BACKGROUND: The prognosis of patients with advanced colorectal tumor is poor. Therefore, other therapy regimes for non-resectable hepatic metastases are necessary. In this prospective study, two regional chemotherapy protocols were compared. PATIENTS AND METHODS: An arterial port system was implanted in 64 patients. Sixty patients were assigned to the two therapy protocols for hepatic arterial infusion (HAI): protocol A (n=24): 5-FU/FA (300 mg/m2 folinic acid and 600 mg/m2 5-fluorouracil daily for 5 days with a 14-day interval); protocol B (n=36): 5-FU/FA/IFN/DSM (450 mg starch microspheres (DSM) with 5 million IU recombinant interferon (IFN), alpha 2b 500 mg/m2 FA and 600 mg/m2 5-FU). RESULTS: The response rate was 50% in protocol A patients and 69.4% in protocol B. The median times for disease progression were 11 months for protocol A and 20 months for protocol B (p = 0.038), while median survival times of 14 months and 26 months, respectively, were obtained (p = 0.015). There were no significant differences in terms of toxic side-effects. Major toxicity problems were observed in 12% of the protocol A-treated patients and in 11% of the protocol B-treated patients. CONCLUSION: Combination therapy with HAI-5-FU/FA/IFN/DSM was superior to HAI-5FU/FA, with a high response rate (69% vs. 55%) and few toxic side-effects. These findings suggest that these combinations should be evaluated in larger studies as first- or second-line therapy in patients with hepatic metastases of colorectal cancer.

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The role of hemorheology in the pathophysiology and treatment of arterial occlusive disease.

Hemorheological types of treatment are more and more used in the field of clinical angiology. On the other hand a good portion of criticism is necessary not to go the wrong way. In spite of really attractive pathophysiological ideas the bed side situation is quite a different affair. Up to now it is not clear under which conditions and to what extent pathological hemorheological values are causative or at least aggravating factors of arterial occlusive diseases and the resultant functional impairment. So the essential points of what is called "clinical hemorheology" are not yet solved. Direct observation and documentation of hemorheological induced clinically interesting effects in humans as well as the serious trial to give definitions of clinical conditions in which the effects obtained are of clinical relevance are extremely necessary to enlighten an attractive and exciting component of clinical angiology.

Arterial Occlusive Diseases↗