Irving M. Ariel

TREATMENT OF INOPERABLE PRIMARY PANCREATIC AND LIVER CANCER BY THE INTRA-ARTERIAL ADMINISTRATION OF RADIOACTIVE ISOTOPES (Y90 RADIATING MICROSPHERES).

Treatment of Inoperable Primary Pancreatic and Liver Cancer by the Intra-Arterial Administration of Radioactive Isotopes (Y Radiating Microspheres) Irving Ariel; Annals of Surgery

TREATMENT OF INOPERABLE CANCER OF THE LIVER BY INTRA-ARTERIAL RADIOACTIVE ISOTOPES AND CHEMOTHERAPY.

One hundred eighteen patients were treated. Of 22 patients given cancer chemotherapeutic drugs alone (methotrexate and 5‐FU), 27% showed objective responses and 59% subjective responses; the average duration of life was 3.9 months. Of 37 patients treated with radioactive isotopes alone (90Y radiating microspheres), objective responses were observed in 32% and subjective responses in 54%; the average duration of life was 4.6 months, 4 patients still are alive at 4 to 18 months. Of 59 patients treated by a combination of cancer chemotherapy and 90Y microspheres, 47% showed objective responses and 61% subjective responses; the average duration of life was 5.6 months and 4 patients still are alive at 5 to 36 months. In the selection of suitable patients for treatment, hepatic gammascanning has been useful, particularly the combined scans utilizing 131iodine rose bengal and 198gold, for determining the gross anatomic extent of cancerous hepatic involvement and the status of the noninvolved hepatic parenchyma.

Intracavitary administration of radioactive isotopes in the control of effusions due to cancer: Results in 267 patients

This presents a series of 267 patients given a total of 325 treatments of radioactive isotopes administered intracavum in the control of ascites and hydrothorax. The following radioactive isotopes were employed: Radioactive gold (Au198), radioactive chromic phosphate (CrP32O4), radioactive AU198 and CrP32O4 in combination and radioactive yttrium (Y90). The intracavitary instillation of radioactive Au198 and/or CrP32O4 afforded 54% of patients some degree of salutary benefit. Of 99 patients with hydrothorax 5.0% had an excellent response to treatment and 24% a good response; pleural effusion from a primary cancer of the breast, lung and lymphoma showed the most satisfactory response. Of 145 patients with cancerous ascites, 54% received benefit, 12% showing excellent response and 19% showing good response; ascites due to a primary cancer in the female genital tract (especially the ovary), the gastrointestinal tract and the lymphomas enjoyed the best palliation. Cancerous effusion carries an ominous prognosis; the average duration of life in our treated series was 6.3 months. In contrast, patients with effusion due to lymphoma survived an average period of 15 months. In half the patients treated, an undetermined restraint in fluid formation was noted with a probable resultant indeterminate prolongation of life. Complications were minimal.

Malignant melanoma of the trunk: A Retrospective review of 1128 patiens

Of 3,305 patients with malignant melanoma seen at the Pack Medical Group, New York, during the period from 1935–1975, there were 1,128 (34%) melanomas of the trunk. There were 646 melanomas of the skin of the chest wall (20% of all melanomas) and 482 melanomas of the abdominal wall (15%). Of 646 patients treated more than ten years ago, 138 were indeterminate as they were seen only in consultation or with evidence of blood‐borne disseminated melanoma. Of the determinate 516 patients, 148 are free of evidence of melanoma after ten years, giving an absolute ten‐year survival rate of 29%. All patients who died or who were lost to followup were considered to have died from the melanoma. Of 386 patients with melanoma of the thoracic wall, 296 were determinate, of which 88 (30%) have survived the ten‐year period. Of the 260 patients with melanoma of the abdominal wall, 220 were determinate and 60 (27%) are alive and well ten years post treatment. Of 340 males, 74 survived the ten‐year period (22%), much lower than the 32% ten‐year survival of the 148 females. A preceding mole which existed in 254 patients resulted in a ten‐year survival rate of 45%, much higher than the 116 patients whose moles arose de novo, of which 27% survived the ten year period. Of fifty patients with superficial melanomas, 34 (68%) survived ten years. The ten‐year survival of 386 patients with infiltrating melanomas was 22%. The ten‐year survival for patients in Stage I was 59%. Of 262 patients in Stage II, the ten‐year survival rate decreased to 14% and for the 60 patients in Stage III, the ten‐year survival rate was 7%. The situation was the same for melanomas of the chest wall as well as for the abdominal wall. Elective node dissection was performed in 122 patients with Stage I melanoma and in 42 (34%), microscopic evidence of melanoma was observed. The ten‐year survival of patients with positive nodes was 38%. In 62 patients, no elective node dissection was performed and in 26 (42%), clinical evidence of metastases developed later. Of these, six (23%) survived the ten year period after a therapeutic lymph node dissection. We conclude that melanomas over 1 ml in depth (Breslows classification), or Levels III, IV and V in Clark‐Mihms classification, elective regional lymph node dissection is warranted. Further studies are necessary to determine the exact treatment procedures for the superficial (Level II) melanomas. Level I melanomas should not be included in a report of metastasizing malignant melanoma.

Hepatic gammascanning: An aid in determining treatment policies for cancer involving the liver☆

In the preparation for surgery of a patient with intra-abdominal cancer, the surgeon is concerned with the possibility of metastasis being present within the liver. If present, the extent of the metastasis is important in order to determine the proper treatment policies. For the same reason, if one is dealing with cancer of the liver it is important to know whether one or more lobes are involved.

METABOLIC STUDIES IN PATIENTS WITH CANCER OF THE GASTROINTESTINAL TRACT. VIII. THE CHEMICAL COMPOSITION OF THE LIVER, ESPECIALLY IN PATIENTS WITH GASTROINTESTINAL CANCER

Excerpt INTRODUCTION Previous studies from this hospital have demonstrated that patients with gastrointestinal cancer frequently have several abnormalities of hepatic function.1, 2The existence of ...

Metabolic Studies in Patients with Cancer of the Gastro-Intestinal Tract. XX. Lipotropic Properties of Protein.∗

Conclusions 1. Patients with gastrointestinal cancer fed protein-rich diets pre operatively do not have fatty infiltration of the liver at laparotomy. 2. Patients with gastro-intestinal cancer who ingested 75 g of amino acid mixture during the 10 hours before operation were found at laparotomy to have concentrations of fat as abnormally high as those of fasted patients.

METABOLIC STUDIES IN PATIENTS WITH CANCER OF THE GASTROINTESTINAL TRACT. IX. EFFECTS OF DIETARY CONSTITUENTS UPON THE CHEMICAL COMPOSITION OF THE LIVER, ESPECIALLY IN PATIENTS WITH GASTROINTESTINAL CANCER

Excerpt INTRODUCTION In a previous investigation the livers of patients with gastrointestinal cancer were found to have abnormally high concentrations of fat and probably low concentrations of glyc...