[Efficacy of current adjuvant and neoadjuvant therapeutic concepts in gastric cancer?]. / Welchen Stellenwert hat die neoadjuvante und die adjuvante Therapie im Behandlungskonzept des Magenkarzinoms?

The incidence of gastric cancer in Europe is declining but the prognosis after curatively intended surgery remains dismal. In recent years several studies and meta-analysis concerning the impact of adjuvant postoperative chemotherapy and chemoradiation as well as preoperative chemotherapy were published. This review aims to interpret results and to support decision making in individual patients. Results of trials on adjuvant chemotherapy were inconsistent and the studies were underpowered to detect meaningful but modest advantages. Meta-analyses including more than 3 000 patients revealed a significant survival benefit but no specific chemotherapy protocol can be regarded an optimal regimen. Postoperative adjuvant schedules including cisplatin led to high drop out rates due to toxicity. Applying cisplatin and infusional fluorouracil initially after diagnosis as a so called neoadjuvant therapy is better tolerated. Two trials testing this approach showed a significant survival benefit with preoperative cisplatin and infusional fluorouracil as compared to surgery alone. Postoperative chemoradiation was shown to be effective concerning local regional relapses and survival benefit in a large trial in the US but the majority of patients were treated with less radical lymph node dissection than it is routine in Germany. Enrollment of patients in prospective trials evaluating the impact of adjuvant and neoadjuvant strategies is warranted.

[Laser-induced thermotherapy (LITT) for malignant liver tumours: the role of sonography in catheter placement and observation of the therapeutic procedure]. / Laser-induzierte Thermotherapie (LITT) bei malignen Lebertumoren: Einsatz der Sonographie zur Katheterplatzierung und Prozessbeobachtung.

AIM: Evaluation of sonography in the placement of catheters for laser-induced thermotherapy (LITT) as well as for the observation of the therapeutic procedure in cases of malignant liver tumours. METHODS: Following the placement of 1-4 LITT applicators, 18 patients with malignant liver tumours (recurrence of hepatocellular carcinoma n = 5, metachronous liver metastases n = 13) were examined by ultrasound to determine the position of the applicators as well as the sonographic visualisation of the respective lesion. The laser treatment procedure was also observed sonographically. As standard reference method for the documentation of thermally induced necroses we used magnetic resonance tomography 24-48 hours after the procedure. RESULTS: The tip of the applicator could be localised in all cases, and the position of the applicator relative to the lesion could be directly visualised in 78% of cases. The hyperechogenic thermal effect during LITT had a median size of 4.5 cm, thus proving to be significantly larger than the actual necrosis induced (p < 0.01). The sonographic observation of the procedure identified 8/10 primarily incomplete ablations which were then treated again immediately after correction of the position of the applicators. CONCLUSION: Continuous sonographic observation of the procedure of LITT can yield important additional information.

Weekly 24-hour infusion of high-dose 5-fluorouracil plus folinic acid in combination with mitomycin C for the treatment of advanced gastric cancer.

PURPOSE: This study was performed to investigate the activity and safety of high dose 5-fluorouracil (5-FU) given as a weekly 24-hour infusion in combination with folinic acid plus mitomycin C in patients with advanced gastric cancer. PATIENTS AND METHODS: Chemonaive patients with locally advanced inoperable, recurrent or metastatic gastric cancer were treated with 15 mg/m(2) i.v. mitomycin C as bolus on day 1 of a 7-week cycle followed by a 2-hour infusion of folinic acid (500 mg/m(2)) and a 24-hour infusion of 5-FU (2,600 mg/m(2)) given on days 1, 8, 15, 22, 29, and 36 as outpatient treatment. RESULTS: Thirty evaluable patients (median age 58 years and median ECOG performance status 1) received 1-4 cycles (median 3). 53% of the patients had liver metastases. Treatment-related toxicity was low with 10% of patients experiencing diarrhea >/=grade 3, 3% mucositis grade 3 and 3% nausea grade 3 (CTC). Hematological toxicity was mild with 13% thrombopenia grade 3 and no leukopenia grade 4. Eleven patients achieved a partial remission (major response rate 37%; 95% confidence interval 22-53%). Median time to progression was 5 months and median overall survival time was 7 months. CONCLUSION: This regimen is a well-tolerated outpatient treatment for patients with advanced gastric cancer with efficacy being comparable to other chemotherapy protocols.