Vascular Perfusion In Cancer Therapy

Substantial relief of discomfort may be anticipated by most patients suffering from pelvic and lower-extremity pain who are treated by arterial infusion of nitrogen mustard. Seventy-three patients with intractable pain secondary to malignancy arising in the pelvis received 83 percutaneous pelvic arterial infusions of this drug. Sixty infusions (72%) resulted in marked relief from pain for periods averaging 6-8 weeks. Advantages of the procedure are low toxicity, relative simplicity and availability of technique, and an acceptable rate of complications with minimal morbidity. Patients experiencing satisfactory results may expect significant relief from a second infusion for recurrent pain. The most rewarding result is the freedom from the cyclic return of pain characterized by oral and intramuscular analgesic therapy. Little or no relief can be expected in patients with pain caused by compression fractures of the vertebrae, or where the tumor burden is so great that adequate perfusion of the involved nerves is not possible. One should consider this procedure for controlling pain before resorting to the more dangerous and potentially disabling techniques of spinal cordotomy or intrathecal alcohol injection. References Bateman JR, Hazen JG, Stolinsky DC, Steinfeld JL (1966) Advanced carcinoma of the cervix treated by intra-arterial methotrexate. Am J Obstet Gynecol 96: 181-187 Calabresi P, Parks RW Jr (1970) Alkylating agents, antimetabolites, hormones. and other antiproliferative agents. In: Goodman LS, Gilman A (eds) The pharmacological basis of therapeutics, 4th edn.

This book summarizes current knowledge on blood perfusion and the microenvironment of human tumors, enabling the reader to gain a deeper insight into the physiological components of malignant tumors. Among a range of topics, detailed consideration is given to circulatory parameters, including blood and nutrient supply, transvascular and interstitial transport, and oxygenation, as well as to bioenergetic status and the influence of pH on the responsiveness of malignant tumors to nonsurgical treatments such as radiotherapy and chemotherapy. For the clinician, it will be of special interest to read about the various invasive and noninvasive methods (including MR and PET) that allow the tumor physiology and microenvironment of an individual patient to be characterized.

Microspheres and Regional Cancer Therapy takes an interdisciplinary approach to the subject of microspheres and regional cancer therapy. It synthesizes laboratory and clinical data to demonstrate the utility of microsphere-based strategies in the treatment of localized solid tumors (particularly in the liver) not amenable to surgery and as a component of strategies for treatment of disseminated disease. Using the same techniques that show the deficiencies of delivery strategies involving antibodies, liposomes, and synthetic polymers, clear evidence is presented describing how microspheres of appropriate size can be localized in solid tumor deposits in the liver with little exposure to other organs. To exploit this phenomenon, the extent and nature of the incorporation of active agents within microspheres is discussed in relation to release, pharmacokinetics, and tumor response achieved by intensification of therapy in the manner described. This book will benefit laboratory-based scientists and clinicians in pharmaceutics, pharmacology, physiology, surgical oncology, and nuclear medicine. In addition, cancer clinicians interested in the value of regional therapy will be able to evaluate the underlying theory and learn the necessary methodology.

Angiogenesis (formation of new vessels from pre-existing ones) is a crucial early event in the process of tumor development. New vessels supply the tumor with nutrients that are needed for further local growth and enable distant metastases (Folkman 1995). Judah Folkman (1971) highlighted the potential therapeutic imp- cations of tumor angiogenesis. He hypothesized that if tumor angiogenesis is inhibited, then tumor growth and metastasis will be impaired greatly or even impossible. The subsequent quest for endogenous and exogenous inhibitors of angiogenesis has yielded a variety of promising therapeutic agents that block one or more angiogenic pathways, a few of which have been approved by the FDA (e. g. , bevacizumab, sorafenib, sunitinib) for use as single agents or in combination with chemotherapy in specific populations of cancer patients (Sessa et al. 2008). There has also been a dramatic expansion in the exploration of novel anti-angiogenic agents pre-clinically and in clinical trials (Ferrara 2002). Some of the most promising data comes from the development of agents that inhibit one of the key growth factors involved in tumor angiogenesis – vascular endothelial growth factor (VEGF) (Ferrara et al. 2003). Bevacizumab is a monoclonal antibody against VEGF that was the first an- angiogenic agent that improved significantly the overall survival of patients with colorectal and non-squamous non-small cell lung cancer (Ferrara et al. 2005). Various agents that target tumor angiogenesis are currently under investigation in different cancer types in many clinical trials (Ferrara and Kerbel 2005).

A variety of cutting-edge imaging techniques, including their use for best practice, are addressed in this book. The book also provides examples of results found in both pre-clinical and clinical studies. This comprehensive text covers the entire spectrum of in vivo imaging for oncology. It will aide clinicians at all levels in keeping up with the most cutting-edge techniques.

Present knowledge in regional cancer therapy is presented in this volume. The latest research addresses the questions of optimal drug development, the best galenic form and schedule to control tissue distribution at the tumor site and efficient treatment of specific anatomical regions.

This book summarizes current knowledge on blood perfusion and the microenvironment of human tumors, enabling the reader to gain a deeper insight into the physiological components of malignant tumors. Among a range of topics, detailed consideration is given to circulatory parameters, including blood and nutrient supply, transvascular and interstitial transport, and oxygenation, as well as to bioenergetic status and the influence of pH on the responsiveness of malignant tumors to nonsurgical treatments such as radiotherapy and chemotherapy. For the clinician, it will be of special interest to read about the various invasive and noninvasive methods (including MR and PET) that allow the tumor physiology and microenvironment of an individual patient to be characterized.

Since the first observations of Busch in 1866, the possible use of heat as a therapeutic agent in the cure of cancer has been repeatedly subject to bursts of interest, almost invariably followed by periods of neglect and skepticism. In 1963-1964, this problem was again attacked by us both from the biochemical and from the clinical points of view. The first results of this joint effort were positive beyond expectation, and generated a new revial of studies aimed at the identification of the nature of the bio chemical lesion as well as at the optimization of technique and of the therapeutic schedules connected with clinical use. Although the number of mammalian tumors which have been proved to be heat-sensitive is now relatively large, and although in some cases a correlation has been demonstrated between tumorigenicity and heat-sensitivity of in vitro cultured cell lines, the question of a direct and constant relationship between neoplastic character and higher sensitivity to hyperthermic exposure is still open to continuing investigation and reappraisal. Several studies deal in fact with the determination of the conditions under which, in vitro and or in vivo, different tumors are efficiently damaged by elevated temperatures.