Aguilar W.L.A.K. W. Law Wlaya-Nam-Adiki W.L. Barneke W. Lee O'Daniel W. Dmowski Wojciech Drabowicz Wojciech Front Wojciech Gąssowski Wojciech. RSFSR) - život a činnost - vzpomínky vlastní nam a22 1 gk on the Philosophy of Tadeusz Kotarbiński / Wojciech W. Gasparski ; Transl. from . s pl pol ABA cze ABA ABA ()=84 Gąssowski. Katarzyna gartner - Ernest Bryll - Zagrajcie nam dzisiaj . Starobrnenska 12 - Muzikanti, hrejte nam. Wojciech Gąssowski - Love me tender.
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The full text of this article hosted at iucr. E-mail address: Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. However, residual tumor is present in the majority of patients, which limits survival prognosis. Different therapy approaches should be utilized to improve prognosis in these patients. The two groups were investigated and compared with respect to tumor resection rates, blood transfusion requirements, morbidity, and mortality during surgery, duration of surgery, and median survival.
Time spent in surgery, blood transfusion requirements, morbidity, and mortality during surgery were not significantly different. Patients with advanced ovarian carcinoma of FIGO Stage IIIC who will benefit only marginally from conventional therapy can be identified by evidence of large ascites volume. Higher tumor resection rates and longer median survival can be achieved in these patients by the use of neoadjuvant chemotherapy.
A prospective randomized multicenter study currently is being performed by the Society for Gynecological Oncology in Germany to confirm these findings.
Cancer ; In this therapeutic procedure, postsurgical macroscopic tumor free status is the decisive prognostic factor for subsequent disease course. Neoadjuvant font fly emirates jobs in ovarian carcinoma has been described up to now in isolated retrospective studies; however, to our knowledge there is no conclusive evidence as yet for an advantage compared with conventional treatment of patients.
In addition, we show that patients benefiting from neoadjuvant chemotherapy can be identified using ascites volume. For these patients, numerous factors were tested for prognostic impact on further disease course including age, postsurgical residual tumor, grading, and lymph node status. In addition, the factor ascites volume, which was quantitatively measured in every patient before and during surgery, was evaluated with regard to both prognostic impact and to possible prediction of operative resectability of the tumor.
Extensive details regarding surgical techniques and procedures have been reported elsewhere. Details regarding patient data, including surgical procedures and rate of macroscopic tumor free status, are given in Table 1.
Tumor debulking surgery as described earlier was performed after these cycles. Tumor resection rates, blood transfusion requirements, morbidity and mortality during surgery, duration of surgery, and median survival were analyzed both in the patients included in the study and in the control group. Details concerning patient data in the study and control groups are provided in Table 2. Informed consent was obtained from all patients treated within the study before wojciech gasowski to za nami google beginning of wojciech gasowski to za nami google by the gynecologic oncologist.
The institutional study protocol was approved by the local ethics commission. Table 3 summarizes the univariate and multivariate analysis of various prognostic factors. Postoperative residual tumor shows the strongest prognostic impact. Moreover, in addition to patient age, the factor ascites volume wojciech gasowski to za nami google an wojciech gasowski to za nami google cutoff of mL was an independent prognostic factor for patient survival.
Lymph node status and grading, which are significant in univariate analysis, did not remain significant in the multivariate context.
One patient who received neoadjuvant chemotherapy did not wojciech gasowski to za nami google surgery because of a lung embolism. Table 4 shows no difference between perioperative morbidity and mortality in the two patient groups.
Neither the median duration of surgery nor the required number of blood transfusions appeared to differ between the two patient groups. The influence of different factors on the disease course for patients in the study and control groups was shown by multivariate analysis, in which age, postoperative surgical result, form of therapy, and tumor grading were investigated.
With the exception of tumor grading, all factors investigated were found to be prognostically significant in univariate analysis, whereas in multivariate analysis postoperative tumor residual and age remained as independent, significant parameters for prognosis Table 5.
Efforts to attain an increased percentages of patients free of postoperative residual tumor have applied ultraradical surgical techniques including upper abdominal surgery; however, in our investigations, such efforts led to considerably increased perioperative morbidity and mortality, so that the indication for such surgical techniques must be established on a very individual basis.
The results of studies regarding therapy for patients with advanced carcinomas of the pancreas and esophagus provide clear evidence that neoadjuvant chemotherapy before surgery enables wojciech gasowski to za nami google and thus improves the operability as well as the prognosis of patients.
In studies by Schwartz et al. For these patients, additional improvement of these already relatively favorable therapy results due to neoadjuvant chemotherapy was not very likely, so that any possible advantage of neoadjuvant chemotherapy becomes very difficult mp3 gratis jika cinta dia prove within the group of patients with potentially completely resectable tumors.
Therefore, the current study was designed to identify patients with a low probability of successful complete tumor resection and who hence were likely to benefit only marginally from conventional therapy. Large ascites volumes generally are an expression of diffuse peritoneal carcinosis, which seldom can be resected completely even if radical surgical techniques including extensive deperitonizations are applied.
The cutoff ascites volume value of mL determined by us allowed avg renewal reliable prediction of the result of surgery, as already shown by Heintz et al.
Additional procedures such as scores constructed by wojciech gasowski to za nami google various criteria obtained from computer tomography or from preoperative determination of the tumor marker CA also could improve predictive performance further. Patients with advanced ovarian carcinoma who were identified based on their ascites volume as having an unfavorable prognosis underwent wojciech gasowski to za nami google debulking after neoadjuvant chemotherapy.
The rate of tumor resection and the median survival were significantly superior to that of the conventionally treated control group, with equal rates of perioperative morbidity and mortality. Comparison of perioperative blood transfusion requirements and duration of surgery in the two patient groups yields no significant differences, in contrast with the findings of Schwartz et al.
A conceivable explanation for the lack of a detectable difference in the current study that cannot be excluded entirely concerns the subjective attitude of the surgeon toward the particular therapeutic procedures: The hope of improving the prognosis of patients by a new approach using neoadjuvant chemotherapy could have led to increased efforts to perform successful tumor resection compared with the conventional approach.
Such increased surgical efforts could have led to surgical duration and transfusion requirements in the group of patients treated by neoadjuvant chemotherapy that were closer to those of conventionally treated patients despite tumor regression and a lower underlying tendency toward hemorrhaging. Neoadjuvant chemotherapy was found to be a significant prognostic parameter for patients on univariate analysis but did not appear to be independently relevant for prognosis in multivariate analysis, because the factor neoadjuvant chemotherapy is masked by the factor postoperative tumor residual.
However, because patients treated by neoadjuvant chemotherapy have a significantly higher tumor resection rate compared with conventionally treated patients, the multivariate analysis still can be regarded as an indirect proof that the application of neoadjuvant chemotherapy improved patient prognosis.
On the basis of the experimental treatment plan, all patients but one who had a lung embolism underwent tumor debulking surgery independent of their response to chemotherapy. Using neoadjuvant chemotherapy as a bioassay, it is possible to evaluate the sensitivity of the tumor to chemotherapy; hence, in the future it would be conceivable to identify patients with early primary disease progression or those with early recurrences who could be spared the burden of tumor debulking because of their limited prognosis.
Conversely, for patients for whom neoadjuvant chemotherapy induces substantial remission, it would be possible to intensify surgical radicality for prognostic improvement. Neoadjuvant chemotherapy appears to improve prognosis of a subgroup of patients with advanced ovarian carcinoma; however, care is required because these results have been obtained in a study that was not randomized.
Before the routine clinical application of neoadjuvant chemotherapy, these findings should be confirmed by a large prospective randomized study. Hence, in the next therapy study of patients with advanced ovarian carcinoma, the Society for Gynecological Oncology in Germany will investigate the impact of neoadjuvant chemotherapy in a prospective randomized manner, to clarify the indication conclusively.
Volume 92Issue If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username.
Cancer Volume 92, Issue Original Article Free Access. Walther Kuhn M. Corresponding Author E-mail address: Stefan Rutke M. Barbara Schmalfeldt M. Gerd Florack M. Burkhardt von Hundelshausen M.
Dmytro Pachyn M. Kurt Ulm M. Henner Graeff M. First published: Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Characteristic No. International Federation of Gynecology and Obstetrics. N1, Nx 0.
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Figure 4 Open in figure viewer PowerPoint. Dependence of perioperative surgical data on time of surgery Table 4 shows no difference between perioperative morbidity and mortality in the two patient groups. Multivariate analysis The influence of different factors on the disease course for patients in the study and control groups was shown by multivariate analysis, in which age, postoperative surgical result, form of therapy, and tumor grading were investigated.
Primary cytoreductive surgery for epithelial ovarian cancer. Obstet Gynecol ; Crossref Google Scholar. Google Scholar. Citing Literature Number of times cited according to CrossRef: Wiley Online Library. Volume 92Issue 10 15 November Pages Figures References Related Information. Email or Customer ID. Forgot password? Old Password. New Password. Your password has been changed. Returning user. Request Username Can't sign in?
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