Studies on the treatment and prevention of colorectal liver metastases

Liver metastases occur in as many as 50% of patients with colorectal cancer and are regarded as a principal cause of death. Both clinical and experimental studies have been undertaken in an attempt to understand the haemodynamic changes occurring in established liver metastases. Trials of various forms of treatment based on these observations are described. In addition attempts to reduce the incidence of subsequent liver metastases are discussed.

Natural history of patients with untreated liver metastases from colorectal cancer

One hundred fifty-five patients, laparotomized because of colorectal cancer, were retrospectively evaluated with special attention given to the natural course of untreated synchronous liver metastases. The median survival time for patients with synchronous liver metastases was 4.5 months. The survival time was mainly influenced by the extent of tumor involvement in the liver. Patients with elevated levels of serum-alkaline phosphatase at the time of operation had a significantly shorter survival time than those with normal values. Serum alkaline phosphatase levels are a good indication of prognosis. The incidence of synchronous liver metastases was 16 percent. This low rate is partly explained by the development of metachronous liver metastases in five patients within 1 year. Comparison with previous reports, often more than 10 years old, reveals that the poor prognosis of patients with untreated liver metastases from colorectal cancer has remained unchanged.

Measurement of DNA synthesis by flow cytometry

Cells were stained for DNA content with Hoechst 33258 combined with propidium iodide and analyzed on an epi-fluorescence flow cytometer. Scatterplots of red versus blue fluorescence of control cells showed a straight line indicating that both dyes were measuring proportional amounts of cellular DNA. Scatterplots of cells incubated with the thymidine analog bromodeoxyuridine, however, showed a displacement from the control straight line that increased with longer exposure time to bromodeoxyuridine. These results suggest that bromodeoxyuridine incorporation in DNA can be detected by flow cytometry.

Regional growth differences of human tumour xenografts in nude mice

Human tumour cells of the HEP-2 and SW480 cell lines were inoculated subcutaneously into 4 locations on the athymic (nude) mouse lateral trunk. There was no difference in size between tumours grown on the right side of the body and those grown on the left. However, 4 weeks after inoculation, anterior tumours were 3 times as large as posterior tumours. The results indicate a predilection for tumour xenograft growth in the anterior region of the lateral nude mouse trunk.

Screening for liver metastases from colorectal cancer with carcinoembryonic antigen and alkaline phosphatase

A sensitive and economic method of screening for liver metastases in patients with colorectal cancer was developed using serum alkaline phosphatase and carcinoembryonic antigen. The upper limit of normal for alkaline phosphatase and carcinoembryonic antigen did not represent the optimal levels for use in predicting liver metastases. However, with alkaline phosphatase greater than 135 I.U., and/or carcinoembryonic antigen greater than 10 ng/ml, sensitivity was 88%: 23 of 26 patients with liver metastases fulfilled either or both criteria. The false-positive rate was 12%. Liver scanning, alone, demonstrated metastases in only 69% of 35 patients with liver metastases. The combination of alkaline phosphatase and carcinoembryonic antigen can be used economically to screen for liver metastases, and to determine which patients should undergo a liver scan.

Immunological reconstitution of tumour-transplanted and thymus-grafted nude mice

Two different malignant tumours were transplanted prior to or after thymus grafts in nude mice, and the degree of immunological reconstitution was studied. All mice which rejected either of the tumour types had reconstitution as expressed by an excess of splenic plaque-forming cells. The level of response was dependent upon the age of the thymus graft and whether a tumour was transplanted or not. In contrast, the result of the phytohaemagglutinin stimulation assays of spleen cells were always subnormal in thymus-grafted as well as in thymus- plus tumour-transplanted mice.

The suppression of tumorigenicity in human X mouse cell hybrids. I. Derivation of hybrid clones, chromosome analysis and tumorigenicity studies

The nature of genetic determinants associated with the regulation of malignancy was investigated in interspecies (human X mouse) cell hybrids. An apparently transformed diploid human cell strain (ME) was fused with a malignant, HGPRT-deficient, mouse cell line (A9). A primary hybrid with an unusual stellate appearance that contained the isozymic forms of lactate dehydrogenase from both parent cells was selected. Through further cloning, four tertiary hybrid cell clones were obtained in which malignancy was substantially inhibited and in which the human chromosome content was reduced or completely absent. Two of the hybrid clones whose malignant phenotype was stably suppressed contained no apparent human chromosomes, whereas the other two, whose phenotype was unstable, contained a part of a human chromosome. Our results are consistent with the view that suppression of malignancy occurs in interspecies hybrids consisting of a malignant mouse and a transformed human parent cell. At present, however, any assignment of a specific human chromosome, or specific fragments thereof, that may suppress the expression of malignancy in these hybrids, is a matter of conjecture.

Behavior of the chromosome core in mitosis and meiosis

A simple method has been described for the visualization of chromosomes cores with light microscopy in conventional chromosome preparations. The technique is relatively simple, highly reproducible and can be used effectively on fresh and aged slides. The following observations have been made: (1) a core existed in mitotic chromosomes in all the materials employed, confirming the findings of Howell and Hus (1979). (2) The microchromosomes of the chicken and double minutes of a human carcinoma cell line also exhibited the core structure. (3) The core structure of meiotic chromosomes appear weak, disorganized, and disintegrating.

Membrane-associated antigens on tumor cells from transitional-cell carcinoma of the human urinary bladder. I. Immunological characterization by xenogeneic antisera

An antiserum was raised in rabbits by immunization with a human tumor cell line, T-24, derived from transitional cell carcinoma (TCC) of the urinary bladder. The specificity of the IgG fraction was assessed by antibody-dependent cellular cytotoxicity (ADCC), using purified blood lymphocytes from healthy human donors as effector cells and seven human cell lines as target cells (T-24 and two additional TCC-lines, two normal urothelial lines, one colon carcinoma and one malignant melanoma). The IgG induced strong lysis of all seven target cell types. However, lysis of the five urothelial lines was significantly stronger than that of the control tumors. Conversely, antisera to either of the control tumors induced a significantly stronger lysis of the homologous tumors than of the urothelial cells. All antisera contained antibodies to fetal bovine serum but removal of these by absorption did not change the specificity of the ADCC reactions. When the anti T-24 serum was exhaustively absorbed with glutaraldehyde-fixed spleen homogenate, the cytotoxicity to the control tumor targets was abolished. Although absorption reduced the antibody titer of the IgG preparation, ADCC to the TCC targets remained at a high level. There was no difference in the degree of lysis of the three TCC targets. Lysis of the two target lines from normal urothelium was slightly lower than that of the tumor cells. The results indicate that the anti-TCC serum contained antibodies to one or several antigens shared by five urothelial cell lines but not by the control tumors. Whether or not it also contained antibodies to TCC-associated antigens remains to be established. The molecular basis for these findings will be given in the accompanying paper.

Orbital carcinoid tumor metastatic from the colon

Acute exophthalmos and ophthalmoplegia of the left eye developed in a 58-year-old woman convalescing from a right hemicolectomy for a carcinoid tumor of the colon. Roentgenograms of the orbit and computed tomograms showed a large posterior left orbital mass. Lateral orbitotomy and biopsy confirmed the diagnosis of metastatic carcinoid tumor. Irradiation with radioactive cobalt (60Co) resulted in early relief of the ocular symptoms. To the best of our knowledge, this is the second documented case of orbital metastatic carcinoid tumor and the first patient with orbital involvement from a primary carcinoid tumor of the colon. Orbital irradiation for metastatic orbital carcinoid tumor has not been previously reported and should be used for symptomatic relief, because long-term survival is possible in patients with metastatic carcinoid tumors.

Transbrachial hepatic arterial chemotherapy using an implanted infusion pump

Two patients with hepatic metastases from colonic cancer were treated with hepatic arterial FUDR using an innovative drug infusion system. The two patients reported underwent transbrachial hepatic artery catheterization with a 5 French polyethylene catheter. This catheter was amputated just distal to its exit from the brachial artery and attached to a totally implantable, percutaneously refillable drug infusion pump placed in the infraclavicular position. The patients received FUDR at flow rates of 3--4 ml/day. The pumps were refilled weekly by percutaneous injection. One patient was treated for seven weeks, and another for ten weeks without technical difficulties. This innovative approach offers marked improvement in comfort and convenience for patients who are candidates for long-term hepatic artery chemotherapy, and avoids the morbidity of laparotomy for direct hepatic arterial catheterization.

[Computed X-ray tomography in cases of metastatic brain tumors]

The authors describe the role of computerized tomography in the diagnosis of metastases to the brain and orbit, and analyse computer tomography findings in different types of metastases. Because the metastases are visualized better after administration of contrast medium the importance of this tomography done before and after administration of contrast medium is discussed.

Internal radiation therapy of hepatic cancer

Established cancer in the liver can, in selected patients who have a good arterial circulation in these tumors, be effectively treated by intrahepatic artery radioactive yttrium-90 resin microspheres. Even in unselected patients treated in the last five years by the author, 17 of 25 patients treated have had good objective regression of cancers, improvement of symptoms and prolongation of life. Treatment is relatively simple and associated with few side effects. For adjuvant therapy of colon cancer having positive nodes (Dukes C), internal radiation therapy of the liver is best done with Phosphorus-32 Colloid passed through the circulation of the gut to be effectively and homogeneously trapped by the Kupffer cells of the liver. Four such patients have been subjected to a pilot study--three of the four are doing well without significant side effects and no evidence of liver cancer after two years. When the fourth died of brain metastases, he too had less liver cancer than would be expected.