http://repub.eur.nl/res/aut/7550/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/19315/ 2010-01-01T00:00:00Z Doel: Evaluatie van de mate waarin de in 2005 herziene behandelingsrichtlijn voor het melanoom werd gevolgd en de aandachtspunten van de vorige richtlijnevaluatie (in 2001) werden geïmplementeerd. Opzet & Methode: Retrospectief observationeel cohortonderzoek. De evaluatie werd uitgevoerd met gegevens uit de pathologieverslagen van patiënten die in de periode 1 april-30 september 2007 gediagnosticeerd werden met een melanoom van de huid in de ziekenhuizen in de regio’s van het Integraal Kankercentrum Zuid (IKZ) en het Integraal Kankercentrum West (IKW). Resultaten: Voor 85% van de patiënten werd het melanoom conform de richtlijn in twee sessies behandeld met een diagnostische excisie gevolgd door een therapeutische re-excisie. Voor melanoma in situ was dit cijfer 69% en voor invasief melanoom 87%; de andere patiënten werden in één sessie behandeld. In de pathologieverslagen van de patiënten met een invasief melanoom werd de marge van de diagnostische excisie voor 64%, de breslow-dikte voor 97% en de aan- of afwezigheid van ulceratie voor 77% vastgelegd. In de IKW-regio werd de marge van re-excisie nagegaan: bij 86% van de patiënten met een invasief melanoom voldeed deze marge aan de richtlijn. Conclusie: Ten opzichte van de vorige richtlijnevaluatie in 2001 was het excisiebeleid verbeterd. Verbetering van de rapportage van de excisiemarge en van de aan- of afwezigheid van ulceratie in het pathologieverslag verdient aanbeveling. http://repub.eur.nl/res/pub/15401/ 2003-01-01T00:00:00Z This article addresses the question why in the Netherlands it was the orthodox protestants who were able to mobilize the masses and not, the political establishment of liberals and enlightened protestants during the latter part of the nineteenth century. The biblical rhetoric of their leader Abraham Kuyper reflects the lack of a tradition of popular political participation until late in the nineteenth century in the Netherlands. In contrast, the liberal language of his Victorian counterpart Gladstone, whose evangelical creed was equally orthodox, was marked by the absence of biblical drama. The familiarity of the masses with the moral rationalism of political liberalism is related to a longer tradition of political participation and agitation among working men and the power of popular liberalism in general, in England during the nineteenth century. http://repub.eur.nl/res/pub/8640/ 1996-01-01T00:00:00Z OBJECTIVE: The objective of the study was to achieve limb salvage in patients with locally advanced soft tissue sarcomas that can only be treated by amputation or functionally mutilating surgery by performing an isolated limb perfusion (ILP) with tumor necrosis factor (TNF) + melphalan (M) as induction biochemotherapy to obtain local control and make limb-sparing surgery possible. SUMMARY BACKGROUND DATA: To increase the number of limb-sparing resections in the treatment of locally advanced extremity soft tissue sarcoma, preoperative radiation therapy or chemotherapy or a combination of the two often are applied. The ILP with cytostatic agents alone is another option but rarely is used because of rather poor results. The efficacy of the application of TNF in ILP markedly has changed this situation. METHODS: In 8 cancer centers, 186 patients were treated over a period of almost 4.5 years. There were 107 (57%) primary and 79 (43%) recurrent sarcomas, mostly high grade (110 grade III; 51 grade II; and 25 very large, recurrent, or multiple grade I sarcomas). The composition of this series of patients is unusual: 42 patients (23%) had multifocal primary or multiple recurrent tumors; median tumor size was very large (16 cm); 25 patients (13%) had known systemic metastases at the time of the ILP. Patients underwent a 90-minute ILP at 39 to 40 C with TNF + melphalan. The first 55 patients also received interferon-tau. A delayed marginal resection of the tumor remnant was done 2 to 4 months after ILP. RESULTS: A major tumor response was seen in 82% of the patients rendering these large sarcomas resectable in most cases. Clinical response rates were: 33 complete response (CR) (18%), 106 partial response (PR) (57%), 42 no change (NC) (22%), and 5 progressive disease (PD) (3%). Final outcome was defined by clinical and pathologic response: 54 CR (29%), 99 PR (53%), 29 NC (16%), and 4 PD (2%). At a median follow-up of almost 2 years (22 months; range, 6-58 months), limb salvage was achieved in 82%. Regional toxicity was limited and systemic toxicity minimal to moderate, easily managed, with no toxic deaths. CONCLUSIONS: In the setting of isolated limb perfusion, TNF is an active anticancer drug in patients. The ILP with TNF + melphalan can be performed safely in many centers and is an effective induction treatment with a high response rate that can achieve limb salvage in patients with locally advanced extremity soft tissue sarcoma.