Preoperative main portal branch transection combined with liver locoregional transarterial neo and adjuvant immunochemotherapy for patients with hepatocellular carcinoma.

BACKGROUND/AIMS: Main portal branch embolization was developed several years before in an attempt to improve prognosis and outcome for patients suffering from advanced liver malignancies. METHODOLOGY: From September 1993 to September 2000 43 patients with advanced hepatocellular carcinoma underwent main portal branch transection and neo- and adjuvant transarterial immunochemotherapy. Forty days after initial surgery, all patients underwent a phase II surgical exploration for liver resection. RESULTS: Survival ranged from 18 months to 64 months with a median of 41 months. Two- and 5-year survival was 75% and 57%, respectively. CONCLUSIONS: Main portal branch transection combined with major liver resection and neoadjuvant and adjuvant locoregional immunochemotherapy fulfilled our expectations firstly for increasing the resectability rate and secondly for increasing the overall survival and the disease-free survival.

Metastatic melanoma: transplenic immunostimulation--a new therapeutical alternative for an ever-challenging disease.

BACKGROUND/AIMS: The successful management of metastatic melanoma is mostly relevant to the feasibility of a sustained immunostimulation requiring high doses of interleukin-2 (IL-2). Sustained immune response is initiated, in terms of cellular and humoral immunity, persisting for 15 days following the end of exogenous IL-2 transplenic administration. METHODOLOGY: We proceed to the transplenic immunostimulation using IL-2 suspended in lipiodolurografin emulsion through an arterial catheter, which is introduced into the splenic artery through laparotomy for the management of patients with advanced metastatic melanoma. Eligible for our study were 19 patients undergoing transplenic immunostimulation and locoregional or systemic chemotherapy, in relation to the site of the disease. In cases of metastatic liver melanoma, transtumoral immunostimulation was also carried out. RESULTS: Complete response to the regimen, partial response, stable disease and progressive disease were observed in 21%, 42%, 16%, and 21%, respectively. CONCLUSIONS: Transplenic immunostimulation has promising potentials in metastatic melanoma patients, on the basis of present results.

Resectional liver surgery in metastatic liver disease.

BACKGROUND/AIMS: To increase resectability rate and decrease intra-hepatic recurrence of metastatic liver disease of patients suffering from secondary liver tumors. Metastatic liver disease remains challenging and life threatening. At the time of diagnosis only 10% of patients are amenable to liver resection and of those 60-70% will develop recurrence in the residual liver 16 to 24 months following liver resection METHODOLOGY: Seventy patients out of a total number of 305 seen between November 1991 and May 1998, underwent combined liver resection followed by adjuvant locoregional targeted immunochemotherapy. Patients were divided in two groups. Group A (n=32) had uni-lobular localization of their disease and group B (n=38) had bi-lobular spread of the disease, but tumor occupied was less than 70% of liver surface. All had hepatic resection followed by adjuvant immuno-chemotherapy. RESULTS: Group A (n=32) had a 5 year survival of 75% with 8 patients alive more than 6 years and a mean survival for alive and dead patients of 50 months. Group B (n=38) had a mean survival of 40 months with 6 patients alive longer than 5 years. CONCLUSIONS: Liver resection combined with adjuvant immuno-chemotherapy enhances overall long-term survival in both patients with limited and advanced metastatic liver disease, and is recommended as a promising therapeutical alternative.

Pancreatic resection for pancreatic carcinoma combined with neo- and adjuvant locoregional targeting immuno-chemotherapy--a prospective randomized study.

BACKGROUND/AIMS: The effects on early and late results of combined pancreatic resection with neo- and adjuvant immuno-chemotherapy for patients undergoing pancreatic resection are prospectively evaluated. METHODOLOGY: A group of 26 patients was divided into two groups, which were matched in terms of age-sex ratio, stage of disease, histological diagnosis and mode of pancreatic resection. Group A patients received a multimodality therapy, combining pancreatic resection with neo- and adjuvant locoregional targeting immunochemotherapy. Group B received pancreatic surgery only. RESULTS: For Group A patients (n = 14pts), a complete response was seen in 11 patients with a time interval ranging from 9 to 29 months. In the remaining 3 patients liver secondaries developed 12 months after pancreatic resection in 2 patients and the other patient developed pulmonary metastases 22 months after pancreatic resection. All patients (n = 3pts) are alive, but continue to have the disease. For Group B patients (n = 12pts), a complete response was seen in 3 patients with a survival of 9, 10 and 20 months following pancreatic resection. Six patients died due to locoregional recurrence of the disease, with the survival rate ranging from 7 to 18 months (mean 10 months). Locoregional recurrence was complicated with liver secondaries (n = 3) and with peritoneal dissemination of the disease in a further 3 patients. The remaining 3 patients are alive, but continue to have the disease due to locoregional recurrence. CONCLUSIONS: Patients in whom neo- and adjuvant locoregional immunochemotherapy was carried out in conjunction with pancreatic resection, demonstrated a significantly higher response rate to treatment. Therefore the data collected offers clear evidence, regarding the usefulness, applicability and safety of combined neo- and adjuvant therapy with pancreatic resection. A Multi-modality approach is therefore highly recommended.

Targeting locoregional immunochemotherapy with new drugs in metastatic liver disease: a promising alternative.

BACKGROUND/AIMS: A retrospective report of our experience with adjuvant targeted locoregional immunochemotherapy using new drugs in 29 Stage IV colorectal cancer patients with unresectable metastatic liver disease from September 1997 to December 1998. METHODOLOGY: After pre-operative screening, all patients were subjected to laparotomy for insertion of transhepatic and transplenic arterial catheters, both implanted subcutaneously in the right upper abdominal quadrant. A bolus transhepatic arterial chemotherapy using Eloxatine 150 mg/m2 and Campton 140 mg/m2, suspended in a 5:1 lipiodol-urografin emulsion, was given 15 days post-operatively, followed the day after by 5 daily transplenic artery and then 5 daily transhepatic arterial injections of IL-2 in a 5:1 lipiodol-urografin mixture. This treatment schema was repeated at 2-month intervals. RESULTS: Treatment response was recorded: CR=24.2%, PR=55.2%, SD=10.3%, and PD=10.3%. Seventy-nine percent responded favorably with 7 patients (24.2%) showing marked tumor bulk reductions. There were no treatment-related morbidities or mortalities. CONCLUSIONS: All 29 patients are alive with a median survival of 11 months as of this writing. Eighty percent report a significant improvement in quality of life. Targeted locoregional immunochemotherapy using the above drugs is a promising option for patients with far-advanced metastatic liver disease.

A prospective randomized study using adjuvant locoregional chemoimmunotherapy in combination with surgery for pancreatic carcinoma.

BACKGROUND/AIMS: A prospective randomized clinical trial combining adjuvant locoregional chemoimmunotherapy for pancreatic carcinoma in 512 patients was conducted from September 1991 to September 1998 at Athens Medical Center. METHODOLOGY: All patients were randomly assigned to (A) Resective Surgery (n=274), and (B) Palliative Surgery (n=238) groups. Each group was further subdivided into: (1) surgery alone, and (2) surgery plus 1-day bolus chemotherapy (Gemcitabine 1 gm/m2, Carboplatin 200 mg/m2 and Mitoxantrone 0.2 g/kg bw suspended in 10 ml of Lipiodol and 2 ml of 58% urografin), and immunotherapy (1 ml IL-2 and 0.5 ml gamma-IFN suspended in 5 ml of Lipiodol and 1 ml of 58% urografin) followed by a 5-day course of transplenic and another 5-day course of transtumoral immunotherapy using the same agents. This was repeated at 2-month intervals during the first post-operative year and every 3 months thereafter. RESULTS: Significant reduction in patient symptomatology and improvements in post-treatment quality of life were noted in patients receiving adjuvant chemoimmunotherapy. Moreover, the mean survival rate significantly improved in patients receiving the adjuvant treatment, both for the resective (32 months) and the palliative (16 months) groups. CONCLUSIONS: The treatment regimen employed was well tolerated and did not contribute to any clinical deterioration. Adjuvant targeted locoregional chemoimmunotherapy is therefore a promising avenue in the management of patients with pancreatic carcinoma.