Brachytherapy after laser recanalization versus external beam radiotherapy after laser recanalization versus laser alone in inoperable oesophagocardial cancer: a controlled pilot study.

PURPOSE: To compare the results of combined laser/radiation therapy with laser treatment alone, and to evaluate the potential benefit of brachytherapy vs. external beam radiotherapy after laser recanalization in patients with dysphagia due to oesophagocardial cancer. PATIENTS AND METHODS: Twenty patients with grade 4 malignant dysphagia caused by oesophagocardial cancer underwent Nd: YAG laser desobstruction up to grade 0-1. Ten of them were referred afterwards for external beam radiotherapy at a dose of 30 Gy for 10 sessions, while the remaining were administered endocavitary afteloading brachytherapy at a dose of 2x7.5 Gy. Twenty preselected patients (to maximally match the above group), who successfully underwent laser re-establishment of the continuity, served as controls to the groups described. Criteria for evaluation were: mean interval to re-stenosis, mean number of additional laser procedures needed, mean survival and Karnofski's performance status (PS). Patients were followed to death. Statistical analysis was carried out with the Student's t-test. RESULTS: It was found that laser plus brachytherapy increased almost 3 times the interval to re-stenosis and decreased almost 2 times the need of additional laser usage in comparison to laser alone. It was also found that laser plus brachytherapy is statistically superior option to laser plus external beam radiotherapy. CONCLUSION: Laser plus brachytherapy has the potential to become a single modality-single session treatment for the relief of dysphagia in patients with stage IV oesophagocardial cancer.

[Extensive right-sided hepatectomy for a metastatic process in patients operated on for colonic carcinoma]. / Desnostranna razshirena khepatektomiia zaradi metastatichen protses pri operirani za kartsinoim na kolona.

Proceeding from experience with a large number of liver resections performed for single or multiple metastases atypical in appearance, including left lobectomies, a description is presented of wide right-sided hemihepatectomy, done for the first time (13 May 1997) in the surgical clinic of the National Oncological Center. The intervention is undertaken because of two metastases in the liver subsequent to radical operation for carcinoma of the sigmoid colon. The single stages of the operation are likewise described. The effectiveness of application of Penchev's "Parenchymatome" (made in Bulgaria--Military Medical Academy) and "Tisomat" apparatus is evaluated. Using the latter the resection liver surface is sprayed with a bicomponent fibrin adhesive "Tisucol", obtained from the firm Immuno-AG.

Photodynamic therapy in gastrointestinal cancer.

Six patients with an early stage of gastrointestinal (GI) cancer (T1N0M0, stage I) were successfully treated by photodynamic therapy (PDT) as follows: esophagus-1, stomach-2, rectum-3. The patients were photosensitized 72 hrs prior to treatment with pure hematoporphyrin at a dose of 5.10(-6) kg/kg b.w. in a slow intravenous infusion. Argon-pumped dye laser light at 0.630 microns wavelength was used in single and multiple treatment sessions with the power density ranging from 0.015 to 0.192 W.m-2 and a dose varying from 0.320 to 1.600 kJ.m-2. Tumor eradication (complete response) was obtained in each of the patients. No early or late treatment related complications were recorded. The patients were followed-up in the course of 7-16 months after treatment and no local recurrence or general development of disease (metastases) were reported. PDT in the early stage of GI carcinoma was recognized as a radical therapeutic method in clinical oncology.

Studies on the photodynamic effect of haematoporphyrin derivative.

A case-control photodynamic therapy (PDT) was studied on adenocarcinoma (AC755) in BDF1 mice. Haematoporphyrin derivative (HPD; Porphyrin Products, U.S.A.) and a Bulgarian HPD were used as photosensitizers at doses of 10 mg kg-1. An argon dye laser system with lambda em=630 nm (400 mW cm-2) was used for PDT with a total light dose of 400 J cm-2. The therapeutic effect was assessed by the changes in tumour dimensions, the size of photonecrosis and the mean survival time of the animals. Histologic and ultrastructural studies were carried out. No significant difference was recorded between the antitumour effects of the two photosensitizers. Best results were obtained in small tumours (less than 10 mm) with incision of covering skin. Results are discussed in an attempt to advocate an optimal regimen for PDT in experimental tumours.

Photodynamic therapy in lung and gastrointestinal cancers.

Twelve central bronchial carcinoma patients and two gastrointestinal (GI) tract (oesophageal and colonic) early-stage cancer patients were treated with photodynamic therapy (PDT). Haematoporphyrin (HP/5, Jacopo Monico, Italy) at a dose of 5 mg kg-1 body weight was used as photosensitizer. Laser light at 628.2-630 nm generated by two different laser systems (gold vapour laser (I.P. Optics, Sofia, Bulgaria) in lung cancer cases and an argon dye laser system (Spectra Physics, Mountain View, U.S.A.) in GI tract cancers) was used. Lung cancers were irradiated 48 h after drug administration and GI tract cancers were irradiated 72 h after infusion of the photosensitizer. Both tumour sites were treated with a total energy dose in the range 350-600 J cm-2. Efficiency of PDT in lung cancer was evaluated by X-rays and endoscopic and functional respiratory tests for bronchial de-obstruction. Complete remission after PDT of GI tract cancers was considered to be tumour eradication (histologically and cytologically proved) and a tumour-free interval of at least 12 months.

[The diagnosis and immediate treatment results in retroperitoneal tumors]. / Diagnostika i neposredstveni lechebni rezultati pri retroperitonealnite tumori.

Immediate results of treatment of 20 patients with primary retroperitoneal tumors treated over a period of 5 years (1980-1985) at the Research Institute of Oncology in Sofia are reported. Attempt is made for anamnestic analysis, aimed at elucidating the semiotics of the disease. Analysis of the diagnostic methods serves to give recommendations for "first-rate" diagnostic procedure--computer tomography when a retroperitoneal tumor is suspected. Complex therapeutic approach consisting of radical operation and adjuvant radiation treatment is advised.

[The prevention of postoperative suppurative complications in stomach cancer]. / Profilaktika na sledoperativnite gnoini uslozhneniia pri stomashen rak.

Bacteriologic studies of gastric juice and purulent drainage fluids in the event of complications were carried out in 80 patients who had undergone gastric resections and had been on conventional parenteral antibiotic treatment (control group). Another (experimental) group of 37 patient, having undergone the same operations, received prophylaxis of the suppurative complications with 5-nitrox and Flagyl solutions through nasogastric probe once in 3 hours for 6 to 8 days. The suppurative complications in the experimental group were reduced from 47.5 to 8.1 per cent and of the postoperative lethality due to suppurative complications from 22.5 to 0 per cent.

Endoscopic indirect lymphography in gastric cancer.

An oil-in-water emulsion containing 55% Lipiodol, 5% Tween 80 and 40% Angiografin was injected into stomach walls at 20 points to visualize the regional lymph nodes. At each point 0.5 ml emulsion was injected into the submucosal layer. Conventional X-ray pictures of the upper left abdomen were taken at the 24th, 48th, and 72nd hours and on the day before surgery. The method was employed in 18 stomach cancer patients and 5 healthy controls. X-ray findings were verified during the operation and by histological sections stained with hematoxylin eosin, Sudan III and Sudan black. It was established that almost all lymph nodes were visualized, and the lymphograms showed no changes in the healthy stomach. In stomach carcinoma cases metastatic signs were node enlargement, vacuolization with central and/or peripheral filling defects or absence of contrast in nodes. The possibility of applying the method for regional preoperative chemotherapy in early carcinoma stages is discussed.