Y. Adachi

Proliferative activity as a prognostic factor in Borrmann type 4 gastric carcinoma.

Proliferative activities in 181 primary Borrmann type 4 gastric carcinomas were investigated using percentage labelling of proliferating cell nuclear antigen (PCNA) and an argyrophilic nucleolar organiser region (AgNOR) count. Tumours with a high proliferative activity often metastasised to lymph nodes (P < 0.01), and these patients had a lower survival rate (P < 0.05). A significant correlation was recognised between the PCNA labelling percentage and AgNOR count (r = 0.452, P < 0.001). Coxs regression analysis showed that PCNA labelling percentage is an independent prognostic factor. These results indicate that estimating proliferative activity may be useful in predicting lymph node metastasis and patients prognosis in cases of Borrmann type 4 gastric carcinoma.

Preoperative hyperthermia combined with chemotherapy and radiotherapy for patients with rectal carcinoma may prevent early local pelvic recurrence.

We examined retrospectively the results of hyperthermia combined with irradiation and chemotherapy (HCR) prescribed preoperatively for patients with adenocarcinoma of the rectum. We compared two groups of patients: Group A: 23 were treated surgically between 1986–1988 and received HCR therapy; group B (controls) 48 were treated with surgery alone or surgery plus chemotherapy from 1980–1985. The recurrence rate within 2 years was compared. Although there was a difference in follow-up time, the two groups were comparable with regard to various prognostic factors. The incidences of local recurrence and of lung metastasis were nil in those given the HCR therapy. In group B, however, the incidences were 15% and 10%, respectively. These differences were statistically significant (P<0.05). The incidence of liver metastasis was much the same between the two groups. All patients tolerated the HCR therapy well except for one with myelosuppression and who refused local hyperthermia because of mild anal pain. There were no other side effects requiring cessation of this treatment. These findings suggest that preoperative HCR therapy for patients with rectal carcinoma decreases the frequency of local recurrence and the likelihood of tumour cell spread during surgical procedures.RésuméNous avons examiné rétrospectivement les résultats de lhypothermie combinée à lirradiation et à la chimiothérapie (HCR) préopératoire chez des malades présentant un adénocarcinome du rectum. Nous avons comparé deux groupes de patients: groupe A 23 malades ont été traités chirurgicalement entre 1986 et 1988 et ont reçu HCR; groupe B (contrôle) 48 malades ont été traités avec la chirurgie seule ou la chirurgie plus chimiothérapie entre 1980 et 1985. Les taux de récidives dans les 2 ans ont été comparés. Bien quil y ait eu une différence dans le temps de suivi, les deux groupes étaient comparables en ce qui concerne les facteurs pronostics variés. Les incidences de récidives locales et de métastases pulmonaires étaient nulles dans le groupe ayant reçu HCR. Dans le groupe B, par contre, les incidences étaient respectivement de 14.6% et de 10.4%. Ces différences étaient statistiquement significatives (P<0.05). Lincidence de métastases hépatiques était la même dans les deux groupes. Tous les patients ont bien toléré HCR excepté un avec myelosuppression et qui a refusé lhyperthemie locale en raison dune douleur anale modérée. Il ny a pas eu dautre effet secondaire nécessitant larrêt du traitement. Ces résultats suggèrent que HCR pré=opératoire chez les patients ayant un cancer du rectum diminue la fréquence des récidives locales et la possibilité de dissémination de cellules tumorales durant lacte chirurgical.

Malignant lymphoma of the rectum treated preoperatively with hyperthermia and radiation

A 58-year-old Japanese woman with primary malignant lymphoma of the rectum was treated preoperatively with radiation and intraluminal hyperthermia, after which abdominoperineal rectal amputation (Miles operation) was done. The rectal tumor disappeared and there were no lymphoma cells in the resected specimens. The postoperative course was smooth and she is being followed in the outpatient department. At this writing, five years after the surgery, she remains well.