Faculty Bibliography

Celestin intubation of the esophagus is occasionally employed in the palliation of unresectable esophageal carcinoma and in the obturation of malignant tracheoesophageal fistulas. Fourteen of 192 patients with carcinomas of the esophagus had Celestin tubes inserted at our institution between October 1977 and October 1982. Although tube insertion carries a low operative risk, there is significant subsequent morbidity associated with its use. Complications were identified radiographically in 11 of the 14 patients. Gastroesophageal reflux with aspiration pneumonia, tube obstruction, and tube migration were demonstrated most often. When Celestin tube use is deemed appropriate, the clinician and radiologist should be aware of the possible complications.

Twenty-three patients with gallbladder and cholangiocarcinoma were treated with m-AMSA at doses of 60-120 mg/m2 i.v. repeated at 4-week intervals. Toxicity was primarily hematologic. Partial responses occurred in 1/12 patients with gallbladder cancer and 1/11 patients with cholangiocarcinoma. The activity of m-AMSA in these neoplasms appears similar to that seen in hepatomas.

Quinone derivatives have shown intensive antitumor activity in a broad variety of neoplasias. Aziridinylbenzoquinone is designed to have adequate lipid solubility to attain useful drug concentrations in the central nervous system. A Phase I study of aziridinylbenzoquinone was conducted in 32 patients with advanced solid cancers. The drug was given as a slow i.v. injection on Days 1, 8, 15, and 22 of a 42-day cycle with a 2-week rest. Five dose levels ranging from 5 to 20 mg/sq m were studied, with 3 to 10 patients treated at each level; a total of 156 doses were administered. The major toxicity was myelosuppression with the median nadir in platelet and white blood cells occurring at Days 15 to 27 of the cycle, and first appearing at doses greater than 10 mg/sq m. Anemia was first seen at the 10-mg/sq m dose level, occurring between Days 22 and 40. Nonmyelosuppressive toxic effects included nausea and vomiting, anorexia, diarrhea, stomatitis, slight alopecia, and transient fever. The highest tolerated dose was 20 mg/sq m, the recommended dose for Phase II studies. Plasma and urine pharmacokinetics were studied in 17 patients by a high-pressure liquid chromatography method. Plasma decay curves could be fitted to a two-compartment open-system model with an overall average alpha and beta half-life values of 10.5 +/- 6.28 min and 16.90 +/- 8.63 (S.D.) hr. Aziridinylbenzoquinone levels were determined in urine samples of 12 patients, but less than 0.1% of the dose was excreted in the 0- to 4-hr sample of two patients, and none was detected in the urine of 10 patients.

One hundred and twenty-one cancer patients received 134 courses of total parenteral nutrition (TPN); almost all were treated with chemotherapy and/or radiotherapy. The average weight loss prior to TPN was 6.7 kg and albumin 3.1 g%/patient; 25% glucose solution with 4.25 g% amino acids was used as a calorie and nitrogen source. The average weight gain was 2.6 kg for those who received TPN less than 2 wk and 4.5 kg if TPN was given for greater than 2 wk. Complications were low; 3% had proven TPN-related septicemia. Mild to moderate reversible metabolic complications were common, although severe complications were rare; no one died because of TPN. Our experience confirms the previous reports that TPN can be given safely to malnourished compromised cancer patients.

Under the auspices of the Southwest Oncology Group, Wayne State University tested a schedule using bleomycin and mitomycin C that was previously reported to give a response rate of 88%. In our patients the same regimen produced similar toxic effects but a far different response rate of 15.8% (one complete remission and two partial remissions). The only discernible difference in the two patient groups was the amount of radiation given prior to chemotherapy.