Is there a future role for immunoscintigraphy in the diagnosis of colorectal carcinoma?

Immunoscintigraphy combines the advances in immunology and nuclear medicine to target tumor sites. Visualization of colorectal carcinomas is based on different monoclonal antibodies and their fragments against tumor-associated antigens labeled with gamma emitting radionuclides which accumulate in the tumor tissue due to their interaction with corresponding antigens. Available data on the role of immunoscintigraphy in detection of recurrence and metastases of colorectal carcinomas are reviewed. Despite a variety of investigations related to the application of immunoscintigraphy in diagnostics of colorectal cancer, using different radiolabeled immunoreactive agents and imaging methods there has not been a consensus among the investigators regarding the best modality of the method, including the specific radiopharmaceutical for this purpose. Some general conclusions concerning potentials of immunoscintigraphy in such diagnostics, including expectancy of the newly developed SPECT/CT systems, are suggested. The possibilities of PET imaging of colorectal carcinomas using monoclonal antibodies labeled with positron emitting radionuclides, as well as of the radioimmunoguided surgery and radioimmunotherapy are also discussed. Key words: Immunoscintigraphy, colorectal cancer, recurrences, metastases, radioimmunoguided surgery, SPECT/CT.

Bimonthly 24 h infusion of high-dose 5-fluorouracil vs EAP regimen in patients with advanced gastric cancer. A randomized phase II study.

BACKGROUND: To investigate the activity and toxicity of high dose (HD) infusional 5-FU in comparison to EAP regimen as first-line chemotherapy in patients with advanced gastric cancer. PATIENTS AND METHODS: Histologically confirmed measurable advanced gastric cancer, age < 72 yr, ECOG performance status 0-2, no prior chemo- and radiotherapy, adequate organ functions. TREATMENT: EAP arm: doxorubicin (40 mg/m(2)), etoposide (360 mg/m(2)), and cisplatin (80 mg/m(2)) every 28 d; HD 5-FU arm: 5-FU 2.6 g/m(2) 24 h infusion, biweekly. RESULTS: Sixty patients were randomized. Patient characteristics (arms EAP/HD 5-FU): Median age 57/55 yr, median PS 1/1, LAD (patients) 3/8, M1 (patients) 27/22. Median number of cycles (range): EAP arm 4 (2-8), HD 5-FU arm 2 (1-8). Worst toxicity per cycle (grade 3 and 4 in%): Neutropenia 20/3, thrombocytopenia 9/0, anemia 9/13, diarrhea 3/10, nausea 17/7, vomiting 10/0 for EAP and HD 5-FU arms, respectively. All patients were eligible for response in both arms. Confirmed response rate (95%CI): EAP arm 34% [16-50%]/HD 5-FU arm 10% (0-21%), no change: 46/40%, progression of disease: 20/50, respectively. Overall survival (range): EAP arm A 7 mo [3-27], HD 5-FU arm 6 mo (4-25). CONCLUSIONS: Infusional HD 5-FU showed a low incidence of severe toxicity. But given the low efficacy of 5-FU in the dosage we applied in the study, it cannot be recommended as a single treatment for further studies. Assessment of higher dose intensity and/or dose density of 5-FU, with introduction of other active drugs in combination, could be an option for further studies.

Long-term results of surgically treated traumatic rectourethral fistulas.

OBJECTIVE: Rectourethral fistulas are uncommon, usually iatrogenic injuries that are demanding to treat. We present the challenging problems involving the treatment of rectourethral fistulas caused by war wounds. MATERIALS AND METHODS: In the period 1991-1996, during the war in Croatia and Bosnia, six patients with rectourethral fistulas caused by war injuries were operated in our institution by the same surgeon. All patients were young males with a mean age of 24.6 years. In all patients, double diversion (diversion colostomy and cystostomy) was performed at the time of the injury in military hospitals. In three patients, multiple unsuccessful operations were performed in other institutions to close rectourethral fistula. We found urethrocystography and proctoscopy as the most reliable diagnostic studies and performed them in all patients. In first three patients, we performed transanal repair with anterior rectal wall advancement flap. Because it failed in all three patients, we performed York-Mason trans-sphincteric approach and anterior rectal wall advancement flap after which rectourethral fistula closed in all patients. Because of the satisfactory results, we performed the same procedure in other three patients. RESULTS: In all patients rectourethral fistula healed 2 months after the operation. Closure of diverting colostomy was performed after urethrocystography and proctoscopy proved that the rectourethral fistula has healed. There were no operative deaths and no major complications. Urethral stenosis developed in one patient and was successfully managed by dilatation. CONCLUSION: We believe that York-Mason trans-sphincteric approach offers straightforward access through healthy tissues and good fistula visualization. Anterior rectal wall advancement flap can easily be performed and offer good chances for definitive closure of the rectourethral fistula.