Genetic alteration in gastrointestinal cancer. A molecular and cytogenetic study.

We examined 16 cases of gastrointestinal cancer, of which 11 were from the colon, 1 from the rectum, and 4 of gastric origin, cytogenetically for expression and for loss of heterozygosity (LOH) on chromosome 18 using Deleted Colon Cancer (DCC) gene. LOH on chromosome 18 with DCC probe was detected in 7 out of 11 cases of colon, in 4 out of 4 cases of gastric and in 1 case of rectum cancer. In all gastrointestinal tumors the expression of DCC gene was absent, while it was present in normal tissue. We also found rearrangements of chromosomes 18 (10 cases) and 17 (9 cases), leading respectively to deletions of long and short arms. Other additional abnormalities were observed involving chromosomes 5, 6, 15 and 19. The data recorded in our series differ from other authors' data in three respects: a high incidence of pseudodiploid chromosome number, rearrangements of chromosome 19 and 15, and involvement of DCC gene in the development of gastric cancer, as well as in colorectal cancer as previously reported.

Multiple genetic lesions in solid tumors: relevance to diagnosis, prognosis, and molecular mechanisms.

In recent years, significant progress has been made in identifying characteristic chromosomal and molecular rearrangements associated with several solid tumors. Most solid tumors studied have been found to be characterized by recurrent chromosomal abnormalities that are specific to histologic types. We have studied primary specimens of malignant melanoma, gastrointestinal cancer, renal carcinoma, lung and ovarian cancer, by cytogenetic and molecular means, and we discuss the genetic alterations found. Brief descriptions of the potential clinical utility, and biological relevance changes in these disorders are also discussed.

Day-surgery. The "Regina Elena" National Cancer Institute experience.

The Authors thorough analyse the subject of day-surgery underscoring the advantages this procedure represents in the light of the experience gained at "R.Elena" National Cancer Institute. The aims of ambulatorial surgery are, in broad terms, the safety of procedures, patients' compliance as well as organisational and economic savings for the health structure. In the future, one-day surgery might represent an important contribution to surgical therapeutical strategies allowing, if well organized, an excellent compromise between safety, convenience and reduced costs.

Dacarbazine-based chemotherapy for metastatic melanoma: thirty-year experience overview.

Dacarbazine (DTIC) is the only single-agent approved by the Food and Drug Administration for treating metastatic melanoma. With DTIC as single agent, an approximately 20% objective response rate can be achieved with median response duration of 5 to 6 months and complete response rates of 5%. Current status of DTIC single agent and DTIC-based combination chemotherapy has been extensively reviewed in this article. Moreover, future directions including new combination chemotherapies and/or new therapeutical approaches have been considered. The addition to DTIC of agents such as cisplatin, nitrosoureas and tubular toxins has been reported to yield high response rates, up to 40%, in single-institution phase II trials. Historically, promising combination regimens like BOLD (bleomycin, vincristine, lomustine and DTIC) and CVD (cisplatin, vinblastine and DTIC) have induced responses on metastatic lesions to the liver, bone and brain, commonly unresponsive to DTIC alone, even though have failed to produce impact on patient survival. Several other studies have suggested a significant enhancement of antitumor effect associated with the addition of tamoxifen to various cytotoxic regimens. The four-drug combination CBDT (cisplatin, carmustine, DTIC and tamoxifen) or "Dartmouth regimen" has yielded high response rates, up to 55%, with continuous, maintained, complete responses, up to 82 months, in a subset of patients, that is considerably longer than observed with other combinations. Some authors recommend CBDT as reference therapy, even though recently presented results of a randomized phase III trial of CBDT versus DTIC alone, show no statistical difference in survival between the two groups. While a survival benefit from DTIC-based chemotherapy or DTIC alone has never been shown in metastatic melanoma patients and, therefore, the survival has remained unchanged over the past 30 years, some long term survivors have been reported with the "Dartmouth regimen" and/or with high dose interleukin-2 (IL-2) based regimens whose role is going to be defined in prospective randomized phase III trials. On the other hand, the better understanding of the mechanisms responsible for melanoma chemoresistance and the development of new therapeutical strategies could change the scenario in the next future.

13-cis retinoic acid and interferon alfa-2a in the treatment of metastatic renal cell carcinoma.

Eleven patients, pre-treated with chemotherapy and immunotherapy, with renal cell carcinoma were given 13-cis-retinoic acid (CRA) in association with interferon alfa-2a (IFN 2a). 13-ci retinoic acid was administered at the dose of 1 mg/Kg/die while interferon alfa-2a at the dose of 3X10 U.I./die s.c. All patients had been previously treated with chemotherapy in association with immunotherapy. Therapy was not discontinued until neoplastic progression occurred. Clinical results were as follows: partial responses (PR) were observed in two patients, disease stabilization (SD) in 5 and progression (PD), with 8-month median treatment duration, in 4. Side effects were mild.

Letrozole for the treatment of pretreated advanced breast cancer patients: preliminary report.

Twenty patients (pts) with metastatic breast cancer with disease progression, previously treated with chemotherapy and tamoxifen, were administered oral letrozole (2.5 mg/day) therapy. Fifteen of the patients were postmenopausal and 5 were premenopausal. Ten were estrogen receptor (ER)-positive, 7 were unknown and 3 were ER-negative. All the patients were assessed after 6 months (mo) of chemotherapy. Nine pts (45%) presented a partial response (PR), five (25%) had a stable disease (SD) and six (30%) had a progressive disease (PD). In the pts with PD, six out of 15 (33%) obtained a PR while undergoing tamoxifen therapy. The treatment caused no significant toxicity.

Triple combination antimicrobial regimen in the treatment of infections of neutropenic cancer patients.

Twenty-six cancer patients (pts) with chemotherapy-related neutropenic fever were treated with vancomycin 30 mg/m2/day i.v. every 12 hrs, imipenem 1500 mg/day i.v. every 8 hrs, and pefloxacin 800 mg/day i.v. every 12 hrs. Twelve fevers of unknown origin (FUO), 10 gram-positive, 3 gram-negative and 1 mycoplasma were also treated. Globally, cure was observed in 22 pts (84%) and failure in 4 pts (16%); in gram-positive infections alone, cure was observed in 10 pts (80%) and failure in 4 pts (20%). Defervescence was obtained within 3 days in 77% pts. No relevant side effects were observed.

The biological and clinical significance of tumor markers in tissue extracts.

A quantitative study of carcinoembryonic antigen (CEA) activity was made in plasma and in 25 colorectal tumors, 30 lung tumors, 20 breast tumors, and 20 fibrocystic dysplasias of the breast. The CEA content was detected by enzyme assays (EIA) in solid phase. In colorectal cancer the amount of CEA ranged from 40 to 800 ng/mg protein. In lung cancer, values ranged from 5 to 130 ng/mg protein. Differences in mean content of CEA between normal and cancer yielded the highest significant value of P less than 0.001. In 54 of 95 of cases, high concentrations of CEA in tissues were associated with high values in plasma. In fibrocystic dysplasia of the breast, the CEA concentration levels were lower than in cases of breast carcinoma. The CEA concentration values in fibrocystic dysplasia were associated with the epithelial proliferation and the degree of dysplasia. Therefore, the presence of elevated CEA tissues values may be indicative of patients with higher risk of malignant transformation.

A proposed TNM classification for malignant primary liver tumours.

On the basis of 211 hepatic resections and reresections, a study was made to evaluate the possibility of compiling a checklist for primary liver tumours according to the TNM classification. This would aid the surgeon in planning therapy and provide a useful guide for prognosis and late results.

Our experience with resection of primary and secondary liver tumours.

The authors retrospectively analyse the results achieved in recent years by surgical treatment of 103 malignant primary or secondary liver cancers: (Three patients have been operated on twice at different times for recurrence.) 23 hepatic resections were performed for benign lesions. The operative mortality is very low, the incidence of postoperative complications is minimal, and the survival up to 8 years is rather satisfactory. In all cases we used Ton That Tung's surgical technique, that is, "finger fracture with intraparenchymal ligature of the vasculobiliary pedicles."

Peritoneovenous shunt and neoplastic ascites: a 5-year experience report.

The cases of 42 patients with malignant ascites treated with a peritoneal venous shunt over a 5-year period are reviewed to establish the incidence of surgical and postsurgical complications. Although the yield of malignant cells found in the peripheral blood was increased after shunting, no new hematogenous metastases were observed after the operation. No evidence of disseminated intravascular coagulation was observed after shunt placement. While the shunt effectively relieved the discomfort due to abdominal distention and respiratory impairment, no restoration of cutaneous hypersensitivity was observed in the nine patients who were anergic prior to surgery. The median survival of patients with breast and gynecological cancer, after surgery, was significantly longer than the survival of patients with primary gastrointestinal neoplasma. In conclusion, peritoneal venous shunt appears to be an effective and safe method to improve the quality of life of patients with malignant ascites.