Intrasplenic immunostimulation in malignancies fact or fiction? Present and future.

BACKGROUND/AIMS: The clinical application of intrasplenic immunostimulation with IL-2 in a group of patients suffering from metastatic renal carcinoma, melanoma, recurrent rectal carcinoma, lung carcinoma and gastric carcinoma are discussed in terms of clinical applicability, effectiveness and survival. METHODOLOGY: From May 1996 to February 1998, 45 patients with advanced malignancies were admitted to Athens Medical Center for intrasplenic immunostimulation. Transplenic immunostimulation was carried out via a subcutaneously implanted port. The injected therapy included IL-2 (Proleukin) 1 ml 18 x 10(6) suspended in 1.5 ml of lipiodol and 0.5 ml of urografin. In conjunction gamma-INF (Immukin) 0.5 ml 100 mcg, was administered. RESULTS: Patients included in this study have completed their treatment, or are still undergoing maintenance treatment. The duration of the CR was between 11 and 16 months, and for PR was between 10-14 months. For melanoma patients (n = 9), 3 patients with PD died 9, 10 and 12 months after initial treatment began. The remaining patients (n = 6) are alive with a mean survival rate of 16 months. Of those patients, 4 have been classified as complete responders, being completely free of disease at this time. The number of CR for patients with lung, renal and recurrent rectal cancer was achieved as a result of the continuing maintenance treatment. Twenty-two patients remain alive and 23 patients have died. From those alive (n = 22), 10 patients are complete responders and free of disease, 10 are partial responders with controlled disease and 2 remain with standard disease. For those surviving patients with lung cancer, the mean survival time is 14 months. Patients with recurrent rectal cancer and renal cancer were shown to have a mean survival time of 15 and 13 months, respectively. CONCLUSION: The safety, effectiveness and feasibility of long-lasting administration of high dosages of IL-2 are documented from the data of this study. Intrasplenic immunostimulation utilizing lipiodol-urografin emulsion as a carrier, offers new possibilities for the safe administration of long lasting high dosages of IL-2 and gamma-INF. Further studies are warranted, to further elucidate the results of this phenomenon.

Resection of unresectable secondary liver tumors--new frontiers in liver surgery.

BACKGROUND/AIM: Despite remarkable advances in diagnostic and therapeutic techniques for metastatic liver disease, this disease remains a challenge for patients and surgeons. In this study we describe our experience in the management of 21 patients referred for treatment due to metastatic disease, between 1992 and 1997, in Athens, Greece. METHODOLOGY: Patients diagnosed with unresectable liver tumors, received a standard treatment, which included neo-adjuvant locoregional immuno-chemotherapy, surgical resection and adjuvant locoregional immuno-chemotherapy. Twenty days after liver resection a standard protocol of combined locoregional immuno-chemotherapy was administered. The protocol included 10 daily courses of transplenic (5-day) and transtumoral (5-day) immunostimulation using proleukine suspended in lipiodol Urografin emulsion. Five days later a standard dose of chemotherapeutical drugs suspended in lipiodol Urografin were given via the catheter of the hepatic artery. The above mode of adjuvant treatment was continued every 2 months for the first postoperative year and every 3 months for the 2nd and 3rd postoperative years, every 4 months for the 4th and 5th postoperative years. At the end of each treatment a blood test, which included the serum values of the tumors markers and an upper abdominal computer tomography was carried out for each patient. The treatment response was evaluated accordingly, and divided into the following categories: complete response, partial response, stable disease and progressive disease. RESULTS: There was no operative mortality. Sequelae and side effects secondary to treatment were minimal In group A and B of this study a 5-year survival rate of 65% and 20% and an overall response rate of 80% and 68% in the above groups was noted, respectively. CONCLUSION: The mode of management offered satisfactory results regarding quality of postoperative life.