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Bessell EM, Graus F, López-Guillermo A, Villá S, Verger E, Petit J, Holland I, Byrne P. CHOD/BVAM regimen plus radiotherapy in patients with primary CNS non-Hodgkin's lymphoma. Int J Radiat Oncol Biol Phys 2001; 50:457-64. [PMID: 11380234 DOI: 10.1016/s0360-3016(01)01451-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the efficacy and toxicity, including long-term neurotoxicity, of combined therapy with the CHOD/BVAM regimen given before cranial radiotherapy in the treatment of primary CNS lymphoma (PCNSL). METHODS AND MATERIALS Thirty-one consecutive patients with PCNSL were treated with one cycle of cyclophosphamide, doxorubicin, vincristine, and dexamethasone (CHOD) and two of carmustine (BCNU), vincristine, cytosine arabinoside, and methotrexate (BVAM), followed by cranial radiotherapy (45 Gy whole brain plus a 10-Gy boost for single lesions). The median age was 59 years (range 21-70) and 39% had poor performance status. The median follow-up of patients was 4.1 years (range 2.7-9.0). RESULTS Twenty-one patients had no PCNSL at the end of treatment. The 5-year actuarial probability of survival was 31% (95% confidence interval [CI]: 11%-57%), with a median survival of 38 months. Patients < 60 years had a survival significantly longer than those > or = 60 years (4-year survival: 58% (95% CI: 34-82%) vs. 29% (95% CI: 5-53%), respectively; p = 0.04). Two patients died during chemotherapy from pulmonary embolism and bronchopneumonia, respectively, with no evidence of PCNSL at the autopsy. Dementia probably related to treatment occurred in 5 (62%) of the 8 patients 60 years and older, and 4 of them died without evidence of relapse of PCNSL. Dementia correlated with developing brain atrophy and leuco-encephalopathy on serial CT or MR scans. CONCLUSION This regimen can be given with the planned dose intensity to patients aged less than 70 years, and produces better survival than that reported with radiotherapy alone; however, dementia occurs in the majority of patients aged 60 years of age or more.
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Caro-Gallarin M, Conill C, Vilalta A, Molla M, Verger E, Toscas J, Biete A. Brachytherapy with Iridium-192 as a treatment of carcinoma of eyelid's tarsal structure. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81273-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Viñolas N, Gil M, Verger E, Villá S, Pujol T, Caral L, García M, Graus F, Estapé J. High-dose chemotherapy (HDCT) with G-CSF support before radiotherapy (RT) in malignant gliomas (MG): phase II trial. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)80869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Villà S, Viñolas N, Verger E, Yaya R, Martínez A, Gil M, Moreno V, Caral L, Graus F. Efficacy of radiotherapy for malignant gliomas in elderly patients. Int J Radiat Oncol Biol Phys 1998; 42:977-80. [PMID: 9869218 DOI: 10.1016/s0360-3016(98)00356-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Age above 65 years is a strong negative prognostic factor for survival in patients with malignant gliomas (MG) treated with radiotherapy (RT) and its value has been questioned. We analyzed the effect of RT on the survival of elderly patients with malignant gliomas. METHODS AND MATERIALS We examined 85 consecutive elderly patients with a histological diagnosis of MG. Age ranged from 65 to 81 years (median 70 years). Glioblastoma multiforme (GBM) was diagnosed in 64 patients (75.3%). Surgical treatment included needle biopsy in 32 patients (37.6%). Median postoperative Karnofsky Performance Status (KPS) was 60 (range: 30-100). Survival probability was estimated using Kaplan-Meier method and compared with the log-rank test. Crude and adjusted hazard ratios (HR) were calculated using Cox's regression models. RESULTS Median survival time for all patients was 18.1 weeks. In multivariate analysis, RT was the only independent prognostic variable for survival (HR: 9.1 [95% CI: 4.5-18.7]). Forty-two patients did not start RT mostly due to low KPS (<50). The median survival of the 43 patients who started RT was 45 weeks. In these patients, Cox multivariate analysis indicated that age was independently associated with prolonged survival (HR: 2.85 [95% CI 1.31-6.19]). Median survival of patients age 70 years and younger was 55 weeks compared with 34 weeks for patients older than 70 years. CONCLUSIONS The overall survival for elderly patients with MG is poor. RT seems to improve survival in patients up to 70 years, but in older patients treated with RT the survival is significantly shorter.
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Conill C, Verger E, Henríquez I, Saiz N, Espier M, Lugo F, Garrigos A. Symptom prevalence in the last week of life. J Pain Symptom Manage 1997; 14:328-31. [PMID: 9409097 DOI: 10.1016/s0885-3924(97)00263-7] [Citation(s) in RCA: 128] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Palliative care is the management of patients with progressive, far-advanced disease for whom the prognosis is limited and the focus of care is quality of life. During the last days of life, it is important to redefine the goals, as previously present symptoms may increase and new symptoms may appear. To assess these symptoms, 176 patients were evaluated. A questionnaire evaluated symptoms during the last week of life and compared these prevalences with those at the first evaluation. The patients comprised 121 men and 55 women. The mean age was 67.7 years. Metastases were present in 66.5% and were multiple in 52%. The most frequent symptoms at the end of life (> 50%) were anorexia, asthenia, dry mouth, confusion, and constipation. The majority of patients died at home (64.2%). We observed good control of "reversible" symptoms, but many symptoms were difficult to control at the end of life. Symptom assessment is important in this population.
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Ruiz V, Henríquez I, Reig A, Conill C, Verger E. Has radiation therapy any role in signet-ring cell breast adenocarcinoma? Eur J Cancer 1997; 33:977-8. [PMID: 9291826 DOI: 10.1016/s0959-8049(97)89336-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Villà S, Viñolas N, Verger E, Gil M, Caralt L, Moreno V, Graus F. 2067 Malignant gliomas (MG) in the elderly. A study of 85 consecutive patients in two institutions. Int J Radiat Oncol Biol Phys 1997. [DOI: 10.1016/s0360-3016(97)80836-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Conill C, Alsina M, Verger E, Henríquez I. Radiation therapy in AIDS-related cutaneous Kaposi's sarcoma. Dermatology 1997; 195:40-2. [PMID: 9267735 DOI: 10.1159/000245682] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Treatment of cutaneous Kaposi's sarcoma associated with AIDS depends on localization, extension, associated symptoms and the patient's general condition. The most frequent sites of involvement are the face and neck. The aim of this retrospective study was to evaluate the response rate as well as the cosmetic results comparing two different schedules of palliative radiation treatment. METHODS 251 Skin lesions in 22 patients were treated with irradiation using 100 kV X-ray energy. Applied doses varied between 8 Gy/1 fraction and 30 Gy/10 fractions. The mean age of patients was 38 years (28-59 years). According to Mitsuyasu's staging, 2 patients had stage I, 8 stage II and 12 patients stage IV. The lesions were localized on the face (n = 190), lower extremities (n = 28), upper extremities (n = 24) and the thorax (n = 9). The total given dose was 30 Gy in 68 lesions (27%), 21 Gy in 11 lesions (4.4%), 20 Gy in 2 lesions (0.8%) and 8 Gy in 170 lesions (67.8%). RESULTS Complete response with or without residual pigmentation was achieved in 95.2% of lesions, while 4.4% had a partial response and 0.4% no response. Pain was completely relieved in all patients. CONCLUSIONS Radiotherapy can be recommended as palliative treatment to relieve physical discomfort (pain) and to improve the cosmetic results in patients with AIDS-related Kaposi's sarcoma. Doses ranging from 8 Gy/1 fraction to 30 Gy/10 fractions, tailored to the individual patient's need, permit to achieve an excellent local control with minimal toxicity.
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Henríquez I, Conill C, Verger E, Graus F. Is the time interval between diagnosis and radiation treatment an important factor in brain metastases? Eur J Cancer 1996; 32A:2184. [PMID: 9014766 DOI: 10.1016/s0959-8049(96)00240-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Yaya R, Martínez A, Viñolas N, Villà S, Graus F, Gil M, Verger E, Caralt M. 693High grade gliomas in old patients. Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80702-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Conill C, Verger E, Alsina M, Güett J, Ferrer F, Casals J, Henriquez I, Biete A. 785 Radiotherapy in the management of cutaneous epidemic Kaposi's sarcoma. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96034-b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rovirosa A, Ferrer F, Sánchez-Reyes A, Berenger J, Verger E, Ferre J, Guell J, Casals J, Farrús B, Biete A. 205 Quality control in brachytherapy (BT) treatments for head and neck neoplasms. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)95462-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Conill C, Verger E, Ferrer F, Ferré J. [Oral Kaposi's sarcoma: role of radiotherapy]. Med Clin (Barc) 1995; 104:436-7. [PMID: 7715266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Conill C, Astudillo J, Verger E. Prognostic significance of metastases to mediastinal lymph node levels in resected non-small cell lung carcinoma. Cancer 1993; 72:1199-202. [PMID: 8393367 DOI: 10.1002/1097-0142(19930815)72:4<1199::aid-cncr2820720411>3.0.co;2-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The prognosis of patients who have non-small cell lung carcinoma (NSCLC) with mediastinal lymph node metastases remains a controversial issue. This study was performed to evaluate survival by level of mediastinal lymph node metastasis and the number of mediastinal levels involved. METHODS The authors retrospectively reviewed the cases of 113 patients with NSCLC and pathologic mediastinal lymph node involvement who underwent a complete tumor resection and ipsilateral mediastinal lymphadenectomy. RESULTS Most patients presented with involvement of only one mediastinal lymph node level (68.2%). The overall survival rate was 17% at 3 years. No differences in survival were observed in relation to which lymph node level was involved (P = 0.667). Differences in survival based on the number of lymph node levels involved were statistically significant (P = 0.001). CONCLUSIONS Although there were no differences in survival when only one of any of the three defined levels was involved, metastasis to more than one level was associated with significantly poorer survival.
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Conill C, Verger E, Vilalta A, Palou J. Case report: squamous cell carcinoma of the nail bed. Br J Radiol 1993; 66:163-4. [PMID: 8457832 DOI: 10.1259/0007-1285-66-782-163] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Verger E, Conill C, Chicote S, de Azpiazu P. [Value of the Karnofsky index as indicator of life prognosis in terminal oncology patients]. Med Clin (Barc) 1993; 100:74. [PMID: 8429714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Conill C, Verger E, Salamero M, de Azpiazu P. [Reliability and validity of the Karnofsky index]. Med Clin (Barc) 1992; 99:718. [PMID: 1479853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Conill C, Verger E, Biete A. [Treatment of elderly patients with cancer]. Med Clin (Barc) 1992; 99:636-7. [PMID: 1460931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Verger E, Conill C, Pedro A, Chicote S, Salamero M, de Azpiazu P, Gil E, Biete A. [Palliative care in cancer patients. Frequency and priority of symptoms]. Med Clin (Barc) 1992; 99:565-7. [PMID: 1281248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The presence of multiple symptoms is very frequent in patients with advanced cancer disease. In this situation in which cure is not a realistic aim, the goal is to achieve symptom control and to give support to the patient and family. This study was designed to identify the most common and priority symptoms in patients with advanced cancer. METHODS Patients were given a questionnaire with a list of symptoms and were asked to underline those they presented, and also number those they considered most distressful from 1-3. Physicians and nurse independently answered the same questionnaire. RESULTS Asthenia was the most frequent symptom (patient evaluation 84%, nurse 82% and doctor 93%). Psychopathological disturbances showed a high prevalence. Regarding patient evaluation, dry mouth was the third symptom in frequency (73%), but it was detected by nurses in 39% and by physicians in 16%. Priority symptoms for the three groups were pain, asthenia, anorexia and anxiety. Pain was controlled in 19/22 patients (86%), while psychopathological symptoms were only controlled in 7/19 patients (27%). CONCLUSIONS In order to optimize treatment patient participation is mandatory. An interdisciplinary team (physicians, nurses, social workers, and psychologists) is necessary to take care of these patients.
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Verger E, Conill C, Vila A, Pomés J, Graus F, Biete A. [Contribution of magnetic resonance imaging in the early diagnosis of epidural metastasis]. Med Clin (Barc) 1992; 99:329-31. [PMID: 1435000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Vertebral bone metastases represent the most frequently affected region within the skeleton. They are of important relevance because of the risk of medullar compression. The diagnosis of medullar canal invasion is of particular interest in order to prevent neurological dysfunction. A prospective study was carried out to detect the frequency and degree of invasion of the spine. METHODS Twenty-eight patients were studied (13 males and 15 females), with a median age of 61 years (range 35-85), with cancer diagnosis and vertebral bone metastases, and local or radicular pain, without signs or symptoms suggesting myelopathy. Neurological, physical examination, radiological study (anteroposterior and lateral) and magnetic resonance imaging (MRI) study was performed in all patients to detect medullar canal invasion. RESULTS Local pain was present in 43% of patients (n = 12), and radicular in 57.1% (n = 16). The most frequent radiologic vertebral involvement was thoracic (46.4%), with 71% of vertebral body collapse. MRI showed epidural space invasion in 75% of patients (n = 21), with a degree superior to 50% in 43%. CONCLUSIONS The beginning of vertebral pain in a patient with cancer diagnosis, with evidence of bone invasion after radiological study, represents a major indicator to perform a MRI study to detect epidural involvement.
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Verger E, Salamero M, Conill C. Can Karnofsky performance status be transformed to the Eastern Cooperative Oncology Group scoring scale and vice versa? Eur J Cancer 1992; 28A:1328-30. [PMID: 1515244 DOI: 10.1016/0959-8049(92)90510-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There is no consensus regarding the equivalence of performance status between the Karnofsky (KPS) and the Eastern Cooperative Oncology Group (ECOG) scales. In the present study KPS and ECOG scores were compared in 150 consecutive cancer patients. An empirical relation was established through regression analysis in a subsample of 75 patients and the results tested in the second subsample. Transformation tables including 95 and 66% confidence intervals were calculated. Both performance scales are highly correlated, but inferences about individual patients were subject to a high level of error. These results stress the difficulty of translating one score to another, especially in the range of lower performance status where a wide spread is observed.
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Verger E, Conill C. [A descriptive study of 105 patients with cerebral metastases]. Med Clin (Barc) 1991; 97:718. [PMID: 1770825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Sarri Y, Conill C, Verger E, Tomas C, Gomis R. Effects of single dose irradiation on pancreatic beta-cell function. Radiother Oncol 1991; 22:143-4. [PMID: 1957005 DOI: 10.1016/0167-8140(91)90011-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We have irradiated abdominal cavity of 23 rats with 10 Gy irradiation-induced hypoglycemia on the fourth day after intervention. Islets collected at this time showed an impaired insulin secretion without affecting insulin content. This impairment persisted after one month follow-up with reduced number of beta-cells in morphological examination.
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