| Autor: |
K Fotherby, R A Sellwood, Ian Burn |
| Rok vydání: |
1974 |
| Předmět: |
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| Zdroj: |
Proceedings of the Royal Society of Medicine. 67:854-857 |
| ISSN: |
0035-9157 |
| Popis: |
In a few patients most notably those with cancer of the breast remarkable remissions may take place when the endocrine environment is altered by administration of hormones or ablation of endocrine glands. These last for 18 months to 2 years only. Androgens estrogens progestogens and corticosteroids have been used for this purpose. Removal of the ovaries adrenals and pituitary have been done. Radiotherapy and cytotoxic drugs may have some part. A rational plan of management is described. Usually ablative operations have been reserved until last. Some early pituitary ablations were done by insertion of rods of radioactive yttrium-90 into the gland under X-ray control. Bilateral oophorectomies were done for some premenopausal women. When patients failed to respond or when the disease later progressed a course of fluoxymesterone was given. When this was ineffective late ablation of the pituitary was carried out. In postmenopausal women stilbestrol or ethinyl estradiol was first given followed by fluoxymesterone. Eventually pituitary ablation was used. The choice of treatment did not influence the response. Of 54 treated by early pituitary ablation 13 (22%) responded. Of 54 treated by late pituitary ablation 15 (27%) responded. Of 47 postmenopausal patients treated by early pituitary ablation 9 (19%) responded and of 47 first treated with stilbestrol 13 (27%) responded to the estrogen. The survival curve of the group treated by early ablation was similar to that for the group treated by late ablation. It is concluded that no advantage is gained by early ablation of the pituitary and in postmenopausal women estrogens are as effective as pituitary ablation. A maximum of 27% of responses was obtained by any method. Prediction of those likely to respond has been related to relative amounts of steroids in the urine of patients. Relatively high 11-deoxy-17-oxosteroids and low 17-hydroxysteroids were favorable for a good response. A modified simple method of Guys discriminant the Hammersmith discriminant for making the deteriminations is described. Those with unfavorable findings and other factors such as a short free interval or less than 5 years postmenopausal should be spared ablative surgery. The survival time of patients responding was longer than that of the others. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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