. Adjuvant hormonal (Hazard rate ratio (HR) 0.58; 95% CI 0.48–0.69) and chemotherapy (HR 0.73; 95% CI 0.60–0.90) were associated with a markedly decreased CBC risk. A metachronous CBC worsened survival (HR 1.44; 95% CI 1.33–1.56). Conclusion Young breast cancer patients experience high synchronous and metachronous CBC risk. Adjuvant hormonal or chemotherapy considerably reduced the risk of CBC. CBC occurrence adversely affects prognosis, emphasizing the necessity of long-term surveillance directed at early CBC-detection.
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Affiliation(s)
- Michael Schaapveld
- Comprehensive Cancer Center North-Netherlands, PO Box 330, Groningen 9700 AH, The Netherlands.
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Mom CH, Engelen MJA, Willemse PHB, Gietema JA, ten Hoor KA, de Vries EGE, van der Zee AGJ. Granulosa cell tumors of the ovary: The clinical value of serum inhibin A and B levels in a large single center cohort. Gynecol Oncol 2007; 105:365-72. [PMID: 17306349 DOI: 10.1016/j.ygyno.2006.12.034] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 12/15/2006] [Accepted: 12/20/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In patients with a granulosa cell tumor of the ovary, the value of serum inhibin A and B concentrations for the assessment of disease status was investigated. METHODS In 30 consecutive patients with a stage I-III granulosa cell tumor, inhibin A and B concentrations were measured in pre- and post-treatment serum samples. Clinical data concerning diagnosis, treatment and follow-up of these patients were related to serum inhibin A and B concentrations. Serum samples from 41 premenopausal females with cervical dysplasia served as controls. RESULTS In 30 patients, 13 (43%) recurrences were observed during a median follow-up of 10 years (range 1-31 years). Serum inhibin A and B concentrations were elevated in respectively 67% and 89% of the patients at diagnosis, and in 58% and 85% at recurrence. Inhibin A and B concentrations were normal in all controls. Sensitivity of inhibin A testing for the diagnosis of granulosa cell tumor was 67% with a specificity of 100%, compared to 89% and 100% respectively for inhibin B (ns). Elevations in serum inhibin B concentrations predated recurrences by a median of 11 months. None of the patients in remission showed increased concentrations of inhibin A and B. CONCLUSION Inhibin B seems to be the predominant form of inhibin secreted by granulosa cell tumors and appears to reflect disease status more accurately than inhibin A. Measurement of serum inhibin B concentrations may be preferred for the follow-up of granulosa cell tumors.
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Affiliation(s)
- C H Mom
- University Medical Center Groningen, Department of Medical Oncology, PO Box 30 001, 9700 RB Groningen, The Netherlands.
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24
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Nijhuis ER, van der Zee AGJ, in 't Hout BA, Boomgaard JJ, de Hullu JA, Pras E, Hollema H, Aalders JG, Nijman HW, Willemse PHB, Mourits MJE. Gynecologic examination and cervical biopsies after (chemo) radiation for cervical cancer to identify patients eligible for salvage surgery. Int J Radiat Oncol Biol Phys 2006; 66:699-705. [PMID: 16904839 DOI: 10.1016/j.ijrobp.2006.05.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2006] [Revised: 05/23/2006] [Accepted: 05/30/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate efficacy of gynecologic examination under general anesthesia with cervical biopsies after (chemo) radiation for cervical cancer to identify patients with residual disease who may benefit from salvage surgery. METHODS AND MATERIALS In a retrospective cohort study data of all cervical cancer patients with the International Federation of Gynecology and Obstetrics (FIGO) Stage IB1 to IVA treated with (chemo) radiation between 1994 and 2001 were analyzed. Patients underwent gynecologic examination under anesthesia 8 to 10 weeks after completion of treatment. Cervical biopsy samples were taken from patients judged to be operable. In case of residual cancer, salvage surgery was performed. RESULTS Between 1994 and 2001, 169 consecutive cervical cancer patients received primary (chemo) radiation, of whom 4 were lost to follow-up. Median age was 56 years (interquartile range [IQR], 44-71) and median follow-up was 3.5 years (IQR, 1.5-5.9). In each of 111 patients a biopsy sample was taken, of which 90 (81%) showed no residual tumor. Vital tumor cells were found in 21 of 111 patients (19%). Salvage surgery was performed in 13 of 21 (62%) patients; of these patients, 5 (38%) achieved long-term, complete remission after salvage surgery (median follow-up, 5.2 years; range, 3.9-8.8 years). All patients with residual disease who did not undergo operation (8/21) died of progressive disease. Locoregional control was more often obtained in patients who underwent operation (7 of 13) than in patients who were not selected for salvage surgery (0 of 8 patients) (p < 0.05). CONCLUSIONS Gynecologic examination under anesthesia 8 to 10 weeks after (chemo) radiation with cervical biopsies allows identification of those cervical cancer patients who have residual local disease, of whom a small but significant proportion may be salvaged by surgery.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/pathology
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Adult
- Aged
- Anesthesia, General
- Biopsy
- Carcinoma, Adenosquamous/drug therapy
- Carcinoma, Adenosquamous/pathology
- Carcinoma, Adenosquamous/radiotherapy
- Carcinoma, Adenosquamous/surgery
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Cervix Uteri/pathology
- Combined Modality Therapy/methods
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Neoplasm, Residual
- Retrospective Studies
- Salvage Therapy
- Survival Analysis
- Uterine Cervical Neoplasms/drug therapy
- Uterine Cervical Neoplasms/pathology
- Uterine Cervical Neoplasms/radiotherapy
- Uterine Cervical Neoplasms/surgery
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Affiliation(s)
- Esther R Nijhuis
- Department of Gynecologic Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Duiker EW, Mom CH, de Jong S, Willemse PHB, Gietema JA, van der Zee AGJ, de Vries EGE. The clinical trail of TRAIL. Eur J Cancer 2006; 42:2233-40. [PMID: 16884904 DOI: 10.1016/j.ejca.2006.03.018] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Accepted: 03/27/2006] [Indexed: 10/24/2022]
Abstract
The naturally occurring tumour necrosis factor related apoptosis-inducing ligand (TRAIL) induces apoptosis through two death receptors, death receptor 4 (DR4) and death receptor 5 (DR5), that are expressed on the cell membrane. Binding of the ligand to the death receptors leads to activation of the extrinsic apoptosis pathway. Chemotherapy on the other hand stimulates the intrinsic apoptosis pathway via activation of p53 in response to cellular damage. Many cancer cells have mutations in p53 causing resistance to chemotherapy-induced apoptosis. Concomitant signalling through the extrinsic pathway may overcome this resistance. Moreover, enthusiasm for TRAIL as an anticancer agent is based on the demonstration of rhTRAIL-induced selective cell death in tumour cells and not in normal cells. In this review, we provide an overview of the TRAIL pathway, the physiological role of TRAIL and the factors regulating TRAIL sensitivity. We also discuss the clinical development of novel agents, i.e. rhTRAIL and agonistic antibodies, that activate the death receptors.
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Affiliation(s)
- E W Duiker
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
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26
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Crijns APG, Duiker EW, de Jong S, Willemse PHB, van der Zee AGJ, de Vries EGE. Molecular prognostic markers in ovarian cancer: toward patient-tailored therapy. Int J Gynecol Cancer 2006; 16 Suppl 1:152-65. [PMID: 16515584 DOI: 10.1111/j.1525-1438.2006.00503.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In ovarian cancer the ceiling seems to be reached with chemotherapeutic drugs. Therefore a paradigm shift is needed. Instead of treating all patients according to standard guidelines, individualized molecular targeted treatment should be aimed for. This means that molecular profiles of the distinct ovarian cancer subtypes should be established. Until recently, most studies trying to identify molecular targets were single-marker studies. The prognostic role of key components of apoptotic and prosurvival pathways such as p53, EGFR, and HER2 has been extensively studied because resistance to chemotherapy is often caused by failure of tumor cells to go into apoptosis. However, it is more than likely that different ovarian cancer subtypes with extensive molecular heterogeneity exist. Therefore, exploration of the potential of specific tumor-targeted therapy, based on expression of a prognostic tumor profile, may be of interest. Recently, new profiling techniques, such as DNA and protein microarrays, have enabled high-throughput screening of tumors. In this review an overview of the current status of prognostic marker and molecular targeting research in ovarian cancer, including microarray studies, is presented.
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Affiliation(s)
- A P G Crijns
- Department of Gynecological Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Engelen MJA, van der Zee AGJ, de Vries EGE, Willemse PHB. Debulking surgery for ovarian epithelial cancer performed by a gynaecological oncologist improved survival compared with less specialised surgeons. Cancer Treat Rev 2006; 32:320-3. [PMID: 16707225 DOI: 10.1016/j.ctrv.2006.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M J A Engelen
- Department of Gynecologic Oncology, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Willemse PHB, de Vries EGE. [The role of trastuzumab in mammary carcinoma in The Netherlands]. Ned Tijdschr Geneeskd 2006; 150:770-5. [PMID: 16649393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Trastuzumab is the first humanised monoclonal antibody to demonstrate activity in patients with HER2/neu-positive breast cancer. It has taken almost 20 years of research from the first description of HER2/neu as an unfavourable prognostic factor until the development of a clinically applicable antibody that has now shown convincing activity in the adjuvant setting: not only progression-free survival (HR: 0.48-0.54) but also distant disease-free survival (HR: 0.47-0.49) and overall survival (HR: 0.41-0.67) were improved after four years. It is a good thing, therefore, that shortly after the publication of these striking results, the specialists concerned have designated trastuzumab in combination with chemotherapy as the standard adjuvant treatment for patients with HER2/neu-positive rumours. This decision anticipates the formal registration for this indication and the rules for reimbursement. Nevertheless, this effective form of treatment may not be withheld from the patients concerned in the Netherlands merely on formal grounds, since there can be no doubt as to the indication.
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Affiliation(s)
- P H B Willemse
- Universitair Medisch Centrum Groningen, afd. Medische Oncologie, Hanzeplein I, 9713 GZ, Groningen.
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Engelen MJA, Kos HE, Willemse PHB, Aalders JG, de Vries EGE, Schaapveld M, Otter R, van der Zee AGJ. Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma. Cancer 2006; 106:589-98. [PMID: 16369985 DOI: 10.1002/cncr.21616] [Citation(s) in RCA: 205] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Consultant gynecologic oncologists from the regional Comprehensive Cancer Center assisted community gynecologists in the surgical treatment of patients with ovarian carcinoma when they were invited. For this report, the authors evaluated the effects of primary surgery by a gynecologic oncologist on treatment outcome. METHODS The hospital files from 680 patients with epithelial ovarian carcinoma who were diagnosed between 1994 and 1997 in the northern part of the Netherlands were abstracted. Treatment results were analyzed according to the operating physician's education by using survival curves and univariate and multivariate Cox regression analyses. RESULTS Primary surgery was performed on 184 patients by gynecologic oncologists, and on 328 patients by general gynecologists. Gynecologic oncologists followed surgical guidelines more strictly compared with general gynecologists (patients with International Federation of Gynecology and Obstetrics [FIGO] Stage I-II disease, 55% vs. 33% [P=0.01]; patients with FIGO Stage III disease, 60% vs. 40% [P=0.003]) and more often removed all macroscopic tumor in patients with FIGO Stage III disease (24% vs. 12%; P=0.02). When patients were stratified according to FIGO stage, the 5-year overall survival rate was 86% versus 70% (P=0.03) for patients with Stage I-II disease and 21% versus 13% (P=0.02) for patients with Stage III-IV disease who underwent surgery by gynecologic oncologists and general gynecologists, respectively. The hazards ratio for patients who underwent surgery by gynecologic oncologists was 0.79 (95% confidence interval [95%CI], 0.61-1.03; adjusted for patient age, disease stage, type of hospital, and chemotherapy); when patients age 75 years and older were excluded, the hazards ratio fell to 0.71 (95% CI, 0.54-0.94) in multivariate analysis. CONCLUSIONS The surgical treatment of patients with ovarian carcinoma by gynecologic oncologists occurred more often according to surgical guidelines, tumor removal more often was complete, and survival was improved.
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Affiliation(s)
- Mirjam J A Engelen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
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Schaapveld M, de Vries EGE, van der Graaf WTA, Otter R, de Vries J, Willemse PHB. The Prognostic Effect of the Number of Histologically Examined Axillary Lymph Nodes in Breast Cancer: Stage Migration or Age Association? Ann Surg Oncol 2006; 13:465-74. [PMID: 16485149 DOI: 10.1245/aso.2006.02.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Accepted: 09/13/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND The number of pathologically examined axillary nodes has been associated with breast cancer survival, and examination of >or=10 nodes has been advocated for reliable axillary staging. The considerable variation observed in axillary staging prompted this population-based study, which evaluated the prognostic effect of a variable number of pathologically examined nodes. METHODS In total, 5314 consecutive breast cancer patients who underwent mastectomy or breast-conserving surgery and axillary dissection between 1994 and 1999 were included. The prognostic effect of the examined number of nodes was assessed with crude and relative survival analysis. RESULTS A median number of 12 (range, 1-43) nodes were histologically examined, and 59% of the patients had no nodal tumor involvement. The number of examined nodes decreased with age (P<.001) and increased with tumor size (P<.001). Stratified for the number of tumor-positive nodes, overall survival seemed to be worse for patients with <10 compared with patients with >or=10 examined nodes (P<.001), whereas the relative survival did not differ. After adjusting for age, tumor size, number of positive nodes, and detection by screening in a multivariate analysis, the number of examined nodes was not associated with relative survival. CONCLUSIONS This study shows that the association between the number of pathologically examined axillary nodes and overall survival in node-negative and node-positive patients results from stage migration. The absence of an association between the number of examined nodes and relative survival further indicates that the association between the number of examined nodes and crude survival is confounded by age.
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Affiliation(s)
- Michael Schaapveld
- Comprehensive Cancer Center North-Netherlands, P.O. Box 330, Groningen, 9700 AH, The Netherlands.
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de Kort SJ, Willemse PHB, Habraken JM, de Haes HCJM, Willems DL, Richel DJ. Quality of life versus prolongation of life in patients treated with chemotherapy in advanced colorectal cancer: A review of randomized controlled clinical trials. Eur J Cancer 2006; 42:835-45. [PMID: 16481158 DOI: 10.1016/j.ejca.2005.10.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2005] [Accepted: 10/04/2005] [Indexed: 11/25/2022]
Abstract
Oncologists disagree if chemotherapy in advanced cancer can improve quality of life (QoL), to prolong duration of life, or both. The objective of this study was to clarify the main treatment intention of palliative chemotherapy (PCT): the prolongation of life (PoL); or QoL. Randomized controlled clinical trials of PCT in advanced colorectal cancer that included HRQoL assessment were selected from PubMed and reviewed. Authors' conclusions were based on both PoL- and QoL-related outcomes. However, if PoL and QoL outcomes of the experimental arm were opposite, which was the case in 13 out of 28 trials, the authors generally based their conclusion on PoL outcomes. Authors' conclusions focused mainly on PoL-related outcomes, while QoL-related outcomes were of overriding importance in only 1/28 case. QoL can therefore not be considered as the main outcome of PCT. The review shows that in the context of chemotherapy in advanced colorectal cancer, 'palliative' refers to a life-prolonging intention, whereas within palliative care it refers to an improvement in QoL.
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Affiliation(s)
- Susanne Joëlle de Kort
- General Practice Department, Academic Medical Center (AMC), University of Amsterdam, #J2-225, Meibergdreef 9, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
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deVries H, Wijffels RTM, Willemse PHB, Verschueren RCJ, Kema IP, Karrenbeld A, Prins TR, deVries EGE. Abdominal angina in patients with a midgut carcinoid, a sign of severe pathology. World J Surg 2006; 29:1139-42. [PMID: 16086212 DOI: 10.1007/s00268-005-7825-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In 36 consecutive patients with a foregut carcinoid with extensive local tumor growth and liver metastases with a carcinoid syndrome, six patients had complaints of postprandial abdominal pain and attacks of subileus based on segmental intestinal ischemia. A diagnosis of abdominal angina was supported by a positive response to nitroglycerin in two and ischemia of the ileum demonstrated by angiography in two other patients. Complaints were reduced in all patients after surgery. Histopathology of the resected small bowel specimens showed elastic vascular sclerosis in three patients and ischemic changes in three other patients, confirming the clinical diagnosis. Resection of ischemic bowel can provide relief in patients with segmental intestinal ischemia caused by carcinoid-induced vascular sclerosis.
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Affiliation(s)
- Harry deVries
- Department of Surgery, University Medical Center Groningen, 30.001, 9700 RB Groningen, The Netherlands.
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Mom CH, Buijs C, Willemse PHB, Mourits MJE, de Vries EGE. Hot flushes in breast cancer patients. Crit Rev Oncol Hematol 2006; 57:63-77. [PMID: 16343926 DOI: 10.1016/j.critrevonc.2005.04.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2005] [Revised: 04/25/2005] [Accepted: 04/26/2005] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES A literature search was conducted to gather information concerning the pathophysiologic mechanisms leading to hot flushes, their prevalence and severity in breast cancer patients, their influence on quality of life, and the best therapeutic option. METHODS Relevant studies in English were selected from Medline. RESULTS AND CONCLUSION Pathophysiologic mechanisms leading to hot flushes are poorly understood. Estrogen withdrawal is considered to have a central role. Also, serotonin and norepinephrine seem to be involved in hot flush induction. Menopause induced by chemotherapy or ovarian ablation, is accompanied by an abrupt decrease in estrogen level, causing vasomotor symptoms. Hot flushes are also a side effect of tamoxifen and aromatase inhibitors. Quality of life in breast cancer patients may be negatively influenced by hot flushes, and therefore, adequate treatment is important. Currently, of the several non-hormonal options, the selective serotonin-reuptake inhibitor (SSRI) venlafaxine is the most effective in breast cancer patients. However, studies on interaction between SSRIs and tamoxifen may influence future recommendations.
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Affiliation(s)
- Constantijne H Mom
- Department of Medical Oncology, University Medical Center, P.O. Box 30001, 9700 RB Groningen, The Netherlands
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Schaapveld M, de Vries EGE, Otter R, de Vries J, Dolsma WV, Willemse PHB. Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy. Br J Cancer 2005; 93:520-8. [PMID: 16136027 PMCID: PMC2361605 DOI: 10.1038/sj.bjc.6602747] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This population-based study aimed to analyse variations in surgical treatment and guideline compliance with respect to the application of radiotherapy and axillary lymph node dissection (ALND), for early breast cancer, before and after the sentinel node biopsy (SNB) introduction. The study included 13 532 consecutive surgically treated stage I–IIIA breast cancer patients diagnosed in 1989–2002. Hospitals showed large variation in breast-conserving surgery (BCS) rates, ranging between 27 and 72% for T1 and 14 and 42% for T2 tumours. In multivariate analysis marked inter-hospital and time-dependent variation in the BCS rate remained after correction for case-mix. The guideline adherence was markedly lower for elderly patients. In 25.2% of the patients aged ⩾75 years either ALND or radiotherapy were omitted. The proportion of patients with no ALND after an SNB increased from 1.8% in 1999 to 37.8% in 2002. However, in 2002 also 12.2% of the patients with a positive SNB did not have an ALND. Guideline compliance for BCS, with respect to radiotherapy and ALND, fell since the SNB introduction, from 96.1% before 2000 to 91.4% in 2002 (P<0.001). Noncompliance may however reflect patient-tailored medicine, as for elderly patients with small, radically resected primary tumours. The considerable variation in BCS-rates is more consistent with variations in surgeon preferences than patient's choice.
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Affiliation(s)
- M Schaapveld
- Comprehensive Cancer Center North-Netherlands, PO Box 330, 9700 AH Groningen, The Netherlands.
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Russo S, Kema IP, Haagsma EB, Boon JC, Willemse PHB, den Boer JA, de Vries EGE, Korf J. Irritability rather than depression during interferon treatment is linked to increased tryptophan catabolism. Psychosom Med 2005; 67:773-7. [PMID: 16204437 DOI: 10.1097/01.psy.0000171193.28044.d8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Treatment with recombinant interferon is associated with high rates of psychiatric comorbidity. We investigated the relation between catabolism of the essential amino acid tryptophan, being rate-limiting of peripheral and cerebral serotonin formation, and psychiatric symptoms in patients undergoing combination treatment with interferon-alpha and ribavirin. PATIENTS AND METHODS Eighteen patients with viral hepatitis C who received interferon were included. A psychiatrist screened patients before and while on interferon-alpha treatment for 2 months, using a structured diagnostic interview. Fasting plasma tryptophan and platelet serotonin levels were measured at each visit. RESULTS At baseline no evident psychopathology was observed. After 2 months of interferon treatment, 10 patients experienced increased irritability. No other structural psychopathology was observed. Decreased plasma tryptophan level correlated with the presence of irritability (p = .047). Platelet serotonin levels were found to be decreased during treatment (p = .002). CONCLUSIONS Aggressive impulse dysregulation is highly prevalent in patients receiving interferon treatment. This is associated with decreased plasma tryptophan levels which may lead to attenuated peripheral and central serotonergic neurotransmission.
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Affiliation(s)
- Sascha Russo
- Department of Biological Psychiatry, University Hospital Groningen, Groningen, The Netherlands.
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Hougardy BMT, Maduro JH, van der Zee AGJ, Willemse PHB, de Jong S, de Vries EGE. Clinical potential of inhibitors of survival pathways and activators of apoptotic pathways in treatment of cervical cancer: changing the apoptotic balance. Lancet Oncol 2005; 6:589-98. [PMID: 16054570 DOI: 10.1016/s1470-2045(05)70281-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cervical cancer is the most common gynaecological malignant disorder worldwide. The best possible treatment of locally advanced cervical cancer is a combination of radiation and cisplatin-based chemotherapy. However, 5-year overall survival is still only 52%. To improve treatment results, research should focus on the discovery of innovative drug strategies. Drugs directed at inducing tumour-cell apoptosis are regarded as important treatment modalities. Here, we present an overview of the molecular options that can change the apoptotic balance in cervical cancer, through increasing death-receptor-mediated apoptosis, the use of proteasome inhibitors, short interfering RNAs, or non-steroidal anti-inflammatory drugs (NSAIDs). Furthermore, the potential of attacking prosurvival signalling through the epidermal-growth-factor receptor and insulin-like-growth-factor receptor to support the apoptotic process is discussed. Additional research is needed to elucidate the clinical potential of these compounds in the treatment of cervical cancer.
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Affiliation(s)
- Brigitte M T Hougardy
- Department of Gynaecological Oncology, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
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De Vos FYFL, Bos AME, Schaapveld M, de Swart CAM, de Graaf H, van der Zee AGJ, Boezen HM, de Vries EGE, Willemse PHB. A randomized phase II study of paclitaxel with carboplatin +/- amifostine as first line treatment in advanced ovarian carcinoma. Gynecol Oncol 2005; 97:60-7. [PMID: 15790438 DOI: 10.1016/j.ygyno.2004.11.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Will amifostine (A) protect against chemotherapy-induced neuro- and myelotoxicity. PATIENTS AND METHODS Ninety ovarian cancer patients were randomized to receive standard paclitaxel + carboplatin without (PC) or preceded by amifostine 740 mg/m(2) (PC + A). RESULTS The mean baseline values of hemoglobin, leukocyte, and platelets were slightly lower in the amifostine group, but the mean percentual decrease of these parameters after each treatment cycle showed no difference between both arms. Symptoms of neurotoxicity remained absent in 40% PC vs. 49% PC + A cycles; sensory neurotoxicity grade I occurred in 45% vs. 48% and grade II in 12% PC vs. 2% of PC + A cycles (overall P < 0.001). Nausea grade II was reported in 2% vs. 6% (P = 0.007) and vomiting grade II in 1% of PC vs. 8% PC + A cycles (P < 0.001). Amifostine was temporarily interrupted in five patients due to hypotension, but no dose reductions were indicated. Quality of life questionnaires showed no difference in neurotoxicity scores between both study arms at treatment completion. The median progression-free survival was 16 vs. 22 months (n.s.) for PC and PC + A patients. In a pooled analysis of four randomized studies, amifostine diminished the risk of developing neurotoxicity grade II-III (Odds Ratio 0.3, 95% confidence interval 0.15-0.63, P < 0.05), but had no effect on the risk for bone marrow toxicity. CONCLUSION Amifostine shows only minor but significant activity in diminishing neurotoxicity without preventing paclitaxel + carboplatin-induced bone marrow toxicity.
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Affiliation(s)
- F Y F L De Vos
- Department of Medical Oncology, University Hospital of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Bos AME, De Vos FYFL, de Vries EGE, Beijnen JH, Rosing H, Mourits MJE, van der Zee AGJ, Gietema JA, Willemse PHB. A phase I study of intraperitoneal topotecan in combination with intravenous carboplatin and paclitaxel in advanced ovarian cancer. Eur J Cancer 2005; 41:539-48. [PMID: 15737558 DOI: 10.1016/j.ejca.2004.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Revised: 10/25/2004] [Accepted: 12/03/2004] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the maximum tolerated dose (MTD) of intraperitoneal (i.p.) topotecan combined with standard doses of intravenous (i.v.) carboplatin and paclitaxel and to investigate its pharmacokinetics. Women with primary ovarian cancer stage IIb - IV received six cycles of i.v. carboplatin and paclitaxel with escalating topotecan doses i.p. of 10, 15, 20 and 25 mg/m(2). Twenty-one patients entered this trial. Febrile neutropenia, thrombocytopenia requiring platelet transfusion and fatigue grade 3 were dose-limiting toxicities (DLT) at 25 mg/m(2) i.p. and 20 mg/m(2) i.p. of topotecan was considered to be the MTD. The mean plasma t(1/2) was 3.8 +/- 2.3 h for total topotecan and 4.4 +/- 3.9 h for active lactone. The area under the curve (AUC) was proportional with dose, R = 0.54, p < 0.05 for total topotecan and the peritoneal / plasma AUC ratio was 46 +/- 30. Fifteen patients who completed treatment had a median progression-free survival (PFS) of 27 months. In this setting the MTD of topotecan is 20 mg/m(2) i.p. The efficacy of this regimen should be explored further in a formal phase III study.
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Affiliation(s)
- A M E Bos
- Department of Medical Oncology, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Abstract
Since Folkman defined angiogenesis more than 25 years ago as the most important process in tumour growth and metastasis, specific anti-angiogenic agents have been developed. One obvious route to block this process was until recently overlooked, however. Tumour endothelial cells are different from normal endothelial cells and may respond differently to conventional cytotoxics. Chemotherapeutic-induced vascular toxicity has been observed in various clinical studies and seems to be based on endothelial cell damage as seen in vitro in human umbilical vein endothelial cells (HUVEC) models with protracted low-dose cytostatic exposure. Translated into the clinical setting, such "metronomically" administered chemotherapy could lead to anti-angiogenesis enhancing anti-tumour efficacy of cytostatic drugs. This paper reviews the desired anti-tumour endothelial activity versus the unwanted general vascular toxicity of cytostatic drugs. Several ways to enhance the anti-tumour activity and to circumvent the unwanted vascular toxicity of these "accidental" anti-angiogenic drugs will be discussed.
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Affiliation(s)
- F Y F L de Vos
- Department Internal Medicine, Division Medical Oncology, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Schaapveld M, Otter R, de Vries EGE, Fidler V, Grond JAK, van der Graaf WTA, de Vogel PL, Willemse PHB. Variability in axillary lymph node dissection for breast cancer. J Surg Oncol 2004; 87:4-12. [PMID: 15221913 DOI: 10.1002/jso.20061] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The axillary nodal status may influence the prognosis and the choice of adjuvant treatment of individual breast cancer patients. The variation in number of reported axillary lymph nodes and its effect on the axillary nodal stage were studied and the implications are discussed. METHODS Between 1994 and 1997, a total of 4,806 axillary dissections for invasive breast cancers in 4,715 patients were performed in hospitals in the North-Netherlands. The factors associated with the number of reported nodes and the relation of this number with the nodal status and the number of positive nodes were studied. RESULTS The number of reported nodes varied significantly between pathology laboratories, the median number of nodes ranged from 9 to 15, respectively. The individual hospitals explained even more variability in the number of nodes than pathology laboratories (range in median number 8-15, P < 0.0001). The number of reported nodes increased gradually during the study period. A decreasing trend was observed with older patient age. A higher number of reported nodes was associated with a markedly increased chance of finding tumor positive nodes, especially more than three nodes. The frequency of node positivity increased from 28% if less than six nodes to 54% if >/=20 nodes were examined, the percentage of tumors with >/=4 positive nodes increased from 4 to 31%. Multivariate analysis confirmed these results. CONCLUSIONS This population-based study showed a large variation in the number of reported lymph nodes between hospitals. A more extensive surgical dissection or histopathological examination of the specimen generally resulted in a higher number of positive nodes. Although the impact of misclassification on adjuvant treatment will have varied, the impact with regard to adjuvant regional radiotherapy may have been considerable.
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Affiliation(s)
- Michael Schaapveld
- Comprehensive Cancer Center North-Netherlands (CCCN), Groningen, The Netherlands.
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Schaapveld M, de Vries EGE, van der Graaf WTA, Otter R, Willemse PHB. Quality of adjuvant CMF chemotherapy for node-positive primary breast cancer: a population-based study. J Cancer Res Clin Oncol 2004; 130:581-90. [PMID: 15258754 DOI: 10.1007/s00432-004-0583-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Accepted: 04/17/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE Adjuvant 'classical' oral cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) has long been the mainstay of adjuvant chemotherapy for premenopausal breast cancer patients. The Comprehensive Cancer Center North Netherlands (CCCN) breast cancer working group performed a retrospective audit of treatment guideline adherence and quality of CMF in hospitals in the CCCN area. METHODS The CMF treatment data of 251 consecutive axillary lymph node-positive breast cancer patients <50 years old, diagnosed between 1993 and 1996, were analyzed. RESULTS Ninety-four patients (42%) completed adjuvant CMF without dose adjustment or delay. Overall median relative dose intensity (RDI) was 92.6 (IQR 85.5-97.7). Sixty patients (24%) had an RDI <85, and 7% had an RDI <65. Myelotoxicity was the main reason for reductions and delays. Of 176 irradiated patients, 96% received radiotherapy simultaneously with CMF. Median CMF dose intensity nor median duration differed between patients who underwent mastectomy, mastectomy and radiotherapy, or breast-conserving therapy. Radiotherapy did not influence the median RDI (94 without versus 92 with radiotherapy). G-CSF, administered at least once to 76 patients, did not result in a higher median RDI. Median RDI was slightly higher when >3 patients/year (P=0.014) were treated by one specialist or >10 patients classified for adjuvant chemotherapy yearly in a hospital (P=0.037). CONCLUSION The adherence to CMF treatment guidelines was generally good. Simultaneous radiotherapy did not affect the median RDI of CMF. G-CSF had no impact on the median RDI but patient volume did influence the RDI.
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Affiliation(s)
- Michael Schaapveld
- Comprehensive Cancer Center North-Netherlands, P.O. Box 330, 9700 AH Groningen, The Netherlands.
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Affiliation(s)
- C Buijs
- Department of Medical Oncology, University Hospital of Groningen, the Netherlands
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Abstract
OBJECTIVE Carcinoid tumors can produce excessive amounts of biogenic amines, notably serotonin. We assessed psychiatric symptoms in carcinoid patients and peripheral metabolism of tryptophan, the precursor of serotonin. METHODS Twenty consecutive patients with carcinoid syndrome underwent a structured psychiatric interview applying DSM-IV (Diagnostical Statistical Manual) criteria. Tumor activity was measured by determination of 24-hour urine excretion of 5-hydroxyindoleacetic acid (5-HIAA) and platelet serotonin levels. Plasma tryptophan levels were measured and compared with sex- and age-matched references. RESULTS Fifteen patients (75%) fulfilled diagnostic DSM-IV criteria for a disorder of impulse control. Tryptophan plasma levels were lower in patients compared with controls (p =.031) and were correlated negatively with urinary 5-HIAA excretion (p =.001). CONCLUSIONS Impulse control disorders are prevalent in patients with carcinoid syndrome. The serotonin production by the tumor possibly decreases the tryptophan pool in the cerebrospinal fluid, which is the essential substrate for the production of brain serotonin as a pivotal neurotransmitter.
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Affiliation(s)
- Sascha Russo
- Department of Biological Psychiatry, University Hospital Groningen, The Netherlands
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Jansman FGA, Postma MJ, van Hartskamp D, Willemse PHB, Brouwers JRBJ. Cost-benefit analysis of capecitabine versus 5-fluorouracil/leucovorin in the treatment of colorectal cancer in the Netherlands. Clin Ther 2004; 26:579-89. [PMID: 15189755 DOI: 10.1016/s0149-2918(04)90060-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND Capecitabine is an oral prodrug of 5-fluorouracil and has been studied for the treatment of colorectal cancer. In 2 Phase III trials, capecitabine was at least as effective as 5-fluorouracil plus leucovorin and had a more favorable toxicity profile. OBJECTIVE A cost-benefit analysis was used to assess the pharmacoeconomic profile of capecitabine compared with 5-fluorouracil/leucovorin, given according to the Mayo regimen, for colorectal cancer patients treated in the Netherlands. METHODS The medical files of patients treated for colorectal cancer at a single center from 1999 to 2002 were examined to determine the numbers of outpatient visits for 5-fluorouracil/leucovorin administration, health care use and medication to manage adverse effects, and travel distance to and from the hospital. The costs of capecitabine treatment were simulated by assuming that the same patients were treated with capecitabine instead of 5-fluorouracil/leucovorin. Toxicity data for capecitabine were derived from 2 Phase III studies that compared capecitabine and 5-fluorouracil/leucovorin. RESULTS The files of 65 patients were reviewed. Thirty-two patients received adjuvant treatment and 33 patients were treated palliatively for metastatic disease. The mean total costs of palliative treatment were Euro 4004 with capecitabine and Euro 5614 with 5-fluorouracil/leucovorin. These results were robust in sensitivity analyses. The cost savings were primarily related to the number of outpatient visits for capecitabine versus the number of day-care treatment days for 5-fluorouracil/leucovorin, despite the higher acquisition costs of capecitabine. CONCLUSIONS Based on this analysis, treatment of colorectal cancer with oral capecitabine is cost saving in the Netherlands compared with 5-fluorouracil plus leucovorin administered according to the Mayo regimen. Baseline savings were estimated at Euro 1610 for palliative treatment and Euro 934 for adjuvant treatment.
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Affiliation(s)
- Frank G A Jansman
- Department of Clinical Pharmacy, Isala klinieken, Zwolle, the Netherlands.
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de Vos FYFL, Nuver J, Willemse PHB, van der Zee AGJ, Messerschmidt J, Burgerhof JGM, de Vries EGE, Gietema JA. Long-term survivors of ovarian malignancies after cisplatin-based chemotherapy. Eur J Cancer 2004; 40:696-700. [PMID: 15010070 DOI: 10.1016/j.ejca.2003.11.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2003] [Accepted: 11/28/2003] [Indexed: 11/29/2022]
Abstract
Male germ cell tumour patients treated with cisplatin-based chemotherapy frequently develop cardiovascular risk factors and disease, but sparse information is available about long-term complications of this type of chemotherapy in women. We investigated the prevalence of cardiovascular risk factors and vascular damage in 21 women (median age 39 years; range 26-57 years) with an epithelial or germ cell tumour of the ovary cured by cisplatin-based chemotherapy after a median follow-up of 14 years (range 3-21 years). Hypercholesterolaemia was present in 62%, obesity in 24%, hypertension in 14%, insulin resistance in 14%, and microalbuminuria in 24% of patients. Microalbuminuria was more frequent in long-term cancer survivors than in a female background population with a similar age (23.8 versus 3.2%; P<0.05). A substantial portion of young female patients cured by cisplatin-based chemotherapy are likely to develop cardiovascular risk factors and signs of endothelial damage at an early stage.
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Affiliation(s)
- F Y F L de Vos
- Department of Medical Oncology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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van der Horst-Schrivers ANA, Wymenga ANM, Links TP, Willemse PHB, Kema IP, de Vries EGE. Complications of midgut carcinoid tumors and carcinoid syndrome. Neuroendocrinology 2004; 80 Suppl 1:28-32. [PMID: 15477713 DOI: 10.1159/000080737] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The carcinoid syndrome, associated with carcinoid tumors of the midgut, consists of symptoms such as diarrhea, flushing, wheezing and cardiovascular symptoms. This review focuses on these symptoms and discusses therapeutic options. The symptoms are caused by the secretion of biogenic amines, polypeptides and other factors of which serotonin is the most prominent. However, diarrhea is also due to factors such as malabsorption. Besides antitumor therapy, more specific interventions such as serotonin receptor blockers can be useful. The carcinoid heart disease involves the tricuspid and pulmonary valve. In the pathogenesis, serotonin plays a central role. The therapeutic approach is mostly symptomatic. Other cardiovascular complications include bowel ischemia and hypertension. Pellagra and psychiatric symptoms are due to a depletion of tryptophan, which is consumed by the carcinoid tumor for serotonin synthesis. Finally, follow-up and clinical practice of patients with carcinoid tumors are discussed.
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de Vos FYFL, Bos AME, Gietema JA, Pras E, Van der Zee AGJ, de Vries EGE, Willemse PHB. Paclitaxel and carboplatin concurrent with radiotherapy for primary cervical cancer. Anticancer Res 2004; 24:345-8. [PMID: 15015619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Concurrent radiochemotherapy is currently considered the new standard treatment in locally advanced cervical cancer. PATIENTS AND METHODS Eight women with cervical cancer stage IB2-IVA were treated with standard radiation therapy in combination with standard carboplatin (AUC=2, once weekly, x 6) and escalating doses of paclitaxel (60 mg/m2, once weekly, x 4, then x 5 and x 6). RESULTS At the lowest dose level, four weekly paclitaxel cycles in six patients, three developed grade III diarrhoea and one severe radiation enteritis several weeks after radiotherapy. Two patients did not achieve complete remission and underwent additive salvage hysterectomy. All patients remained free of local recurrence, but one patient had distant metastases after 13 months. The median disease-free survival was 25 months with a median follow-up of 26 months. CONCLUSION Standard pelvic radiotherapy in combination with weekly carboplatin and paclitaxel is poorly tolerated due to dose-limiting diarrhoea.
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Affiliation(s)
- F Y F L de Vos
- Department of Medical Oncology, Groningen University Hospital, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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de Vos FYFL, Willemse PHB, de Vries EGE. Successful treatment of metastatic esthesioneuroblastoma. Neth J Med 2003; 61:414-6. [PMID: 15025418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
This case report describes a patient with a metastasised olfactorial esthesioneuroblastoma Hyams grade 4 who has been treated with debulking surgery and radiotherapy. After relapse in lymph node, lung and brain, he received additional irradiation and six cycles of carboplatin, vincristine and cyclophosphamide intravenously every three weeks. The patient has now been disease free for 7.8 years. Our data suggest that metastatic esthesioneuroblastoma is sensitive to platinum-based chemotherapy. This patient illustrates that this tumour is very sensitive to platinum-based chemotherapy and that durable complete response can be achieved, even in a metastatic ENB.
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Affiliation(s)
- F Y F L de Vos
- Department of Medical Oncology, University Hospital of Groningen, PO Box 30 001, 9700 RB Groningen, The Netherlands.
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Pras E, Wouda J, Willemse PHB, Midden ME, Zwart M, de Vries EGE, Schultz WCMW. Pilot study of vaginal plethysmography in women treated with radiotherapy for gynecological cancer. Gynecol Oncol 2003; 91:540-6. [PMID: 14675673 DOI: 10.1016/j.ygyno.2003.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE After pelvic radiotherapy for gynecological cancer, changes in the vaginal epithelium might influence sexual arousal and satisfaction, leading to dyspareunia and relational problems. The aim of the study was to determine the feasibility of vaginal plethysmography in order to measure physical late effects of this therapy on sexual function. METHODS Patients treated with radiotherapy for cervical, endometrial, or ovarian cancer, who were in complete remission for over 1 year, underwent vaginal plethysmography to measure changes in vaginal vasocongestion, while watching erotic video fragments. Afterward two questionnaires, designed to measure feelings of sexual arousal during the video, and to identify sexual dysfunction, were completed. The results were compared with those of healthy women. RESULTS Patients (n = 9) and volunteers (n = 8) did not differ in baseline amplitude of plethysmography and showed comparable changes in vaginal vasocongestion during the various video fragments. The decline in amplitude during the last video fragment in the patient group did not reach significance, but the group of patients is small and heterogeneous. Addressing subjective sexual arousal during the video, patients reported less feelings of lust and desire and fewer bodily sensations while watching than the controls. Patients worried more about the sexual satisfaction of their partners than controls. CONCLUSION Vaginal plethysmography can be used to measure vaginal vasocongestion in patients treated with radiotherapy to the proximal vagina. In this pilot study the changes of vaginal vasocongestion during sexual arousal between patients and healthy volunteers were not different. This correlates with a comparable sexual satisfaction, although patients reported less feelings of lust.
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Affiliation(s)
- Elisabeth Pras
- Department of Radiation Oncology, University Hospital, Groningen, The Netherlands.
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Maduro JH, Pras E, Willemse PHB, de Vries EGE. Acute and long-term toxicity following radiotherapy alone or in combination with chemotherapy for locally advanced cervical cancer. Cancer Treat Rev 2003; 29:471-88. [PMID: 14585258 DOI: 10.1016/s0305-7372(03)00117-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Randomised studies in locally advanced cervical cancer patients showed that cisplatin should be given concurrently with radiotherapy, because of a better long-term survival compared to radiotherapy alone. This increases the relevance of treatment related toxicity. This review summarises the acute and long-term toxicity of radiotherapy given with or without chemotherapy for cervical cancer. Acute toxicity (all grades) of radiotherapy is reported in 61% of the patients in the rectosigmoid, in 27% as urological, in 27% as skin and in 20% as gynaecological toxicity. Moderate and severe morbidity consists of 5% to 7% gastrointestinal and 1% to 4% genitourinary toxicity. Adding chemotherapy to radiotherapy increases acute haematological toxicity to 5% to 37% of the patients and nausea and vomiting in 12% to 14%. Late effects of radiotherapy include gastrointestinal, urological, female reproductive tract, skeletal and vascular toxicity, secondary malignancies and quality of life issues. For at least 20 years after treatment, new side effects may develop. Gastrointestinal toxicity usually occurs in the first 2 years after treatment in about 10% of the patients. The incidence of moderate and severe urological toxicity can increase up to 10% and rises over time. Gynaecological toxicity usually occurs shortly after treatment while skeletal and vascular toxicity can occur years to decades later. Thus far, no increase in late toxicity has been observed after the addition of cisplatin to radiotherapy. Finally, methods to prevent or decrease late toxicity and therapeutical options are discussed. However, most randomised studies still have a limited follow-up period.
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Affiliation(s)
- J H Maduro
- Department of Radiotherapy, University Hospital Groningen, Groningen, The Netherlands
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