A randomized trial of cisplatin, etoposide and bleomycin (PEB) versus carboplatin, etoposide and bleomycin (CEB) for patients with 'good-risk' metastatic non-seminomatous germ cell tumors

BACKGROUND: Cisplatin-based combination chemotherapy will cure 70% to 80% of patients with metastatic non-seminomatous germ cell tumors but is associated with the possibility of severe neuro-, oto- and nephro-toxicities. Carboplatin, a cisplatin analogue, is an active drug in testicular cancer with a more favourable spectrum of side effects. In a randomized trial, the German Testicular Cancer Study Group compared a combination regimen of carboplatin, etoposide and bleomycin (CEB) to standard cisplatin, etoposide and bleomycin (PEB) chemotherapy for patients with 'minimal-' and moderate-disease' non-seminomatous germ cell tumors, according to the Indiana University classification. PATIENTS AND METHODS: PEB was given for three cycles at standard doses (given days 1-5), and the CEB regimen consisted of carboplatin (target AUC of 5 mg/ml x min) on day 1, etoposide 120 mg/m2 on days 1 to 3 and bleomycin 30 mg on days 1, 8 and 15. Four cycles of CEB were given, with the omission of bleomycin in the fourth cycle. Thus, the cumulative doses of etoposide and bleomycin applied in the two treatment arms were comparable. Fifty-four patients were entered on the trial, 29 were treated with PEB and 25 with CEB chemotherapy. Patients were stratified according to disease extent (minimal versus moderate) and the degree of tumor marker elevation. Thirty-two patients (59%) belonged to the group with minimal disease and low markers. RESULTS: No significant difference in response to chemotherapy was seen between the two arms, with CR rates of 81% for the PEB arm and 76% for CEB treatment. However, more patients treated with CEB (32% versus 13%) have relapsed after therapy, and 4 patients (16%) have died of disease progression after CEP in contrast to 1 (3%) after PEB therapy. The first interim analysis of negative events (relapse, vital tumor at secondary resection, death from disease and therapy-associated death) showed a significantly higher rate after CEB than after PEB therapy, and the trial was terminated early. After a median follow-up of 33 months for all patients, the calculation of negative events is still significantly in favour of PEB-treated patient, particularly since three late relapses > 2 years have been observed in the CEB arm (P = 0.03). CONCLUSION: This randomized trial demonstrates that even with the use of adequate doses of etoposide and full-dose bleomycin, carboplatin cannot altogether replace cisplatin in patients with testicular cancer. Treatment with the PEB regimen remains the standard approach in patients with 'good-risk' non-seminomatous germ cell tumors.     

Algorithmen zur Pulsweitenmodulation für Wechselrichter mit in Echtzeit berechnetem Pulsmuster

Übersicht Mit Hinblick auf die zunehmend Verbreitung findende Pulsmusterberechnung in Echtzeit werden in dem Aufsatz Gesichtspunkte diskutiert, die sich aus den Eigenschaften des leistungselektronischen Stellgliedes, des Pulswechselrichters, ergeben. Die bei Abtastregelungen für die Dauer einer Abtastperiode konstante Stellgröße muß bei ihm durch Pulsweitenmodulation in ein Pulsmuster mit konstanter Amplitude und Pulsen variabler Breite umgesetzt werden. Durch ein neues Verfahren mit versetzter Abtastung haben dabei Rechentotzeiten bis zur Dauer einer halben Abtastperiode keinen Einfluß mehr auf das Pulsmuster.

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Algorithms for pulswidth modulation of inverters with online calculated pulse patterns

Contents Online calculation of pulse patterns will be employed more intensively in the future. Aspects concerning the powereleotronic circuit, the pulsewidth-modulated inverter, are to be discussed. The set value being constant for the duration of a sampling interval, has to be converted by a modulation algorithm into a pulse pattern with constant amplitude and pulses of variable width. Calculation dead-times up to half of sampling interval have no influence on the pulse pattern when using a new algorthm with shifted sampling instants.

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Herrn Prof. Dr.-Ing. Klemens Heumann zum 60. Geburtstag gewidmet     

Initial Stages in the Metal-dusting Process on Alloy 800

The initial stages of the metal-dusting process on Alloy 800 at 620 °C were investigated by light optical microscopy, RAMAN spectroscopy, atomic-force microscopy, Auger electron spectroscopy, transmission-electron microscopy and electron back-scatter diffraction. As it turned out the incubation period for metal-dusting is characterized by simultaneous formation of a heterogeneously growing oxide scale and deposition of carbon. The material surface shows different tarnish colors depending on the substrate-grain orientation with different susceptibility to the beginning of metal-dusting attack. “Low-index” grains were not attacked within the times investigated while the other grain orientations showed pitting. Carbon is evidently incorporated into the oxide scale from the very beginning of exposure with different intensities depending on the underlying substrate-grain orientation leading to differences in the tarnish colors. As a consequence carbides are formed even underneath “dense” oxide layers. Evidently metal-dusting attack starts at positions of the oxide scale where “higher carbon concentrations” are present.