Chemoembolization facilitates limb salvage surgery in stage III soft tissue sarcoma.

A 26 year-old male was referred to our unit because of a stage III soft tissue sarcoma in the shoulder girdle-axillary area and reduced forearm-distal arm strength. Imaging studies revealed that the tumor encompassed the axillary artery and brachial plexus. We chemoembolized it using vincristine, adriamycin and cyclophosphamide (VAC) plus gel foam and performed limb salvage surgery (LSS) afterwards. The patient received adjuvant chemotherapy (ifosfamide/mesna, adriamycin, and dacarbazine/MAID) and finally radiation therapy (RT; 6500 cGy total dose). Thirty-six months after the operation the patient remains free of disease, without local recurrence and excellent neurological recovery and functional rehabilitation. In stage III soft tissue sarcomas, especially in proximity with major nerve/arterial bundles, a multimodality approach is mandatory; chemoembolization is very effective in shrinking the tumor and defining its margins so as to make feasible a LSS.

Expandable wallstents for treatment of tracheoesophageal fistulas of malignant origin.

PURPOSE: To present our experience with endoscopic placement of esophageal endoprosthesis with self-expandable wallstents in patients with malignant tracheoesophageal fistulas. PATIENTS AND METHODS: 16 patients were retrospectively evaluated, in whom 16 stents were positioned at the esophagus because of tracheoesophageal fistulas: 12 of them suffered of malignant tumors of the esophagus and 4 of malignant tumors of the lung. All stents were placed with guide wire. We used self-expandable wallstents with internal silicon-basedcovering with flared ends, made of a stainless-steel alloy woven into a tubular mesh. RESULTS: Stents were successfully places in all patients. No procedure-related mortality or significant morbidity occured. Two patients complained of transient swallowing discomfort, but none of them required any additional analgesia. Thirty-day mortality was nil. Immediate leak occlusion was obtained on erect contrast assessment after the procedure in all patients. CONCLUSION: Self-expandable wallstents endoprosthesis in the esophagus for fistulas of malignant origin is an easy, well tolerated, safe and effective procedure without important complications or mortality.

Percutaneous stent placement in malignant cases of superior vena cava syndrome.

PURPOSE: Superior vena cava (SVC) syndrome is caused by SVC stenosis or occlusion, frequently as a consequence of lung cancer or a mediastinal tumor. SVC syndrome is characterized by unpleasant symptoms and the condition usually leads to death if untreated. Treatment with radiation therapy and chemotherapy may produce an initial relief, whereas operations with bypass are associated with high mortality and morbidity. The PURPOSE of our study was to show the efficiency of percutaneous stenting in the SVC for relieving SVC syndrome secondary to malignant diseases. PATIENTS AND METHODS: From January 1999 to March 2003, 17 patients with malignant SVC syndrome were evaluated at the "Metaxa" Cancer Hospital. Their caval stenoses were confirmed by means of computed tomography and venography. There were 15 males and 2 females with a median age of 62 years (range 47-79). The SCV syndrome was caused by malignant disease in all patients: bronchogenic carcinoma in 14 and lymphoma in 3. All patients underwent placement of a self-expandable (wallstent) endovascular (vena cava) prosthesis. RESULTS: All procedures were successfully carried out without complications. The average time for wallstent placement was 37 min. There was no sign of bleeding and the wallstent was well positioned on chest roentgenograms. All patients, without exception, noticed an immediate improvement, with relief of dyspnea and rapid resolution of headache. Cyanosis disappeared over the first hour and swelling resolved gradually over the first 24 hours. CONCLUSION: Percutaneous venous wallstent placement in the SVC is a simple, safe and effective technique to rapidly relieve SVC syndrome caused by malignant diseases.

Malignant fibrous histiocytoma of the trunk metastatic to the liver: treatment with transcatheter intrahepatic chemoembolization.

We report a patient with symptomatic liver metastases as the sole site of recurrence of a previously resected malignant fibrous histiocytoma of the trunk. We treated the patient with two sessions of transcatheter chemoembolization. Tumor regression was achieved, and the patient remained free of symptoms 23 months after the diagnosis of liver involvement, when he died of acute myocardial infarction. To our knowledge, this is the only case of transcatheter chemoembolization of liver metastases from soft-tissue sarcoma reported in the literature. Although it is a single case, it shows that this method may be a promising therapy for this grave disease.

Emergency endovascular treatment of a superior mesenteric artery occlusion.

Endovascular treatment of acute mesenteric ischemia is rarely reported. We report a patient with a 1-year history of chronic mesenteric ischemia who presented with acute worsening of his symptoms and peritoneal signs. Aortography depicted an occlusion of the superior mesenteric artery, which was successfully managed with immediate percutaneous angioplasty (PTA) and stent placement. The patient's clinical condition improved markedly and an exploratory laparotomy performed the following day confirmed the viability of the intestine. He remains symptom-free 12 months after the procedure, and color Doppler follow-up showed that the stent is patent.

Malignant biliary obstruction: management with percutaneous metallic stent placement.

BACKGROUND/AIMS: To report our experience on palliative management of malignant biliary obstruction with percutaneous placement of metallic stents. METHODOLOGY: During a 3-year period 20 patients with malignant biliary obstruction were treated with percutaneous insertion of metallic biliary endoprostheses. RESULTS: Stent placement was successful in 19 patients, with significant improvement of jaundice in 18 patients. 17 patients have died up to date. In this group survival was 4-324 days (mean: 107 days) and mean stent primary and secondary patency 94.3 and 97.4 days, respectively. Three patients are alive with a follow-up from 20-195 days. Mean secondary patency is 65.3 days (20-134 days). We encountered serious complications in 4 patients (20%). Thirty-day mortality was 15%, while procedural mortality was 10%. Four patients presented 13-120 days (mean: 71.5 days) after the procedure with stent reocclusion (reocclusion rate: 20%). CONCLUSIONS: The procedure is relatively easy and safe to perform, yields excellent palliation of the patient's symptomatology and, therefore, contributes substantially to the maintenance of good quality of life of the patient with malignant biliary obstruction.

Folinic acid plus high-dose 5-fluorouracil with allopurinol protection in the treatment of advanced colorectal carcinoma.

Protection by prolonged administration of allopurinol against high-dose 5-fluorouracil (5-FU) administered with folinic acid in 74 patients with colorectal cancer was investigated. The dose of 5-FU was 700 mg/m2 per day for 5 days. Of 41 patients without previous chemotherapy, 1 had a complete response and 4 had partial responses (total 12%), 15 remained stable and 21 progressed. Mean duration of response was 7.4 (1.8-12.6) months. The most frequent toxicities were decreased granulocytes (13%), diarrhoea (37%), and stomatitis (35%), which were similar to the frequencies of other studies with lower doses of 5-FU without allopurinol. Prolonged administration of allopurinol thus gives some protection to patients with colorectal cancer who receive folinic acid plus high-dose 5-FU but responses were not better than those with conventional doses.