Second-Look Operation for Colon Carcinoma After Fluorouracil Therapy

Mackman, Sanford; Curreri, Anthony R.; Ansfield, Fred J.

doi:10.1001/archsurg.1970.01340220203034

Cited by 19 publications

(4 citation statements)

References 10 publications

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“…The major problem of second-look surgery as advocated by Gilbertson and Wangensteen was the operative morbidity and optimal timing.25 In 1970, Mackman and colleagues modified this concept by advocating chemotherapy before second-look procedures. 26 Of the 58 patients, second-look surgery revealed persistent disease in 26, and 5 of these patients were rendered diseasefree. A similar approach has been analyzed by Roseman and Minton in 50 patients with recurrent intra-abdominal disease from either ovarian or colon primary.…”

Section: Discussionmentioning

confidence: 98%

Colon carcinoma in children and adolescents. A review of 30 cases

Rao

Pratt

Fleming

et al. 1985

Cancer

121

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Carcinoma of the large bowel is rare in persons under the age of 30, and generally presents with advanced stages of disease. From 1964 to 1984, 30 patients presented with nonfamilial large bowel malignancies. Seventeen patients were male, and 13 female (age range, 8–25 years). In 15 patients the primary was in the right transverse colon. In 26 patients the lesion was above the peritoneal reflection. Classification by Dukes' staging demonstrated Stage B in 3 patients, Stage C in 7 patients, and Stage D in 20 patients. Twenty‐five patients had a mucinous variety of adenocarcinoma. Surgery at initial laparotomy consisted of biopsy (10 patients), palliative segmental resection (7 patients) and complete resection (13 patients; survival in each of these groups ranged from 1 to 15 months (median, 6 months), 6 to 36 months (median, 8 months) and 7 months to 14 years (median, 6 months), respectively. The only long‐term survivors are three patients who had complete resection, two of whom are surviving free of disease after 5 and 15 years, respectively. Common sites of abdominal recurrence were the omentum (6 patients) and ovaries (7 patients). All patients received chemotherapy. In 16 of 24 evaluable patients, responses lasting 3 to 18 months were observed. Five patients also received radiation therapy. Follow‐up of these patients included computed tomographic scans, ultrasound, and determination of carcinoem‐bryonic antigen (CEA) levels. The CEA level in 9 of 23 patients did not correspond with the presence of either residual disease or progression of disease. Chemotherapy combined with a second‐look surgical procedure in selected cases may improve the proportion of patients surviving and the duration of survival. Cancer 55:1322‐1326, 1985.

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Section: Discussionmentioning

confidence: 98%

Colon carcinoma in children and adolescents. A review of 30 cases

Rao

Pratt

Fleming

et al. 1985

Cancer

121

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“…How much more useful would it have been to institute an optimal loading course of 5-FU, 3 weeks postoperatively followed by weekly maintenance doses. We have instances [15] of biopsy-proven small liver metastases eradicated after at least 1 year of aggressive 5-FU therapy and only depressed scars free of tumor found on second-look operation. We have many patients with moderate liver metastases on 5-FU therapy month after month and some year after year in good remission.…”

mentioning

confidence: 92%

“…It is readily apparent that the smallest metastases are disseminated foci of cells too small to recognize with the means we have available today, yet pres ent in approximately two-thirds of patients with colon cancer who at the time of the curative resection are found to have positive regional nodes and in approximately 50% of the colon cancer patients with negative regional nodes but with transmural involvement [15].…”

mentioning

confidence: 99%

“…In colon cancer, however, 5-FU used as an adjuvant to the cancer resec tion in patients with positive regional nodes or transmural involvement showed definitely promising results [15]. 29 of such patients received 4 cour ses of 5-FU with 30-day intervals between courses, then a waiting period of 3 months followed by a second-look operation with 25 found negative.…”

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confidence: 99%

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Newer Concepts in Chemotherapy of Cancer

Ansfield¹,

Mackman²,

Ramirez³

1972

Oncology

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Small lesions of breast or colorectal origin have been eradicated with 5-fluorouracil (5-FU) therapy and did not recur after the chemotherapy was discontinued. This has not occurred in larger lesions. It is preferable to treat patients with known remaining disease early rather than to wait for them to become symptomatic which often renders them poor risk for effective chemotherapy. In patients having curative resections for gastrointestinal, breast, or testicular cancers that are high risk for developing recurrence, adjuvant chemotherapy appears promising.

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Intrahepatic arterial infusion with 5-fluorouracil

Ansfield

Ramírez

Skibba

et al. 1971

Cancer

116

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Since 1964, 200 patients were treated with intra‐arterial 5‐FU infusion. Of them, 127 failed with intravenously injected 5‐FU, and 27 were unsuitable for such treatment as their involvement was so far advanced as to have jaundice due to extensive parenchymal involvement. In all but 12 patients, the catheter was placed percutaneously through the brachial artery. The criteria for improvement included at least a 6‐cm decrease in distance of the liver edge from the xiphoid or costal margin, a 50% decrease in the abnormal enzyme studies, a return of elevated bilirubin levels to normal so that jaundice disappeared, and all these responses continued for at least 2 months. Inpatients were treated with 5‐FU, 25 mg/kg/day × 4, then 15 mg/kg/day for 7 or 8 days. If no toxicity appeared, the 5‐FU was then increased to 20 mg/kg/day until the total infusion period was 21 days, and the catheter was removed. Outpatients received 500 mg daily in 140 ml 5% dextrose and 2,500 units heparin daily for 90 days, and then the catheter was removed. Following the termination of the infusion, the patient was given weekly intravenous doses of 5‐FU at 15 mg/kg. After several months, with reactivation of the disease, the intra‐arterial infusion was repeated. Minimal toxicity occurred, and there was one death from the procedure. Morbidity in the forms of infection and hemorrhage did occur, but, in the last 100 patients, there were only 2 minor infections. Of 113 study patients, 69 (61%) met our criteria of improvement and had a median survival of 8.7 months. Forty‐four (39%) failed, and their median survival was 2.5 months. This demonstrates a significantly increased survival in the responders.

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Second-Look Operation for Colon Carcinoma After Fluorouracil Therapy

Cited by 19 publications

References 10 publications

Colon carcinoma in children and adolescents. A review of 30 cases

Colon carcinoma in children and adolescents. A review of 30 cases

Newer Concepts in Chemotherapy of Cancer

Intrahepatic arterial infusion with 5-fluorouracil

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