Central visual field impairment during and following cystoid macular oedema.

AIM: To determine differential light threshold values obtained with the Micro Perimeter 1 (MP1) in uveitis patients suffering from cystoid macular oedema (CMO) and to compare these measures to retinal thickness. METHODS: Static threshold perimetry was performed with the MP1 Microperimeter in 27 eyes of 21 patients with a history of chronically recurring CMO. Active CMO was confirmed in 19 eyes. Eight eyes with a history of recurrent CMO were found to have normal foveal contours in optical coherence tomography (OCT). Differential light threshold values (MP1) were compared with the corresponding retinal thickness measures (OCT). RESULTS: Mean differential threshold values within the central two degrees of the stimulation pattern were reduced compared with normal values and ranged from 5.8 to 9.5 dB in CMO eyes and from 9.3 to 12.9 dB in eyes with a normal foveal contour but a history of previous CMO. The corresponding mean retinal thickness ranged from 390 (SD 90) to 389 (88) microm (at 0 degrees and 1 degree, respectively) for active CMO and from 199 (36) to 211 (33) microm in eyes with normal fovea following CMO resolution. Statistical correlations between mean differential sensitivity threshold and retinal thickness were only weak and showed no association. CONCLUSIONS: Active CMO causes a marked reduction in central retinal sensitivity. In addition, following the resolution of the CMO, a substantial impairment of central retinal sensitivity remains. Morphology in terms of retinal thickness in OCT does not correlate with visual function in terms of retinal sensitivity in these patients.

Semicircular tumor of the iris and uveitis as unilocal manifestation of sarcoidosis.

PURPOSE: To describe an unusual manifestation of sarcoidosis as a large tumor of the iris and ciliary body without any other involvement of the body. METHODS: We describe a 20-year-old female presenting with a granulomatous tumor of the right iris and ciliary body and concomitant uveitis. RESULTS: Extensive ocular and systemic workup revealed the tumor to be a large solitary sarcoid granuloma. As systemic steroids were not able to control the activity of the uveitis and granuloma, only the initiation of immunosuppressive therapy with cyclosporine A achieved a lasting remission. CONCLUSION: The possibility of an exclusively ocular sarcoidosis should always be kept in mind despite negative regular screening tests. In these cases, a biopsy should be considered and immunosuppressive agents like cyclosporine A should be evaluated in cases not responding to first-line treatment with systemic steroids.

Docetaxel monotherapy in heavily pretreated metastatic breast cancer: a multicenter, community-based feasibility trial.

PURPOSE: To evaluate the efficacy and safety of docetaxel in heavily pretreated and anthracycline-resistant patients with metastatic breast cancer in an outpatient setting. PATIENTS AND METHODS: Between February 1996 and June 1998, 98 consecutive patients who had progressed during or relapsed following prior anthracycline-containing chemotherapy were enrolled into the trial. Docetaxel was administered at a dose of 100 mg/m2 by intravenous infusion every 3 weeks. The administration of colony-stimulating factors was at the discretion of the attending physician. Premedication with dexamethasone was mandatory for all patients. RESULTS: Of the 98 patients, 93 were evaluable for toxicity and response. Patients had received two palliative regimens (median, range 1-5) prior to docetaxel treatment. The most frequent toxicity observed was leukopenia grade III and IV (WHO grading system) which occurred in 47% of patients (grade IV only in 14%). Except for alopecia grade III (64% of patients), nonhematologic side effects grade III-IV were rare (1-7% of patients) and included nausea, stomatitis, diarrhea, peripheral neuropathy, fluid retention and pulmonary toxicities. There were no treatment-related deaths. Objective responses occurred in 40% of patients (CR 6%, PR 34%), and stable disease in 38% of patients. The median duration of response was 5.3 months (range 0.7-18.1 months) while the median survival was 15 months (range 2 36 months). CONCLUSION: Docetaxel is a highly active agent in patients with anthracycline-resistant metastatic breast cancer, even in heavily pretreated patients, with moderate toxicity.

Elevated vitreous interleukin-10 level is not diagnostic of intraocular-central nervous system lymphoma.

OBJECTIVE: Diagnosis of intraocular-central nervous system (CNS) lymphoma is commonly made by identifying malignant lymphocytes in the vitreous. However, such cells are in the minority in the vitreous cellular infiltrate (most are reactive lymphocytes), and therefore lack of cytologic support from biopsied vitreous samples in patients suspected of having intraocular-CNS lymphoma may occur. Recent data suggest that interleukin-10 (IL-10) levels are elevated in the serum and vitreous of patients with non-Hodgkin's lymphoma, whereas IL-12 and IL-6 levels are elevated in patients with uveitis of non-neoplastic etiology. The authors evaluated the usefulness of measuring vitreous levels of IL-6, -10, and -12 in the diagnosis of intraocular-CNS lymphoma. DESIGN: Prospective case series. PARTICIPANTS: Seventeen patients with intraocular inflammation who underwent a diagnostic or therapeutic vitrectomy: 4 patients with intraocular-CNS lymphoma and 13 patients with uveitis unrelated to a neoplasm. INTERVENTION: Eighteen vitreous specimens were obtained prospectively. Concentrations of IL-6, -10, and -12 were measured by enzyme immunosorbent assay, and relative ratios of the interleukins were calculated. Cytopathologic examination and flow cytometry of vitreous cells were also performed. MAIN OUTCOME MEASURES: The ratio of IL-10/IL-12 and IL-10/IL-6 was calculated to assess any association of intraocular-CNS lymphoma and high vitreous IL-10 relative to IL-6 and IL-12 levels. RESULTS: The IL-10/IL-6 and IL-10/IL-12 ratio was greater than 1 in 8 of 14 vitreous specimens obtained from 13 patients with non-neoplastic uveitis. One of the four specimens from patients with cytologically proven intraocular-CNS lymphoma had vitreous IL-10/IL-6 and IL-10/IL-12 ratios of less than 1. CONCLUSION: Although a helpful diagnostic tool, an elevated vitreous IL-10 to IL-6 or IL-12 ratio is not always associated with intraocular-CNS lymphoma.

Dose intensification of epidoxorubicin and cyclophosphamide in metastatic breast cancer: a randomised study with two schedules of granulocyte-macrophage colony stimulating factor.

A randomised phase II/III study was conducted in patients with advanced breast cancer to determine the dose intensity achievable through an acceleration of administration of chemotherapy with epidoxorubicin and cyclophosphamide (EC) alone, as compared with the combination of this regimen with two different schedules of granulocyte-macrophage colony stimulating factor (GM-CSF). 73 patients received EC intravenous (i.v.) (epidoxorubicin 100 mg/m2, cyclophosphamide 600 mg/m2) on day 1 (group A), or the same chemotherapy plus sub-cutaneous (s.c.) GM-CSF (5 micrograms/kg/day) either from days 3 to 12 (group B) or from days -6 to -3 (group C). The primary objective of the study was the investigation of dose intensity delivered in the three treatment arms, whereas the secondary objective was response rate. A significant increase (P = 0.006) in dose intensity of 21% was observed for treatment group B, whereas the increase in dose intensity achieved in group C (7%) was not significant (P = 0.086). Response rates (complete response (CR) + partial response (PR)) of 56% were observed in group A, 65% in group B, and 57% in group C, respectively. This difference in response rates did not reach statistical significance (P = 0.271). We thus conclude that an acceleration of the EC regimen over the standard schedule could be accomplished with postchemotherapeutic GM-CSF support, leading to an increase in dose intensity, whereas pretherapeutic short-term GM-CSF administration did not reach this goal.

Cimetidine and coumarin therapy of renal cell carcinoma. A pilot study.

Thirty-eight patients with metastatic renal-cell carcinoma (RCC) and 1 patient with a second primary RCC were treated with coumarin and cimetidine. Patients received 400 mg cimetidine p.o. daily and after 1 week 100 mg coumarin p.o. daily in addition until tumour progression. Two complete remission (30 and 50+ months) and 3 partial remissions (14, 13.8 months) could be achieved. Problems regarding possibly spontaneous regressions and comparable results of other treatment in RCC are discussed.

Phase II study of lonidamine in non-small cell lung cancer: final report.

Lonidamine (LND) is a new anti-cancer drug which interferes with the energy-yielding processes of tumour cells without affecting DNA replication. A total of 69 previously untreated patients with non-small cell lung cancer (NSCLC) entered this study. LND was given orally as a single agent at doses ranging from 450 to 900 mg day-1 until tumour progression (2 to greater than or equal to 1,402 days). Partial responses (PR) occurred in 7/69 patients (10.1%); 4/25, 1/27 and 2/9 for epidermoid, adenocarcinoma and large cell cancer respectively. PR by stage was 4/10, 1/3, 1/20 and 1/28 for stages I, II, III and IV, respectively. The median duration of response was 303 days (greater than or equal to 61 to greater than or equal to 338 days). The median survival for the whole group was 261 days. Toxicity was assessed in all patients. No myelosuppression occurred. The main side-effects were myalgia (68%), loss of appetite (23%), asthenia (20%) and testicular pain (13%). Doses above 450 mg day-1 produced more severe side-effects without any improvement in therapeutic activity.

[Tumor markers in breast cancer: on the diagnostic value of serum determinations in clinical freedom from tumor and manifest disease]. / Tumormarker bei Mammakarzinom: Zur diagnostischen Wertigkeit von Serumbestimmungen bei klinischer Tumorfreiheit (NED) und manifester Erkrankung.

We have analyzed 1301 serum determinations of the tumor markers CA 15-3 and CEA in 405 breast cancer patients. CA 15-3 exhibited a higher accuracy than CEA (sensitivity-specificity diagram). Using cut-off levels of 30 U/ml (CA 15-3) and 5 ng/ml (CEA) we observed a sensitivity of 70.7% versus 61.8% and an approximate specificity of 93.8% versus 83.4%. The sensitivity of the panel of both markers was 80.9%, the specificity 84.5%. The high specificity of both markers caused high positive predictive values. The marker expression was higher in patients with hematogenic metastasis than with local recurrences (the median for CA 15-3 levels was 88.2 U/ml versus 26.6 U/ml; for CEA: 10.0 ng/ml versus 2.5 ng/ml). Less expression of both markers in patients younger than 40 years in comparison to patients older than 40 seems to be remarkable. Early detection of relapse - a marker increase over the cut-off level before clinical proof - was observed in 43.8% (CA 15-3; median of leadtime 6.1 months) of 73 patients; CEA: 24.7%, 7.2 months. Metastasis was predicted 3-6 times more often than local recurrences. Monitoring of the manifest more or less progressed tumor is still the main task of present tumor markers. But the results also suggesting the use of these markers for early detection of metastasis, especially in panels.

Phase II study of lonidamine in inoperable non-small-cell lung cancer.

31 patients with inoperable non-small-cell lung cancer were treated with Lonidamine at daily doses of 450-900 mg orally. Side effects mostly consisted of myalgias, often severe, and gastrointestinal symptoms. Lonidamine was discontinued in 8 patients because of tumor progression and in 2 on account of side effects. 3 partial responses were observed, 2 in patients with epidermoid tumors.