Reduced hepatic acute-phase response after simultaneous resection for gastrointestinal cancer with synchronous liver metastases

Serum cytokines and hepatic acute-phase responses were studied in seven patients undergoing simultaneous resection of primary gastrointestinal cancer and synchronous metastatic liver tumours and in 12 undergoing partial hepatectomy alone for metachronous hepatic metastases. The incidence of postoperative infectious complications was significantly higher after simultaneous resection than after partial hepatectomy alone (P < 0.05). Although the peak interleukin 6 level was significantly higher after simultaneous resection (P < 0.05), plasma levels of acute-phase proteins were significantly lower (P < 0.05). The results suggest that simultaneous resections further reduce the hepatic acute-phase response and render patients liable to infection compared with partial hepatectomy alone, and result in a higher incidence of postoperative infective complications.

Differences in serum tumor markers between colon and rectal cancer. Comparison of CA 242 and carcinoembryonic antigen

PURPOSE

We investigated whether there are differences in serum levels of CA 242 and carcinoembryonic antigen (CEA) between patients with colon and rectal cancer.

METHODS

Preoperative serum levels of CA 242 and CEA were determined in 153 patients with colon cancer and in 107 patients with rectal cancer.

RESULTS

At the recommended cut-off levels for CA 242 and CEA, the overall sensitivity of CA 242 was 39 percent for both colon and rectal cancer, whereas the sensitivity of CEA was 40 percent for colon and 47 percent for rectal cancer. A combination of CA 242 and CEA increased overall sensitivity to 57 percent in colon cancer and to 62 percent in rectal cancer, whereas specificity decreased by 10 percent, compared with CEA alone. In colon cancer either or both markers were elevated in 38, 46, 56, and 84 percent of patients with Dukes Stages A, B, C, and D, respectively. Corresponding figures for rectal cancer were 52, 46, 71, and 87 percent, respectively.

CONCLUSIONS

CA 242 showed equal sensitivity for colon and rectal cancer. In Stages A, C, and D, sensitivity of CEA and of a combination of CEA and CA 242 was higher in rectal than in colon cancer, but the difference was not significant. Concomitant use of markers increased sensitivity sharply compared with use of a single marker both in colon and rectal cancer.

Suppository delivery of 5-fluorouracil in rectal cancer

BACKGROUND

Preoperative radiotherapy with concomitant intravenous 5-fluorouracil (5-FU-i.v.) is effective in shrinking locally advanced rectal cancers and facilitating subsequent surgery. Topical 5-FU application may enhance its radiosensitizing and cytotoxic effects. Suppository and intravenous 5-FU administration were compared with respect to myelo-suppression and tissue concentrations.

METHODS

Rats received 120 mg/kg 5-FU-i.v. or via suppository (5-FU-S). White blood cell count, serum albumin, alkaline phosphatase, creatinine, and aspartate aminotransferase (AST) were determined before and serially after 5-FU administration. In a separate experiment, rats received 5-FU-S or 5-FU-i.v. as already described. Portal and systemic blood, rectal, iliac lymph node, liver, and lung tissue were harvested for high-performance liquid chromatography determination of 5-FU concentrations 30 min, 1, 3, 6, and 12 h after drug administration.

RESULTS

No toxicity was observed in 5-FU-S animals, whereas 63% of 5-FU-IV animals had diarrhea. Weight loss and myelosuppression occurred only in 5-FU-i.v. animals. Rectal drug concentrations were significantly higher in the 5-FU-S animals compared with 5-FU-i.v. animals, 0.5-6 h after drug administration. Blood, liver, and lung 5-FU concentrations with 5-FU-S were comparable to those with 5-FU-i.v.

CONCLUSIONS

5-FU suppositories are associated with fewer systemic side effects and higher rectal 5-FU concentrations than with 5-FU-i.v. administration.

[Anterior resection for rectal carcinoma in an anemic Jehovah's Witness]

Anterior resection is accepted treatment for tumors of the middle rectum, with mortality less than 5%. Since such surgery involves blood loss, blood transfusion is regarded as essential. We report a 69-year old anemic Jehovah's Witness who had a bleeding rectal tumor but who refused blood transfusion, despite a hemoglobin level of 4.8 g/dl. Anterior resection of the tumor was successfully performed without substantial blood loss. Her hemoglobin level was 5.8 g/dl on discharge. Jehovah's Witnesses do not oppose medical treatment nor do they practice faith healing. Instead, they seek good medical care but accept only proven medical alternatives to blood transfusions. Physicians, world-wide, are now successfully performing major surgery of all types on both adult and minor Witnesses. Due to their success in the use of alternatives, over 50 hospitals in North America, Europe and Australia have established "bloodless-surgery" centers to serve not only Jehovah's Witnesses but also a growing number of other patients who wish to avoid risks associated with blood transfusion.

Serum CA 242 and CEA detect different patients with recurrent colorectal cancer

The aim of this study was to investigate the clinical value of CA 242 and CEA in the follow-up of patients with colorectal cancer. Serial serum samples were available for analysis in 67 patients with subsequent recurrence, of which 36 patients had been treated for colonic and 31 patients for rectal cancer. Liver metastases were found in 32 patients, local recurrences in 18 patients, lung metastases in 11 patients and other distant metastases in 6 patients. The same serum samples were used in quantitating the serum levels of both CA 242 and CEA. At the time of clinical recurrence an elevated CA 242 level was found in 41 patients and an elevated CEA level in 49 patients. Thirty-six patients (54%) showed an elevation of both CA 242 and CEA, five patients (7%) had increased CA 242 alone and 13 patients (19%) increased CEA alone. Altogether, 54 patients (81%) showed an elevation of either or both markers at the time of clinical recurrence. Initially CA 242 alone began to rise in 14 patients (21%) and CEA alone in 16 patients (24%). The lead time was calculated from 28 patients that had four or more serum samples available during follow-up. CA 242 increased in median 5,7 months and CEA in median 3,4 months before clinical recurrence (p=0.34). CA 242 was more sensitive for lung metastases (64%) than CEA (45%), whereas CEA was superior to CA 242 in liver metastases (88% versus 72%, respectively) and in local recurrences (56% versus 39%, respectively). Both CA 242 and CEA seem to be useful in early diagnosis of a recurrence in the follow-up of patients with colorectal cancer.

Limited clinical significance of the serum tumour marker Ca 72-4 in colorectal cancer

BACKGROUND

We explored the potential value of CA 72-4 in the staging and prognostic prediction of colorectal cancer, as compared to six previously investigated serum tumour markers - CEA, CA 19-9, CA 50, CA 242, TPA, and TPS.

MATERIALS AND METHODS

CA 72-4 was analysed using an immunoradiometric assay in serum samples obtained, prior to surgery, from 196 consecutive patients resected between Jan. 1987 and Nov. 1992.

RESULTS

CA 72-4 levels increased with progressive tumour stages; a high level correlated with poor prognosis. However, the information obtained from CA 72-4 did not improve the ease of staging, as compared with other tumour markers. Various combinations of CA 72-4 with the other tumour markers did not add any substantial information to the staging process either. The value of the CA 72-4 in prognostic prediction, as shown in the univariate analysis, was limited in the multivariate tumour marker analyses.

CONCLUSIONS

CA 72-4 does not improve the staging and prognostic prediction of colorectal cancer, when compared with other serum tumour markers used.

[Changes in plasma levels of lipid peroxidation products and myoglobin in patients with malignant tumors in the early postoperative period]

Changes in the levels of free myoglobin and lipid peroxidation products (hydroperoxides and malonic dialdehyde) were studied in cancer patients. Their baseline levels were found to be higher in patients with cancer of the lung, large bowel, and rectum than those in controls, which indicates higher lipid peroxidation, which led to the destabilization of cellular membranes and seems to cause baseline hypermyoglobinemia. There was a drastic rise in the levels of free myoglobin in the first 24 postoperative hours. The duration and severity of hypermyoglobinemia were much higher in the complicated than uncomplicated postoperative period. There was a less rise in malonic dialdehyde concentrations, whose peak was observed on days 1-2 postsurgery. The content of hydroperoxides decreased in the first 24 postoperative hours and began gradually increased from day 2. The correlation between the concentrations of myoglobin and malonic dialdehyde suggests that there is an association between hypermyoglobinemia and the status of cellular membranes.

Serum selenium and colonic neoplastic risk

BACKGROUND

Selenium deficiency has been associated with cancer risk in several organs. This association was investigated in neoplasia of the colorectum.

DESIGN

A case-control study is reported with two patient series, colorectal cancer and colorectal adenomatous polyps, and a control group found to be free of colorectal neoplasia. Diagnosis was determined by colonoscopy and histologic review of suspected neoplasms. Serum drawn at the time of colonoscopy was subsequently assayed for selenium content, and quartiles based on selenium were defined. Crude and adjusted odds ratios with 95 percent confidence intervals for adenoma related to selenium were calculated, controlling for known or suspected risk factors including gender, age, race, body mass index, family history, tobacco use, alcohol consumption, serum beta carotene, serum alpha tocopherol, and serum ferritin.

RESULTS

There were 138 controls who had no neoplastic disease, 139 adenoma patients, and 25 cancer patients. For adenoma, comparing higher quartiles of selenium to the first (lowest selenium), the adjusted odds ratio for the second quartile was 1.7 (95 percent confidence interval, 0.8-3.7), the third quartile was 1.4 (0.7-3.2), and the fourth (highest selenium) quartile was 1.8 (0.9-4). The odds ratios for cancer patients were 0.8 for the second quartile, 1 for the third quartile, and 1.7 for the fourth quartile.

CONCLUSION

No trend could be detected toward a protective effect of higher levels of serum selenium for colonic benign or malignant tumors.

Detection of circulating tumour cells with the magnetic activated cell sorter

A technique has been developed for the detection of tumour cells in blood with the magnetic activated cell sorter (MACS). Colonic carcinoma cell lines and disaggregated primary tumours were used to establish optimal conditions of separation. A murine monoclonal antibody specific for epithelial cells was added to the suspension of leucocytes and tumour cells, followed by magnetic labelled goat antimouse antibody. The labelled tumour cells were retrieved by passing this suspension through a MACS separation column in a strong magnetic field. Tumour cells were detected at a dilution of 10 cells per ml blood. Tumour cells were identified in mesenteric blood in three of 24 patients undergoing surgery for colorectal cancer. This study supports the use of the MACS to detect circulating tumour cells.

Administration of nicotinamide during chart: pharmacokinetics, dose escalation, and clinical toxicity

PURPOSE

To determine nicotinamide pharmacokinetics in patients undergoing accelerated radiotherapy with the CHART regimen (continuous, hyperfractionated, accelerated radiotherapy) and given nicotinamide on a daily basis. The aim was to establish the pharmacokinetic profiles and their reproducibility during repeated administration, the maximum tolerated dose with fractionated radiotherapy, whether such a dose achieves sufficiently high plasma levels for radiosensitization, the optimal time interval between nicotinamide and irradiation, and toxic side effects.

METHODS AND MATERIALS

Nicotinamide plasma concentrations were determined using high performance liquid chromatography in 11 patients with advanced carcinomas of the head and neck and rectum being treated with CHART (36 fractions in 12 days). Kinetic profiles on the first day of radiotherapy and residual 24-h values were obtained in 10 patients; in four of these, full profiles were repeated two or three times during the course of treatment. In one other, a single sample per day was taken four times over the 12-day period. Doses of 80, 90, or 100 mg/kg/day were given 90 min prior to the second radiotherapy fraction on each day.

RESULTS

A dose of 80 mg/kg/day was well tolerated by all the patients. However, an increase of 10-25% in dose led to significant drug accumulation and major clinical toxicity, and none of the patients in the dose-escalation arm completed the planned regimen. Large interpatient variations in absolute peak concentrations were seen from 0.4 to 1.4 mumol/ml (mean 0.9 +/- 0.3; standard deviation (SD)). Of the five samples with the lowest peak levels, four were obtained from one patient. The time taken to peak concentration was also very variable from 0.8 to 4 h (mean 2.1 +/- 1.3 h; SD). In 70% of the samples, absolute plasma levels > or = 0.7 mumol/ml were reached within 1-2 h after administration and maintained for up to 6 h (mean 2.8 +/- 1.8 h; SD). There was a small but nonsignificant increase in the half-life of nicotinamide when the dose was increased from 80 to 90 or 100 mg/kg (7.1 h and 8.6 h, respectively).

CONCLUSIONS

In an accelerated regimen such as CHART, 80 mg/kg/day of oral nicotinamide is feasible and clinically tolerated, giving no or few side effects, and a 2-h interval between its oral administration and radiotherapy should achieve effective plasma levels in most patients.

[Lung metastases from colorectal cancer: results of surgery]

OBJECTIVES

Surgery has become a recognized therapeutic means in selected patients with isolated pulmonary metastases, with a 5-year survival rate of about 35%, but specific studies on the results and prognosis of surgery for pulmonary metastases from colorectal cancer remain relatively rare.

METHODS

Between 1980 and 1991, 65 patients (34 men, 31 women, mean age 58.2 years) underwent 81 thoracic operations with curative intent (including 15 bilateral operations and 7 incomplete resections) for pulmonary metastases from colorectal cancer.

RESULTS

The 5- and 10-year probabilities of survival (Kaplan-Meier) after the first thoracic operation were 27% and 22% respectively. The site of the primary tumor (colon or rectum), the disease-free interval, previous resection(s) of hepatic metastases, and the size of pulmonary metastases were not found to the have a statistically significant influence on prognosis. On the other hand, the quality of resection (complete or incomplete) (p < 0.001), the number of resected pulmonary metastases (p = 0.016), and the preoperative carcino-embryonic antigen level (p < 0.001) were found to be highly significant prognostic factors.

CONCLUSION

Complete resection of pulmonary metastases from colorectal cancer seems to prolong survival in a significant number of patients, and the results from this study should help to select those who may benefit from this treatment.

Measurement of weekly prostate specific antigen levels in patients receiving pelvic radiotherapy for nonprostatic malignancies

PURPOSE

To study the response of nonmalignant prostatic tissue to ionizing irradiation in terms of the resultant changes in serum prostate specific antigen (PSA) levels.

METHODS AND MATERIALS

Weekly serum PSA values were determined during radiotherapy (RT) in nine patients ("treatment group") without clinical evidence of prostate cancer (PC), and who received pelvic RT for other indications. Slopes for the rate of change in PSA was determined using model: log PSA = beta 0 + beta 1*week + beta 2*week2 + error. These results are compared with 17 normal volunteers ("control group") who were not exposed to ionizing irradiation. An attempt is made to compare any similarities and differences in subsets of 64 T1-T4N0M0 PC patients who received pelvic RT.

RESULTS

An elevation in the serum PSA levels were noted in eight of nine patients in the "treatment group" with a median time of 4.2 weeks to reach the maximum serum PSA values. After an initial increase, PSA values declined. In some patients, manifold increase in PSA was noted, for example, from 1.8 to 13.5 ng/ml and 3.3 to 9.8 ng/ml in two patients. The PSA increase ranged from 50-650%. The median slope was 0.601 week-1 (range 0.192-3.045 week-1). No such increases were seen in the "control group" (median slope = 0.03 week-1; range, 0.18-0.13 week-1). When differences between the mean increase/decrease for each week compared to pretreatment values were analyzed, the irradiated group had statistically significant elevations in the PSA for weeks 3 (p = 0.034), 4 (p = 0.035), and 5 (p = 0.024). A similar trend of increasing PSA levels during radiotherapy was noted in prostate cancer patients whose initial PSA values were < or = 20 ng/ml: whereas positive slopes (i.e., increasing PSA levels during radiotherapy course) was seen in 7.1% of those with > 20 ng/ml preradiotherapy PSA values, such trends were seen in 52.7% of those with < or = 20 ng/ml preradiotherapy PSA values.

CONCLUSIONS

(a) Incidental exposure of noncancerous prostate to ionizing irradiation appears to lead to an initial elevation followed by a decline in serum PSA. (b) Similar elevations in serum PSA levels are seen in over 50% of prostate cancer patients with < or = 20 ng/ml pretreatment PSA. (c) Acinal cell death and sudden release of PSA into the circulation is the most likely explanation for our observations, although other mechanism cannot be excluded. (d) Our observations have to be considered in modeling PSA kinetics induced by RT and in correlating such kinetics to long-term outcomes. (e) Our findings in the control group indicate that there appears to be no significant variation in serum PSA over many weeks under physiological conditions in normal healthy ambulatory men.

Serum levels of transforming growth factor alpha in gastrointestinal cancer patients

Transforming growth factor alpha (TGF alpha), a polypeptide growth-stimulating factor, has been implicated to play a role in the progression of gastrointestinal (GI) cancer. It has been suggested that TGF alpha expression in tumors or TGF alpha in the biological fluids of cancer patients may have tumor marker value. The serum levels of TGF alpha in GI cancer patients have not been reported. In this study, the serum TGF alpha levels of 100 GI cancer patients, as well as 74 healthy individuals, were determined by a TGF alpha-specific RIA kit. All of the cancer patient sera and 67% of the normal sera had detectable levels of TGF alpha. The TGF alpha concentrations in GI cancer patients ranged from 119 to 760 pg/ml, with a mean value of 269 +/- 102 pg/ml. Fifty normal individuals had detectable levels of TGF alpha, and their levels ranged from 120 to 207 pg/ml, with a mean value of 147 +/- 18 pg/ml. Differences in serum TGF alpha concentration between cancer patients and healthy individuals were found to be statistically significant, as evaluated by Mann-Whitney and Student's t tests. Serum TGF alpha levels were found to be significantly elevated in all disease stages of gastric, pancreas, colon, and rectal cancers, and only in the late stages of esophageal cancer. Serum carcinoembryonic antigen levels were significantly elevated only in the late stages of these diseases. The potential of serum TGF alpha as a tumor marker for GI malignancy, therefore, warrants further investigation.

[Dynamics of the level of plasma myoglobin in oncology patients with and without complications in the postoperative period]

Initial hypermyoglobinemia was found in patients with cancer of lungs, large intestine and rectum. Within early postoperational period under favourable conditions moderate increase in content of free myoglobin was detected, most pronounced in patients with lung cancer. Maximum concentration of myoglobin was estimated within first postoperational day, normalization occurred within 3-4 days after the operation. In patients with postoperational complications (peritonitis, pneumonia, sepsis, etc) increase in content of myoglobin was more distinct (1.6-2-fold) and was maintained within the longer period. Increase in content of blood plasma myoglobin occurred usually before manifestations of clinical symptoms related to postoperational complications.

Anal submucosal injection: methotrexate concentration in rectal tumor tissue and serum after anal compared with parenteral injection

As the results of adjuvant chemotherapy in the treatment of advanced rectal cancer are unsatisfactory, more effective regimens and routes of administration are being tried. Submucosal anal injection of methotrexate (MXT) has given encouraging results in the treatment of pelvic malignancies. This communication studies the MXT level in serum and rectal cancer tissue after either anal submucosal or parenteral MXT administration. Twenty four patients, mean age 46.4 years (16 men and eight women), with stage C rectal cancer were divided into two equal, age- and sex-matched groups. MXT (50 mg) was administered to each patient intravenously in one group and into the anal submucosa in the other. A blood sample was taken 30, 60 and 120 min after injection, and again after 24 h. A tumor sample was also taken each 30 and 60 min of injection. The serum and tissue MXT levels were determined using a radioimmunoassay kit. The serum MXT concentration was significantly higher after parenteral than after anal injection. Meanwhile, the concentration of MXT in tumor tissue was higher after anal administration. In conclusion, the anal route of administration of MXT, by inducing a high MXT concentration in the tumor tissue associated with a low serum level, might achieve satisfactory therapeutic results in advanced rectal cancer, with minimal side effects.

Application of cancer procoagulant as an early detection tumor marker

BACKGROUND

In spite of many advances in the analytical reagents (antibodies), analytical systems, and the clinical application of tumor markers, the present markers do not detect early stage cancer. Preliminary data with an antigen specific to tumor tissue, cancer procoagulant (CP), suggest its possible role in the detection of early stage cancer. This study was aimed at determining the clinical use of CP as an early stage tumor marker.

METHODS

An improved enzyme-linked immunosorbent assay (ELISA) was developed to measure CP concentration in serum. A panel of 817 blinded serum samples were examined from three groups of people: 573 cancer, 106 benign, and 139 normal.

RESULTS

The sensitivity of all samples analyzed from cancer patients was 80%. The CP ELISA was able to detect ovarian, colon, and kidney cancer at a sensitivity greater than 85%; breast, prostate and small cell lung cancer was detected at a sensitivity of 80-85%. Particularly interesting was the observation that early stage cancers, regardless of site, were detected effectively. In some groups, the CP assay correctly identified 100% of the patients with stage I and II cancer. The assay was able to identify correctly noncancer patient sera at a specificity of 83% for those with benign disease and 82% for the normal individuals.

CONCLUSIONS

The CP assay has potential as an aid in diagnosing early stage malignancies and thereby may significantly improve the survival rate of cancer patients.

An expert system approach for the objective interpretation of serum tumour marker levels

The aim of our work was to study specific aspects of statistical Weinstein-Bayes's analysis in order to find the most suitable program for presenting our results and for obtaining information which could be used as a guide in the clinical decision-making process. Our efforts resulted in a computer processing system based on modified Weinstein-Bayes receiver operating characteristics (ROC) analysis. The data analysis provides numeric values of sensitivity, specificity, positive predictive value and negative predictive values as output tumour marker databases, which would serve as graphic input. It becomes possible to plot the ROC curve as a graphical distribution of tumour marker levels. The computer program also allows the estimation of the potential utility of the serum tumour marker measured in patients with various diseases, simultaneous determination of serum tumour markers in diseased patients, and the real value of each serum tumour marker level in diseased patients.

Blood transfusion and survival in colorectal cancer

PURPOSE

This study examined the effect of blood transfusion on the prognosis of patients undergoing surgery for colorectal cancer.

METHODS

Potentially curative resections for colorectal cancer were performed in 266 patients who were followed prospectively, with a minimum follow-up of 41 months. They were divided into transfused (n = 121) and nontransfused (n = 145) groups according to their perioperative blood transfusion requirements.

RESULTS

There were significantly more rectal tumors (chi 2 = 9.5, df = 1, P = 0.002) and fixed tumors (chi 2 = 4.5, df = 1, P = 0.03) in the transfused group. There was no statistically significant difference between the two groups with regard to recurrence-free survival (chi 2 = 1.1, df = 1, P = 0.3) and overall survival (chi 2 = 2.8, df = 1, P = 0.09).

CONCLUSION

In this study we have found no statistically significant effect of perioperative blood transfusion on the prognosis of colorectal cancer patients.

CEA as a prognostic factor in colorectal cancer

We have measured serum CEA levels in 207 patients with colorectal cancer. CEA sensitivity was related to tumor stage in tumors located in the right colon, but not in tumors located in the left colon or the rectum. CEA had prognostic value in patients with tumors located in the right colon (p < 0.001) but not in the left colon or the rectum. However, CEA did not have prognostic value independent of Dukes stage even in tumors in the right colon. Our results underline the different sensitivities and prognostic values for primary tumors in the left and right colorectal regions.

Improved cumulated nitrogen balance after administration of recombinant human growth hormone in patients undergoing gastrointestinal surgery

OBJECTIVE

To examine the effect of recombinant human growth hormone (rhGH) on the catabolic state following major gastrointestinal surgery.

DESIGN

The study was designed as a prospective controlled randomized clinical trial.

SETTING

Intensive care unit and the surgical ward of the Department of Surgery, Städtische Kliniken Dortmund, FRG.

PATIENTS

39 patients were studied postoperatively following gastrectomy or resection of the rectum. The patients were 40-75 years old.

INTERVENTION

0.075 (n = 11), 0.15 (n = 9) or 0.30 IU rhGH/kg/day (n = 9) or placebo (n = 10) were given subcutaneously at 8:00 a.m. during 5 postoperative days. Resting energy expenditure (REE) on the 1st postoperative day was 2,042 +/- 82 kcal/24 h (REE/BEE 1.44 +/- 0.04). Isocaloric, isonitrogenous total parenteral nutrition provided the energy requirements (4 g carbohydrates/kg, 0.9 g fat/kg, 1.25 g amino acids/kg).

RESULTS

After 5 days of treatment, cumulated nitrogen balance (CNB) was improved dose-relatedly. In controls, net nitrogen losses (-20.47 +/- 3.86 g) were significantly higher than after 0.15 (-12.14 +/- 3.5 g) and 0.30 IU rhGH/kg (-10.0 +/- 2.61 g). 0.075 IU rhGH/kg showed no significant effect on CNB (-18.07 +/- 5.73 g). The modulation of protein metabolism by GH may be mediated by insulin-like growth factor-I (IGF-I). Postoperatively serum (S)-IGF-I was decreased in all groups. rhGH caused a significant dose-related increase in S-IGF-I levels on day 6, whereas in controls it remained unchanged during the study period. Besides significant elevations in serum glucose in some cases of both larger dosage groups no side effects were detected.

CONCLUSIONS

The protein-sparing effect of rhGH after major gastrointestinal surgery is dose related but not linear. A threshold value for a significant improvement in the CNB seems to be at least at 0.15 IU rhGH/kg/day.

Treatment of advanced colorectal cancer with folinic acid and 5-fluorouracil in combination with cisplatinum

51 patients with metastatic colorectal cancer (stage Dukes D) were treated with intravenous (i.v.) infusion on days 1, 3, 5, 8 and 16 with folinic acid (200 mg/m2) and 5-fluorouracil (600 mg/m2), and on days 1, 8 and 16 with cisplatinum (25 mg/m2 i.v.); cycles were repeated every 4 weeks. All 51 patients were evaluable for toxicity and response criteria. 26 patients had objective responses (3 complete responses, 5.9%; 23 partial responses, 45.1%), relative risk 51% (95% confidence intervals 36.7-65.0%). Response duration ranged from 4 to 28.0 months (median 16.8). Overall median survival of all patients included was 14.7 months (range 3.0-33.0). Toxicity of WHO grade III, requiring dose reduction, occurred in 9 (18%) patients. The regimen described here appears to be active, safe and well tolerated for treatment of patients with advanced colorectal cancer.

Host markers and prognosis in recurrent rectal carcinomas treated with radiotherapy

The value of blood tests as prognostic factors in patients with recurrent rectal carcinomas treated with radiotherapy was studied in one retrospective (n = 114, 1976-1984) and one prospective (n = 100, 1985-1989) group of patients. The retrospective group was used for validation of the results from the prospective group. In univariate survival analyses, 19 of totally 38 variables significantly correlated to the survival. Of 13 significant blood parameters, lactate dehydrogenase (LD), erythrocyte sedimentation rate (ESR), alpha 1-, alpha 2-globulin, fibrinogen, carcinoembryonic antigen (CEA), C-reactive protein (CRP), haptoglobin, granulocytosis and thrombocytosis were the most important ones (p < or = 0.01). In the multivariate analyses (Cox regression) of the prospective group, LD, alpha 1-globulin, diagnosed liver metastases and CEA were found to be significant predictors of survival. A prognostic index was derived from the prospective group including ESR, LD and relapse-free interval. This clearly separated the patients in the retrospective group into one low- and one high-risk group.