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C Hottenrott

Publications and source records attributed to C Hottenrott.

At least 19 recordsLinked to original sources
PubMed1992

Continuous regional treatment with fluoropyrimidines for metastases from colorectal carcinomas: influence of modulation with leucovorin.

Hepatic regional treatment represents an attempt to improve tumor response by increasing drug concentration with low systemic toxicities. Recently in vitro and clinical studies have shown that the cytotoxicity of 5-fluorodeoxyuridine (FUDR) and 5-fluorouracil (5FU) can be potentiated by high doses of leucovorin (LCV). Two pilot studies with intraarterial FUDR, 5FU, and LCV were initiated. Since 1982, 221 patients with colorectal liver metastases were treated by various forms of long-term monthly continuous regional treatment using implantable ports or pumps. FUDR (0.05 to 1.7 mg/kg/d) was administered alone or combined with 5-FU and leucovorin. In 61 patients curative liver resection was possible and was followed by adjuvant arterial treatment. Overall median survival time (MST) was 15 months and increased to 36 months after liver resection. This was influenced by the following important factors: treatment, number of metastases, extent of infiltration, tumor volume, and minimal intraoperatively diagnosed extrahepatic disease. The response rate varied from 69% to 23%. Time of development of extrahepatic progression was not delayed by additional systemic treatment. Local side effects significantly depended on the duration of arterial infusion. The rate of biliary sclerosis ranged from 19% to 0%. Occurrence of chemical hepatitis was between 7% and 38%. In contrast, after combined intraarterial treatment with LCV, systemic side effects, mainly stomatitis and diarrhea, were dose limiting. Despite the improvement of survival after regional treatment, further randomized trials are mandatory to compare regional with relevant systemic treatment.

Colorectal Neoplasms↗
PubMed1992

[Primary open therapy of acute necrotizing pancreatitis by the "open abdomen"].

There is no agreement about a conservative surgical strategy in the therapy of acute necrotizing pancreatitis yet. This report describes our experience with "open packing" laparostomy. This procedure is only performed when renal and pulmonary insufficiency is proceeding, despite optimal conservative treatment. Since 1986 15 patients were treated in this manner. Three compartments are established: an upper compartment (stomach, liver, spleen--covered by the omentum majus, which is dissected from the colon transversum); a lower compartment (small bowel--covered by the left colon) and the mid compartment that permanently opens the bursa omentalis and the left retrocolic space. Initially a careful necrosectomy is performed, followed by a tamponade. At the intensive care unit changing of the tamponade and lavage of the bursa omentalis was done every day. So far two patients have died pursuing this therapeutic regimen.

Abdomen↗
PubMed1990

A critical evaluation of effectivity of extended lymphadenectomy in patients with carcinoma of the stomach. An analysis of early results and long-term survival.

The therapeutic benefit of extended lymphadenectomy in patients with gastric cancer is not generally accepted. We therefore analyzed the data of 82 patients with total gastrectomy and extended lymphadenectomy (compartment I: lymph nodes 1-6 and compartment II: lymph nodes 7-11) from 1979 to 1986 (GL group) for morbidity, mortality and survival and compared these with the results of a historical control group of 81 patients from 1971 to 1986 (group G), who similarly had undergone total gastrectomy but only compartment-I lymphadenectomy (lymph nodes 1-6). The 30-day operative mortality in the GL group was 6% (5/82), which was no higher than that of the control group (9.5%, 4/42) during the same observation period (1979-1986). The comparison of the actuarial survival according to the old TNM system (UICC 1978) in both groups showed no significant differences: stages I and II P = 0.22, stage III P = 0.29, all curative cases (stages I+II+III) P = 0.12. In addition, the patients of the GL group were restaged according to the new TNM system (UICC 1987). The calculated 5-year survival rate in this group was: stage I, 89%; stage II, 64%; stage III, 21%; curative total (stages I+II+III), 62%; stage IV, 0%. All patients (n = 12) with involvement and dissection of lymph nodes of compartment II died within 38 months. Only two of these patients (17%) had a potentially curative operation. Our results indicate that compartment-II lymph node dissection did not influence the operative mortality or the prognosis compared with compartment-I lymphadenectomy. Since patients with positive lymph nodes in compartment II did not benefit from the extended lymph node dissection of this area, obviously because of systemic spread, the question of the effectiveness of the extended lymphadenectomy remains unresolved.

Humans↗
PubMed1990

[Chemoembolization of primary liver cancer].

At the University of Frankfurt/M. we perform chemoembolization of the liver in patients with inoperable liver cell carcinoma. Before application of embolization material vasoconstriction of healthy blood vessels is achieved by intraarterial injection of norepinephrine. This procedure improves selectivity of tumor embolization. Methods, indications, contraindications and results are presented.

Carcinoma, Hepatocellular↗
PubMed1990

[Elective portasystemic shunt: selection criteria, choice of procedure,results].

The results of conservative medical (propranolol) and endoscopic therapy for bleeding esophageal varices show that the surgical shunt is indicated in both, acute and elective situations. The portocaval end-to-side-shunt should be preferred for hemodynamic reasons. However, special selection of patients is required to prevent postoperative liver failure. Linton, Drapanas and Warren shunts have a higher recurrence rate, but seem more appropriate for liver transplantation candidates. In our own series, preoperative diagnostic shunt-simulation by balloon-occlusion of the portal vein via an umbilical catheter has tremendously improved the results, even for child C-patients.

Esophageal and Gastric Varices↗
PubMed1989

[Prognostic significance of the Lauren classification of patients with stomach carcinoma. A statistical analysis of long-term results following gastrectomy].

To evaluate the prognostic difference between the 2 major histological types of Lauren classification in gastric cancer, data on patients who underwent the same surgical procedure -- total gastrectomy -- were studied. 124 consecutive total gastrectomy cases treated from 1979 to 1986 were classified according to Lauren retrospectively into 2 groups, comprising 63 patients (50.8%) with intestinal type carcinoma and 61 in another group of diffuse (n = 44, 35.5%) or mixed type (n = 17, 13.7%) carcinoma. In regard to extent of total gastrectomy the two groups were comparable (splenectomy 50 times and compartment II lymphadenectomy 43 times in the intestinal type group, vs 49 and 39 times in the diffuse or mixed type group). The proportion of males (42 men, 21 women) and older patients (mean: 62 years) was greater in the intestinal type group than in the group of diffuse or mixed type carcinoma (34 men, 27 women, mean: 57 years). According to TNM stage no significant difference was observed in local tumor infiltration (pT stage), lymph node metastases (pN) and distal metastases (pM) between the two groups at the time of surgery. The stages of disease (UICC 1987) were similar in the two groups: Stage I: intestinal type 25.4% (16/63), diffuse or mixed type 23% (14/61), stage II: 19% (12/63) vs 14.7% (9/61), stage III: 14.3% (9/63) vs 19.7% (12/61), stage IV: 41.3% (26/63) vs 42.6% (26/61). The hospital mortality was 9.5% (6/63) in the intestinal-type group and 8.5% (5/61) in the group of diffuse or mixed carcinoma (no significant difference).(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1989

Prevention of extrahepatic disease during intraarterial floxuridine of colorectal liver metastases by simultaneous systemic 5-fluorouracil treatment? A prospective multicenter study.

Fifty-two (52) patients with nonresectable hepatic-only metastases from colorectal carcinoma (tumor volume less than 75%) were treated by intraarterial FUdR, 0.2 mg/kg/d x 14 days/month (IA) using implantable pumps (Infusaid). They were randomized either for IA or for IA + systemic 5-FU 700 mg/m2/d x 3 days/month (IA/IV). Forty-six (46) patients were evaluable (26 IA; 20 IA/IV). Both groups were comparable in respect to primary tumor stage, age, liver function tests, tumor markers and extent of tumor infiltration. Twenty-six (26) patients (56%) demonstrated a complete (CR) or partial response (PR) with at least a 50% decrease in CEA levels and a significant tumor volume reduction (IA 50%; IA/IV 65%). Quality of response was significantly correlated with median survival (MS) time of 25 months for CR and PR. Approximate MS for IA and IA/IV was 16 and 19.5 months, respectively, and approximate median survival time to extra- and/or intrahepatic progression was 9 months (IA) and 11 months (IA/IV). Incidence of extrahepatic recurrence was not influenced by any treatment (IA 62%; IA/IV 60%). Overall approximate median time to occurrence of extrahepatic disease was 12.5 months (IA 13; IA/IV 10). Liver disease progression was observed in 38 patients (IA 85%; IA/IV 80%). A median time of 8 months to diagnosis of liver disease progression was calculated for IA, and IA/IV was 11.5 months. Incidence of chemical hepatitis for IA and IA/IV was 54 and 45%, while biliary sclerosis occurred in 15% and 10% of the cases, respectively, and did not correlate with response rates. Systemic side effects (25%) were only observed in the IA/IV group and induced significantly more interruptions of therapy than in the IA group. It is concluded from this study that additional systemic 5-FU treatment does not prevent the occurrence of extrahepatic disease under local chemotherapy of the liver.

Adenocarcinoma↗
PubMed1989

[European topic: liver surgery II--regional chemotherapy].

The most important methods of regional chemotherapy are exemplified by 657 cases of primary and secondary liver only malignancies. I. Adjuvant portal therapy of the liver with resection of the colorectal primary malignancy seems to be advantageous for advanced tumors. II. It is still unresolved whether survival is prolonged by adjuvant treatment of the liver following curative resection of colorectal liver metastases. III. The median survival time (FUDR, pump) is 17 months for palliative local chemotherapy of unresectable colorectal liver metastases. IV. Primary non-resectable liver malignancies show the best results after chemoembolisation (Frankfurt method).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Temporary chemoembolization of colorectal liver metastases with degradable starch microspheres.

Increasing drug delivery to the tumor should induce improved tumor response. To study this the effect of degradable starch microspheres (DSM) and mitomycin was evaluated in 11 patients with chemoembolization of colorectal liver metastases (CRLM) and previous floxuridine (FUDR) treatment. In 10 patients access to the hepatic artery was obtained either by infusaid pump or infusion chambers. Indications for chemoembolization were: Failure of continuous FUDR treatment (n = 7), biliary sclerosis (n = 2), incomplete liver perfusion (n = 2), extensive disease (n = 2). Preliminary observations showed a wide range of required DSM dose. Therefore each individual dose was determined by the use of digital subtraction angiography (DSA). Seventy-five percent of the DSM dosage, which induced reversed flow in the common hepatic artery, was selected for treatment. DSM was then administered four times every 2 hours/day/monthly. The last DSM doses were mixed with 10 mg mitomycin C. Observed response rates, controlled by chemotherapy (CT) and tumor markers, were: complete response 1/11; partial response 3/11; stable disease 2/11; progression 5/11. The median duration of response was 6.5 (range 3-21) months. DSM application induced redistribution of arterial flow towards previously unperfused portions of the liver. The required DSM doses decreased about 20-30% from the first to the last chemoembolization cycle. Although there was no systemic toxicity, embolization was associated with several local side effects. Moderate to heavy pain in spite of morphia and neuroleptics was experienced in 55% of all treatments. Some patients demonstrated an elevation in body temperature of up to 39 degrees C. Postembolization liver biopsies revealed more intense tumor necrosis associated with more severe hepato-toxicity than was seen with continuous FUDR treatment. It is concluded that the optimal sequence and dosage of mitomycin and DSM has to be further evaluated in prospective trials before clinical application.

Adult↗
PubMed1988

[Therapy of stomach carcinoma in older people].

Of 242 gastric cancer patients undergoing surgery in this clinic between 1979 and 1986, 84 (35%) were aged over 70. Staging of patients by the UICC (1978) classification was I: 4.8%, II: 16.7%, III: 18% and IV: 60.5%. Resection rate was 71.4% (60/84) with postoperative hospital mortality of 11.7% (7/60). Mortality in non-resected patients was 25% (6/24). Mortality after total gastrectomy was 11% and after distal resection 5.3%. Actuarial 5-year survival with curative resection was 43.5%, whereas no patient with palliative resection was alive 2 years (range 2-22 months) after surgery (p less than 0.01). These results show that curative resection is the therapy of choice even in elderly patients, due to the low operative risk and excellent survival.

Actuarial Analysis↗
PubMed1988

[Surgical treatment and prognosis of stomach carcinoma with special reference to gastrectomy as a standard operation].

Data on 25 early and 227 advanced gastric cancer patients treated surgically in our clinic over an eight-year period from 1979 to 1986 have been analyzed retrospectively. In 45.5% (n = 110) curative resection and in 27.3% (n = 66) palliative resection was performed. In another 27.3% (n = 66) only a non-resecting procedure was possible. The overall hospital mortality was 10.7% (26/242). It was 9.1% (16/176) after resection and 15% (10/66) after non-resecting procedures. Total gastrectomy "de principe" with compartment II lymphadenectomy was performed in 70.5% (124/176). Total hospital mortality was 8.9% (n = 11) and leakage of the proximal anastomosis was observed in 8.1% (n = 10). Hospital mortality of the remaining resected patients was 3.2% (1/31) after distal resection, 20% (3/15) after proximal resection and 16.7% (1/6) after total esophagogastrectomy with colon interposition. All patients were staged according to UICC classification and staging was I 8.5%, II 14%, III 23% and IV 54.5%. Actuarial 5-year survival in all patients surviving resection was depending on stage of disease at operation (stage I 100%, II 53.3%, III 29% and IV 0%). It differed most significantly (p less than 0.001) for curative (49%) and palliative resections (0%). These results indicate that improvement of results requires early diagnosis with immediate surgical intervention.

Adult↗
PubMed1988

[A totally implantable permanent central venous access, long-term experience with subcutaneous infusion chambers].

Subcutaneously implanted infusion chambers represent a new method of central venous access. In 57 evaluable out of 70 patients, four different models of infusion chambers with an accumulative observation time of 57 years were implanted. In 72% of the patients, up to 12 cycles of polychemotherapy were administered. Parenteral nutrition and blood drawing were also performed. After 4,970 punctions of the system and 12.2 years of use 46 complications in 38 patients were observed, however, most were minor ones, such as temporary occlusions (12) and extravasations (14). Septum luxation (1), septum perforation (1), catheter fracture (1) and catheter migration (2) as well as 7 cases of septicemia or port-pocket-infection required explanation. Infusion chambers seem to be particularly suitable for intermittent and long-term chemotherapy and emergency bolus injections with a significant advantage (10 complications per one thousand days of use) compared to externally placed venous catheters. However, follow-up and care must be performed by a skilled team.

Adolescent↗
PubMed1988

[Regional therapy of isolated liver metastases from breast cancer].

Because of the high rate of response in colorectal liver metastases, intra-arterial chemotherapy was studied in 14 patients with isolated breast cancer liver metastases. After extrahepatic metastasization had been ruled out, a catheter was placed surgically and connected to a cytostatic pump (in two cases) or to a subcutaneous infusion chamber (in 12 cases). Every four to six weeks, the patients with an infusion chamber received a modified FAM treatment (fluorouracil, doxorubicin, mitomycin C) for three days continuously. In 11 out of 14 patients (79%) a clear tumor reduction was observed (duration of remission 11 months). In an average of six cycles of chemotherapy administered, a total of 50% of the patients manifested local side effects (including two cases of toxic hepatitis, one case of biliary sclerosis). Systemic side effects were negligible. Termination of therapy was necessitated by three catheter tip migrations and two thromboses of the hepatic artery. Extrahepatic metastases occurred in six patients. Here, the average latency period between diagnosis of the primary tumor and that of liver metastasis was significantly shorter (x = 9 months) than in the other patients (x = 39 months). Intra-arterial chemotherapy thus represents a therapeutic method which, although complicated, is extremely effective in selected patients with isolated breast cancer liver metastases. A final evaluation must be subject to a randomized comparison with a systemic therapy.

Adult↗