Combined Modality Therapy of Gastrointestinal Tract Cancer by M. Gignoux, A. Roussel, B. Paillot, M. Gillet, P. Schlag, O.

By M. Gignoux, A. Roussel, B. Paillot, M. Gillet, P. Schlag, O. Dalesio, M. Buyse, N. Duez (auth.), Professor Dr. Peter Schlag, Dr. Peter Hohenberger, Priv. Doz. Dr. Urs Metzger (eds.)

Modern surgical oncology is characterised through multimodal treatment. in recent times a variety of healing techniques of pre-, peri-, intra-and postoperative remedy were in­ vestigated with reference to their use together with surgi­ cal intervention. It now's time to research and to outline the kingdom of our wisdom. For tumors of the gastrointestinal tract there are a number of encouraging healing methods, equivalent to preop­ erative chemotherapy in esophageal and perioperative chemotherapy in colon melanoma. For a few specified tumors, like anal carcinoma, we've sincerely outlined mixed treatments which even now needs to be considered as typical remedy. it's also time to illustrate the result of numerous clini­ cal stories which have been carried out in the previous couple of years that mixed surgical efforts with pre- or postinter­ ventional chemotherapy or radiotherapy. it is vital to guage no matter if those trials give a contribution to growth in onco­ logical remedy. The editors of this quantity - surgeons on the collage hospitals of Heidelberg and Zurich - needs to be given the mer­ it of attaining those targets. It used to be specifically acceptable for the dept of surgical procedure in Heidelberg, in shut coopera­ tion with the excellent melanoma heart Heidelberg/ Mannheim, to organize a evaluation of our current wisdom of surgical oncology because it is within the culture of trying to mix diverse healing methods to melanoma therapy.

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Roth 32 Table 3. Results of treatment, controlled randomized clinical trial Treatment modality Weight loss Complete response (100%) 5- Fluorouracil <10% 8 (61 %) Bleomycin >10% 3 (20%) + + Radiation Total 5- Fluorouracil <10% Adriamycin >10% + + Radiation Total 11 (39%) 1 2 (8%) Stable disease (0%-50%) Progresslon Response rate 3 2 0 11/13 (85%) 7 3 2 10/15 (67%) 5 2 21/28 (75%) 7 3 0 8/11 (73%) 9 2 5 10/17 (59%) 5 5 18128 (64%) Partial response (> 50%) 10 (36%) 16 (57%) of 5-FU (10 mg/kg i. v.

No thrombocytopenia was Combination of Chemotherapy and Irradiation 35 Table 8. Toxic side effects (33 patients) Grade Alopecia Mucositis with retrostemal pain Leukopenia Thrombocytopenia ECG changes Cardiac failure II III IV 2 13 3 8 15 1 23 5 5 2 1 (100%) (100%) (27%) (9%) observed. Alopecia was present in all cases: grades II and III in 10 and grade IV in 23 patients. Tracheobronchial fistulae were not observed. Insofar as cardiotoxicity is concerned, there was not a single case of heart failure.

The goal of the F AM2 protocol is to improve the efficacy of the treatment by increasing the chemotherapeutic dose. It is obviously too early to determine the possible therapeutic advantages of FAM2 in this protocol. Thus far, we can say that the increased doses of the three agents undoubtedly cause more toxicity, although this remains fairly constant in the three cycles. Mainly because of the hematologic toxicity, chemotherapy had to be reduced or postponed in a significant number of patients.

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