The evaluated schedule provides a safe and highly effective combination treatment for patients with early breast cancer, which is suitable for phase III studies.
The primary objective was to determine the optimal doses for gemcitabine (prolonged infusion), liposomal doxorubicin (Myocet) and docetaxel as primary (neoadjuvant) chemotherapy for locally advanced breast cancer. Secondary objectives included evaluation of the safety and efficacy of the regimen. Patients (n=19) with histologically confirmed stage II or III breast cancer were treated with liposomal doxorubicin (50-60 mg/m2) and docetaxel (60-75 mg/m2) on day 1, and gemcitabine as 4-h infusion (350-400 mg/m2) on day 4. Treatment was repeated every 3 weeks for a maximum of 6 cycles. The maximum tolerated doses were gemcitabine 350 mg/m2, liposomal doxorubicin 60 mg/m2 and docetaxel 75 mg/m2. Dose-limiting toxicities were stomatitis, diarrhea and infection. The predominant hematologic toxicity was mild-to-moderate myelosuppression with grade 3/4 neutropenia in 20% of cycles. Non-hematologic toxicity was generally mild, with no grade 4 toxicities being observed. Predominant non-hematologic toxicity was stomatitis, which occurred in 95% of patients. Grade 3 toxicities were reported for stomatitis, nausea, diarrhea, infection and constipation. No cases of cardiac, renal, pulmonary or neurotoxicity were observed. The clinical response rate was 83% and histologically confirmed, clinically complete remissions occurred in two patients (11%). We conclude that the combination of gemcitabine (prolonged infusion), liposomal doxorubicin and docetaxel is safe and highly effective in patients with locally advanced breast cancer as defined by maximum tolerated doses. The evaluated schedule is suitable for phase II studies.
Carcinoma of the cervix is the fourth most common cancer in women. Accurate staging of the disease is essential in selecting optimal therapy. The clinical staging based on the criteria of the FIGO is inaccurate. With MRI an excellent imaging of the tumour spread within the cervix can be achieved, also tumour extension to the parametria and infiltration of the neighbouring structures as bladder and rectum. MRI is the method of choice in the preoperative staging of cervical cancer. Computed tomography and sonography have lower staging value compared to the MRI. An advantage of CT, compared with MRI, is the high accuracy in investigations of patients with ureteral obstruction and hydronephrosis. Both methods MRI and CT are comparable in assessing pelvic and paraaortic lymph node metastases.
Die Schwangerschaft wird selten durch das Auftreten von bösartigen Genitaltumoren kompliziert. Im Zusammenhang mit einer Gravidität wird am häufigsten das Zervixkarzinom, gefolgt von Ovarialmalignomen diagnostiziert. Die Endometriumkarzinome werden sehr selten im Abort-oder im Abradatmaterial (z. B. bei Blutungen post partum) beobachtet. Die Therapie des Zervixkarzinoms im Zusammenhang mit einer Schwangerschaft wird in Abhängigkeit vom Tumorstadium, dem Schwangerschaftszeitpunkt und den Wünschen der Patientin im Bezug auf die Erhaltung der Schwangerschaft und ihre weitere Fertilität geplant. Unter den Ovarialmalignomen werden in der Schwangerschaft am häufigsten die Keimzellkarzinome (Dysgerminome) beobachtet. Eine konservative operative Therapie mit Erhaltung der Schwangerschaft ist nur bei Tumoren im Stadium I a möglich. Erste Erfahrungen mit einer adjuvanten Chemotherapie in der Schwangerschaft liegen vor. Das Endometriumkarzinom in der Schwangerschaft ist eine Rarität. Vermutlich entstehen diese Tumoren schon vor der Schwangerschaft. Die hohen Progesteronwerte in der Schwangerschaft verhindern ein schnelles Tumorwachstum. Eine organerhaltende Therapie bei dringendem Kinderwunsch der Patientin ist prinzipiell möglich. Die Therapie der gynäkologischen Malignome während der Schwangerschaft stellt eine groûe Herausforderung für die Geburtshelfer, gynäkologischen Onkologen und Neonatologen dar und sollte ausschlieûlich in entsprechend qualifizierten Zentren erfolgen.
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