[Regional chemotherapy in locally advanced and metastatic gastric cancer].

During 2008-2011 32 patients with locally advanced and metastatic gastric cancer passed 154 procedures of interventional radiology. Tumors of gastroesophageal junction were revealed in 7 patients, tumors of the fundus--in 15 patients, tumors of the pylorus--in 10 patients. At the time of treatment and hospitalization complicated course was observed in 14 patients. Upon initial treatment 25 patients (78%) manifested metastatic lesions in the liver. As an independent type of treatment interventional radiology was carried out in 20 patients. The combined treatment (surgery + intraarterial regional chemotherapy) was performed in 12 patients. 19 patients underwent chemoembolisation of the tumor (56 procedures in total). All patients had repeated courses of intraarterial regional chemoinfusion at intervals of 4-6 weeks (98 procedures in total). Surgical treatment was performed in terms of 7-16 days after the last course of neoadjuvant regional chemotherapy. A decrease of tumor size by 15% -35% (26% in average) was registered in all patients; a decrease in accumulation of radiopharmaceutical in tumors of the stomach was 18% -27% (20% in average). The results of the application of intraarterial regional chemotherapy (chemoembolisation tumors of the stomach and regional chemoinfusion) demonstrated the possibility of effective influence both on the primary tumor, and on the stages of lymph node metastasis. Also the use of regional neoadjuvant chemotherapy did not complicate the course of the postoperative period even in the group of patients who underwent extensive combined surgical intervention.

[Combined treatment for malignant tumors using focal ethanol injections].

The potential of focal ethanol injection therapy (FEIT) as a component of combined treatment for malignant tumors was investigated. Thirty-four patients with inoperable primary and recurrent liver cancer received 72 FEIT procedures at the Institute's Clinic - 16 males (47%) and 18 females (53%), aged 35-80, (average 57), (1991-2004). Forty-three metastatic foci - colorectal carcinoma (23), non-colorectal carcinoma (20) and hepatocellular carcinoma (11) - were detected. Size of metastatic foci ranged 3.2-27.8 cm3 (average 15.4+/-6.4 cm3), while those of hepatocellular carcinoma - 156.7-982.4 cm3, (average 492.4+/-136.8 cm3). All patients received regional endovascular chemotherapy, without any life-threatening complications. Reduction in focal size after FEIT for hepatocellular carcinoma ranged 490.2+/-136.8 - 41.8+/-14 cm3. One-, three- and five-year survival was 100, 80 and 60%, respectively. In cases of hepatocellular carcinoma, ethanol-treated foci shrank by 88.4% - from 15.5+/-1.6 to 1.8 +/- 0.3 cm3 (p<0.05). One-, and three-year survival rates were 83 and 14%, respectively. After ethanol ablation, size of metastatic foci fell by 79%, from 13.9+/-4.3 to 2.9+/-2.4 cm3 (p<0.05). One- and three-year survival rates were 91 and 13%, respectively.

[Long-term results of local ethanol injection therapy in the treatment of hemangiomatosis of the liver]. / Otdalennye rezul'taty lokal'noi in"ektsionnoi terapii étanolom pri lechenii gemangiomatoza pecheni.

During the period from 1989 till 1998 local ethanol injection therapy (LEIT) was used in treatment of 37 patients aged 39-78. The multiple focused form of hemangioma of the liver was observed in 15 (41%) patients, solitary in 20 (54%), the diffuse-focused in 2 (5%) patients. The distribution of the tumors according to the histological structure was as follows: cavernous hemangioma in 22 (60%) patients, capillary--in 2 (5%) patients, mixed in 13 (35%). Local injection therapy was the only method of treatment of 17 patients. In 13 patients this method gave insufficiently effective embolization of the hepatic artery, in 2 patients the injection therapy was combined with ligation of the hepatic artery and in 5 patients--with resection of the liver because of another tumor. The volume of a single use of ethanol varied from 6 to 60 ml. Long-term results were followed-up during 3-6 years. By the data of USI, CT, NMR in all the patients there were changes in the tumor typical of fibrosis. Positive results of the treatment such as a reduced size of hemangioma were noted in 27 patients (73.0%), pains disappeared in 10 out of 29 patients (35%) who had pain syndrome. A conclusion is made that local ethanol injection therapy with 96% ethyl alcohol is effective in treatment of hemangioma of the liver. It gives good long-term results including a combination with the endovascular treatment and resection of the liver.