Oxaliplatin, 5-fluorouracil/leucovorin and epirubicin as first-line treatment in advanced gastric carcinoma: a phase II study.

The association between oxaliplatin and 5-fluorouracil (5-FU) has been extensively reported to improve prognosis of gastric cancer patients. The present study is aimed at evaluating response rate and the toxicity profile of the association with oxaliplatin, 5-FU/lecovorin and epirubicin in gastric cancer patients with locally advanced or metastatic disease. Thirty-six patients have been enrolled and 35 evaluated. The treatment schedule was oxaliplatin (100 mg m(-2)), 5-FU (400 mg m(-2)), leucovorin (40 mg m(-2)) and epirubicin (60 mg m(-2)) intravenously. administered every 3 weeks for 6 months, for a total of 185 therapy cycles . Response rate and toxicity were assessed according to the international WHO criteria. Every patient received a mean of 5.3 therapy cycles in a day-hospital setting. Sixteen of 35 patients (46%) showed an objective response, two complete response and 14 partial response. Median time to progression was 33 weeks with an overall median survival of 49 weeks. During the study, anaemia grade 3 and neutropenia grade 3 were observed in 9 and 11% of patients respectively. A grade 3 periferic sensorial neuropathy was observed in 6% of patients. No life threatening or cardiac toxicity was recorded. The regimen used showed anticancer activity against gastric carcinoma, a tolerable toxicity profile and excellent patient compliance.

Randomized trial of adjuvant chemotherapy versus control after curative resection for gastric cancer: 5-year follow-up.

Adjuvant chemotherapy of gastric cancer after curative resection is still subject to discussion. In this study 137 patients with gastric adenocarcinoma, all with positive nodes, were randomized after curative resection so that 69 received epidoxorubicin (EPI), leucovorin (LV) and 5-fluorouracil (5-FU) on days 1-3 every 3 weeks for 7 months, whereas the remaining 68 did not. After a follow-up period of 5 years, 21 of the 69 treated patients (30%) and nine controls (13%) were still alive; median survival time was 18 months for the controls and 31 months for the patients treated with adjuvant chemotherapy (P< 0.01).

[Splenic injuries: recent acquisitions concerning the treatment]. / Traumi splenici: recenti acquisizioni in tema di trattamento.

The Authors briefly review spleen functions and the consequences of splenectomy particularly for what the immune function is concerned. Data concerning postoperative infections following splenectomy for staging laparotomy in 92 patients with lymphoma are analysed. Data concerning immunological function of 17 pts. who underwent splenectomy in the last 5 yrs. compared to 17 normal controls, homogeneous for sex and age, are reported. Plasma IgM decrease in 3 cases, CMI anergic status in 3 cases and CD4+/CD8+ lymphocyte ratio increase in 8 cases were observed. This article also reviews surgical techniques and recent knowledge in relation to the best treatment for splenic traumas, emphasizing advantages and disadvantages of conservative treatment. The Authors conclude presenting their personal series of 42 pts. affected with traumatic lesions of the spleen treated in the last 10 yrs., also illustrating a treatment flow-chart.

Surgical management of adrenal cortical carcinoma.

The experience with the surgical management of 14 patients with adrenal cortical carcinoma is presented. Four patients were males and 10 females (mean age: 37 years). Seven patients (50%) has proven hormonal activity and 7 (50%) had "non functioning" tumors. The location of carcinoma involved the left adrenal gland in 9 cases, the right in 3 and it was bilateral in 2. The mean diameter of the mass was 10 cm. The most helpful diagnostic tests were shown to be sonography and computed tomography. The surgical procedure was chosen according to the patients condition: this included resection of primary lesion and excision of local lymph nodes and all involved structures. Adjuvant treatment with either mitotane, 5-FU or local irradiation did not result in any benefit with respect to the expected survival. There was a slightly better survival for functioning versus non functioning tumors. Surgery remains the treatment of choice for these tumors. Prognosis is exceedingly poor: only 5 patients (36%) have survived beyond two years after surgery.