Anal submucosal injection: a new route for drug administration in pelvic malignancies. IV. Submucosal anal injection in the treatment of cancer of uterine cervix--preliminary study

Anal submucosal injection: a novel modality for the treatment of advanced rectal cancer

AIMS

To investigate the efficacy of methotrexate (MTX) submucosal anal injection in the treatment of advanced rectal cancer.

METHODS

Thirty-six patients (age 36-66 years; 21 men, 15 women; 20 patients with stage T3N1M0 and 16 with T4N1M1 rectal cancer) were injected with MTX in the anal submucosa. A comparative group of eight patients (age 38-62 years: five men, three women; four with T3N1M0 and four with T4N1M1 rectal cancer) was injected with MTX intravenously. The dose in both groups was 100 mg every 5 days for five consecutive doses and the course was repeated at 3-week intervals. MTX serum and tumour concentrations were estimated 30 and 60 min after MTX injection. The patients received MTX as outpatients.

RESULTS

In the anal group, six of 20 patients with T3 tumour showed complete tumour regression and were alive 28-46 months after the start of the treatment. Partial response occurred in 25 patients: 14 of stage T3 and 11 of T4. The 14 T3 patients underwent combined excision operation and 9/14 were alive 26-68 months from the time of operation. Five of the 16 T4 patients showed tumour and metastatic progression. Mild toxicity occurred in six of 36 patients while the haematological reserve was unchanged in all the patients. All eight patients in the parenteral group showed progress of the malignant lesions under treatment and toxic manifestations were so severe that the treatment had to be interrupted. The MTX concentration in serum was significantly higher after parenteral than after anal injection, while in tumour tissue it was higher after anal administration.

CONCLUSIONS

The results show that MTX submucosal anal injection is effective in treatment of T3 rectal cancer due to high MTX concentration in the tumour. Toxicity was mild owing to low level of serum MTX. The anal route of administration is safe, well tolerated and can be used on an outpatient basis.

Anal submucosal injection: a new route for drug administration. VI. Chronic prostatitis: a new modality of treatment with report of eleven cases

The anal submucosal route was used for the treatment of chronic bacterial prostatitis in 11 patients. Prior to presentation, the patients had received different antimicrobial agents; the symptoms disappeared only to recur whenever the drug was discontinued. After repeated failure, the patients were treated with gentamicin to which the organisms were sensitive, via the anal submucosal route. A daily injection was given for ten days on an outpatient basis. The technique of injection is described. The patients were followed up clinically and by segmented cultures for three years. No anorectal complications were encountered as had been demonstrated experimentally. The symptoms of chronic prostatitis disappeared, and culture was negative by the end of treatment and for two to three years thereafter in all patients. It appears that the antimicrobial agent, via anal route, reaches the prostatic tissues at a higher concentration than that of the serum. The route adopted by the drug to reach the prostate from the anal submucosa is presented.