Melvin L. Reed

Comparison of continuously infused 5-fluorouracil with bolus injection in treatment of patients with colorectal adenocarcinoma.

In a randomized series of 70 patients with with colo rectal adenocarcinoma, a comparison of systemic 5‐fluorouracil chemotherapy administered as a continuous 120‐hours infusion vs. intravenous bolus injection daily for 5 days demonstrated superiority of prolonged intravenous infusion. The most striking advantage of prolonged infusion of 5‐FU was the absence of myelotoxicity. Fifteen of the 34 patients treated with infusion and 8 of the 36 patients treated by bolus injection developed objective tumor responses. The difference in response rate at least in part is explainable by unequal distribution of patients with different characteristics between the two treatment groups.

The practicality of chronic hepatic artery infusion therapy of primary and metastatic hepatic malignancies: Ten‐year results of 124 patients in a prospective protocol

Ten‐year results are presented of 124 patients with malignancy apparently limited to the distribution of the hepatic artery, treated by prospective protocol with continuous infusion of 5‐FUdR through an hepatic artery catheter. Nearly all patients had moderate to massive hepatic replacement. Of 88 patients with colorectal carcinoma, 64 (73%) had clinically significant objective and subjective remission. Median survival for responders was 13 months; for the entire group, ten months. Of 13 patients with hepatoma, nine had clinically significant regression with a median survival of 11 months. Ten patients had carcinoma of the gall bladder or bile duct with seven obtaining clinically significant regression. Complications encountered are discussed and are similar to other series. Of the patients experiencing clinically significant remission, all but one reached the complete independence performance status, and 84% reached normal activity levels. Thus, for hepatic localized tumor, this therapy is worthwhile and practical.

Chemotherapy for nasopharyngeal carcinoma a ten‐year experience

Seventeen patients, 14 after radiation therapy relapse, with measurable nasopharyngeal carcinoma were treated with chemotherapy. Remissions were observed in 9 of 17 (53%) with 3 complete (CR) and 6 partial responses (PR). Five (2 CR + 3 PR) of seven patients with lymphoepithelioma achieved remission, 4 (1 CR + 3 PR) of 8 with keratinizing squamous cell carcinoma, and 2 progressions with transitional cell carcinoma. Complete remissions were only achieved with CDDP‐based combinations, with 2 of the 3 CR rendered histologically free of disease at the time of repeat biopsy of the tumor bed. Nasopharyngeal carcinoma is responsive to chemotherapy, even after radiation therapy relapse. The most effective chemotherapy combinations contain CDDP. Histologic differentiation did not appear to influence the frequency of remissions.

Evaluation of combination vs. sequential cytotoxic chemotherapy in the treatment of advanced breast cancer

Combination chemotherapy has been used in the treatment of acute leukemia, malignant lymphoma, and, more recently, solid tumors. This study was designed to randomize between combination 5‐fluorouracil (5‐FU) cyclophosphamide, and vincristine sulfate, vs. sequential use of these drugs in patients with breast carcinoma. Forty‐six patients received 5‐FU 7.5 nig/kg, cyclophosphamide 4 mg/kg daily for 5 days, and vincristine sulfate 0.015 mg/kg on days 1 and 8, repeated monthly. Thirty patients received a single drug in full dose (5‐FU 15 mg/kg, cyclophosphamide 8 mg/kg daily for 5 days in monthly course, or vincristine sulfate.02 mg/kg weekly). The design was such that if the patients tumor failed to respond to the single agent, the subsequent drug was used. In the combination group, 20 (43.5%) had objective responses. The mean survival of the combination group was 8.6 months. Sixteen of the 30 patients (53.3%) receiving sequential therapy responded to one or more of the three drugs. Mean survival of this group was 10.2 months. Evaluation of the drug toxicity between sequential vs. combined therapy revealed three drug‐related deaths in the patients treated with 5‐fluorouracil alone, with one death in the combination‐treated group. Statistical analysis showed no significant difference in tumor response or patient survival between patients treated with these three drugs used in sequence or in combination.

Hypercalcemia in head and neck carcinoma incidence and prognosis

A retrospective review of all head and neck cancers seen between January 1, 1975, and September 1, 1981, at Harper‐Grace Hospitals, Detroit, Michigan, was performed. Of 1438 patients with head and neck cancers, 41 (2.9%) had hypercalcemia (calcium > 11.0 mg%) during the course of their disease. The incidence of hypercalcemia by site was 13 of 351 (3.7%) larynx, 7/280 (2.5%) pharynx, 19/733 (2.6%) oral cavity (floor of mouth 4/171, tongue 9/209, tonsil 5/176, palate 1/95, other 0/82, 2/26 (7.7%) nasal cavity, and 0/48 salivary gland carcinomas. Chest radiograph results were positive for mass lesions in 17/35 (49%). Bone scans and/or x‐ray results were positive in 15/31 (48%), negative in 16/31 (52%), and were not evaluated in 10 patients. Of five patients tested, all had inappropriately elevated serum parathyroid hormone (PTH) for their serum calcium level. The hypercalcemia was medically treated in 29/41 (70%), with return‐to‐normal calcium levels in 17/29 (59%). Twelve patients (30%) received only terminal care. Survival from the diagnosis of hypercalcemia ranged from 1 to 514+ days (mean, 80+ days; median 33 days). It is concluded that hypercalcemia is unusual in head and neck carcinoma. Furthermore, hypercalcemia frequently is a late manifestation and terminal event. Finally, hypercalcemia in some patients may be mediated by PTH production. Cancer 52:2261‐2263, 1983.

Treatment of Disseminated Carcinoid Tumors Including Hepatic-Artery Catheterization

HEPATIC-artery catheterization by way of the brachial artery for the treatment of malignant lesions in the liver has recently been revived and expanded.1 We have had the opportunity to utilize this...

Combined 5-FIuorouracil and Vinblastine Therapy for Gastrointestinal and other Solid Tumors

75 patients with various solid tumors treated with combined 5-fiuorouracil (5-FU) and Velban, were compared to those patients treated with 5-FU or Velban alone. Drug toxicities caused by the combined