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Norbert Graf - One of the best experts on this subject based on the ideXlab platform.
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wilms tumor in adults results of the society of pediatric oncology siop 93 01 society for pediatric oncology and hematology gpoh study
Journal of Clinical Oncology, 2004Co-Authors: Harald Reinhard, Christian Ruebe, Stefano Aliani, Michael Stöckle, Ivo Leuschner, Norbert GrafAbstract:Purpose In the Society of Pediatric Oncology (SIOP) 93-01 study, 30 patients older than 16 years were found to have Wilms' tumor. They were treated according to the pediatric protocol and were analyzed for clinical presentation, Stage Distribution, and prognosis. Patients and Methods Patient age ranged from 16 to 62 years (median, 25.4 years). Tumor Stages were defined according to SIOP, and treatment was risk-adapted according to SIOP 93-01/Society for Pediatric Oncology and Hematology (GPOH) protocol. The patients were evaluated with regard to response, toxicity, and prognosis. Specimens of all tumors were centrally reviewed. Results Ten patients (33%) had metastatic disease at the time of diagnosis (liver, four patients; lung, three patients; liver and lung, three patients). The local Stage Distribution showed a predominance of higher Stages (Stage I, eight patients; Stage IIN−, three patients; Stage IIN+, four patients; Stage III, 15 patients). Histologic studies revealed intermediate-risk in 23 of 30...
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the role of preoperative chemotherapy in the management of wilms tumor the siop studies international society of pediatric oncology
Urologic Clinics of North America, 2000Co-Authors: Norbert Graf, M F TournadeAbstract:More than 25 years after introducing preoperative chemotherapy for Wilms' tumor, the benefits of this approach are well known. The preoperative protocol results in easier operations with significantly fewer tumor ruptures during surgery and a favorable Stage Distribution. Acute toxicity and late effects are minimized without jeopardizing disease-free and overall survival. Future clinical trials of Wilms' tumor should seek additional risk factors to stratify and individualize treatment. These prognostic factors will improve the cure rates for high-risk patients by intensifying therapy and the quality of life for children with more favorable prognosis by lowering therapy to a minimum. As is true for radical surgery, partial nephrectomy in unilateral disease must be evaluated in carefully selected patients according to clear and well-defined indications. Molecular genetic studies should increase understanding of Wilms' tumor, influencing treatment and outcome.
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the role of preoperative chemotherapy in the management of wilms tumor the siop studies
Urologic Clinics of North America, 2000Co-Authors: Norbert Graf, M F Tournade, Jan De KrakerAbstract:More than 25 years after introducing preoperative chemotherapy for Wilms' tumor, the benefits of this approach are well known. The preoperative protocol results in easier operations with significantly fewer tumor ruptures during surgery and a favorable Stage Distribution. Acute toxicity and late effects are minimized without jeopardizing disease-free and overall survival. Future clinical trials of Wilms' tumor should seek additional risk factors to stratify and individualize treatment. These prognostic factors will improve the cure rates for high-risk patients by intensifying therapy and the quality of life for children with more favorable prognosis by lowering therapy to a minimum. As is true for radical surgery, partial nephrectomy in unilateral disease must be evaluated in carefully selected patients according to clear and well-defined indications. Molecular genetic studies should increase understanding of Wilms' tumor, influencing treatment and outcome.
Bernard Rachet - One of the best experts on this subject based on the ideXlab platform.
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p0115 effect of differential Stage or treatment on socioeconomic inequalities in survival from non small cell lung carcinoma nsclc mediation analysis using osaka population based cancer registry data in japan
European Journal of Cancer, 2015Co-Authors: Bernard Rachet, R Li, A Ioka, Tomio NakayamaAbstract:Background Wide socioeconomic inequalities in cancer survival were observed in Osaka, Japan. Both 1-year and 5-year survival from non-small-cell lung carcinoma (NSCLC) differed by about 5% between the most affluent and most deprived patients. We aimed to estimate the part played by differential Stage Distribution and surgical treatment in such inequalities. Methods We did an observational study using population-based cancer registry data. The final analysis included 30,528 patients diagnosed with a NSCLC in Osaka Prefecture in 1993–2004, who were followed up for at least 5 years. 11% were excluded because of missing information on tumour Stage. Mediation analyses using Monte Carlo simulation were used to estimate the proportion of the socioeconomic effect mediated by tumour Stage on (i) cancer survival and (ii) receiving surgical treatment of curative intent. Findings Compared with the highest socioeconomic patients, higher 1-year mortality in lower socioeconomic groups was mediated by adverse Stage Distribution in nearly half of cases. Stage explained none of the higher conditional 5-year mortality among lower socioeconomic patients. Lower socioeconomic levels were also associated with decreasing proportions of surgery with curative intent, but this association was mediated by Stage only in the lowest socioeconomic group: the lower proportion of treatment was explained by adverse Stage Distribution in nearly 80% of cases. Interpretation Access to earlier diagnosis should be deployed in low socioeconomic populations. Suboptimal management observed among the poorest NSCLC patients needs to be further investigated. This is crucial in an equitable society with a universal health-care system.
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Stage at diagnosis and colorectal cancer survival in six high income countries a population based study of patients diagnosed during 2000 2007
Acta Oncologica, 2013Co-Authors: Camille Maringe, Bernard Rachet, Sarah Walters, John Butler, Tony Fields, P J Finan, Roy Maxwell, Bjorn S Nedrebo, Lars Pahlman, Annika SjovallAbstract:Background. Large international differences in colorectal cancer survival exist, even between countries with similar healthcare. We investigate the extent to which Stage at diagnosis explains these differences. Methods. Data from population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK were analysed for 313 852 patients diagnosed with colon or rectal cancer during 2000-2007. We compared the Distributions of Stage at diagnosis. We estimated both Stage-specific net survival and the excess hazard of death up to three years after diagnosis, using flexible parametric models on the log-cumulative excess hazard scale. Results. International differences in colon and rectal cancer Stage Distributions were wide: Denmark showed a Distribution skewed towards later-Stage disease, while Australia, Norway and the UK showed high proportions of 'regional' disease. One-year colon cancer survival was 67% in the UK and ranged between 71% (Denmark) and 80% (Australia and Sweden) elsewhere. For rectal cancer, one-year survival was also low in the UK (75%), compared to 79% in Denmark and 82-84% elsewhere. International survival differences were also evident for each Stage of disease, with the UK showing consistently lowest survival at one and three years. Conclusion. Differences in Stage at diagnosis partly explain international differences in colorectal cancer survival, with a more adverse Stage Distribution contributing to comparatively low survival in Denmark. Differences in Stage Distribution could arise because of differences in diagnostic delay and awareness of symptoms, or in the thoroughness of staging procedures. Nevertheless, survival differences also exist for each Stage of disease, suggesting unequal access to optimal treatment, particularly in the UK.
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breast cancer survival and Stage at diagnosis in australia canada denmark norway sweden and the uk 2000 2007 a population based study
British Journal of Cancer, 2013Co-Authors: Sarah Walters, Bernard Rachet, Camille Maringe, John Butler, Peter Barrettlee, Jonas Bergh, John Boyages, Peer Christiansen, M Lee, Fredrik WarnbergAbstract:Background: We investigate whether differences in breast cancer survival in six high-income countries can be explained by differences in Stage at diagnosis using routine data from population-based cancer registries. Methods: We analysed the data on 257 362 women diagnosed with breast cancer during 2000-7 and registered in 13 population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK. Flexible parametric hazard models were used to estimate net survival and the excess hazard of dying from breast cancer up to 3 years after diagnosis. Results: Age-standardised 3-year net survival was 87-89% in the UK and Denmark, and 91-94% in the other four countries. Stage at diagnosis was relatively advanced in Denmark: only 30% of women had Tumour, Nodes, Metastasis (TNM) Stage I disease, compared with 42-45% elsewhere. Women in the UK had low survival for TNM Stage III-IV disease compared with other countries. Conclusion: International differences in breast cancer survival are partly explained by differences in Stage at diagnosis, and partly by differences in Stage-specific survival. Low overall survival arises if the Stage Distribution is adverse (e. g. Denmark) but Stage-specific survival is normal; or if the Stage Distribution is typical but Stage-specific survival is low (e. g. UK). International differences in staging diagnostics and Stage-specific cancer therapies should be investigated.
M D Peake - One of the best experts on this subject based on the ideXlab platform.
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the beneficial effects of specialist thoracic surgery on the resection rate for non small cell lung cancer
Lung Cancer, 2004Co-Authors: Antonio E Martinucar, David A Waller, Jane L Atkins, Daniel E B Swinson, Kenneth J Obyrne, M D PeakeAbstract:We aimed to evaluate the effect of the appointment of a dedicated specialist thoracic surgeon on surgical practice for lung cancer previously served by cardio-thoracic surgeons. Outcomes were compared for the 240 patients undergoing surgical resection for lung cancer in two distinct 3-year periods: Group A: 65 patients, 1994-1996 (pre-specialist); Group B: 175 patients, 1997-1999 (post-specialist). The changes implemented resulted in a significant increase in resection rate (from 12.2 to 23.4%, P < 0.001), operations in the elderly (over 75 years) and extended resections. There were no significant differences in Stage Distribution, in-hospital mortality or Stage-specific survival after surgery. Lung cancer surgery provided by specialists within a multidisciplinary team resulted in increased surgical resection rates without compromising outcome. Our results strengthen the case for disease-specific specialists in the treatment of lung cancer.
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the beneficial effects of specialist thoracic surgery on the resection rate for non small cell lung cancer
Faculty of Health; Institute of Health and Biomedical Innovation, 2004Co-Authors: Antonio E Martinucar, David A Waller, Jane L Atkins, Daniel E B Swinson, Kenneth J Obyrne, M D PeakeAbstract:We aimed to evaluate the effect of the appointment of a dedicated specialist thoracic surgeon on surgical practice for lung cancer previously served by cardio-thoracic surgeons. Outcomes were compared for the 240 patients undergoing surgical resection for lung cancer in two distinct 3-year periods: Group A: 65 patients, 1994-1996 (pre-specialist); Group B: 175 patients, 1997-1999 (post-specialist). The changes implemented resulted in a significant increase in resection rate (from 12.2 to 23.4%, P<0.001), operations in the elderly (over 75 years) and extended resections. There were no significant differences in Stage Distribution, in-hospital mortality or Stage-specific survival after surgery. Lung cancer surgery provided by specialists within a multidisciplinary team resulted in increased surgical resection rates without compromising outcome. Our results strengthen the case for disease-specific specialists in the treatment of lung cancer. © 2004 Published by Elsevier Ireland Ltd.
Camille Maringe - One of the best experts on this subject based on the ideXlab platform.
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Stage at diagnosis and colorectal cancer survival in six high income countries a population based study of patients diagnosed during 2000 2007
Acta Oncologica, 2013Co-Authors: Camille Maringe, Bernard Rachet, Sarah Walters, John Butler, Tony Fields, P J Finan, Roy Maxwell, Bjorn S Nedrebo, Lars Pahlman, Annika SjovallAbstract:Background. Large international differences in colorectal cancer survival exist, even between countries with similar healthcare. We investigate the extent to which Stage at diagnosis explains these differences. Methods. Data from population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK were analysed for 313 852 patients diagnosed with colon or rectal cancer during 2000-2007. We compared the Distributions of Stage at diagnosis. We estimated both Stage-specific net survival and the excess hazard of death up to three years after diagnosis, using flexible parametric models on the log-cumulative excess hazard scale. Results. International differences in colon and rectal cancer Stage Distributions were wide: Denmark showed a Distribution skewed towards later-Stage disease, while Australia, Norway and the UK showed high proportions of 'regional' disease. One-year colon cancer survival was 67% in the UK and ranged between 71% (Denmark) and 80% (Australia and Sweden) elsewhere. For rectal cancer, one-year survival was also low in the UK (75%), compared to 79% in Denmark and 82-84% elsewhere. International survival differences were also evident for each Stage of disease, with the UK showing consistently lowest survival at one and three years. Conclusion. Differences in Stage at diagnosis partly explain international differences in colorectal cancer survival, with a more adverse Stage Distribution contributing to comparatively low survival in Denmark. Differences in Stage Distribution could arise because of differences in diagnostic delay and awareness of symptoms, or in the thoroughness of staging procedures. Nevertheless, survival differences also exist for each Stage of disease, suggesting unequal access to optimal treatment, particularly in the UK.
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breast cancer survival and Stage at diagnosis in australia canada denmark norway sweden and the uk 2000 2007 a population based study
British Journal of Cancer, 2013Co-Authors: Sarah Walters, Bernard Rachet, Camille Maringe, John Butler, Peter Barrettlee, Jonas Bergh, John Boyages, Peer Christiansen, M Lee, Fredrik WarnbergAbstract:Background: We investigate whether differences in breast cancer survival in six high-income countries can be explained by differences in Stage at diagnosis using routine data from population-based cancer registries. Methods: We analysed the data on 257 362 women diagnosed with breast cancer during 2000-7 and registered in 13 population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK. Flexible parametric hazard models were used to estimate net survival and the excess hazard of dying from breast cancer up to 3 years after diagnosis. Results: Age-standardised 3-year net survival was 87-89% in the UK and Denmark, and 91-94% in the other four countries. Stage at diagnosis was relatively advanced in Denmark: only 30% of women had Tumour, Nodes, Metastasis (TNM) Stage I disease, compared with 42-45% elsewhere. Women in the UK had low survival for TNM Stage III-IV disease compared with other countries. Conclusion: International differences in breast cancer survival are partly explained by differences in Stage at diagnosis, and partly by differences in Stage-specific survival. Low overall survival arises if the Stage Distribution is adverse (e. g. Denmark) but Stage-specific survival is normal; or if the Stage Distribution is typical but Stage-specific survival is low (e. g. UK). International differences in staging diagnostics and Stage-specific cancer therapies should be investigated.
Alberto Lopes - One of the best experts on this subject based on the ideXlab platform.
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sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer and Stage Distribution of detected cancers results of the prevalence screen of the uk collaborative trial of ovarian cancer screening ukctocs
Lancet Oncology, 2009Co-Authors: Usha Menon, Aleksandra Gentrymaharaj, Rachel Hallett, Andy Ryan, Matthew Burnell, Aarti Sharma, Sara Lewis, Susan Davies, Susan Philpott, Alberto LopesAbstract:Summary Background Ovarian cancer has a high case–fatality ratio, with most women not diagnosed until the disease is in its advanced Stages. The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) is a randomised controlled trial designed to assess the effect of screening on mortality. This report summarises the outcome of the prevalence (initial) screen in UKCTOCS. Methods Between 2001 and 2005, a total of 202 638 post-menopausal women aged 50–74 years were randomly assigned to no treatment (control; n=101 359); annual CA125 screening (interpreted using a risk of ovarian cancer algorithm) with transvaginal ultrasound scan as a second-line test (multimodal screening [MMS]; n=50 640); or annual screening with transvaginal ultrasound (USS; n=50 639) alone in a 2:1:1 ratio using a computer-generated random number algorithm. All women provided a blood sample at recruitment. Women randomised to the MMS group had their blood tested for CA125 and those randomised to the USS group were sent an appointment to attend for a transvaginal scan. Women with abnormal screens had repeat tests. Women with persistent abnormality on repeat screens underwent clinical evaluation and, where appropriate, surgery. This trial is registered as ISRCTN22488978 and with ClinicalTrials.gov, number NCT00058032. Findings In the prevalence screen, 50 078 (98·9%) women underwent MMS, and 48 230 (95·2%) underwent USS. The main reasons for withdrawal were death (two MMS, 28 USS), non-ovarian cancer or other disease (none MMS, 66 USS), removal of ovaries (five MMS, 29 USS), relocation (none MMS, 39 USS), failure to attend three appointments for the screen (72 MMS, 757 USS), and participant changing their mind (483 MMS, 1490 USS). Overall, 4355 of 50 078 (8.7%) women in the MMS group and 5779 of 48 230 (12·0%) women in the USS group required a repeat test, and 167 (0·3%) women in the MMS group and 1894 (3·9%) women in the USS group required clinical evaluation. 97 of 50 078 (0·2%) women from the MMS group and 845 of 48 230 (1·8%) from the USS group underwent surgery. 42 (MMS) and 45 (USS) primary ovarian and tubal cancers were detected, including 28 borderline tumours (eight MMS, 20 USS). 28 (16 MMS, 12 USS) of 58 (48·3%; 95% CI 35·0–61·8) of the invasive cancers were Stage I/II, with no difference (p=0·396) in Stage Distribution between the groups. A further 13 (five MMS, eight USS) women developed primary ovarian cancer during the year after the screen. The sensitivity, specificity, and positive-predictive values for all primary ovarian and tubal cancers were 89·4%, 99·8%, and 43·3% for MMS, and 84·9%, 98·2%, and 5·3% for USS, respectively. For primary invasive epithelial ovarian and tubal cancers, the sensitivity, specificity, and positive-predictive values were 89·5%, 99·8%, and 35·1% for MMS, and 75·0%, 98·2%, and 2·8% for USS, respectively. There was a significant difference in specificity (p Interpretation The sensitivity of the MMS and USS screening strategies is encouraging. Specificity was higher in the MMS than in the USS group, resulting in lower rates of repeat testing and surgery. This in part reflects the high prevalence of benign adnexal abnormalities and the more frequent detection of borderline tumours in the USS group. The prevalence screen has established that the screening strategies are feasible. The results of ongoing screening are awaited so that the effect of screening on mortality can be determined. Funding Medical Research Council, Cancer Research UK and the Department of Health, UK; with additional support from the Eve Appeal, Special Trustees of Bart's and the London, and Special Trustees of University College London Hospital.
