p53 genetic alterations, protein expression and autoantibodies in human colorectal carcinoma: A comparative study

This study investigated a total number of 120 colorectal malignant tumor tissues by applying a new quantitative luminometric assay (LIA)-mat, immunohistochemistry (IHC) (n=100), PCR/SSCP (n=42), and sequencing (n=7). Sera were collected from 235 patients suffering from colorectal carcinoma in addition to 195 healthy individuals as a control group. Manual ELISA kit was developed to detect p53 autoantibodies in the sera of those patients. Our data demonstrated that the LIA-mat yields reliable estimates of p53 expression in soluble cell extracts as compared with results obtained by immunohistochemistry which showed positive immunostaining in 63% of the studied cases. Using a cut-off value of 1.8 ng/mg protein, 65 tumors out of 120 (54%) were classified to be positive by LIA-mat, manifesting protein overexpression, while 22 out of 42 (52%) tumor samples showed p53 gene alteration when applying single strand conformation polymorphism (SSCP) analysis on polymerase chain reaction products. In tumor samples without a p53 gene alteration, the median soluble p53 protein level was 4.3 ng/mg protein, whereas the median p53 protein level for tumor samples with p53 gene alteration was 7.5 times higher. Despite a significant correlation between the outcome of LIA and SSCP, a disagreement was found in 30% of cases. We found no significant correlation between p53 protein overexpression and clinicopathological findings except for distant metastasis (p=0.33), indicating p53 immunoreactivity to be an independent prognostic factor. Our data showed that 18% of patients suffering from colorectal cancer developed autoantibodies against p53 in their sera which might be an early indicator for tumor development and distant metastasis.

Prognostic value of CA 19-9 serum course in pancreatic cancer

BACKGROUND/AIMS

The aim of this study was to determine the sensibility and specificity of a new assay in the diagnosis of pancreatic cancer and predictability of resection rates. In addition, the serum CA19-9 levels was utilised as a prognostic indicator.

METHODOLOGY

Serum expression of the tumor marker CA 19-9 was studied in 2119 patients.

RESULTS

The discriminating capacity of CA 19-9 between benign and malignant disease was high, especially in patients with pancreatic cancer (n = 347). The sensitivity of CA 19-9 was 85%. In patients who were Lewis blood type positive, the sensitivity increased to 92%. The CA 19-9 levels were significantly lower in patients with resectable tumors (n = 126) than in those with unresectable tumors (n = 221, p < 0.0001) (sensitivity 74% versus 90%). The CA 19-9 levels dropped sharply after resection but normalized only in 29%, 13%, and 10% of patients with stage I, II, and III, respectively. In unresectable tumors, no significant decrease in CA 19-9 levels after laparotomy or bypass was found. Among patients with the same tumor stage, the median survival time of those whose CA 19-9 levels returned to normal after resection was significantly longer than those with postoperative CA 19-9 levels that decreased but did not return to normal (stage I: 33 versus 11.3 months; stage II: 41 versus 8.6 months; stage III: 28 versus 10.8 months). In patients with recurrent disease, 88% had an obvious rise in CA 19-9 levels.

CONCLUSION

CA 19-9 measurement is a simple test which can be used for diagnostic purposes, as well as the prediction of resectability, survival rate after surgery, and the potential for recurrence.

Thymidylate synthase is a predictor for response and resistance in hepatic artery infusion chemotherapy

The value of intratumoral thymidylate synthase (TS) quantitation as a predictive parameter for hepatic artery infusion (HAI) chemotherapy in patients with colorectal liver metastases was investigated. Relative TS mRNA levels were determined in 29 tumor samples using a quantitative RT-PCR amplification method. The median level of expression was 3.0 x 10(-3) (no units) and varied considerably among the tumors over a range of 135-fold. Patients with low TS levels were 4.1-fold more likely to respond (P < 0.03) compared to patients with high TS levels. Our results indicate that TS quantitation is a valuable predictive marker for tumor response to HAI therapy.

[Duodenum-preserving pancreatic head resection--a standard method in chronic pancreatitis]

In patients with chronic pancreatitis the inflammatory process in the pancreatic head is frequently the pacemaker of the disease. In these cases an inflammatory tumor develops which leads to local complications in half of the patients. Duodenum-preserving pancreatic head resection, contrary to procedures used in the past, offers the possibility to preserve stomach, duodenum, biliary tree, and the insulin secretory capacity. Duodenum-preserving pancreatic head resection is a subtotal resection of the pancreatic head. In a series of 380 patients the hospital mortality rate was 0.8%, the frequency of reoperation 5.3%, and the median hospitalisation time 13.9 days. The early postoperative glucose metabolism was deteriorated in 2% and improved in 9% of cases. After a median follow-up time of 6 years, 88% of the patients were completely painfree or suffered pain rarely. Sixty-three percent were gainfully employed; the late mortality was 8.9%. Only 10% of the patients had further bouts of pancreatitis. The decisive advantage of duodenum-preserving pancreatic head resection over Kausch-Whipple resection is preservation of the endocrine pancreatic function and of neighbouring organs.

[Clinical value of the CA 19-9 tumor marker with special reference to the Lewis phenotype]

BACKGROUND

Because of structure and biosynthesis of CA 19-9, it was postulated that patients with the Lewis phenotype Le(a-b-) are not able to synthesize CA 19-9. But some patients with Le(a-b-) on red blood cells showed elevated levels of this tumor marker.

PATIENTS AND METHOD

In 164 patients suffering from benign or malignant diseases both CA 19-9 and the Lewis phenotype were determined in sera. In addition in 51 patients red blood cells were tested for Lewis substances.

RESULTS

The frequencies of the different Lewis phenotypes on red blood cells were compared with the results found in sera. The prevalence of the phenotype Le(a-b-) on erythrocytes was significantly higher than in sera. In 51 patients both determinations were performed. These results were compared additionally. The phenotype Le(a-b-) found on red blood cells agreed with the results found in sera only in 30% of the cases. A loss of Lewis substances on erythrocytes could be seen both in malignant and benign diseases. Only in patients with Lewis substances found in sera elevated levels of CA 19-9 could be seen.

CONCLUSION

Considering only the Lewis phenotype in sera, it could be confirmed that patients with the genotype Le(a-b-)are not able to express elevated concentrations of CA 19-9.

Diagnostic value of CA 19-9 in patients with pancreatic cancer and nonspecific gastrointestinal symptoms

Serum expression of the tumor marker CA 19-9 was studied in 2119 patients. The discriminating capacity between benign and malignant disease was high for CA 19-9, especially in patients with pancreatic cancer (n = 347). The sensitivity of CA 19-9 was 85%. In patients who were Lewis blood type positive, the sensitivity increased to 92%. CA 19-9 levels were significantly lower in patients with resectable tumors (n = 126) than in those with unresectable tumors (n = 221, P < 0.0001; sensitivity 74% vs. 90%). CA 19-9 levels dropped sharply after resection but normalized in only 29%, 13%, and 10% of patients with stage I, II, and III tumors, respectively. In unresectable tumors no significant decrease in CA 19-9 levels after laparotomy or bypass surgery was found. Among patients with the same tumor stage, the median survival time in those whose CA 19-9 levels returned to normal after resection was significantly longer than in those who had postoperative CA 19-9 levels that decreased but did not return to normal (stage I, 33 months vs. 11.3 months; stage II, 41 months vs. 8.6 months; and stage III, 28 months vs. 10.8 months). In patients with recurrent disease, 88% had an obvious increase in CA 19-9 levels. CA 19-9 measurement is a simple test that can be used for diagnosis, for evaluation of resectability, and for prediction of survival after surgery and recurrences.

CA 19-9 serum course and prognosis of pancreatic cancer

CONCLUSION

CA 19-9 measurement is a simple test that can be used for diagnosis as well as for prediction of resection, survival rate after surgery, and recurrences.

METHODS

Serum expression of the tumor marker CA 19-9 was studied in 2119 patients.

RESULTS

The discriminating capacity between benign and malignant disease was high for CA 19-9, especially in patients with pancreatic cancer (n = 347). The sensitivity of CA 19-9 was 85%. In patients who were Lewis blood type positive, the sensitivity increased to 92%. CA 19-9 levels were significantly lower in patients with resectable tumors (n = 126) than in those with unresectable tumors (n = 221, p < 0.0001) (sensitivity 74 vs 90%). CA 19-9 dropped sharply after resection, but normalized only in 29, 13, and 10% in patients with stage I, II, and III, respectively. In unresectable tumors no significant decrease of CA 19-9 after laparotomy or bypass operation was found. In patients of the same tumor stage, the median survival time in those whose CA 19-9 levels returned to normal after resection was significantly longer than in those with postoperative CA 19-9 levels that decreased, but did not return to normal (in stage I, 33 vs 11.3 mo, in stage II, 41 vs 8.6 mo, and in stage III, 28 vs 10.8 mo). In patients with recurrent disease, 88% had an obvious rise in CA 19-9 levels.

CAM 17.1--a new diagnostic marker in pancreatic cancer

CAM 17.1-Ab is a recently described monoclonal antibody that detects a mucus glycoprotein with high specificity for intestinal mucus, particularly in the colon, small intestine, biliary tract and pancreas. We investigated the expression and release of CAM 17.1 in pancreatic carcinoma cell lines and tissue specimens of normal pancreas, chronic pancreatitis and pancreatic cancer. CAM 17.1 was weakly expressed on normal ductal cells and chronic pancreatitis, whereas it was overexpressed in pancreatic cancer. Serum analysis using a new enzyme-linked antibody sandwich assay (CAM 17.1/WGA) of patients with chronic pancreatitis, pancreatic cancer or other gastrointestinal cancer and of healthy blood donors revealed a high sensitivity (67%) and excellent specificity (90%) of CAM 17.1/WGA assay in pancreatic cancer. In comparison with the tumour marker CA19-9, the sensitivity of the CAM 17.1/WGA assay was similar to the sensitivity of CA 19-9 (67% and 76%, P = 0.22), whereas the specificity of CAM 17.1/WGA assay was higher than in CA 19-9 (90% compared with 78% in chronic pancreatitis, P > 0.05).

[Recurrence and survival rate after surgical therapy of rectal carcinoma]

Between 1983 and 1993, 680 patients with rectal carcinoma were treated at Ulm University. The resection rate was 84%. After undergoing radical surgery, 492 of the patients were followed up regularly at our hospital for a median of 66.9 months (range 4-177.6). Recurrences occurred in 172 patients (35%) and were diagnosed a median of 13 months (range 4-106 months) postoperatively; 9.4% had regional recurrences, 10.4% regional recurrences and distant metastases and 10.2% distant metastases. The 10-year survival rate of the patients in tumour stages I, II and III was 88%, 62%, and 32%. In patients with carcinoma of the midrectum, after anterior resection or abdominoperineal amputation the same local recurrence rate was found.

[Morbidity and mortality in surgical therapy of colorectal cancer]

Morbidity and mortality of various surgical therapy protocols for large bowel carcinoma were analysed in 1270 patients and compared to data from other working groups. We found a decline of mortality rates, especially after abdomino-perineal rectum extirpation. The infection rate of the sacral wound is, however, still as high as it used to be. The anastomotic insufficiency rate after anterior rectum resection is depending on location of the anastomoses, amounting to about 7-8% after manual suture as well as after stapled anastomosis. In colon surgery general complications are more frequent than surgical ones.

Is follow-up of colorectal cancer patients worthwhile?

Between 1978 and 1989, 1,045 of 1,399 patients (580 male and 474 female) underwent curative surgery for colorectal carcinoma. Of these patients, 350 (33 percent) had recurrences, another 16 (1.5 percent) developed a metachronous colorectal cancer, and 23 (2 percent) had cancers of other organs. An isolated locoregional recurrence was found in 75/350 (21 percent). The remaining 275/350 patients (79 percent) showed systemic dissemination of the carcinoma. Reoperations with curative intent were performed on 56/350 patients (16 percent). Only 21 of the 56 resected patients (38 percent), i.e., 21/350 (6 percent), were without recurrence at the end of the follow-up period on December 31, 1990. Despite a curative reoperation, 62 percent of the patients again developed recurrent growths. There is an imbalance between the efforts invested in tumor follow-up and the benefits gained. Further follow-up programs should be investigated in a controlled, prospective fashion.

[The value of tumor volumetry as opposed to bidimensional determination of tumor size during follow-up of hepatic metastases from colorectal carcinoma]

36 patients with liver metastases due to colorectal carcinoma under treatment with arterial perfusion chemotherapy of the liver with 5-fluoro-2-desoxyuridine (FUDR) via a subcutaneous pump were investigated by axial liver CT at 6-monthly intervals. In all examinations a dynamic CT scan with intravenous bolus injection of contrast medium was carried out following a native scan. Changes in tumour size were documented by means of 1. volumetry and 2. bidimensional measurement according to WHO criteria. Since we were not able to assess small newly developing lesions within the liver using the volumetric classification, the WHO-classification showed much higher sensitivity in cases of progressive disease. In addition, volumetric determination of tumour size by means of region-of-interest technique proved to be rather impracticable in clinical routine compared to bidimensional measurement.

[Free intraperitoneal tumors cells in pancreatic cancer--significance for clinical course and therapy]

Intraoperative peritoneal cytology was performed in 36 patients with pancreatic ductal adenocarcinoma. 12 patients (33%) showed malignant cells in the peritoneal cavity. In the further course these patients developed more non-local metastases and had a significantly shorter survival rate. Peritoneal carcinomatosis became evident in 75% of the patients with free cancer cells in contrast to only 14% of the patients without. Detection of free cancer cells was directly related to the histological tumor stage (TNM-system). Iatrogenic shedding of malignant cells by surgical tumor manipulation or needle biopsy was not observed. The technique of intraoperative peritoneal lavage with consecutive cytology and its possible effects on further treatment is discussed.

The value of the tumor marker CA 15-3 in diagnosing and monitoring breast cancer. A comparative study with carcinoembryonic antigen

To estimate the utility of the tumor-associated antigen CA 15-3 in the diagnosis of patients with breast cancer, this tumor marker was measured preoperatively in 1342 patients. This group included 509 patients with malignant disease (134 breast cancer patients and 375 patients with other malignancies not involving the breast) and 833 patients with benign surgical diseases (95 patients with fibroadenoma of the breast and 738 patients with other benign diseases). The results were compared with those obtained for carcinoembryonic antigen (CEA) in the diagnosis of breast cancer. The CA 15-3 level was above normal (25 U/ml) in 31% of the patients with breast cancer, in 22% of patients with other malignancies, and in 9% of patients with benign diseases. The CEA level was elevated in 26% of patients with breast cancer (more than 3 ng/ml). There was a good correlation of CA 15-3 levels with the tumor stage of breast cancer. Both CA 15-3 and CEA also were determined in 671 patients who had received initial curative surgery of breast cancer and who regularly attended our follow-up clinic. The CA 15-3 was found to be more sensitive than CEA in detecting recurrences of breast cancer. In the postcare period, carcinoma recurred in 205 patients. Of these, 73% had CA 15-3 concentrations above 25 U/ml; only 50% had CEA values above 3 ng/ml (P less than 0.0001). Although neither CA 15-3 nor CEA were sensitive enough for the screening and diagnosis of early breast cancer, CA 15-3 was significantly better than CEA in the detection of breast cancer metastases.

[Does tumor aftercare in colorectal carcinoma make sense?]

The aim of regular follow-up of cancer patients after curative surgery is to detect any recurrence or second cancer as early as possible. Some workers have claimed that in such cases prompt surgical therapy can cure large numbers of patients. To answer this question, a detailed follow-up programme was carried out in 1054 patients (585 men, 469 women, mean age 62 [25-79] years) who had undergone surgery for colorectal cancers in TNM stages I, II, or III, the operations having been aimed at cure, not merely palliation. During a median observation time of 38 (4-140) months recurrences arose in 350 patients, while 16 patients developed a second carcinoma and 23 patients a carcinoma of some other organ. In 75 of the 350 patients there was an isolated local or regional recurrence, but in 275 patients there were distant metastases. Second operations aimed at cure were performed in 56 of the 350 patients. Only 21 of these 56 patients, i.e., 6% of all the patients whose tumours recurred, were free from cancer at the end of the observation period. The effort and expense required for a cancer follow-up programme of the kind at present advocated for patients with colorectal cancer are out of proportion to the results achieved. This conclusion should prompt a review of the value of other follow-up programmes.

[Surgical treatment results in colonic obstruction]

Between 1982 and 1988 94 patients with obstruction of the colon were operated (52 male, 42 female, median age 66 years). Carcinoma accounted for the majority of cases: in 51% of patients enteral, in 9% local tumor growth extraenteral, in 17% peritoneal carcinosis. Therapeutic procedures were chosen according to the necessities in benign courses and in extraenteral tumor growth. In obstructing colorectal carcinoma (48 patients) a policy of primary tumor resection was pursued. 48 patients (40%) developed postoperative complications, 3 patients (3.1%) had to be reoperated. The overall mortality rate in patients with acute obstructions of all courses was 9.6%, in patients with obstruction secondary to carcinoma 14.6%. 74% of patients with colorectal tumors had TNM tumor stage III and IV. The 5-years-survival rate amounted to 21% overall, but after primary tumor resection it was 47%.

Regional chemotherapy in liver metastases of colorectal carcinoma: monitoring with arterial computed tomography

Continuous chemotherapy was administered to 82 patients through the hepatic artery via Infusaid pumps. In order to obtain a primary status and to evaluate the success of therapy, the perfusion patterns of the liver and of the existing tumor masses in the liver were estimated by conducting arterial angiocomputed tomographies (AACTs) immediately after pump implantation of every 3 months thereafter. In 70% of the patients, findings showed both liver lobes to be homogeneously perfused, 24% demonstrated distinct inhomogeneities. The response of the latter cases should depend primarily on the efficacy of the administered cytostatic agent. Six percent of the patients showed selective perfusion of either the left or right hepatic lobe. In these cases, only the perfused liver regions exhibited stable disease or regression of the metastases, whereas the metastases of the nonperfused regions progressed. At 3-month follow-up, the majority of the patients (50-57%) showed homogeneous hepatic perfusion. Inhomogeneities were found in 26-36% of the patients, 12 patients demonstrated incomplete perfusion. There was no association between the perfusion patterns of the metastases or of the prechemotherapeutic liver involvement and the response of the metastases to regional chemotherapy. In regional chemotherapy, liver perfusion should be controlled both intraoperatively or directly postoperatively and during therapy.

Tumor markers in pancreatic cancer. Sensitivity and specificity of CA 19-9

The tumor marker CA 19-9 is based on monoclonal antibody to colonic carcinoma cell lines. In this study, the utility of the tumor marker in the diagnosis of pancreatic carcinoma was evaluated. CA 19-9 is strongly expressed in most tissue specimens obtained from pancreatic carcinomas. However, this antigen is also found in normal pancreas and specimens from chronic pancreatitis. The CA 19-9 is released into the circulation, and was found at increased concentrations (greater than 37 U/ml) in 87% of the patients with pancreatic carcinoma n = 145, as compared with only 13% in the group of patients with benign diseases n = 1,081 and 29% of those with extrapancreatic malignancies n = 691 (P less than 0.0001). The preoperatively raised CA 19-9 concentration in patients with stage I pancreatic carcinoma decreases after curative resection of the carcinoma to values within the normal range. However, in no CA 19-9 estimation following palliative surgical intervention of stage III and IV patients or in cases of inoperable carcinomas was a serum concentration of less than 37 U/ml recorded. Accordingly, the median survival of stage I patients was 29 months, and of stage III, IV and patients with inoperable carcinomas 6 months only.

Arterial perfusion abnormalities of the liver after hepatic arterial infusion chemotherapy and their correlation with changes in the metastases: evaluation with CT and angiography

We studied the progress of hepatic arterial perfusion abnormalities in 50 patients receiving long-term arterial infusion chemotherapy for palliative treatment of liver metastases from colorectal cancers and correlated the findings with changes in the metastases. Intraarterially and IV enhanced CT scans and digital subtraction angiograms of the liver were made in all patients before chemotherapy and at 3-month intervals during chemotherapy for 1 year. Before the chemotherapy, all patients had normal hepatic arterial perfusion. Arterial perfusion abnormalities were detected in 30 patients (60%) after 6 months of chemotherapy and in 41 patients (82%) after chemotherapy for 1 year. After 6 months of chemotherapy, 36% of the regressive and 39% of the progressive metastases were located in areas with arterial perfusion abnormalities. After 1 year of chemotherapy, 54% of the regressive and 60% of the progressive metastases were situated in portions of the liver with perfusion abnormalities. Hepatic arterial perfusion abnormalities were found to be progressive during intraarterial infusion chemotherapy. No relationship between arterial perfusion abnormalities and tumor response to chemotherapy could be detected.

[Regional chemotherapy of liver metastases in colorectal carcinoma. Intra-arterial vs intravenous plus intra-arterial therapy]

Regional chemotherapy with floxuridine was undertaken in 50 patients (32 men and 18 women, mean age 57 years) with colorectal carcinoma with metastases only to the liver. In 25 patients (group I) the drug (0.2 mg/kg) was administered exclusively intraarterially into the hepatic artery, while in the remaining 25 (group II) it was given both intraarterially (0.21 mg/kg) and intravenously (0.09 mg/kg) via the inferior vena cava. The remission rate in group I was 56% (14 of 25), in group II it was 64% (16 of 25). It was subsequently discovered that 4 of the 25 in group II already had extrahepatic metastases at the time of implantation of the infusion catheter. The difference in remission rate between the two groups is not significant. Extrahepatic tumour recurrence occurred after a median period of 16 months in 17 patients of group I (68%) and six of 21 of group II (29%, P less than 0.01). Over an observation period of 34 months the survival rates of the two groups were not significantly different. However, these results suggest that over a longer period a higher survival rate is to be expected for the intraarterially plus intravenously treated group.

Regional chemotherapy for hepatic metastases of colorectal carcinoma (continuous intraarterial versus continuous intraarterial/intravenous therapy). Results of a controlled clinical trial

Sixty-four patients with a biopsy diagnosis of colorectal cancer with liver metastases were treated with 5-fluorodeoxyuridine (FUDR) infusions. In a pilot study, the first 20 patients were given hepatic artery infusions of FUDR by implanted pumps. The remaining 44 patients were then randomized prospectively to compare the effectiveness of continuous hepatic artery and intravenous infusion of FUDR (IA/IV group; 21 patients) with hepatic artery infusion alone (IA group; 23 patients). A continuous 14-day infusion regimen of FUDR was applied each month. The dosage was 0.2 mg/kg/d of FUDR for the IA group and 0.3 mg/kg/d for the IA/IV group. The complete and partial response rates were each 50% in the pilot study and 52% and 48% in the IA and IA/IV randomized groups, respectively. Drug toxicities in the 64 patients included gastroenteritis (21%), chemical hepatitis (57%), and biliary sclerosis (25%). There was no difference in the toxicity of FUDR in the two randomized groups (P greater than 0.1). Extrahepatic spread of cancer during therapy was found in 61% (n = 14) of the IA group and 33% (n = 7) of the IA/IV group. There was no difference in survival between the randomized groups. The 64 patients were categorized into the following two groups according to their response to therapy: (1) responders (patients with complete or partial remission [n = 32]) or nonresponders (patients with stable disease or progression of metastases [n = 32]). The median survival time was 31 months for responders and 16 months for nonresponders (P less than 0.0001). Intraarterial FUDR infusion provided control of liver metastases. The combination of intraarterial and intravenous therapy seemed to prevent extrahepatic spread during therapy in most of the patients. Survival appeared to be significantly prolonged in patients with a regression of metastases.

[Effect of tumor size and lymph node status on the prognosis of pancreatic cancer]

Between 1982 and 1987 186 patients with a carcinoma of the pancreas underwent surgery. In 69 patients (37%) a resective surgical procedure was performed. In these patients, lymph node staging was conducted intraoperatively. The operative mortality of the resection was 4.3%. The median survival of the resected patients with papillary carcinoma was 21 months and of the patients with ductal pancreatic carcinoma 7 months. A correlation between survival time and frequency as well as localization of the lymph node attack could be established. Only patients in the TNM stage I of a ductal carcinoma appeared to have profited significantly from the resection compared to the palliative procedure.

[Computed tomographic and angiographic studies of arterial liver perfusion following intra-arterial infusion chemotherapy using 5-fluoro-2-deoxyuridine]

Fifty patients with liver metastases from colorectal primaries underwent hepatic intraarterial chemotherapy using 5-fluoro-2-deoxyuridine as an antitumour agent. Repeated computed tomography and angiography of the liver was performed during a follow-up period of a year. Following six months of regional chemotherapy, arterial perfusion abnormalities of the liver were detected in 40 of the total of 50 patients. After one year of intraarterial chemotherapy normal arterial liver perfusion was found in only two patients. Histology revealed thrombotic occlusion or narrowing of hepatic arteries, respectively.

[Biliary and arterial obstructive processes in regional chemotherapy with FUDR]

By far the majority of 54 patients suffering from hepatic metastases due to colorectal primaries developed obliterations of the arterial vascular bed when being submitted to regional chemotherapy with FUDR. In addition, about 25% exhibited obstructive jaundice in the course of severe sclerosing cholangitis. Either effect, which can be detected by radiological procedures, has to be referred to irritating activities of the chemotherapeutic drug used.