Prognostic factors of gastric non-Hodgkin's lymphomas of the adult.

Sixteen patients, seven men and nine women, with a non-Hodgkin's lymphoma of the stomach (NHLS), have been managed in our institute during the past 15 years. Their median age was 68 years. Ten of them were classified, before treatment, at an early stage (I or II, Ann Arbor system) and six at an advanced one (III or IV). Ten patients were submitted to gastrectomy, and eight out of them had an adjuvant postoperative treatment (radiotherapy and/or chemotherapy). The remaining six patients were treated conservatively by radiotherapy and/or chemotherapy. Two patients that were followed less than 24 months were excluded from further study. In the remaining 14 patients, the 5-year actuarial and age-corrected survival rates were 42% +/- 28 and 53% +/- 35, respectively. In the gastrectomy subgroup, the corresponding rates were 77% +/- 22 and 93% +/- 24. The later ameliorated results also, reflect the effect of an earlier stage. The most important prognostic factors appeared to be the stage and the histologic type. Old age and female sex seem to predispose to a better outcome, but they are not independent prognostic factors. Finally, a bad nutritional status, at presentation, seems an ominous prognostic sign.

Regional intraarterial infusion of methotrexate with leucovorin rescue in a rat tumor model.

Walker 2S6 carcinosarcoma was transplanted in the paw of 52 male Wistar rats. A week later, the animals were divided into 6 separate groups and treated in different ways, as follows. Group I (control): no treatment. Group II: femoral artery ligation (FAL). Group III: ligation-intraarterial chemotherapy (LIC) with methotrexate (MTX). Group IV: the same treatment followed by leucovorin rescue (LIC+RES). Group V: tourniquet intraarterial chemotherapy and rescue (TIC+RES). Group VI: the same treatment applied via the iliac artery (iliac TIC+RES). The best results (primary tumor eradication: 8/10 cases, propagation of the tumor to the inguinal region: 4/10 cases, necroses of the distal part of the paw: 0/10 cases, p > 0.05) were observed in group VI, where iliac LIC+RES was performed. Analysis of the treatment's mechanism of action revealed that there is an area of optimal treatment in the middle of the limb, and two peripheral zones of under-treatment. At the proximal zone (inguinal region) propagation of the tumor can occur, whereas at the distal zone necrosis of the paw can be manifested.

Heat turn-over during hyperthermic peritoneal perfusion. An experimental study.

In order to study heat turnover, 3 experimental models of chemotherapeutic hyperthermic intraperitoneal perfusion (CHIP) were tested, using 15 rabbits divided into 3 separate groups of 5 animals each. A normal saline perfusate, containing a standard concentration of 10 mg of methotrexate per liter, was recycled through the peritoneal cavity, transmitting, in every group, 6,000 calories of heat. In model I, heat transmission was achieved by a high temperature gradient, in model II by the increased thermocapacity of a great priming volume of perfusate, using a peritoneal expander, and in model III by a high flow rate. The rectal and oesophageal temperatures were recorded and the indications converted to calories. The bowel showed a statistically higher heat uptake in model III, whereas thermodilution was more important in model I and especially in model II. The results indicated that the ideal model of CHIP must combine efficiency and safety. The temperature gradient must be ample, but within safe limits, only for cost-efficiency reasons. The priming volume ought to be abundant enough to achieve homogeneity and constancy of heating, but not excessive, in order to avoid abdominal distension and bodily thermo-dilution. Under these conditions, the target level of heating, always calculated in calories, must be administered by appropriate adjustment of the perfusion flow rate.