Complete clinical remission in a patient with advanced pancreatic cancer using mitomycin C-based chemotherapy: the role of adjunctive heparin.

In a patient with advanced pancreatic cancer, with a hypercoagulable state, a complete clinical response was obtained with a mitomycin-based regimen plus adjunctive heparin. The patient converted from a partial response to a complete response with the addition of heparin, raising the possibility that heparin was somehow involved in the process. Recent studies have reported prolongation of survival in patients with cancer who were given heparin along with chemotherapy. The known antiangiogenic and antiproliferative action of heparin may explain this possible synergism. If heparin is, in fact, synergistic with cytotoxic cancer drugs, a fertile field of investigation is open to cooperative groups, especially because long-term heparin therapy is now feasible and safe, the low-molecular-weight heparins even more so.

Surgery and prognosis in stage III epithelial ovarian cancer.

The results of this retrospective case study indicate that a composite of tumor grade, pattern of spread and substage at the time of opening affects the outcome most in the treatment of stage III epithelial tumors of the ovary. The poorest prognosis was associated with grade 3 histology, a pattern of spread requiring extensive and often difficult surgery for removal and a high substage. The best prognosis was usually associated with grade 1, with either very easily removed, isolated spread or low substage. The extent of tumor defined the degree of primary cytoreduction possible. If the tumor was minimally extensive, primary cytoreduction results were excellent. The same conclusions were reached in the case of secondary cytoreduction at the time of second-look procedure. There was no statistically significant difference (z = 1.481, P = 0.069) in 5-year survival between patients with microscopic only disease (59%) at second-look, and patients with gross disease not cytoreduced (36%).

Cancer of the anal canal: treatment with chemotherapy and low-dose radiation therapy.

PURPOSE: To determine the efficacy of a standardized protocol of chemotherapy and low-dose radiation therapy in treatment of patients with anal canal cancer. MATERIALS AND METHODS: Forty-two consecutive patients with anal canal cancer were treated with 15 fractions of 30-Gy photon beam radiation therapy administered anteroposterior-posteroanterior in conjunction with chemotherapy with 5-fluorouracil and mitomycin C. Survival analysis was performed with the lifetest procedure. RESULTS: In patients with stage T1 and T2 tumors, 26 of 29 (90%) were free of disease after chemotherapy and radiation therapy and had no recurrent tumors. In patients with stage T3 and T4 tumors, five of 13 (38%) were free of disease after therapy and had no recurrences. CONCLUSION: This therapy is effective for epidermoid cancers of the anal canal that are smaller than 5 cm regardless of nodal status. Tumors larger than this or that invade adjacent structures are not adequately controlled with this protocol.

Evaluation of the hepatobiliary excretion of technetium-99m-MAG3 and reconstitution factors affecting radiochemical purity.

UNLABELLED: Technetium-99-MAG3 is a renal tubular function agent. However, sporadic liver and gallbladder visualization have raised questions about kit stability, impurities and nonrenal routes of excretion. To address these issues, studies were conducted to optimize the labeling efficiency of the TechneScan MAG3 kit and to evaluate the hepatobiliary excretion of the MAG3 complex. METHODS: Thirty-six vials of the commercial formulation of 99mTc-MAG3 were prepared according to manufacturer's instructions and evaluated for radiochemical purity using two methods: a combination of high-performance liquid chromatography and paper chromatography (HPLC/PC); and the manufacturer's miniature chromatography system (Sep-Pak procedure). RESULTS: The labeling efficiency was significantly higher when the kit was reconstituted with 10 ml (96.6%) of saline versus 5 ml (91.4%) (p < 0.01). The radiochemical purity of the kits remained stable for up to 6 hr, but the purity determined by Sep-Pak averaged 2.5% higher than that determined by HPLC procedures (p < 0.01). Rat studies to evaluate renal and hepatobiliary elimination of MAG3 showed no difference in the %ID excreted into the urine by 60 min in all groups of animals studied. However, the %ID excreted into the bile was significantly higher for the kit formulation than the HPLC-purified MAG3, 9.9% versus 6.6% (p = 0.0475). CONCLUSION: The radiochemical purity of the TechneScan MAG3 kit can be improved by reconstituting with larger volumes. In addition, the studies in rats suggest that fasting or kit impurities may be a contributing factor to increased hepatobiliary visualization in patient studies.

Second-look procedures in ovarian cancer patients receiving six vs. nine courses of platinum, adriamycin, cytoxan (PAC) chemotherapy: the SCPMG experience 1982-1985.

From July 1, 1982, through December 31, 1985, 100 patients with Stage I, II, or III ovarian cancer, who were clinically NED following primary chemotherapy, underwent second look laparotomy. A prospective, nonrandomized study was set up among the various institutions within the Southern California Kaiser Permanente Medical Group. Those patients being treated at the Tertiary Oncology center received six courses of PAC while patients treated at other centers received nine courses of PAC. There was no selection as to severity of disease. Patients with Stage IV disease were not subjected to second-look procedures. Twenty patients with Stage I disease received other than PAC chemotherapy. Eighty patients with Stage II and III disease received PAC chemotherapy; 39 had six courses and 41, nine courses or more of PAC. Standard second-look procedure was performed and the status of the second-look procedure was the determining factor of response. Eighteen of the 39 patients (46%) who received six courses and 26 of 41 patients (63%) who received nine courses of chemotherapy had negative second-look procedures. Sixty-five patients had Stage III ovarian cancer, 34 with six courses of therapy and 31 with nine courses of therapy. There was no statistical difference in the incidence of positive or negative second-look procedures between the groups. The therapeutic index of six courses of PAC chemotherapy was in our hands, higher than with nine courses, since there was no observed difference in the status of the second-look and there was significantly more toxicity with the nine courses of therapy.