Prognostic variables in recurrent limb melanoma treated with hyperthermic antiblastic perfusion

Article Abstract:

Melanoma is a difficult cancer to treat and results are generally disappointing. The isolated perfusion of a limb is a technique used to treat tumors with higher doses of chemotherapeutic agents than can be safely administered to the entire body. The technique has been modified to permit the heating of the external blood supply used to artificially perfuse the limb, so that the tumors in the limb are treated with both chemotherapy and hyperthermia. The technique, called hyperthermic antiblastic perfusion (HAP), was used to treat 136 patients with recurrent limb melanoma. In this study, melphalan was the drug routinely used, and the optimal temperature range was 41.5 to 41.8 degrees Centigrade (C). However, physiologic variations prevented all limbs from being brought to 41.5 degrees C. Only 68 percent of the patients reached this temperature, and analysis showed that this had a significant effect on the probability of a complete response. However, the greatest overall predictor of a complete response was the number of lesions. Although increasing drug dosage seemed to help achieve a complete response, this factor was not statistically significant. However, drug dosage was significant when considered in conjunction with temperature; high temperature combined with high dosage produced a much greater chance of complete response than low temperature combined with lower dosage. In this series, women had a significantly higher overall survival rate than men. Eight of the 136 patients died postoperatively; four patients experienced arterial thrombosis requiring amputation. Twelve others developed thrombophlebitis (inflammation and blockage of a vein) or venous thrombosis (blockage) which resolved in 15 to 20 days. The overall 5-year survival rate in this series was 47.3 percent, which is sufficiently greater than life expectancies that are associated with surgical treatment alone. Other studies have produced varying results, but it appears that the proper monitoring and control of temperature may have dramatic effects on the outcome of these patients. Hyperthermic antiblastic perfusion is an effective treatment and efforts should be made to optimize this method for drug dosage and temperature. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Melanoma, Thermotherapy, Hyperthermia treatment systems (Medical care), Hyperthermia treatment equipment

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Transurethral resection of the prostate and metastatic prostate cancer

Article Abstract:

Transurethral prostatectomy, or TURP, is the removal of the prostate gland through the urethra (the tube connecting the bladder to the outside). While the surgical procedure itself is generally successful, concerns have been raised that cancerous prostate cells might be released and spread through the body by TURP. Indeed, it has proved possible to detect the presence of cancerous prostate cells in the blood specimens collected during TURP. However, the mere presence of these cells in the blood does not necessarily indicate an increased likelihood that prostate cancer will metastasize to other sites. The cancer cells must themselves be prepared to form metastatic colonies of cells, and they must arrive at locations conducive to metastatic cancer growth. Therefore, despite the demonstration that prostate cancer cells circulate in the blood after TURP, fears about the metastatic spread of prostate cancer by this technique must be confirmed directly. An evaluation was conducted of 93 patients receiving radiation therapy for prostate cancer. Fifty-nine of these patients had urinary obstruction and underwent TURP; the remaining 34 patients received radiation therapy alone after biopsy findings. If TURP contributed to the spread of cancer, a greater fraction of treatment failures might be expected in this group. However, no such increase was observed. The treatment failure rate was 47 percent for the patients treated with TURP after a mean follow-up of 49 months. After 50 months, the failure rate of the patients treated only with radiation therapy was also 47 percent. The cases analyzed in this study provide no support for the concerns that TURP may contribute to the metastatic spread of prostate cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Surgery, Prostate cancer, Metastasis, Cancer metastasis, Prostatectomy, Transurethral, Transurethral prostatectomy

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A prospective randomized trial of doxorubicin versus idarubicin in the treatment of advanced breast cancer

Article Abstract:

The majority of modern chemotherapeutic protocols for the treatment of breast cancer include doxorubicin. Although the drug shows significant activity against breast cancer, the usable dosage is limited by the drug's toxicity for the heart. In addition, less serious but distressing side effects include vomiting, hair loss, and tissue necrosis around the site of injection. Idarubicin is a related anti-cancer drug, which can be administered orally. The cardiac toxicity of idarubicin was lower than that of doxorubicin when tested in experimental animals, and preliminary results suggested that the compound had useful activity against advanced breast cancer. To evaluate doxorubicin and idarubicin in a direct comparison, 76 patients with recurrent or metastatic breast cancer were randomly assigned to receive either of the two drugs. A significantly greater proportion of the patients treated with doxorubicin achieved objective responses to treatment. Overall, 46 percent of the patients receiving doxorubicin achieved a response, in contrast to 21 percent of those given idarubicin. Of the patients with prior chemotherapy, 29 percent responded to doxorubicin and 12 percent to idarubicin. The results clearly indicate that doxorubicin should remain the chemotherapeutic drug of choice in the treatment of breast cancer. However, it should be mentioned that idarubicin resulted in less gastrointestinal toxicity and less hair loss. Furthermore, while 4 of 38 patients receiving doxorubicin required treatment for congestive heart failure, no such cases occurred among those receiving idarubicin. Idarubicin may remain an option for selected patients with breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Breast cancer, Chemotherapy, Idarubicin, Doxorubicin

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