Sixty patients with advanced metastatic adenocarcinoma of the liver from a colorectal primary were treated by prolonged and continuous intra-arterial hepatic arterial infusion chemotherapy over a period of time from December 1969 through July 1976. A 10-day course of 5-FU was administered in the hospital, and patients were discharged receiving 5-FUDR by continuous arterial infusion through a chronometric infusion pump. Objective responses of 100% were obtained in 15% of patients, 50% response in 39% of patients, and 25% response in 21% of patients. The median survival from onset of treatment was 8.5 months, 6.9 months, and 7 months, respectively, for 100%, 50%, and 25% responders versus 3.6 months for nonresponders. Survivals from onset of treatment were generally less in those with no disease-free interval. No relationship of response to sex and age was found. Patients previously treated with 5-FU intravenously responded to intra-arterial chemotherapy; 13% had a 100% response, and 54% had a 50% response. No relationship of drug dose to response was observed. Drug toxicity was frequently systemic and mild to moderate. Numerous complications occurred due to the catheter, complete or partial thrombosis occurring in 18.6% and 20.8%, respectively, and 30% of patients had displacement of the catheter. The role of partial arterial occlusion in terms of response and survival may be significant. Future studies should involve comparison of direct surgical placement versus percutaneous placement of catheters.
The usefulness of gallium-67-citrate scanning and lymphangiography in the detection of iliac and paraaortic lymph node involvement was evaluated in 53 patients with Hodgkin's disease and non-Hodgkin's lymphomas who subsequently underwent laparotomy. Our data suggest that the overall accuracies of the two procedures in this regard are comparable. Although in this anatomic area the gallium scan tends to underestimate the presence of disease (higher false-negative rate), the false-negative rate is quite low. The false-negative rate with lymphangiography is lower than with scanning but it tends to overestimate the presence of disease (higher false-positive rate). It was concluded that gallium scanning should be an integral part of the staging of lymphomas and a schema for their clinical staging based on the use of gallium scanning early in the diagnostic sequence is proposed.
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