Therapy of advanced gastric carcinoma. The Georgetown-Lombardi Cancer Center experience.

Gastric carcinoma, despite a decreasing incidence in the United States over the past 40 years, is the seventh most common cause of cancer death in this country and remains a significant worldwide problem. The 5-fluorouracil, Adriamycin (doxorubicin), and mitomycin (FAM) chemotherapy regimen, which was initially reported by Georgetown in 1979, has become a standard for advanced gastric carcinoma with response rates in the 40% range. The FAM regimen as well as subsequent trials conducted at Georgetown and our current approach to management of this tumor are discussed. Despite a decade of intensive clinical research, we have not identified a modification or innovation that is superior to the original FAM.

Vascular distensibility and vascular surgery.

The elastic property of an arterial wall decreases considerably with aging and/or with a variety of pathological conditions. The resulting decrease in vascular compliance has a profound physiological effect on arterial perfusion. The objectives of this study were to assess a quantitative measure of peripheral vascular distensibility (D), to apply it in some clinical conditions, and to establish a potential means of predicting success in vascular surgery for limb salvage. A technique described earlier by us for the determination of D based on an accurate measurement of volume change (delta V) with pressure change (delta P) was further analyzed and then tested in four groups: the first two were non-surgical, 18 normal subjects, and 23 hypertensive men paired with 22 normotensive men; the last two were surgical, patients undergoing aortofemoral bypass (AFB) operations for limb salvage (salvaged vs unsalvaged); and patients who underwent below-knee amputations (BKA) for severe arterial insufficiency (healed vs unhealed). The results indicate that D can be used as a reliable assessment of the pathophysiological status of the arterial system in the lower extremity; furthermore, D can be used as a predictor of success in at least two types of vascular procedures: AFB with profundoplasty for limb salvage and BKA for severe arterial insufficiency.

Noninvasive assessment of vascular disease in the lower limbs of diabetics.

One hundred and fifty seven limbs of diabetic patients free of any symptoms or signs of arterial insufficiency, were studied using noninvasive techniques to determine vascular distensibility in the lower extremities. A relationship between these values and the classification of the diabetic in terms of age, duration of diabetes and control of diabetes was sought. The results revealed a distinct inverse relationship between vascular distensibility and age of the diabetic subject, analogous to the trend found in a normal, non-diabetic group of volunteers. Furthermore, comparison of distensibility in normal and diabetic subjects within the same age group showed lowered values among the diabetics. However, the study revealed little or no apparent relationship to either duration or control of diabetes.

Percutaneous umbilical blood sampling.

Percutaneous umbilical blood sampling (PUBS), also called cordocentesis, is a newly introduced technique that enables blood samples to be obtained from the fetus in utero for a variety of conditions. The major applications are for the diagnosis of fetal infections, karyotype analysis, fetal growth retardation, diagnosis of hematologic conditions, and metabolic evaluation. This procedure is gaining in popularity, since it provides direct information on fetal blood status. It can be applied to therapeutic manipulations such as in utero transfusions or drug administration. The procedure is remarkably safe and has few technical problems. The applicability of its use in the assessment of fetal thrombocytopenia is also discussed in detail.

Phase II trial of methotrexate-FAM (m-FAM) in adenocarcinoma of unknown primary.

Nineteen patients with adenocarcinoma of unknown primary were treated with the m-FAM regimen, consisting of methotrexate 50 mg/m2 days 0, 28; 5-fluorouracil 600 mg/m2 days 1, 8, 29, 36; Adriamycin 30 mg/m2 days 1, 29; and mitomycin-C 10 mg/m2 day 1. All drugs were recycled every 56 days. No complete responses were seen. Seven patients (37%) achieved partial remission for a median duration of 11 months. An additional nine patients (47%) had stable disease for a median duration of 6 months. Median survival for responders was 16 months and was 10 months for those with stable disease. Toxicity was acceptable. This Phase II study attempted to evaluate the clinical impact of the pharmacological modulation of 5-fluorouracil with methotrexate, the goal being improvement of the results of FAM alone in adenocarcinoma of unknown primary. However, the addition of methotrexate, at least in the schedule employed in this study, did not appear superior to FAM.