Intraoperative and external beam radiotherapy in advanced resectable gastric cancer: technical description and preliminary results.

Twenty-two patients with resectable gastric cancer treated with intraoperative radiotherapy and external beam irradiation, in a Phase I-II oriented study, were analyzed. Tumor Stages were III & IV in 18 cases (82%). Tumor histology was described as diffuse undifferentiated type in 14 cases (63%). Following surgical resection of the primary tumor, IORT 15 Gy was delivered in the celiac axis area, using high energy electron beams ranging from 9 to 20 MeV. External beam irradiation fields covered the draining nodal areas of the upper abdomen and the gastric bed. There were no postoperative deaths. Reversible postoperative complications were recorded in 14 patients (63%). Long term complications observed were vertebral collapse and liver hemangiomas. First sites of recurrence have been: hepatic hilum (three cases), peritoneum combined with central axis nodes (two cases), liver metastasis (one case), and lung metastasis (one case). Survival data shows a follow-up period ranging from 1+ to 33+ months, with a median survival time for the entire group of 13+ months. At the time of this report, 16 patients (72%) are still alive and six have died (four from progressive malignant disease and two from intercurrent disease). From this preliminary data, it can be concluded that a combined approach with surgical resection, intraoperative radiotherapy, and external beam irradiation is feasible in advanced gastric carcinoma, and is not limited by toxicity or any complications observed. Despite this intense loco-regional therapeutic approach, the upper abdominal failure rate has been demonstrated in 22% of the cases.

Intraoperative radiotherapy for recurrent and/or residual colorectal cancer.

Intraoperative radiotherapy (IORT) is an attractive boosting modality in the combined treatment of recurrent and/or residual colorectal cancer. Twenty seven patients treated with IORT are analysed. Residual disease following resection of the primary tumor was treated in 11 cases (group I). Localized recurrent disease without previous radiotherapy was treated in 11 cases (group II). IORT was used in five additional patients with local recurrences in previously irradiated areas (group III). The treatment program consisted of maximal tumor resection, IORT (10-30 Gy) to the area of residual disease and external beam radiotherapy (46-50 Gy). The median follow-up time for the entire series of patients is 11 months. Local tumor control rates are 90% in group I, 63% in group II and 60% in group III. Toxicity and complications related to IORT observed in this initial experience have been pelvic pain (29%) and lower extremity neuropathy (3%). These early clinical results suggest that the IORT combined with surgery and external beam radiotherapy is feasible in primary and recurrent disease. Local control rates obtained in patients not suitable for curative surgery are encouraging.

Lymphoma of the gastric stump: report of a case.

We report a case of primary lymphoma on a previously resected stomach in a 62-year-old man. The patient was treated 22 years earlier with a partial gastrectomy and Billroth II reconstruction for a benign gastric ulcer. The rarity of this entity and its possible relationship with pseudolymphoma or lymphoid nodular hyperplasia is discussed, and the literature is reviewed.

[Determination of the lymphocytic and oncofetal antigen subpopulations in patients with adenocarcinomas of the stomach and of the colon and rectum (author's transl)]. / Determinación de las subpoblaciones linfocitarias y antígenos oncofetales en pacientes con adenocarcinoma gástrico y colorrectal.

The authors present a study of 50 patients with adenocarcinomas of the colon and rectum, patients with gastric adenocarcinomas, and 30 healthy individuals as a control group. In all subjects the following parameters were determined: total number of lymphocytes in the peripheral blood, T lymphocytes, T-active lymphocytes, and B lymphocytes. A study of the test for lymphoblastic transformation (TTL) with phytohemagglutinin (PHA) stimulation and the determination of alpha-fetoprotein (AFP) and carcino-embryonic antigen (CEA) were also carried out. In patients with gastric adenocarcinoma the results revealed a lymphopenia, especially at the expense of T and T-active lymphocytes, as well as a depression (in 73 per cent) of the lymphocytic response to the PHA stimulation. Patients with carcinoma of the colon showed significant results in the T-active lymphocyte population. In both neoplastic situations the determination for alpha-fetoprotein was negative, while the CEA presented a clear correlation with the evolutive stage of the tumor, being more demonstrative in the tumors located in the colon and rectum.

[Implantable devices for central venous access in cancer patients. Our experience in 217 cases]. / Dispositivos implantables para acceso venoso central en pacientes oncológicos. Experiencia en 217 casos.

BACKGROUND: The need of having a venous via available for infusion of chemotherapy treatment along with the difficulty of repeated venous access in oncological patients has lead to the ever more frequent placement of central venous access systems (CVAS) implanted into subcutaneous tissue. METHODS: From February 1985 to December 1990 217 CVAS were implanted in 205 oncological patients. Twenty-six were Port-a-Cath and 191 were Implantofix. RESULTS: The average of complications was 0.08/100 days of implantation with an incidence of catheter thrombosis obstruction of 0.03/100 days and system infection of 0.02/100 days. Currently 81 devices continue functioning with 23 having been withdrawn due to complications and 17 for completion of the treatment to which they had been submitted. Ninety-one patients died during this follow up. CONCLUSIONS: The CVAS are devices which are of easy placement, simple handling, requiring minimum care and few complications. Their efficacy is confirmed by the analysis of the data presented in the present study.

[Transplantation of free vascularized jejunum for esophageal reconstruction]. / Trasplante libre de yeyuno vascularizado para reconstrucción esofágica.

Two cases of pharyngo-esophageal carcinoma treated with tumor resection followed by insertion of a vascularized jejunal free graft using microsurgical technique in order to maintain esophageal contiguity are presented. Both cases have received pre-operative radiotherapy. This presentation is motivated by the excellent results obtained in this palliative treatment of said type of cancer. The jejunal transplant improves the quality of life of these patients with less morbidity and mortality compared with other methods of esophageal reconstruction.

[Esophagectomy for esophageal cancer excluding cardial involvement. Analysis of 40 cases]. / Esofaguectomía por cáncer esofágico con exclusión de la localización cardial. Análisis de 40 casos.

This is a study of esophageal resection for cancer of the esophagus in 40 patients, 34 of which were diagnosed as squamous carcinoma and 6 as adenocarcinoma excluding the cardias, tumor localization includes cervical esophagus in one case and all the rest in the thoracic esophagus, 2 in the proximal third, 25 in the middle third and 12 in the distal third. With regard to surgical approach, 11 were treated with total esophagectomy (7 Akiyama, 4 transhiatal resection) and of the 29 treated, of subtotal esophagectomy, 24 were according to the Lewis technique and 5 through a left-sided thoracotomy. Reconstruction was done with stomach in 33 cases six with colon and one with jejunum. Complications were detected in 52.5% the patients with pleuro-pulmonary being the most frequent, anastomotic dehiscence occurred in 5 cases (4 of which were chose manually). The operative mortality rate was 5% and the actuarial survival at 5 years was at 28.4%.

[Treatment of cancer of the esophagus. New strategy with the multidisciplinary treatment]. / Revisión del tratamiento del cáncer de esófago. Nueva estrategia con el tratamiento multidisciplinar.

This study is an update of the clinico-anatomical characteristics of esophageal cancer, as well as the different current therapeutic modalities, their indications and results. The therapeutic protocol for the study and treatment of epidermoid cancer of the esophages followed in the University Clinic of Navarra is likewise espounded.

[Internal derivation in the treatment of hepatic hydatidosis]. / Derivación interna en el tratamiento de las hidatidosis hepáticas.

The results of the surgical treatment of human hydatic cyst by cystojejunostomy are presented. This technique was performed in 17,3% of all cysts treated by the authors. The conditions for using technique, as well as it morbidity and mortality are reviewed. The authors' conclusion is that cystojejunostomy is a valid surgical technique for hydatic cyst in some cases in which it is indicated.

[Oxyphillic adenoma as a cause of primary hyperparathyroidism]. / Adenomas oxifílicos como causa de hiperparatiroidismo primario.

We describe three cases of women who developed symptoms of primary hyperparathyroidism originated by a parathyroid functional tumor. Ostoporosis, arterial hypertension and nefrolitiasis were the most frequent antecedents. The PTH and calcium levels in bood and urine were elevated. The CT and ultrasound confirmed the diagnosis of parathyroid tumor, which was identified histopathology as oxifilic adenoma. All patients underwent surgical treatment. We consider these cases of clinical interest because this kind of adenoma hardly ever produces hyperparathyroidism.

[Multidisciplinary protocol for the treatment of epidermoid carcinoma of the esophagus: experience from 1985 to 1989]. / Protocolo multidisciplinar de tratamiento del carcinoma epidermoide de esófago: experiencia 1985-1989.

A phase II study activated in 1985 for the multidisciplinary treatment of squamous cell carcinoma of the esophagus is described. The treatment program included simultaneous neoadjuvant continuous infusion chemotherapy with cisplatinum and 5-fluorouracil, preoperative radiotherapy (46 Gy in 5 weeks) and delayed programmed surgery (or radical irradiation in selected cases). Twenty-one patients with tumor stages I (6), II (10), III (5) entered in the study and 20 patients completed the treatment program. Severe toxicity observed was: esophagitis 100%, bone marrow aplasia 30%, severe weight loss 52%. One patient developed a tracheo-esophageal fistula at the end of radiotherapy. Clinical objective tumor response rate was 85%. Pathologic complete tumor response rate was 47%. Median follow-up of the entire group is 11 months (range 2 + to 49 + months). Ten patients have been alive for more than 12 months; six are still alive without any evidence of disease (from 12 + to 49 + months). It is concluded that the protocol described is feasible, with treatment related severe but reversible toxicities, and able to induce a high rate of tumor response and long term survivors in patients with initial locally advanced tumor stages.