Intraarterial mitomycin-C for recurrent brain metastases.

Fifteen consenting patients with brain metastases recurrent after cranial irradiation were treated with intraarterial mitomycin-C, 15 mg/m2, administered in a total final volume of 100 ml 0.45% saline over 20 min through a transfemoral catheter with a 0.2-mu in-line filter. There were 2 early deaths (one probably drug-related). Of the 13 evaluable patients, 6 (46%) responded, with both computed tomography (CT) scan and neurological improvement. Median response duration was 25 weeks, and median survival of all 15 patients was 17 weeks. Neurological, ocular, and local skin toxicity were dose-limiting. The degree of toxicity was comparable to that we have noted with other intracarotid regimens, and it appears to be less toxic when infused into the vertebral artery than are most other drugs (although experience is still limited and caution still needs to be exercised). We do not recommend that this replace or be added to cranial irradiation as front-line treatment of brain metastases, but we feel that it is an effective and reasonably well-tolerated regimen for treatment of brain metastases that have recurred after cranial irradiation. We are currently initiating studies of intraarterial mitomycin-C combined with intraarterial cisplatin and teniposide (VM-26) as treatment for recurrent brain metastases.

Multivolumetric analysis of CT scans on patients with glioma.

Brain tumor volumes in patients having multimodal therapy for cerebral gliomas were calculated using graphic methods and Simpsonian integration. Volume assessment calculations differed from the clinical assessment of the patient significantly in some cases. These calculations may be useful in on-going tumor therapy and should be used as a true scientific end point in brain tumor treatment protocols.

Increased lithogenicity of bile on fasting in normal subjects.

The effect of fasting on bile lithogenicity was studied in 19 normal men and 22 normal women. The molar percentages of bile acid, phospholipid, and cholesterol, determined after random overnight fasts of 9, 12, and 16 hr, were plotted on triangular coordinates. The molar percentage of cholesterol increased in both men and women. Analysis using Admirand and Small's criteria for cholesterol saturation revealed that 4.50% of normal women were lithogenic at 9.1 hr and 54.5% at 16.5 hr (P less than 0.005). A similar trend in men was not significant. The mean values for both sexes were lithogenic at 16 hr only. Lithogenic bile was present in 4 men and 1 woman at 9 hr fasting and became more lighogenic with longer fasting. Analysis using the criteria of Hegardt and Dam revealed an increased proportion of both sexes moving into the metastable-labile and supersaturated zones on fasting, again with significant changes for women (P less than 0.01). The duration of fasting is important in interpreting the presence of lithogenic bile; although more pronounced in women, both sexes showed increased cholesterol saturation in bile with fasting.