Reduction of chemotherapy-induced side-effects by parenteral glutamine supplementation in patients with metastatic colorectal cancer

In animal studies, glutamine (Gln) reduces chemotherapy-associated mucositis and mucosal atrophy. Therefore, this study examined the protective effects of a parenteral Gln supplementation in patients with metastatic colorectal carcinoma receiving 5-fluorouracil (5-FU)/calcium-folinate (CF) chemotherapy. In a prospective study, a total of 24 patients underwent three courses of 5-FU/CF chemotherapy and were randomised with (n = 12) or without (n = 12) glycyl-L-glutamine. Effects on gastrointestinal mucosa were assessed by endoscopic examinations and histomorphometric measurements. Clinical side-effects were documented according to the World Health Organisation grading. In the Gln group, a significant reduction in mucositis and ulcerations of the gastric (P < 0.01) and duodenal mucosa (P < 0.05) was documented after the third course of chemotherapy. In the same group, the villus height/crypt depth ratio was significantly higher after therapy than in the unsupplemented group (1st course P < 0.01; 3rd course P < 0.05). However, there were no significant differences in the incidence and severity of clinical side-effects. The results suggest that parenteral Gln supplementation protects the gastrointestinal mucosa against 5-FU/CF chemotherapy-induced damage.

[Magnetic resonance tomography, endosonography and hydrosonography in staging stomach carcinoma]

Endosonography (EUS) results in greater accuracy in small gastric cancers (T1, T2) than MRI. The accuracy rate in correct lymph node staging is 82% (EUS) and 76% (MRI). Hydrosonography provides information but no significant staging.

Perfusion of colorectal liver metastases and uptake of fluorouracil assessed by H2(15)O and [18F]uracil positron emission tomography (PET)

Perfusion and fluorouracil (FU) accumulation were assessed using positron emission tomography (PET) with H2(15)O and 18FU in 36 patients with colorectal liver metastases. The tracers were injected intravenously and via the hepatic artery. Standard uptake values (SUV) were calculated using a region of interest (ROI) technique. The perfusion of non-tumorous liver tissue was similar after intravenous (i.v.) and intra-arterial (i.a.) assessment [mean of 2.67 (s = 0.61) and 2.2 (s = 0.45)]. Metastases were found to be hypoperfused compared to normal liver tissue after i.v. examinations [mean 1.73 (s = 0.77)]; i.a. injections revealed greater perfusion in metastases [mean 6.41 (s = 5.47)]. Single metastases showed up to 10 times greater perfusion with the i.a. injection route than with the i.v. one. However, lesions with no change or lower perfusion were also observed. Generally, accumulation of 18FU in metastases after i.v. infusion was less than after i.a.. Correlation of i.v. perfusion and uptake was moderate (r = 0.54, P = 0.0001); i.a. correlation was only slightly better (r = 0.61, P = 0.008). Perfusion as measured by H2(15)O-PET does not generally predict uptake of 18FU in colorectal liver metastases. To measure FU uptake using PET and 18F seems to be the most accurate method. It would allow one to identify individual patients with considerably greater accumulation of 18FU following i.a. administration who should profit from a cross-over to intrahepatic chemotherapy.

[Oncologic therapy at home: a trial model]

In the course of a trial investigation, 162 patients with malignant tumour were treated in their home between November 1986 and August 1988. A team - consisting of doctor, nurse and psychologist - was the link between patient, family practitioner, tumour centre and social services in an integrated treatment regimen. Chemotherapy was performed at home in 64 patients, artificial parenteral or enteral nutrition in 22. Home treatment was undertaken in 23 patients in the endstage of their illness and in 49 patients after mutilating cancer operations. The complication rate of home treatment was only 0.5%. Rehospitalization became necessary in some, especially because of complications of the underlying disease, which required extension of the treatment. With this regimen patients were able to remain at home for 84% of required treatment time (7921 patient days).

Experiences in home care of cancer patients. A new approach in cancer nursing

As a result of mutilating operative procedures, aggressive cytotoxic chemotherapy and terminal stage of the disease, tumor patients face frequent visits to the tumor center. They are often hospitalized and thereby excluded from family and home. To enable cancer therapy and supportive care on an ambulatory basis, a team consisting of two physicians, two nurses and one psychologist was settled in our department in November 1986. The purpose of this team was to transfer several oncological treatment modalities from the hospital to the homes of the patients. Apart from organizing the patients' discharge from the hospital and coordinating treatment, the main task of the team has been to follow the patient during the course of the disease and give psycological support. In our experience the possibility of home care has clearly improved the patients' quality of life.