Randomized adjuvant study comparing two schemes of 5-fluorouracil and leucovorin in stage B2 and C colon adenocarcinoma: study design and preliminary safety results. Groupe d'Etude et de Recherche Clinique en Oncologie Radiotherapies.

The aim of this randomized open-label study was to compare a bimonthly with a monthly regimen of 5-fluorouracil (5-FU) and leucovorin for the adjuvant treatment of colon and high-rectum adenocarcinoma. The bimonthly regimen was administered for 2 consecutive days every 14 days as d,L-leucovorin 200 mg/m2 or L-leucovorin 100 mg/m2 as a 2-hour infusion followed by 5-FU bolus of 400 mg/m2 and a 600 mg/m2 5-FU 22-hour continuous infusion (LVSFU2). In the monthly regimen, d,L-leucovorin 200 mg/m2 or L-leucovorin 100 mg/m2 15-minute infusion followed by a 400 mg/m2 15 minute 5-FU bolus was administered for 5 consecutive days every 28 days (FUFOL). Nine hundred five patients with recently resected stage B2 or C colon or high-rectum adenocarcinoma (inferior pole of the tumor subperitoneal) were recruited into the study. Patients were randomized in a 2 x 2 factorial design to receive either LV5FU2 or FUFOL for 24 or 36 weeks. Characteristics of the patients in the two different treatment groups were similar at baseline. Compliance was good. Mean 5-FU dose intensities were 930 mg/ m2/wk and 463 mg/m2/wk for LVSFU2 and FUFOL, respectively. The incidence of maximal grade III-IV toxicities for LVSFU2 and FUFOL was neutropenia 6% and 16% (P < .001), diarrhea 4% and 10% (P < .001), and mucositis 2% and 7% (P < .001), respectively. Maximum grade III-IV toxicities in the LV5FU2 treatment group were significantly lower than in the FUFOL group (10% v 26%; P < .001). Although patients in the LV5FU2 group received twice the dose of 5-FU compared with those in the FUFOL group, LV5FU2 was shown to be less toxic. Efficacy data will be available in 2001.

An educational intervention for front-line health professionals in the assessment and management of suicidal patients (The STORM Project).

BACKGROUND: Suicide prevention is a health priority in many countries. Improved management of suicide risk may improve suicide prevention. This study aimed to assess the feasibility of health district-wide training in the assessment and management of people at risk of suicide; and to assess the impact of training on assessment and management skills. METHODS: Staff in three health care settings, namely primary care, accident and emergency departments and mental health services (N = 359), were offered suicide risk management training in a district-wide programme, using a flexible 'facilitator' approach. The main outcomes were the rate of attendance at training, and changes in suicide risk assessment and management skills following training. RESULTS: It was possible to deliver training to 167 health professionals (47 % of those eligible) during a 6 month training period. This included 95 primary care staff (39%), 21 accident and emergency staff(42%) and 51 mental health staff (78%). Of these, 103 (69%) attended all training. A volunteer sample of 28 staff who underwent training showed improvements in skills in the assessment and management of suicide risk. Satisfaction with training was high. The expected costs of district-wide training, if it were able to produce a 2.5% reduction in the suicide rate, would be 99,747 pound sterling per suicide prevented and 3,391 pound sterling per life year gained. CONCLUSIONS: Training in the assessment and management of suicide risk can be delivered to approximately half the targeted staff in primary care, accident and emergency departments and mental health services. The current training package can improve skills and is well accepted. If it were to produce a modest fall in the suicide rate, such training would be cost-effective. However, a future training programme should develop a broader training package to reach those who will not attend.

[Meningeal metastases of ovarian cancer. Contribution of imaging]. / Métastases méningées du cancer de l'ovaire. Apport de l'imagerie.

BACKGROUND: Secondary meningeal localizations are uncommon and may disclose reactivation of a malignant disease. Most meningeal metastases occur in breast cancer, exceptionally in primary ovarian cancer. CASE REPORT: We report 2 cases of secondary meningeal localizations of ovarian cancer. The diagnosis was clinical, supported by cerebrospinal fluid analysis and computed tomography and magnetic resonance imaging. DISCUSSION: Establishing the diagnosis of carcinomatous meningitis may be difficult. Clinical signs and biological data are not always conclusive. If spinal tap is contraindicated or negative, imaging, particularly magnetic resonance imaging is highly contributive in establishing the diagnosis of secondary localization. A precise evaluation of the invaded tissues is quite helpful in guiding therapeutic management based on chemotherapy, tumor resection or radiotherapy.

Primary nonseminomatous germ cell tumor of the prostate.

We describe a case of a primary nonseminomatous germ cell prostatic tumor and discuss the problem of extragonadal germ cell tumors. Prognosis, staging and management of these tumors are similar to that of metastatic primary testicular germ cell tumors.

A prospective study of detorubicin in malignant mesothelioma.

Between January 1981 and December 1983, a prospective therapeutic trial of detorubicin (14-diethoxyacetoxy-daunorubicin [DTR]) was conducted in 40 patients with histologically proven malignant mesothelioma (MM). DTR was given intravenously at 40 mg/m2 on days 1, 2, and 3 for five 21-day cycles, then 40 mg/m2 once every 21 days. Thirty-five patients (32 with pleural MM, 3 with peritoneal MM) were eligible. The overall median survival from onset of chemotherapy was 17 months. Complete relief from chest pain was observed in 8 of 15 cases (53%). Of 21 patients with measurable disease, there were 2 complete responses (10%) and 7 partial responses (33%). Median duration of response was 30 weeks. Congestive cardiac failure developed in two patients after 1100 and 1600 mg/m2 of DTR, respectively. Hematologic toxicity was moderate. This study demonstrates that DTR is effective against MM.

Hepatocellular carcinoma related to hepatitis B virus in a patient with Waldenström's macroglobulinemia.

A patient with long-standing Waldenström's disease and cryoglobulinemia, treated with chlorambucil, developed hepatocellular carcinoma. Although HBs antigen, anti-HBs, and anti-HBc antibodies were not detected in his serum by conventional polyclonal radioimmunoassays, immunofluorescence techniques showed HBs antigen to be present in hepatocytes.

[Primary pseudo-ovarian peritoneal carcinosis. 4 cases]. / Carcinoses péritonéales primitives pseudo-ovariennes. Quatre observations.

Primary papillary carcinosis of the peritoneum is a rare disease seen in elderly women in whom no digestive or ovarian carcinoma could be detected. Its histological structure is identical with that of papillary carcinoma of the ovary. The 4 cases reported here were treated as advanced ovarian carcinomas, with multiple chemotherapy including doxorubicin and cis-platinum. Three patients were re-operated upon after 6 courses. Complete remission was obtained in all 4 cases, but the patients relapsed under maintenance therapy. The diagnosis must be suspected in elderly women presenting with unexplained carcinosis. This is particularly important since effective treatments can now be proposed, as for advanced ovarian carcinomas.

[Hepatic chemotherapy by hepatic arterial catheterization with an implantable system allowing permanent vascular access]. / La chimiothérapie hépatique anticancéreuse par cathétérisme artériel hépatique avec système implantable permettant un accès vasculaire permanent.

This technique of anti-cancer treatment of hepatic cancers has a twofold interest: it delivers local chemotherapy in direct contact with the tumours and it allows repeated access to the blood supply of the liver without the need for surgery. This second point is particularly emphasized in the form of a technical description of the method of approach to the hepatic arterial system, which is as non-aggressive as possible and which allows permanent vascular access. This study, which required close collaboration between the departments of Vascular Radiology, Radiotherapy and Surgery, was initially considered as a feasibility study of a technique enabling the simple use of implantable vascular access sites.

[Metastatic adenocarcinoma without known primary]. / Adénocarcinomes métastasés sans primitif connu.

Metastatic adenocarcinoma of unknown origin is a common and severe condition. Systematic extensive investigative procedures are time consuming and largely unproductive. On the hand, some primary cancers for which specific and effective treatment is available should be looked for routinely. Recent results of chemotherapy are reviewed.

[Cardiotoxicity of anthracyclines]. / La cardiotoxicité des anthracyclines.

The cardiotoxicity of the anthracyclines, of which doxorubicin is the leading drug, manifests itself in two ways: acutely, giving rise to temporary and usually benign phenomena, and chronically, giving rise to cardiac failure which is often irreversible. The risk of cardiomyopathy is related to the total dose of anthracycline administrated. The main risk factors are, age, previous cardiac disease and mediastinal radiotherapy. The prevention of cardiomyopathy is based on the respect of empirical guide lines (interruption of anthracyclines at "threshold" cumulative doses) and on methods of detection of infra-clinical disease. Myocardial angioscintigraphy which is easier to perform than myocardial biopsy and more sensitive and specific than echocardiography seems to be the investigation of choice. The main lines of research are aimed at improving our understanding of the mechanism of the cardiomyopathy, the institution of clinical trials to detect the first signs of toxicity of continuous infusions, the improvement of the standardisation and specificity of methods of detection, better definition of alarm thresholds and the development of new, less cardiotoxic, anthracyclines and cardioprotective agents.

[Relief of cancer pain by daily epidural injections of morphine using an implanted subcutaneous device]. / Sédation des douleurs cancéreuses par injection péridurale quotidienne de morphine grâce à un accès sous-cutané implanté.

Epidural narcotics have been shown to produce prolonged pain relief in chronic cancer pain. The technical hazards of daily injections and risks of infection with percutaneous catheters have delayed implementing this treatment. A completely implantable daily epidural morphine delivery system has been developed. Its technique and efficiency are presented.

Adrenocorticotropic hormone in the prevention of cisplatin-induced nausea and vomiting.

A double-blind trial to evaluate the antiemetic effects of adrenocorticotropic hormone (ACTH) in patients treated with cisplatin was performed. Thirty-seven adults with advanced cancer who were treated with cisplatin were randomly assigned to receive either synthetic long-acting ACTH (1 mg IM given 24 hours, 12 hours, and immediately preceding the administration of cisplatin) or a placebo given under the same conditions. All of the patients received chlorpromazine (50 mg IM) 30 minutes before cisplatin infusion. Patients receiving ACTH and chlorpromazine had significantly fewer episodes of vomiting (p less than 0.01) and shorter periods of nausea (p less than 0.02) than patients receiving placebo and chlorpromazine. Patients receiving ACTH and chlorpromazine were significantly more comfortable than patients receiving placebo and chlorpromazine. No important side effects were observed. ACTH may be an effective agent in preventing nausea and vomiting induced by cisplatin.