[Radiotherapy of metastatic brain tumors]. / Radioterapija metastatskih tumora u mozgu.

On the basis of data from literature, the authors present the role of radiotherapy in the treatment of brain metastases. This role has been considered as a sole treatment or as a combined treatment, especially with surgery. New techniques of radiotherapy which could enable better results in the treatment of brain metastases in the future, are presented.

[In vitro culture of cells from patients with leukemia]. / Gajenje in vitro celija u bolesnika sa leukemijom.

The development of cytological, cytochemical and immunological investigations of leukemic cells as well as new cytostatic drug combinations have led to great progress in the diagnosis and treatment of acute leukemia (AL). However, a heterogeneity in response to the same kind of therapy has been noted in patients with the same cytological type of the disease. This points out the importance of investigations of leukemic cells in culture which should provide more data on proliferation and reactivity of these cells. The population of tumor cells in heterogeneous in morphological and biochemical properties, in proliferative capacity and other characteristics. In cell culture it is possible to investigate the growth of cells and the effects of various agents on normal and malignant cells. In this study we investigated the growth of cells from bone marrow of patients with acute leukemias and acute phase of chronic leukemias. Cells from 17 patients were studied. The patients were from Internal Clinic A in Belgrade and the investigations were performed before treatment. Bone marrow cells were cultured in vitro on plastics and growth of the adherent cells was followed in the course of 2-3 weeks. The results show that bone marrow cells adhered and proliferated in 12/17 patients, there was low proliferation in 4/17 and none in 1/17. It is shown that in these conditions a successful growth of fibroblast-like shaped cells can be obtained with the bone marrow cells, but it is still not possible to correlate the course of the disease and the proliferation in vitro.(ABSTRACT TRUNCATED AT 250 WORDS)

[Single-fraction radiotherapy of painful bone metastases]. / Radioterapija bolnih kostnih metastaza jednom frakcijom.

We analyzed first results obtained in 92 patients treated with single-dose fraction radiotherapy for painful bone metastases. Tumour doses was 10 Gy in a single fraction. Response was obtained in 59/92 (64%) patients. Thirty nine patients had complete response and 20 had partial response. Pain recurred in 18/39 patients who initially responded. Toxicity of this radiotherapeutic treatment is acceptable, and can easily be managed with standard therapy.

[Long-term oral administration of etoposide in the treatment of patients with advanced non-small-cell carcinoma of the lung. The second phase of a clinical study]. / Produzena oralna primena etopozida u lecenju bolesnika s napredovalim nemikrocelulnim karcinomom pluca. Druga faza klinicke studije.

Over the period from May 1989 to May 1992 thirty-four patients with advanced non-small cell lung cancer (NSCLC) were treated with prolonged administration of oral etoposide. Etoposide was administered in a dose of 50 mg/m2 a day for 21 days. Nine (26%) patients partially responded to the treatment that lasted 2-7 months (median 5 months). Median survival time was 6 months, and 1-year survival was 32%. The most common toxic events were alopecia and myelosuppression. No patient died of treatment-related toxicity. Results of this study demonstrate moderate efficiency of the prolonged administration of oral etoposide to patients with advanced NSCLC.

[The effect of extent of tumor resection on the outcome of combined therapy in patients with glioblastoma multiforme]. / Uticaj obima resekcije tumora na ishod kombinovanog lecenja bolesnika s multiformnim glioblastomom.

INTRODUCTION: The importance of the extent of surgery as a prognostic factor in multiform glioblastoma has been investigated for years. Some studies could not establish its influence on survival of patients treated with surgery, postoperative radiotherapy, with or without chemotherapy. On the other hand, there are data suggesting benefit for patients treated with more aggressive surgical approach. The aim of this study was to investigate the influence of the extent of surgery on survival/progression-free survival of patients with multiform glioblastoma treated with two consecutive protocols of a combined approach. MATERIAL AND METHODS: Of 86 patients that entered this study, thirty-seven were treated with surgery, postoperative hyperfractionated radiotherapy using 1.2 Gy b.i.d. to a total tumour dose of 72 Gy in 60 fractions in 30 treatment days and adjuvant chemotherapy consisting of BCNU, vincristine, procarbazine and cisplatin for up to 6 cycles or until tumour progression. Forty-nine patients were treated with surgery and postoperative accelerated hyperfractionated radiotherapy using 1.5 Gy b.i.d. fractions to a total tumour dose of 66 Gy in 44 fractions during 22 treatment days. BCNU and hydroxyurea were given once weekly during the irradiation period. Surgery consisted of biopsy in 25 patients and subtotal or gross total tumour resection in 61 patients. Patients treated with a more radical surgery had longer median survival time and higher 1- and 2-year survival rates than those treated with biopsy (56 v.s. 29 weeks, respectively; 62% and 23% v.s. 16% and 0%, respectively; long rank, p = 0.0000) (Figure 1). They also had longer median time to tumour progression and higher 1-year progression-free survival rate than those treated with biopsy only (33 v.s. 21 weeks, respectively; 20% v.s. 0%, respectively; log rank, p = 0.00000) (Figure 2). Multivariate analyses using both survival and progression-free survival as endpoints confirmed that the extent of surgery was an independent prognostic factor, together with the age, tumour location, and interfraction interval (Tables 3 and 4). DISCUSSION: The benefit of a more radical surgery remains controversial in patients with multiform glioblastoma, although maximal tumour reduction should be supported from the cytokinetic point of view. Findings of various authors support this view. Results of this study add further evidence that the aggressive surgical approach carries significant benefit for patients with multiform glioblastoma regarding the survival and progression-free survival. These observations are confirmed with multivariate analyses that showed independent influence of this prognostic factor.

[Carboplatin-etoposide-bleomycine chemotherapy protocol in the treatment of patients with metastatic non-seminomatous germ-cell testicular tumours with good prognosis]. / Hemoterapijski protokol karboplatini-etopozid-bleomicin u lecenju bolesnika s metastatskim neseminomskim tumorima germinacionih celija testisa s dobrom prognozom.

Fifteen patients with metastatic non-seminomatous germ-cell tumours with good prognosis were treated with carboplatin-etoposide-bleomycine chemotherapy. Patients were followed-up from 8 to 56 months (median 32 months). In 13 patients there was no evidence of the disease and in 2 patients recurred, but recovered after the subsequent secondary chemotherapy (cisplatin-bleomycine-vincristine). Signs and symptoms of toxicity included alopecia in 93% of patients, nausea and vomiting in 40%, while in respect of haematological toxicity, leucopenia was observed in all 15 patients, thrombocytopenia in 80%, and decrease of haemoglobinaemia in 60% of patients. Other toxicities were not observed. Carboplatin-etoposide-bleomycine chemotherapy is effective and little toxic, but a greater number of patients and a longer follow-up are needed for definitive evaluatin of this therapy in the treatment of patients with metastatic non-seminomatous germ-cell testicular tumours with good prognosis.