Intraperitoneal perfusion chemotherapy with hyperthermia in some malignant ascites

Intraperitoneal administration of chemotherapeutic drugs with hyperthermia (HIPEC) increases their local effect on malignant peritoneal diseases and reduces systemic cytotoxicity. The most commonly used are cisplatin, doxorubicin, and mitomycin C. A major disadvantage of intraperitoneal chemotherapy is limited penetration of the drug in the tumor lesion depth (1-3 mm). Extended exposure and increased pressure in the abdominal cavity solution increases penetration of the agent into the tumor and hyperthermia has synergy with cytostatic agent on the permeability of cell membranes and metabolism of the drug. Real clinical hyperthermia is achieved at 41 degrees C. Of greatest importance is the concentration of the drug, but crucial for the prognosis is complete cytoreductive surgery. A major disadvantage of the closed technique is the uneven distribution of the perfusion solution in the peritoneal cavity, and the main advantage is better control of the perfusion, keeping of constant hyperthermia of the solution and regular repetition of manipulation, like intravenous chemotherapy. Laparoscopy determines the stage of the tumor process, refines the indications and preoperative selection for HIPEC, monitors the effects of treatment and determines locations for introducing catheters. In the review the results of the inraperitoneal chemotherapy with hyperthermia in gastric, colorectal, ovarian and other cancers are discussed as well as in diffuse malignant peritoneal mesothelioma and others.

Aggressive surgery in the multimodality treatment of liver metastases from colorectal cancer

PURPOSE

The purpose of this study was to analyze the impact of aggressive surgery concerning resection of liver metastases (LMs) from colorectal cancer (CRC) on morbidity, mortality and survival rates and to establish the benefits of multimodal strategies in increasing the resectability rates of LMs.

PATIENTS AND METHODS

From January 2004 - April 2006 184 patients with CRC underwent surgical interventions at our clinic. Thirty-four (18.4%) of them had LMs at the time of initial diagnosis, and 26 patients developed LMs in a certain period of time after resection of the primary CRC. Multimodal therapeutic approach included thermoablation, neoadjuvant chemotherapy and surgery.

RESULTS

44 resections were performed in 29 patients: one-stage resection of the primary CRC and the LMs in 15 (40%) cases, resection and thermoablation after adjuvant chemotherapy in 2 (4.3%), resection after neoadjuvant chemotherapy in 8 (17.2%), two-stage liver resection in 1 (2.15%), resection after recurrence or because of a newfound LM in 3 (6.45%). Five resections of metastases larger than 5 cm, and 4 resections of 4 or more liver metastases were performed. Morbidity rate was 15.9% (bile leakage in 4 patients, liver abscess in 1 and wound disruption in 2). Mortality rate was 2.2% (1 patient).

CONCLUSION

Multimodal approach in the treatment of LMs of CRC increases resectability and patient survival and has no influence on morbidity and mortality.

[The treatment of cyclic mastalgia--a comparative study between the preparations Bromocriptine and Geritamin]

The aim of the prospective randomized study was to compare the reduction in cyclical breast pain after treatment with oral bromocriptine for 30 days (42 cases) and Geritamine for 40 days (44 cases). The overall response rate to first group was 78.5% and 64.0% to second group. Nine patients treated with bromocriptine and 15 cases with Geritamine have refractory cyclical mastalgia (not influence). The relapse rate after stopping bromocriptine was 30.3% and was 44.8%, with a mean follow-up of 5 months. The investigators indicate that these agents will be used for a twice per year.