Twenty-eight patients affected by non-resectable pelvic recurrence of a primary pelvic malignant neoplasm were treated by isolated pelvic perfusion, at mean hyperthermia, with different drugs, chosen taking into account tumor chemosensitivity. All patients had been previously treated. Four complete and six partial responses were observed; nine patients had stable disease and four other patients were non-responders and died due to progression in a few months. Two patients were lost to follow-up, one patients died for other reasons and two recent patients are not yet assessable.

The peritoneal surface is the second most common anatomical site for recurrence by gastrointestinal and ovarian cancer; 50% of all patients treated for gastric, ovarian or colo-rectal cancer present a "Peritoneal Carcinosis". 50% of patients with PC die without other metastases. Treatment of PC is controversial. Surgery is usually impractical because of its multiplicity and often microscopic size; systemic chemotherapy (CT) is inefficacious because cytotoxic agents do not penetrate into the peritoneal surface in good concentration; intra-peritoneal CT is inefficacious for the low penetration of drugs into the nodule of carcinosis (not more than 1–3 m) in normothermia. Since 1985 Fujimoto et al. showed that intraperitoneal hyperthermic perfusion (IPHP) combined with CT is effective in treatment of Peritoneal Carcinosis. We treat peritoneal carcinosis with Intraperitoneal Hyperthermic Perfusion with high doses of COOP + MMe. Preliminary results in tern of toxicity and responses are impressive according to the data of the literature. The authors report their experience on this new treatment in a disease considered incurable up today. This work has been supported by AIRC, contribution 1994. The peritoneal surface is the second most common anatomical site for recurrence by gastrointestinal and ovarian cancer; 50% of all patients treated for gastric, ovarian or colo-rectal cancer present a "Peritoneal Carcinosis". 50% of patients with PC die without other metastases. Treatment of PC is controversial. Surgery is usually impractical because of its multiplicity and often microscopic size; systemic chemotherapy (CT) is inefficacious because cytotoxic agents do not penetrate into the peritoneal surface in good concentration; intra-peritoneal CT is inefficacious for the low penetration of drugs into the nodule of carcinosis (not more than 1–3 m) in normothermia. Since 1985 Fujimoto et al. showed that intraperitoneal hyperthermic perfusion (IPHP) combined with CT is effective in treatment of Peritoneal Carcinosis. We treat peritoneal carcinosis with Intraperitoneal Hyperthermic Perfusion with high doses of COOP + MMe. Preliminary results in tern of toxicity and responses are impressive according to the data of the literature. The authors report their experience on this new treatment in a disease considered incurable up today. This work has been supported by AIRC, contribution 1994.

The aim of this report is to compare two different approaches using ILP. Two series of patients with stage lIIA or IIIAB melanoma were treated by ILP at the National Cancer Institute, Milan. Forty-four patients (group 1) received α-tumor necrosis factor (α-TNF; 1–4 mg) plus melphalan (50–100 mg) and mild hyperthermia (39°C), while 133 patients (group 2) were treated using melphalan (50–100 mg) and hyperthermia (40.5°–41°). No significant differences were obtained in terms of both overall response rate (complete plus partial responses) in the two series of patients (70.4% in group I; 87.2% in group 2) and relapse rate (34.1% in group 1; 44.4% in group 2). A significant difference in the appearance of new relapses was observed (6 months for group 1; 13 months for group 2). After a median follow-up of II months in group 1,52.3% of patients have no evidence of disease, and 31.8% are alive with disease. In group 2 after a mean follow-up of 43 months, 30% of patients have no evidence of disease, and 8.3% are alive with disease. In conclusion, our experience did not confirm the impressive results demonstrated by other authors using α-TNF by ILP. This work has been supported by AIRC, contribution 1994. The aim of this report is to compare two different approaches using ILP. Two series of patients with stage lIIA or IIIAB melanoma were treated by ILP at the National Cancer Institute, Milan. Forty-four patients (group 1) received α-tumor necrosis factor (α-TNF; 1–4 mg) plus melphalan (50–100 mg) and mild hyperthermia (39°C), while 133 patients (group 2) were treated using melphalan (50–100 mg) and hyperthermia (40.5°–41°). No significant differences were obtained in terms of both overall response rate (complete plus partial responses) in the two series of patients (70.4% in group I; 87.2% in group 2) and relapse rate (34.1% in group 1; 44.4% in group 2). A significant difference in the appearance of new relapses was observed (6 months for group 1; 13 months for group 2). After a median follow-up of II months in group 1,52.3% of patients have no evidence of disease, and 31.8% are alive with disease. In group 2 after a mean follow-up of 43 months, 30% of patients have no evidence of disease, and 8.3% are alive with disease. In conclusion, our experience did not confirm the impressive results demonstrated by other authors using α-TNF by ILP. This work has been supported by AIRC, contribution 1994.

A study was undertaken to identify the nutritional parameters associated with a high risk of postoperative sepsis. The nutritional status of 162 cancer patients subjected to clean or clean‐contaminated elective surgery was preoperatively evaluated according to the following parameters: percentage weight loss, arm circumference, triceps skinfold, arm muscle circumference, creatinine‐height index, total serum protein, serum albumin, total iron‐binding capacity, cholinesterase, peripheral lymphocytes, complement C 3 ‐C 4 components, and skin tests. Patients were followed postoperatively according to a precise protocol to classify them as infected or noninfected. Postoperative sepsis was present in 40 patients who had significantly different mean values for four nutritional parameters from those of 114 patients with no complications, ie, total serum protein, 6.60 vs 6.99 g/dl, p = 0.008; serum albumin, 3.39 vs 3.66 g/dl, p = 0.001; total iron‐binding capacity 301.32 vs 337.17 mmg/dl, p = 0.006; and cholinesterase, 2389.77 vs 2770.10 mU/ml, p = 0.005. Moreover, the relative risk and the attributable risk for these variables were evaluated and the significance was tested by the χ 2 test. By using multiple logistic analysis it appeared that only total serum protein and total iron‐binding capacity gave an independent contribution to the risk of postoperative sepsis, while serum albumin disappeared and cholinesterase became non significant when the contribution of the first two variables was accounted for. It was also possible to identify, in a small number of patients, combinations of two variables that were associated with a very high risk of postoperative sepsis. Although these parameters appear to be reliable indicators of postoperative infections, we do not know if they are only simple nonspecific markers of malnutrition or whether they are directly involved in host defense mechanisms. This point warrants further discussion (Journal of Parenteral and Enteral Nutrition 9 :464–470, 1985)

Although hypocupremia is a well-known consequence of long-term total parenteral nutrition (TPN), its incidence as well as the duration of TPN necessary to induce it are still unsettled. The purpose of this study is to review the changes in serum copper level in 25 patients receiving TPN for a period longer than 2 wk (mean duration 6 wk) at the Istituto Nazionale Tumori of Milan and to evaluate the possible relationship of cupremia with the basic disease. Main indications for TPN included enterocutaneous fistulas (11 patients), cancer cachexia (10 patients), radiation enteropathy (two patients), and severe postoperative stricture following esophagogastric resection (two patients). Mean value of serum copper at the beginning of the study was 143 micrograms/100 ml (normal value 65-165 micrograms/100 ml), and the regression analysis showed a mean fall of 5.64 micrograms/100 ml/wk. Hypocupremia occurred in four patients (three with intestinal fistulas and one with radiation obstructive enteritis) at 5th, 6th, 9th, and 6th wk of TPN, respectively. No patient with cancer cachexia developed hypocupremia. No patient with hypocupremia had clinical evidence of a copper deficiency syndrome. We conclude that 1) hypocupremia does not occur within the first month of TPN; 2) its incidence is about 16% in patients intravenously fed for period longer than 2 wk; 3) it is more frequent in patients with enterocutaneous fistulas, whereas it never occurs in patients with cancer cachexia, and 4) it is not necessarily associated to a clinicometabolic syndrome of copper deficiency. Finally, the "nutritional" meaning of serum copper should be questioned in cancer patients since it could represent a "tumor marker."