A phase II randomised trial of 5-fluorouracil with or without interferon alpha-2a in advanced colorectal cancer.

With the association of 5-fluorouracil (5-FU) and alpha-interferon (IFN), objective responses as high as 26 63% have been reported in untreated patients with advanced colorectal cancer. However, grade 3-4 toxicity has also been reported. We have conducted a prospective phase II randomised study comparing 5-FU to 5-FU + IFN, to investigate whether the addition of IFN to a weekly 5-FU regimen devoid of significant toxicity used at our institutions could improve the effectiveness of 5-FU while maintaining acceptable toxicity. Patients with histologically proven advanced colorectal carcinoma were randomised to receive 5-FU 500 mg m-2 intravenous (i.v.) bolus on days 1-5 followed by 5-FU 500 mg m-2 i.v. bolus weekly from day 15, with or without IFN alpha-2a intramuscularly (i.m.) 1.5 mU daily on days 6-12 and 3 mU i.m. daily thereafter. The treatment was administered on an outpatient basis. Response was evaluated every 3 months, and treatment continued until progression or after two consecutive judgements of stable disease. Response rate was the main end point of the study. Of 141 patients eligible, 72 were randomised to 5-FU alone (arm A) and 69 to 5-FU + IFN (arm B). Responses were 9/72 (12.5%) in arm A and 6/69 (8.7%) in arm B; complete responses were three in arm A and two in arm B. Progression-free survival (median 4 months) and survival (median 12 months) were identical in the two arms. Toxicity was almost absent in arm A and moderate in arm B, represented mainly by haematological toxicity (usually leucopenia). In conclusion, overall survival was good in both arms of treatment and toxicity was moderate. While the response rate with 5-FU alone was in accord with the literature data, response to 5-FU + IFN was lower than expected. At least at this dosage and schedule, the association of 5-FU and IFN is no better than 5-FU alone and is of no clinical interest.

Pancreatic metastasis 25 years after nephrectomy for renal cancer.

The authors report a case of renal cell carcinoma metastasis to the pancreas occurring 25 years after nephrectomy. The need for prolonged follow-up of patients is emphasized. The surgical approach is considered the best way to deal with such late metastases.

[Application of hemodilution and autotransfusion in elective surgery]. / Applicazione in chirurgia di elezione della emodiluizione ed autotrasfusione.

Following careful consideration of physiopathological modifications during haemodilution, reference is made to experience with patients submitted to major surgery, mainly chest and vascular. The technique employed is preoperative normovolaemic moderate acute haemodilution. Reference is also made to the criteria for selecting patients, and the evaluation of clinical and haematochemical parameters used in applying this technique. The experience is judged to be positive and haemodilution is regarded as a useful tool for reducing the use of homologous conserved blood and for preventing the risks connected with it.

[Uses in vascular symptomatology of the ultrasonic flowmeter with Doppler effect in patients revascularized for peripheral obliterating arteritis]. / Applicazioni in semeiotica vascolare del velocimetro ultrasonico ad effetto Doppler nei pazienti rivascolarizzati per arteriti obliteranti periferiche.

The Authors present 38 cases of surgical revascularization for arteriosclerosis obliterans of the lower extremities, operated in Clinica Chirurgica of Ancona during the space of three Years, from 1974-1977. The morphological profile of the sphygmic wave and pressures of occlusion or Travis Winsor's index were studied pre and postoperatively with Doppler ultrasonic flowmeter. The patency of vascular grafts and after thromboendarterectomy was shown by T.W.'s index. With this method, besides establishing a program for postoperative arteriography, a lesser use of the latter was shown.