The effectiveness of adjuvant intraperitoneal hyperthermic chemoperfusion after cytoreductive surgery in locally advanced gastric cancer

BACKGROUND: Intraperitoneal hyperthermic chemoperfusion (IHCP), which is a locoregional treatment used in peritoneal micrometastases in intra-abdominal tumours was first applied in 1980, and since then it has been used as an adjuvant treatment in locally advanced tumours and as palliation in inoperable tumours, especially in tumours of genital and gastrointestinal system origin. AIM: In this study the effectiveness of adjuvant IHCP in treating gastric cancer with serosal invasion after curative surgery was investigated. SETTING AND DESIGN: This study was designed in the Department of General Surgery in the Ankara Oncology Hospital. IHCP was done immediately after cytoreductive surgery. METHODS: After cytoreductive surgery in 10 patients with locally advanced gastric cancer, two drains were placed into the peritoneal cavity and after the closure of the wound, IHCP was done with 10mg/L mitomycin-C at 42\ub0C for 60-90 minutes. RESULTS: No systemic and local complications were seen after perfusion except atelectasis in one patient. Local recurrence and metastatic tumour at the porta hepatis was seen in one patient each, hepatic metastases in five patients, and one patient died from myocardial infarction. The survival analysis was done with Kaplan-Meier method and the 1, 2, and 5-year overall and disease-free survival rates were 80, 70, 40% and 90, 60, 30% respectively. CONCLUSION: Although this study was conducted for a small number of patients it appears that IHCP can be used safely in the adjuvant locoregional treatment of gastric cancer

Temporal variation in the recovery from impairment in adriamycin-induced wound healing in rats

<p>Abstract</p> <p>Background</p> <p>An adriamycin-induced impairment of wound healing has been demonstrated experimentally in rats. The purpose of this study is to investigate a possible temporal variation in recovery from the impairment of wound healing caused by adriamycin administration.</p> <p>Methods</p> <p>The subjects were 120 female Spraque-Dawley rats. They were divided into eight groups, undergoing adriamycin administration (8 mg/kg, i.v.) at 9 a.m. or 9 p.m. on day 0 and laparotomy on day 0, 7, 14 or 21. Blast pressures were recorded after the incision line had been opened, and tissue samples were kept at -30°C for later measurement of hydroxyproline levels.</p> <p>Results</p> <p>Adriamycin treatment in rats at 9 p.m. resulted in significantly lower blast pressure levels than treatment at 9 a.m. between days 7 and 21, indicating a lag effect of healing time in wounded tissues. However the decreased hydroxyproline levels were not changed at these days and sessions.</p> <p>Conclusion</p> <p>It is concluded that adriamycin-induced impairment of wound healing in adult female rats exhibits nycthemeral variation.</p

Locally applied molgramostim improves wound healing at colonic anastomoses in rats after ligation of the common bile duct

Background: Several systemic factors, including jaundice, long-term corticosteroid therapy, diabetes and malnutrition, increase the risk of anastomotic dehiscence. The local application of molgramostim (recombinant human granulocyte-macrophage colony stimulating factor) has been reported to improve impaired dermal wound healing. Since jaundice, one of the systemic risk factors for anastomotic dehiscence, causes significant impairment of anastomotic healing, we hypothesized that locally injected molgramostim could improve the healing of bowel anastomoses in bile-duct-ligated rats used as an experimental model for jaundice. Methods: Eighty-six Sprague-Dawley rats were randomized into 4 groups of 20-22 animals each as follows: group 1 - colonic anastomosis only; group 2 - laparotomy followed 7 days later by colonic anastomosis; group 3 - common-bile-duct ligation (CBDL) followed 7 days later by colonic anastomosis (control group); group 4 - CBDL followed by colonic anastomosis with locally applied molgramostim. Laparotomy was performed under anesthesia in group 2 rats. In groups 3 and 4, laparotomy was followed by ligation and dissection of the common bile duct. After 7 days, colonic anastomosis was performed; in group 4 rats, molgramostim (50 μg) was injected into the perianastomotic area. On postoperative day 3, rats were killed, and the bursting pressures and hydroxy-proline levels measured. Two rats from each group were selected for histopathological examination. Results: The mean bursting pressure in group 4 was significantly higher than that in group 3 (37.8 v. 30.5 mm Hg [p < 0.01]). The mean hydroxyproline level in group 3 was significantly lower than that of the other groups (2.7 v. 3.1-3.5 mg/g tissue [p < 0.01]). On histopathological examination, specimens from group 4 rats showed an increased mononuclear cell population and a smaller gap on the anastomotic line than, those from group 3. Conclusion: The local injection of molgramostim improves healing of the impaired wound in rats subjected to CBDL. © 2005 CMA Media Inc

Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01

The MF07-01 trial is a multicenter, phase III, randomized, controlled study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone for treatment-na < ve stage IV breast cancer (BC) patients

Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01

The MF07-01 trial is a multicenter, phase III, randomized, controlled study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone for treatment-na < ve stage IV breast cancer (BC) patients. At initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. The trial enrolled 274 patients: 138 in the LRT group and 136 in the ST group. Hazard of death was 34% lower in the LRT group than in the ST group (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.49-0.88; p = 0.005). Unplanned subgroup analyses showed that the risk of death was statistically lower in the LRT group than in the ST group with respect to estrogen receptor (ER)/progesterone receptor (PR)(+) (HR 0.64; 95% CI 0.46-0.91; p = 0.01), human epidermal growth factor 2 (HER2)/neu(-) (HR 0.64; 95% CI 0.45-0.91; p = 0.01), patients younger than 55 years (HR 0.57; 95% CI 0.38-0.86; p = 0.007), and patients with solitary bone-only metastases (HR 0.47; 95% CI 0.23-0.98; p = 0.04). In the current trial, improvement in 36-month survival was not observed with upfront surgery for stage IV breast cancer patients. However, a longer follow-up study (median, 40 months) showed statistically significant improvement in median survival. When locoregional treatment in de novo stage IV BC is discussed with the patient as an option, practitioners must consider age, performance status, comorbidities, tumor type, and metastatic disease burden