Cancer Chemotherapy by Infusion

Chemotherapy for-cancer is in a state of evolution. Because some cancers can now be cured with chemotherapy as a singular modality, this therapy can no longer be viewed as simply a palliative contribution. Chemotherapy has assumed an important role as an adjuvant to other modalities, including both surgery and radiation therapy. For some tumors, the primary application of chemotherapy in a combined modality approach to curative therapy has resulted in the application of less radical surgery while achieving substantial of relatively rare tumors such as cure rates. Nonetheless, with the exception childhood tumors, hematologic malignancies, and testicular cancer, the effec tiveness of chemotherapy in most tumors is severely limited. At the cellular level, greater understanding of the specific mechanism of tumor cell killing and of the phenomenon of drug resistance are elusive, critical ingredients in the improvement of effectiveness in cancer chemotherapy. Prolonging the exposure time of the tumor cell to drugs is a concept that was addressed in the early phases of the development of chemotherapy. How ever, technological limitations inhibited the broader application of chemother apy by infusion until recent years. Also, the convenience of intermittent ther apy on an outpatient basis, with the predominant theory of drug effect based on a dose response as well as the proven effectiveness of this schedule in some tumors, has slowed the process of subjecting infusion chemotherapy to the rigors of clinical trials.

Inhalt
Section I - Rationale and Technical Aspects.- 1. Introduction to the Concept and Practice of Infusion Chemotherapy.- 2. Experimental Rationale for Continuous Infusion Chemotherapy.- 3. The Clinical Pharmacology of Infusional Chemotherapy.- 4. Drug Administration Systems for Infusion Chemotherapy.- 5. Technical Aspects of Vascular Access for Infusional Chemotherapy.- 6. Nursing Management of Infusion Catheters.- 7. Pharmaceutical Issues in Infusion Chemotherapy Stability and Compatibility.- Section II - Chemotherapeutic Agents.- 8. Antipyrimidines: 5-Fluorouracil and 5-Fluoro-2?-Deoxyuridine.- 9. Mexthotrexate.- 10. Anthracyclines.- 11. Cisplatin, Platinum Analogues, and Other Heavy Metal Complexes.- 12. Cytosine Arabinoside.- 13. Periwinkle Alkaloids I: Vinblastine and Vindesine.- 14. Periwinkle Alkaloids II: Vincristine.- 15. Bleomycin.- 16. The Epipodophyllotoxins: VP-16 and VM-26.- 17. Alkylating Drugs and Other Agents.- 18. Investigational Agents.- 19. Protracted Infusional Chemotherapy.- Section III - Systemic Infusion by Tumor Category.- 20. Head and Neck Cancer.- 21. Esophageal and Anal Cancer.- 22. Colorectal Cancer.- 23. Gastric, Pancreas, and Biliary Tract Cancer.- 24. Breast Cancer.- 25. Infusion for Hematologic Malignancies.- 26. Lung Cancer.- 27. Testicular Cancer and Other Tumors of the Male Genitourinary Tract.- 28. Gynecologic Malignancy.- 29. Soft Tissue and Osteogenic Sarcomas.- 30. Uncommon Tumors.- Section IV-Regional Infusion.- 31. Head and Neck Cancer.- 32. Regional Infusion for Metastatic Liver Tumors.- 33. Hepatic Arterial Infusion Chemotherapy: Clinical Trials with the Implantable Pump.- 34. Regional Infusion for Primary Hepatic Carcinomas.- 35. Hepatic Artery Ligation and Portal Vein Infusion.- Section V-Special Categories of InfusionChemotherapy.- 36. Regional Infusion for Brain Tumors.- 37. The Clinical Use of 5-Fluorouracil and Other Halopyrimidines as Radiosensitizers in Man.- 38. Intraperitoneal Belly Bath Chemotherapy.- 39. Intraventricular Chemotherapy for Leptomeningeal Carcinoma.- 40. Intravesical Chemotherapy for Bladder Tumors.- 41. Combination Chemotherapy and Infusional Schedules.- 42. Continuous Infusion Antibiotic Therapy for Neutropenic Patients.- 43. Degradable Starch Microspheres Infusion: Basic Considerations for Treatment of Hepatic Neoplasia.- 44. Cost-Effectiveness in Cancer Chemotherapy.- 45. Adjuvant Applications of Infusional Chemotherapy.- References.