Hepatic intra-arterial injection of Yttrium-loaded microspheres for liver metastasis secondary to colorectal cancer: best soups are sometimes made from old recipies.

Colorectal cancer is a severe disease with a significant incidence in Western world. In the course of disease, about 40% of patients will eventually develop metastases to the liver. The majority of them will never be candidate for curative surgical management. For those patients, systemic or intra-hepatic chemotherapy is the treatment's cornerstone. Unfortunately, despite evident improvements and apparition of several active new agents, no hope of cure emerges on the agenda for now. Hepatic intra-arterial injections of radioactive devices have since a long time drawn interest from the medical community. An anti-tumoural activity has been demonstrated with Yttrium-loaded microspheres injected in the hepatic artery for several liver neoplasms including metastases from colorectal cancer. We lack however the results of large randomized phase III trials to define clearly the place of those interventional therapies in the management of colorectal cancer metastatic to the liver.

Perianal Paget's disease: case report and review of the literature.

Cutaneous Paget's disease (PD) is a rare entity, predominantly involving the breasts. Anal involvement is rather exceptional, and can be associated with underlying malignancies, among which prostate and rectal adenocarcinoma. We report the case of a 71-year-old man suffering from a long history of anal itching, associated with an erythematosquamous lesion of the right buttock extending up to the anus. The diagnosis of perianal PD (PAPD) was confirmed by histopathological demonstration of Paget's cells from a biopsy performed after ineffective topical treatment. Radiological and further clinical inspections allowed us to exclude any synchronous malignancy. A first-step surgery consisted in coelioscopic diverting sigmoid colostomy, along with multiple perianal, anal and rectal biopsies revealing an anal canal involvement. Coelioscopic abdominoperineal surgery and a wide cutaneous excision were then performed. Histopathological analysis revealed positive posterior margin, requiring further excision. No adjuvant therapy was prescribed, and to this day, after a one-year and a half follow-up, the patient remains disease-free. Our case report and review of PAPD stress that appropriate management is required to improve the poor prognosis of this rare affection.

The doxorubicin-streptozotocin combination for the treatment of advanced well-differentiated pancreatic endocrine carcinoma; a judicious option?

Due to their rarity, only few trials have studied the role of the doxorubicin-streptozotocin (DS) combination in advanced well-differentiated pancreatic endocrine carcinomas (AWDPEC). However, the published results are inconsistent. We reviewed all AWDPEC (5-year period, 45 patients) treated in our institution with the DS combination for: objective response rate (ORR), progression-free survival, overall survival (OS) and toxicity. An ORR of 36% (95% Confidence Interval (CI) 22-49) was obtained, with 16 partial responses (PR). The mean duration of PR was of 19.7 months. Two and 3-year OS rates were 50.2 and 24.4%, respectively. Toxicities were mainly digestive (grade > or =3 vomiting, 13%) and haematological (grade > or =3 neutropenia, 24%). Previous systemic chemotherapy and malignant hepatomegaly were associated with a poorer ORR (P=0.033, P=0.016) and OS (P=0.008, P=0.045). Multivariate analysis demonstrated previous chemotherapy as the only independent predictive-factor for survival (P=0.013). In conclusion, our data confirm the sensitivity of AWDPEC to the DS combination, with an ORR of 36% and a remarkable median response duration of 19.7 months, and suggests that it could be considered as a valid option in first-line therapy.

Oral fluoropyrimidines in colorectal cancer: a door open to the future?

Since its first use 40 years ago, 5-fluorouracil (5-FU) has become an unquestionable component of colorectal cancer treatment. It is also now well established that infusional 5-FU administration, in combination with leucovorin, is associated with better tolerance and at least equal efficacy than bolus administration. However, requiring catheter and infusion pumps, infusional 5-FU administration is costly, rather inconvenient for patients and potentially associated with morbidity, initiating subsequent oral chemotherapy development. To address intravenous 5-FU related issues, oral fluoropyrimidines have been developed such as capecitabine, preferentially converted to 5-FU into tumour cells, and UFT, able of bypassing intestinal dihydropyrimidine dehydrogenase. We discuss in this article current oral fluoropyrimidines achievements in colorectal cancer management.