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Addition of IFN-alpha was associated with increased toxicity without markedly influencing the outcome and should therefore not be recommended for adjuvant treatment. Addition of FA increased the 5-year recurrence-free and overall survival rate by 9.3 and 11.5 percentage points, respectively. 5-FU + LEV + FA for 12 months may be an effective adjuvant treatment option for locally advanced high-risk colon cancer.

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At the joint International Association of Pancreatology and European Pancreatic Club meeting at King’s College, London (July 9-12, 1997), a satellite meeting of the European Study Group for Pancreatic Cancer (ESPAC) met to discuss the progress of the ESPAC-1 trial. This study will address which, if any, of the following adjuvant treatments are of benefit in patients with resectable pancreatic cancer: radiotherapy (40 Gy with 5-fluorouracil as a sensitising agent); 6 months chemotherapy (5-fluorouracil and folinic acid), or a combination of these treatments. The study, which commenced in 1994, had already recruited 348 patients into the 3 treatment arms and 1 control arm of the study by May 31, 1997. This is the largest study of its kind in pancreatic cancer and should definitively address the question of the role of conventional methods of adjuvant treatment in pancreatic cancer.

Current DataSince Novermber, 1981, 50 patients (predominantly those with metastases of coiorectal carcinomas) have been treated in our clinic by an isolated regional chemotherapy on an average of 9 months after the primary operation. The mortality rate was 8%.The eytostatic drugs applied alone or in combination were 5fluorouracil (5-FU) (300-1,250 mg) and mitomycin C (5-50 mg) in 46 patients, and 5-FU, mitomycin C, and cisplatin (50 mg) in 4 patients. The course of the disease was observed in 41 patients. The median survival was 14 months, 24 months in 11 patients still living, and 12.5 months in those patients who died. An additional treatment with cycles of an intraarterial infusion therapy seeemed to extend the survival time (7.5 months without additional treatment, 18 months with additional treatment). Nine (22%) of 41 patients had a complete remission, and 28 (68%), a partial remission. Lung metastases and/or local tumor recurrences arose in 40% of the patients with secondary liver tumors.We consider the very high eytostatic drug concentrations in the infusion circuit and the additional perfusion of the portal vein to be the advantages of isolated liver perfusion (ILP). Certainly, this therapy can be applied only once, and ILP must he completed by another means of treatment.Patients with liver tumors who do not receive treatment seldom live longer than 1 89 years, and only 2-4 months in advanced stages [1][2][3]. So far, no patient has been registered who lived longer than 5 years. Systemic chemotherapy has hardly improved the results.Intraarterial infusion, first mentioned by Klopp et al. [4], increases the local cytostatic drug concentration considerably and, thus, exploits the dose-effect relationship. In 1951, Biermann [5] inserted a catheter selectively into the hepatic artery. The first experiments of isolated regional perfusion were performed by Ryan [6] and Creech et al. [7]. In the early 1960's, the idea was taken up by other study groups [8][9][10][11]. Aust and Ausman [8] first tried isolated liver perfusion (ILl?) on humans; however, the method was not developed any further and gained importance only in recent years [12].We applied ILP for the first time in November, 1981, on a patient with liver metastases of a rectal carcinoma [ 13,14], only after we had sufficiently perfected the technique in experimental studies [15]. A caval catheter with 2 lumina, which we introduced, considerably simplified the operative procedure.