P. C. Giulianotti

Intrahepatic chemotherapy with floxuridine, leucovorin and dexamethasone in continuous infusion and mitomycin-C bolus in unresectable hepatic metastases from colorectal cancer: A phase II study

Background Intrahepatic continuous infusion FUDR induces a 50% response rate in patients with hepatic metastases from colorectal cancer. Lower rates have been observed in pretreated patients. The combination of floxuridine plus leucovorin has obtained over 70% responses, with high hepatic toxicity. The use of dexamethasone can decrease hepatic toxicity. A randomized study reported an increase in response rate and a decrease in hepatic toxicity in a group of patients treated with floxuridine plus dexamethasone compared to a group receiving only floxuridine. Moreover, the combination of mitomycin C, carmustine and floxuridine is also effective in pretreated patients. Methods On such premises, since July 1993 we have treated 39 patients affected by unresectable hepatic metastases from colon carcinoma (26 patients) and rectal carcinoma (13 patients) with the combination continuous infusion of floxuridine (0.20 mg/kg per day) + leucovorin (7.5 mg/m2/day) + dexamethasone (20 mg on days 1 to 14) and bolus mitomycin C (10 mg/m2 on day 1) via the hepatic artery. Cycles were administered every four weeks. There were as 28 males and 11 females, with a median age of 64 years (range, 39-75) and a median PS = 0. Twenty-two patients were pretreated with systemic chemotherapy including 5-fluorouracil plus leucovorin. Total number of cycles was 189, with a median of 6 cycles per patient (range, 1-12). Results Of 39 patients 37 were assessable for response (2 patients were not assessable because they stopped chemotherapy for occlusion of the catheter after the first cycle). There were 3 complete responses (1 in a naive patient and 2 in pretreated patients), 16 partial responses (11 in pretreated patients and 5 in chemonaive patients), 4 minor responses, 4 stable disease and 10 progressive disease. The overall response rate was 51.3% (95 CI, 51.3-86.7%). Median time to progression was 6 months (range, 1-34+). Overall survival was 18 months (range, 1-34+). Of 39 patients, 36 were assessable for toxicity (WHO) (3 patients died after the first cycle for progression of disease): diarrhea and nausea-vomiting grade 3-4 occurred respectively in 15 (41%) and 3 patients (8%); hepatic toxicity was mild. Conclusions The treatment we used showed an elevated activity in liver metastases from colorectal cancer even in patients pretreated and resistant to systemic chemotherapy, although toxicity grade 3-4 diarrhea occurred in approximately 40% of the patients.

Abdominal aortic aneurysms: Efficacy of sonography for preoperative assessment

Abstract Objective: To investigate the efficacy of sonography for preoperative assessment of abdominal aortic aneurysms. Methods: A series of 101 consecutive patients with abdominal aortic aneurysm who were scheduled for elective surgery were prospectively examined with sonography before the operation. The operators were blinded to the results of previous imaging examinations. Findings at sonography were correlated with findings at laparotomy. Results: The aneurysm was correctly identified in all of 101 patients. The mean difference between sonographic and surgical measurements of the maximum diameter of the aneurysm was 0.5 cm. The right and the left renal arteries were identified in 65/101 patients and 68/100 patients,-respectively (one patient had previously undergone left nephrectomy). The left renal vein was found by the surgeon in the anteaortic position in 94 cases and in the retroaortic route in 6. The sensitivity and the specificity of sonography in recognizing the retroaortic location of the left renal vein were 60% and 100%, respectively. In 92/101 cases (91%) the supra-, juxta- or infrarenal location of the aneurysm was correctly evaluated with sonography. Sonography correctly identified the inflammatory nature of the aneurysm in 9 of 13 cases; two false positive diagnoses of inflammatory aneurysm were made (sensitivity, 69%; specificity, 98%). The sensitivity and specificity of sonography in demonstrating the presence of associated iliac artery aneurysms were 83%, and 97%, respectively. Conclusion: Ultrasonography provides a reliable preoperative assessment of abdominal aortic aneurysms.