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Li G, Sun B, Zheng S, Xu L, Tao W, Zhao D, Yu J, Fu S, Zhang X, Zhang H, Zhai Y, Luo C, Ding H, He Z, Sun J. Zwitterion-Driven Shape Program of Prodrug Nanoassemblies with High Stability, High Tumor Accumulation, and High Antitumor Activity. Adv Healthc Mater 2021; 10:e2101407. [PMID: 34601824 DOI: 10.1002/adhm.202101407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/16/2021] [Indexed: 11/11/2022]
Abstract
Prodrug nanoassemblies have emerged as a promising platform for the delivery of anticancer drugs. PEGylation is a "gold standard" to improve colloidal stability and pharmacokinetics of nanomedicines. However, the clinical application of PEG materials is challenged by in vivo oxidative degradation and immunogenicity. Rational design of advanced biomaterials for the surface modification of nanomedicines is the hot spot of research. Here, a zwitterionic sulfobetaine surfactant is constructed as a novel surface modifier to coassemble with 10-hydroxycamptothecin-linoleic acid conjugate, with the classical PEGylated material as control. Interestingly, both the type and ratio of surfactants have profound impacts on the molecular mechanisms of the assembly of prodrugs, thereby affecting the pharmaceutical properties. Compared with PEGylated spherical prodrug nanoassemblies, zwitterion-modified prodrug nanoassemblies have distinct rod shape and superhydrophilic surface, and exhibit potent antitumor activity due to the combination of multiple advantages in terms of colloidal stability, cellular uptake, and pharmacokinetics. The findings illustrate the crucial role of zwitterionic surfactants as the surface modifier in the determination of in vivo fate of the prodrug nanoassemblies, and pave the way for the development of advanced nanomedicines.
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Affiliation(s)
- Guanting Li
- Department of Pharmaceutics Wuya College of Innovation Shenyang Pharmaceutical University Shenyang 110016 China
| | - Bingjun Sun
- Department of Pharmaceutics Wuya College of Innovation Shenyang Pharmaceutical University Shenyang 110016 China
| | - Shunzhe Zheng
- Department of Pharmaceutics Wuya College of Innovation Shenyang Pharmaceutical University Shenyang 110016 China
| | - Lu Xu
- Department of Pharmaceutics Wuya College of Innovation Shenyang Pharmaceutical University Shenyang 110016 China
| | - Wenhui Tao
- Department of Pharmaceutics Wuya College of Innovation Shenyang Pharmaceutical University Shenyang 110016 China
| | - Dongyang Zhao
- Department of Pharmaceutics Wuya College of Innovation Shenyang Pharmaceutical University Shenyang 110016 China
| | - Jiang Yu
- Department of Pharmaceutics Wuya College of Innovation Shenyang Pharmaceutical University Shenyang 110016 China
| | - Shuwen Fu
- School of Pharmacy Shenyang Pharmaceutical University Shenyang 110016 P. R. China
| | - Xuanbo Zhang
- Department of Pharmaceutics Wuya College of Innovation Shenyang Pharmaceutical University Shenyang 110016 China
| | - Haotian Zhang
- Department of Pharmaceutics Wuya College of Innovation Shenyang Pharmaceutical University Shenyang 110016 China
| | - Yinglei Zhai
- School of Medical Device Shenyang Pharmaceutical University Shenyang 110016 P. R. China
| | - Cong Luo
- Department of Pharmaceutics Wuya College of Innovation Shenyang Pharmaceutical University Shenyang 110016 China
| | - Huaiwei Ding
- School of Pharmaceutical and Engineering Shenyang Pharmaceutical University Shenyang Liaoning 110016 P. R. China
| | - Zhonggui He
- Department of Pharmaceutics Wuya College of Innovation Shenyang Pharmaceutical University Shenyang 110016 China
| | - Jin Sun
- Department of Pharmaceutics Wuya College of Innovation Shenyang Pharmaceutical University Shenyang 110016 China
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Zong L, Wang H, Hou X, Fu L, Wang P, Xu H, Yu W, Dai Y, Qiao Y, Wang X, Yuan Q, Pang X, Han G, Pu X. A novel GSH-triggered polymeric nanomicelles for reversing MDR and enhancing antitumor efficiency of hydroxycamptothecin. Int J Pharm 2021; 600:120528. [PMID: 33781880 DOI: 10.1016/j.ijpharm.2021.120528] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/22/2021] [Accepted: 03/21/2021] [Indexed: 12/15/2022]
Abstract
Tumor multidrug resistance (MDR) is one of the main reasons for the failure of clinical chemotherapy. Here, a bio-responsive anti-drug-resistant polymer micelle that can respond to the reductive GSH in the tumor microenvironment (TME) for delivery of HCPT was designed. A new type of polymer with anti-drug resistance and anti-tumor effect was synthesized and used to encapsulated HCPT to form reduction-sensitive micelles (PDSAH) by a thin-film dispersion method. It is demonstrated that the micelle formulation improves the anti-tumor activity and biosafety of HCPT, and also plays a significant role in reversing the drug resistance, which contributes to inhibiting the tumor growth and prolonging the survival time of H22 tumor-bearing mice. The results indicate that this nanoplatform can serve as a flexible and powerful system for delivery of other drugs that are tolerated by tumors or bacteria.
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Affiliation(s)
- Lanlan Zong
- Institute of Pharmacy, School of Pharmacy, Henan University, N. Jinming Ave., Kaifeng, Henan 475004, China
| | - Haiyan Wang
- Institute of Pharmacy, School of Pharmacy, Henan University, N. Jinming Ave., Kaifeng, Henan 475004, China
| | - Xianqiao Hou
- Institute of Pharmacy, School of Pharmacy, Henan University, N. Jinming Ave., Kaifeng, Henan 475004, China
| | - Like Fu
- Institute of Pharmacy, School of Pharmacy, Henan University, N. Jinming Ave., Kaifeng, Henan 475004, China
| | - Peirong Wang
- Institute of Pharmacy, School of Pharmacy, Henan University, N. Jinming Ave., Kaifeng, Henan 475004, China
| | - Hongliang Xu
- Institute of Pharmacy, School of Pharmacy, Henan University, N. Jinming Ave., Kaifeng, Henan 475004, China
| | - Wenjie Yu
- Institute of Pharmacy, School of Pharmacy, Henan University, N. Jinming Ave., Kaifeng, Henan 475004, China
| | - Yuxin Dai
- Institute of Pharmacy, School of Pharmacy, Henan University, N. Jinming Ave., Kaifeng, Henan 475004, China
| | - Yonghui Qiao
- Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Xuefeng Wang
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510632, China
| | - Qi Yuan
- Institute of Pharmacy, School of Pharmacy, Henan University, N. Jinming Ave., Kaifeng, Henan 475004, China
| | - Xiaobin Pang
- Institute of Pharmacy, School of Pharmacy, Henan University, N. Jinming Ave., Kaifeng, Henan 475004, China.
| | - Guang Han
- Institute of Pharmacy, School of Pharmacy, Henan University, N. Jinming Ave., Kaifeng, Henan 475004, China.
| | - Xiaohui Pu
- Institute of Pharmacy, School of Pharmacy, Henan University, N. Jinming Ave., Kaifeng, Henan 475004, China.
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Peritoneal Carcinomatosis Diagnosis and Treatment in China: Focusing on Training and Collaboration. Indian J Surg Oncol 2019; 10:12-18. [PMID: 30886487 DOI: 10.1007/s13193-019-00890-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/25/2019] [Indexed: 12/20/2022] Open
Abstract
Cancer has become the number one killer. The most difficult part of cancer treatment is the treatment of metastasis, particularly the peritoneal metastasis, generally referred to as peritoneal carcinomatosis (PC). Internationally, the integrated treatment strategy of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has been developed to be the standard treatment for PC. Although the development in this field has been relatively slow, as a result of the hard work put in over the last 20 years, there has been outstanding progress and gratifying achievements in both the diagnosis and treatment of PC in China. Our center (Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University) focuses on the research in diagnostic methods for PC, CRS+HIPEC, and management of perioperative adverse events. Based on these, "Chinese expert consensus on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancies" is developed. Our center that is the pioneering center for this treatment in China has accumulated a wealth of experiences and achievements with more than 1000 cases of CRS+HIPEC. Additionally, our center establishes a nationwide professional training program to promote and standardize the practice of CRS+HIPEC gradually.
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Huang CQ, Yang XJ, Yu Y, Wu HT, Liu Y, Yonemura Y, Li Y. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy improves survival for patients with peritoneal carcinomatosis from colorectal cancer: a phase II study from a Chinese center. PLoS One 2014; 9:e108509. [PMID: 25259574 PMCID: PMC4178169 DOI: 10.1371/journal.pone.0108509] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/21/2014] [Indexed: 12/22/2022] Open
Abstract
Background Peritoneal carcinomatosis (PC) is a difficult clinical challenge in colorectal cancer (CRC) because conventional treatment modalities could not produce significant survival benefit, which highlights the acute need for new treatment strategies. Our previous case-control study demonstrated the potential survival advantage of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) over CRS alone. This phase II study was to further investigate the efficacy and adverse events of CRS+HIPEC for Chinese patients with CRC PC. Methods A total of 60 consecutive CRC PC patients underwent 63 procedures consisting of CRS+HIPEC and postoperative chemotherapy, all by a designated team focusing on this combined treatment modality. All the clinico-pathological information was systematically integrated into a prospective database. The primary end point was disease-specific overall survival (OS), and the secondary end points were perioperative safety profiles. Results By the most recent database update, the median follow-up was 29.9 (range 3.5–108.9) months. The peritoneal cancer index (PCI) ≤20 was in 47.0% of patients, complete cytoreductive surgery (CC0-1) was performed in 53.0% of patients. The median OS was 16.0 (95% confidence interval [CI] 12.2–19.8) months, and the 1-, 2-, 3-, and 5-year survival rates were 70.5%, 34.2%, 22.0% and 22.0%, respectively. Mortality and grades 3 to 5 morbidity rates in postoperative 30 days were 0.0% and 30.2%, respectively. Univariate analysis identified 3 parameters with significant effects on OS: PCI ≤20, CC0-1 and adjuvant chemotherapy over 6 cycles. On multivariate analysis, however, only CC0-1 and adjuvant chemotherapy ≥6 cycles were found to be independent factors for OS benefit. Discussion CRS+HIPEC at a specialized treatment center could improve OS for selected CRC PC patients from China, with acceptable perioperative safety.
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Affiliation(s)
- Chao-Qun Huang
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center & Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, P.R. China
| | - Xiao-Jun Yang
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center & Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, P.R. China
| | - Yang Yu
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center & Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, P.R. China
| | - Hai-Tao Wu
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center & Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, P.R. China
| | - Yang Liu
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center & Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, P.R. China
- NPO Organization to Support Peritoneal Dissemination Treatment, Osaka, Japan
| | - Yutaka Yonemura
- NPO Organization to Support Peritoneal Dissemination Treatment, Osaka, Japan
| | - Yan Li
- Department of Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center & Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, P.R. China
- * E-mail:
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Han K, Sun Y, Zhang J, He A, Zheng S, Shen Z, Yao Y. Cyclophosphamide-hydroxycamptothecin as second-line chemotherapy for advanced Ewing's sarcoma: experience of a single institution. Asia Pac J Clin Oncol 2012; 10:e114-7. [PMID: 23176372 DOI: 10.1111/ajco.12018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2012] [Indexed: 01/01/2023]
Abstract
AIM To investigate the feasibility and efficacy of cyclophosphamide (CTX)-hydroxycamptothecin (HCPT) as second-line chemotherapy on advanced Ewing's sarcoma. METHODS From April 2009 to November 2010, 27 patients with advanced Ewing's sarcoma who had progressive disease after the first-line chemotherapy regimen of vincristine, dactinomycin and cyclophosphamide and ifosfamide and etoposide were retrospectively reviewed in this analysis. CTX was given (0.6 g/m(2), i.v. push day 1) and HCPT (6 mg/m(2), i.v. drip days 1-5) as second-line chemotherapy every 3 weeks. The primary end-point was overall response rate, the secondary end-point included progression-free, overall survival, disease control rate and toxicities. RESULTS A total of 134 cycles were given, median four cycles per patient (range 2-6). Overall response rate was 30% and disease control rate was 82%, with two complete response (8%), six partial remission (22%) and 14 stable disease (52%). The median time to progression and overall survival time were 7 months (95% CI 3-10) and 11 months (95% CI 5-18), respectively. Major severe toxicities (grade 3 and 4) were: nausea/vomiting (17%), alopecia (17%); leukopenia (27%) in total cycles. Mild toxicities (grade 1 or 2) were leukopenia (73%), nausea/vomiting (83%), hepatic lesion (14%) and anemia (44%). CONCLUSION A CTX-HCPT regimen can control disease progression effectively and the side effects can be tolerable for Chinese advanced Ewing's sarcoma patients. Further assessment is necessary to confirm the safety and efficacy of this treatment.
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Affiliation(s)
- Kun Han
- Department of Medical Oncology, The Sixth People's Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China
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Brücher BLDM, Piso P, Verwaal V, Esquivel J, Derraco M, Yonemura Y, Gonzalez-Moreno S, Pelz J, Königsrainer A, Ströhlein M, Levine EA, Morris D, Bartlett D, Glehen O, Garofalo A, Nissan A. Peritoneal carcinomatosis: cytoreductive surgery and HIPEC--overview and basics. Cancer Invest 2012; 30:209-24. [PMID: 22360361 DOI: 10.3109/07357907.2012.654871] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tumor involvement of the peritoneum-peritoneal carcinomatosis-is a heterogeneous form of cancer that had been generally regarded as a sign of systemic tumor disease and as a terminal condition. The multimodal treatment approach for patients with peritoneal carcinomatosis, which had been conceived and developed, consists of what is known as cytoreductive surgery, followed by hyperthermic intraperitoneal chemotherapy (HIPEC). Depending on the tumor mass as assessed intraoperatively and the histopathological differentiation, patients who undergo cytoreductive surgery and HIPEC have a significant survival benefit. Mean increases in the survival period ranging from six months to up to four years have now been reported. In view of the substantial logistic effort and the extent of the surgery involved, this treatment approach represents a major challenge both for patients and for surgical oncologists, as well as for the members of the overall interdisciplinary structure required, which includes oncology, anesthesiology and intensive care, psycho-oncology, and patient management. The surgical procedures alone may take 8-14 hr. The present paper provides an overview of the basis for the approach and the use of specialized classifications and quantitative prognostic indicators.
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Affiliation(s)
- Björn L D M Brücher
- Surgical Oncology, Department of Surgery, Tübingen Comprehensive Cancer Center, University of Tübingen, Germany.
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Wang GP, Guan YS, Jin XR, Jiang SS, Lu ZJ, Wu Y, Li Y, Li M, Luo F. Development of novel 5-fluorouracil carrier erythrocyte with pharmacokinetics and potent antitumor activity in mice bearing malignant ascites. J Gastroenterol Hepatol 2010; 25:985-90. [PMID: 20546454 DOI: 10.1111/j.1440-1746.2009.06155.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To investigate pharmacokinetics and potency of antitumor activity of a novel 5-fluorouracil carrier erythrocyte (RBC-FU) in mice bearing malignant ascites. METHODS RBC-FU was synthesized with a hyperosmotic technique. The entrapment efficiency of targeted carrier erythrocytes was determined by reverse dialysis method with high-performance liquid chromatography (HPLC) for analyzing the quantity of 5-fluorouracil (5-FU). After a H22 hepatocarcinoma malignant ascites model was established in Kunming mice, 5-FU encapsulated by carrier erythrocytes (for Group A) and 5-FU solution (for Group B) at 20 mg per kg were injected into the peritoneal cavity of the mice, respectively. Blood and ascites samples were collected at different times to detect 5-FU quantity by HPLC. Body weight and survival time of mice were recorded in Group A, B and the Control Group in which mice were injected with normal saline only. RESULTS 5-FU was effectively encapsulated into erythrocytes, with an encapsulating effect as 55 +/- 0.50%. In Group A, the maximum concentration (Cmax) and the area under curve (AUC) in peritoneal exudates were significantly higher than those of Group B (P < 0.05). On the other hand, 5-FU level in serum was significantly lower than that in peritoneal exudates of Group A and B (P < 0.05). High drug levels in the abdominal cavity in Group A were maintained longer than those in Group B. Compared with that in Group B and the control, the quantity of malignant ascites in Group A had significant regression and the survival time was prolonged. CONCLUSION The hyperosmotic method described here could be suitable for producing this novel RBC-FU as a liposomal drug of potential value for treating malignant ascites by intraperitoneal administration.
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Affiliation(s)
- Guo-Ping Wang
- Cancer Center, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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Preoperative serum carbohydrate antigen 125 level is an independent negative prognostic marker for overall survival in colorectal cancer. Med Oncol 2010; 28:789-95. [PMID: 20373053 DOI: 10.1007/s12032-010-9518-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 03/26/2010] [Indexed: 01/02/2023]
Abstract
To evaluate the prognostic value of preoperative serum carbohydrate antigen19-9 (CA19-9), carcinoembryonic antigen (CEA), and carbohydrate antigen 125 (CA125) for overall survival (OS) in patients with colorectal cancer (CRC). Preoperative serum CA19-9, CEA, and CA125 levels were detected by C12 protein chip diagnostic system in 80 patients with CRC, and the association of their preoperative status with the patients' OS was analyzed. Patients with positive preoperative serum CA19-9, CA125, and CEA had a worse survival comparing with those negative patients, the difference in CA19-9 and CA125 reached statistical significance (Log rank test, P<0.05), but the difference of CEA did not achieve statistical significance (Log rank test, P>0.05). The OS of patients with CRC with three positive tumor markers (TMs)<1 or 2 positive TMs<negative TM, simultaneously positive serum CA19-9, CEA, and CA125 was the most dismal predicting factor for OS. Spearman correlations revealed that the preoperative serum status of CA19-9 (P=0.000), CEA (P=0.000), and CA125 (P=0.000) had correlations with stage; the preoperative serum CA125 status (r=-0.385, P=0.000) and stage (r=-0.457, P=0.000) and location (r=0.223, P=0.047) had correlations with OS. Multivariate analysis with Cox regression model showed that only stage (P=0.000) and the preoperative serum CA125 status (P=0.016) were independent prognostic factors for OS of patients with CRC. The preoperative status of serum CA19-9, CEA, and CA125 had correlations with CRC stage. The simultaneously positive serum CA19-9, CEA, and CA125 was the most dismal predicting factor for OS of patients with CRC. Preoperative serum CA125 status and stage were independent prognostic factors for OS of CRC.
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Mei LJ, Yang XJ, Tang L, Hassan AHAS, Yonemura Y, Li Y. Establishment and identification of a rabbit model of peritoneal carcinomatosis from gastric cancer. BMC Cancer 2010; 10:124. [PMID: 20359350 PMCID: PMC2858745 DOI: 10.1186/1471-2407-10-124] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 04/01/2010] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Gastric cancer peritoneal carcinomatosis is a common clinical problem, but there are no suitable large animal models to study this problem. This study was to establish a stable rabbit peritoneal carcinomatosis model of gastric cancer using VX2 tumor, and analyze the clinico-pathological features. METHODS VX2 tumor was implanted into 36 New Zealand rabbits by 3 methods: laparotomic orthotopic injection of cancer cells into the submucosal layer of the stomach (Group A), laparotomic implantation of tumor tissue into the greater omentum immediately beneath the gastric antrum (Group B), and percutaneous injection of tumor cells directly into the peritoneal cavity (Group C), 12 rabbits in each group. The animals were closely observed and detailed clinico-pathological studies were conducted. RESULTS The success rates of peritoneal carcinomatosis formation were 100% (12/12), 91.7% (11/12) and 58.3% (7/12), respectively, for Groups A, B and C (P = 0.019, A versus C; P = 0.077, B versus C; P = 0.500, A versus B, Fisher's exact test). Two weeks after submucosal cancer cells injection in Group A, ulcerative gastric cancer with peritoneal carcinomatosis showed typical VX2 tumor pathology, with widespread intraperitoneal metastatic nodules, bloody ascites and perspicuous pulmonary metastases. The clinico-pathological progression pattern was very similar to patients of advanced gastric cancer with peritoneal carcinomatosis. Groups B and C showed similar pattern of cancer progression, but less aggressive. CONCLUSIONS First large animal model of peritoneal carcinomatosis from gastric cancer has been established by laparotomic orthotopic injection of VX2 cancer cells into the submucosal layer of the stomach, providing a more suitable model for surgical interventional studies. The clinico-pathological features of this model resemble human peritoneal carcinomatosis.
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Affiliation(s)
- Lie-Jun Mei
- Department of Oncology, Zhongnan Hospital of Wuhan University & Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, 430071, China
| | - Xiao-Jun Yang
- Department of Oncology, Zhongnan Hospital of Wuhan University & Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, 430071, China
| | - Li Tang
- Department of Oncology, Zhongnan Hospital of Wuhan University & Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, 430071, China
| | - Alaa Hammed al-shammaa Hassan
- Department of Oncology, Zhongnan Hospital of Wuhan University & Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, 430071, China
| | - Yutaka Yonemura
- NPO Organization to Support Peritoneal Dissemination Treatment, Osaka, Japan
| | - Yan Li
- Department of Oncology, Zhongnan Hospital of Wuhan University & Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, 430071, China
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Yang XJ, Li Y, al-shammaa Hassan AH, Yang GL, Liu SY, Lu YL, Zhang JW, Yonemura Y. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy improves survival in selected patients with peritoneal carcinomatosis from abdominal and pelvic malignancies: results of 21 cases. Ann Surg Oncol 2008; 16:345-51. [PMID: 19018599 DOI: 10.1245/s10434-008-0226-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 09/27/2008] [Accepted: 09/27/2008] [Indexed: 12/14/2022]
Abstract
We evaluated the perioperative safety profile and efficacy of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in 21 patients with peritoneal carcinomatosis (PC) from gastrointestinal and gynecological cancers. Twenty-one patients with PC (12 gastric cancer, 5 colorectal cancer, 2 ovarian cancer, 1 pseudomyxoma peritonei, 1 malignant mesothelioma) were treated with CRS + HIPEC with hydroxycamptothecin 20 mg and mitomycin C 30 mg in 12,000 mL of normal saline at 43 +/- .5 degrees C for 60 to 90 minutes. Vital signs were recorded for 5 days after surgery. We analyzed the following: local and systemic infections; gastrointestinal function recovery; hematological, hepatic, and renal parameters; wound healing time; adverse events; survival; and quality of life. The PC index was 2 to 33 (median, 11), the duration of operation 4 to 10 h (median, 8 h), and the highest temperature during 5 postoperative days 38.1 degrees C. Two patients developed generalized edema and were successfully treated. Five patients developed hypoproteinemia on day 1 after surgery. All routine blood tests checked at 1 week after surgery were normal. Time of gastric tube removal was 2 to 7 days. Liquid food intake time was 3 to 8 days. Time of removal of stitches was 8 to 18 days. No local or systemic infections, wound disruption, or other clinically important adverse events occurred. The follow-up was 8 to 43 months (median, 22.5 months). Eleven patients died, three survived with tumor, and seven survived free of tumor. CRS + HIPEC was well tolerated in our selected patients with PC, some of whom had improved survival.
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Affiliation(s)
- Xiao-Jun Yang
- Department of Oncology, Zhongnan Hospital, Cancer Center of Wuhan University, Hubei Cancer Clinical Study Center, Wuchang District, China
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