Limb salvage surgery for bone and soft tissue sarcoma: a Phase II pathologic study of preoperative intraarterial cisplatin

Article Abstract:

When sarcomas (cancer originating in connective tissue) occur in the bone or the soft tissues of a limb, amputation has traditionally been the only therapeutic approach. However, more recent research suggests that, with the proper use of chemotherapy, it is possible in some cases to preserve the limb by using more conservative surgery without sacrificing long-term survival. Evidence is accumulating to suggest that preoperative chemotherapy may be beneficial in the treatment of osteosarcoma, a form of bone cancer. However, there is little evidence on which to judge whether preoperative chemotherapy might be beneficial for patients with soft-tissue sarcomas as well. A study was conducted to evaluate preoperative chemotherapy in the treatment of 28 patients with bone cancer and 12 patients with soft-tissue sarcoma. Prior to surgery, the patients were treated with courses of cisplatin. The major artery leading to the affected area is chosen for intraarterial infusion so that the majority of the cisplatin is carried directly to the spot where it is needed. After surgery, the patients received both radiation to the affected area and intravenous adjuvant chemotherapy. Examination of the tissues removed at surgery revealed that significant destruction, that is, greater than 90 percent of the tumor, had taken place in 11 of 24 cases of bone cancer which could be evaluated. None of the patients with soft-tissue sarcoma had 90 percent tumor destruction at the time of surgery, and two of nine cases which could be evaluated had minimal destruction. The results of this study confirm that preoperative chemotherapy is effective in the treatment of bone cancer, but is not likely to be particularly useful in the treatment of soft-tissue sarcoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Sarcoma, Cisplatin

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Adjuvant intraarterial chemotherapy with nimustine in the management of World Health Organization grade IV gliomas of the brain

Article Abstract:

Malignant gliomas of the brain, tumors comprised primarily of glial brain cells, are generally treated by surgical removal of the tumor and radiation therapy. The prognosis for patients with malignant gliomas is very poor. There is some evidence that chemotherapy can slow the progression of the course of the disease. The efficiency and toxicity of the drug, nitrosourea nimustine (ACNU) was examined in 50 patients with malignant gliomas. ACNU was administered through the arteries near the site of the tumor, which allowed a more local and direct effect. ACNU was given within ten days after surgery and immediately before postoperative irradiation. Additional doses of the drug were administered after irradiation. Of the 35 primary gliomas treated, disease progressed in 11 cases. The median survival time of the patients was 7.8 months; 9.1 percent of the patients survived over 24 months and were termed long-term survivors. In 24 of the cases, the disease remained stable and the patients responded to the drug. For these subjects, the median survival was 18.3 months and 67 percent of the patients were long-term survivors. Seven patients with recurrent malignant gliomas were treated with ACNU and had a median survival time being 6.1 months. Less than ten percent of the patients in the study developed cerebral complications. The results from these studies are encouraging, especially in the treatment of primary gliomas. It is felt that a randomized clinical trial should be initiated using intraarterial administration of ACNU in combination with surgery and radiotherapy for the treatment of malignant gliomas. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gliomas, Brain cancer

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Intraarterial chemotherapy through carotid transposition in advanced head and neck cancer

Article Abstract:

Higher doses of chemotherapeutic agents could be used if the drugs could be delivered more directly to the tumor, allowing less of the toxic substances to be distributed to normal tissue. For tumors of the head and neck, this may be accomplished by injecting directly into the carotid artery. In order to make this injection more convenient, the carotid itself may be moved to a new position directly under the skin. At the same time, collateral branches which travel to unaffected parts of the head and neck may be tied off. This technique was used in the treatment of 39 patients with cancer of the head or neck that was judged not amenable to surgery. The total response rate was 76.9 percent, and 12.8 percent of the patients had a complete response. Sufficient tumor destruction occurred that after chemotherapy, tumors in 28 patients were deemed removable. Seventeen patients had received combination vincristine, bleomycin, and methotrexate (VBM); 22 patients received cisplatin and bleomycin. The systemic side effects were mild, and major systemic side effects involving cardiopulmonary function occurred in only four of the patients receiving VBM. The surgical procedure is simple, acceptable to patients, and has low risk. Further studies should determine if the procedure does indeed provide improved survival for patients with nonresectable cancers of the head and neck. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Surgery, Carotid artery, Carotid arteries, Head and neck cancer

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