Selective regional chemotherapy of unresectable hepatic tumours using lipiodol.

Over a 30 month period from 1987 to 1990, selective hepatic cannulation under fluoroscopic control was performed in 57 consecutive patients with primary and secondary malignancies of the liver. Fifty-three patients were subsequently treated using intra-arterial Lipiodol emulsified with epirubicin. The tumours treated were hepatocellular carcinoma (n = 35), metastatic adenocarcinoma (n = 14), intrahepatic cholangiocarcinoma (n = 3) and leiomyosarcoma (n = 1). For hepatocellular carcinoma the cumulative survival was 38% at one year; the median survival was 12.2 months for Stage I, 6.3 months for Stage II and 0.9 months for Stage III tumours. In metastatic disease the cumulative survival was 63% at one year. These data suggest that targeted intra-arterial chemotherapy with Lipiodol-epirubicin is a useful palliative therapy for patients with Stage I and II HCC, and that a controlled trial of this treatment should be undertaken.

New hope in irresectable hepatoma?

Primary hepatocellular carcinoma (HCC) is mostly irresectable and the survival time is short. Treatment can be palliative but hardly improves survival. Some promising future aspects that should be considered include continuous intra-hepatic chemotherapy (fraught with difficulties but nevertheless worth pursuing), direct percutaneous injection of alcohol into the tumor tissue under ultrasound guidance, as well as cryotherapy of "occult" tumors. Monoclonal technique may help to target toxic therapy to the tumors whereas monoclonal antibodies raised in humans may possibly obviate the imminent dangers of antibody formation that would be an obstacle. Although all this may still smack a little of "Zukunftsmusik" ("music of the future") that would require considerable perseverance and effort before it could be translated into reality, every avenue must of course be explored. Chemical techniques that give rise to new hopes feature radio-labelled lipids selectively retained in foci of hepatocellular carcinomas; research has already gone into the question of retention within the tumor microvasculature, within the extracellular space, and the uptake by tumor cells. The oily anticancer agent SMANCS has already been combined with ethiodol (Lipiodol), an iodine addition product of the ethyl esters of saturated and unsaturated fatty acids, and selectively infused, resulting in a reduction in tumor size, and the survival time also seems to be improved following the use of Lipiodol combined with SMANCS or with other cytotoxic agents. After an encouraging pilot study, we treated 16 patients suffering from HCC, with a combination of Lipiodol and epirubicin, a cytotoxic agent having an enhanced activity against HCC as compared with its parent drug doxorubicin.(ABSTRACT TRUNCATED AT 250 WORDS)

The value and significance of the limited barium enema examination following restorative resection for carcinoma of the rectum.

The results of limited barium enema examinations from a consecutive series of 143 patients who underwent restorative resections for carcinoma of the rectum were studied. An assessment was made of the value of the investigation both in terms of clinical management decisions and also to see whether radiologically detected anastomotic leakage was associated with a higher incidence of tumour recurrence. A study was also made of the incidence of leakage with respect to tumour size, length of the distal resection margin, Dukes' grading and histological differentiation. Results showed that there was a greater incidence of tumour recurrence following anastomoses which leaked, although due to small numbers the figures did not reach statistical significance. There was no relationship between tumour size, grade, differentiation, or length of the distal resection margin, and radiological leakage. We consider that the limited ten day barium enema examination does not contribute significantly to surgical management of these patients, except to define the extent of a leak and in the assessment of new anastomotic techniques. However, we suggest that a larger series may demonstrate a statistically significant increase in pelvic recurrence in patients who developed leakage from the anastomosis. This could dramatically alter the application of the postoperative limited barium enema.