4 research outputs found
Cancer, cytokines and the acute phase response
During isolated limb perfusion with TNFα and melphalan, patients are exposed to high
concentrations of these drugs in the perfused limb and low concentrations in the systemic
circulation. The clinical application of this technique, in the treatment of locally advanced
melanoma and sarcoma, made it possible to study the immunomodulatory effects of
exposure to TNFa and melphalan in man. Effects of longterm exposure to cytokines
were investigated in mesothelioma-patients treated with intrapleural TNFα and
melanoma-patients treated with subcutaneous IFN
Intrapleural administration of tumour necrosis factor alpha (TNFα) in patients with mesothelioma: Cytokine patterns and acute-phase protein response
Systemic toxicity and cytokine/acute phase protein levels in patients after isolated limb perfusion with tumor necrosis factor-alpha complicated by high leakage
BACKGROUND: Since the introduction of high-dose tumor necrosis
factor-alpha (TNFalpha) in the setting of isolated limb perfusion (ILP) in
the clinic, prevention of leakage to the body of the patient is monitored
with great precision for fear of TNF-mediated toxicity. That we observed
remarkably little toxicity in patients with and without leakage prompted
us to determine patterns of cytokines and acute phase proteins in patients
with high leakage and in patients without any leakage. METHODS: TNFalpha,
interleukin (IL)-6, IL-8, C-reactive protein, and secretory
(s)-phospholipase A2 were measured at several time points during and after
(until 7 days) ILP in 10 patients with a leakage to the systemic
circulation varying in percentage from 12% to 65%. As a control, the same
measurements, both in peripheral blood and in perfusate, were performed in
nine patients without systemic leakage. RESULTS: In patients with systemic
leakage, levels of TNFalpha increased during ILP, reaching values to 277
ng/ml. IL-6 and IL-8 peaked 3 hours after ILP with values significantly
higher compared with patients without systemic leakage. C-reactive protein
and s-phospholipase A2 peaked at day 1 in both patient groups,
s-phospholipase A2 with significant higher levels and C-reactive protein,
in contrast, with lower levels in the leakage patients. CONCLUSIONS: High
leakage of TNFalpha to the systemic circulation, caused by a complicated
ILP, led to 10-fold to more than 100-fold increased levels of TNFalpha,
IL-6, and IL-8 in comparison with patients without leakage. The increase
of the acute phase proteins was limited. Even when high leakage occurs,
this procedure should not
Clinical auditing as an instrument to improve care for patients with ovarian cancer: The Dutch Gynecological Oncology Audit (DGOA)
Introduction: The Dutch Gynecological Oncology Audit (DGOA) was initiated in 2014 to serve as a nationwide audit, which registers the four most prevalent gynecological malignancies. This study presents the first results of clinical auditing for ovarian cancer in the Netherlands. Methods: The Dutch Gynecological Oncology Audit is facilitated by the Dutch Institute of Clinical Auditing (DICA) an