Preliminary study of percutaneous alcohol injection into the lung

Effective combination therapy of percutaneous ethanol injection and chemotherapy based on injectable low molecular weight gels

Percutaneous ethanol injection (PEI) therapy was used in liver cancer treatment, however, the therapeutic ethanol in PEI easily flew away from injected solid tumours and hinder the treatment effect. In this paper, injectable supramolecular gels formed by self-assembly of low molecular weight gelators (LMWGs) based on glycylglycine modified phenylboronic acid were prepared to localize ethanol and load chemotherapeutic drug for in situ synergistic therapy. The mechanism, morphology and rheological property of supramolecular gels were characterized by NMR, UV, SEM, etc. The rheological study revealed that the gels were formed in situ rapidly and recovered promptly once damaged. The gels were non-toxicity to both normal 3T3 fibroblasts cells and 4T1 breast cancer cells. Doxorubicin (DOX) hydrochloride and ethanol were encapsulated in the gels for the combination of chemotherapy and PEI therapy. The in vivo anticancer activity of the DOX-loaded gels was carried out in tumour bearing mice. The injected gels were coated around tumour tissues to lock ethanol, and DOX was released sustainingly from the gels to maintain effective concentration to induce the apoptosis of tumour cells. DOX-loaded gels and the ethanol exhibited excellent therapeutic efficacy and low side effects in local cancer therapy.

Ethanol lavage of 14 mucinous cysts of the pancreas: A retrospective study in two tertiary centers

Background:

Mucinous cysts are lesions with malignant potential. Their management is stil difficult. Ethanol lavage under EUS can be used and could be a good alternative treatment. We report a bi-center experience of ethanol lavage in mucinous cysts of the pancreas.

Patients and methods:

A total of 13 patients in 2 tertiary centers (7 men, 6 women, mean age=68.5 years) underwent ethanol lavage for mucinous cysts under endoscopic ultrasound (EUS) from 2001 to 2010. One of the patients had 2 cysts treated during the same procedure. One patient underwent a second procedure of ethanol lavage. Mucinous cyst diagnosis required: (1) EUS showing cystic lesion without nodule and without communication with pancreatic branch duct. Six cysts were located in the isthmus of the pancreas, 3 in the head, 3 in the body, and 2 in the tail. The mean size was 24 mm (11-50); and (2) Intra-cystic ACE level >400 UI/l and/or histologic proof. Diagnosis of mucinous cyst was obtained using ACE levels in 5 cases, histology in 8 cases, and both in 1 case.

Results:

No complication was reported. Complete responses were observed in 11 cases (85%), with no responses in 2 cases (15%). Mean follow-up was 26 months (4-118 months). Contact was lost with 1 patient. No recurrence was noticed in patients with complete responses.

Conclusion:

This study confirms the feasibility and effectiveness of a loco-regional treatment under EUS for pancreatic cysts. The good ratio of response is probably explained by the lack of septa and the small size of the cysts. The follow-up is still short and needs to be increased. Nethertheless loco-regional treatment of pancreatic cysts lesions under EUS should form a part of the management of pancreatic lesions.

Antitumor effect of para-toluenesulfonamide against lung cancer xenograft in a mouse model

BACKGROUND

Conventional chemotherapy and radiation therapy against non-small cell lung cancer (NSCLC) are relatively insensitive and unsatisfactory. Para-toluenesulfonamide (PTS), a unique antitumor drug for local intratumoral injection, shows an efficacy of severely suppressing solid tumor growth with mild side effects in clinical trials. The aim of this study was to investigate the effect of PTS on lung cancer H460 cells in vivo in nude mice and its underlying mechanisms in vitro.

METHODS

A lung cancer model for in vivo experiment was established in BALB/c nude mice using H460 cells to examine the effect of local injection of PTS on tumor suppression. We also assessed the injury to the normal tissue by subcutaneous injection of PTS. In vitro, PTS was diluted into different doses for study on its antitumor mechanisms. We evaluated the necrotic effect of PTS on H460 cells by PI and Hoechst 33342 staining. Cell viability and membrane permeability were also determined by using CCK-8 and LDH assays respectively. All these tests were conducted in comparison with traditional local injection of anhydrous ethanol.

RESULTS

PTS was shown to significantly inhibit the growth of H460 tumor xenografts in nude mice by inducing necrosis of the tumor histologically. Its effect on tumor growth was significantly stronger than that of anhydrous ethanol. By contrast, the injured normal tissue by PTS injection was less than that by ethanol. In vitro, PTS still demonstrated excellent necrotizing effect on H460 cells when diluted to a lower concentration. Detailed analysis of PTS on H460 cells indicated that PTS had a better effect on attenuating the cell viability and increasing the cell membrane permeability than ethanol at the same level.

CONCLUSIONS

PTS exhibits excellent inhibition effect on the growth of lung cancer by necrotizing tumor in vivo and in vitro, reducing tumor cell viability and augmenting the membrane permeability in vitro, with only mild injury to normal tissue. The antitumor effect of PTS on lung cancer in vivo and in vitro is stronger than that of ethanol.

Laser ablation of lung metastases: results according to diameter and location

Lung tumour ablation with a thin-calibre laser applicator system was evaluated. We quantified feasibility, technical success and complication rates in relation to lesion diameter and location. Forty-two patients with 64 lung tumours were treated (39 patients with metastases and three with primary tumours). Mean follow-up was 7.6 months (range 6 weeks to 39 months). Eighty-six percent of treatments were technically successful in the first session. Pneumothorax was the main complication and occurred in 50% of the first 20 patients and in 35% of the rest. Two patients required a chest tube. Fourteen lesions were central and 50 were peripheral. It took several weeks for the effect of the therapy to become apparent on follow-up CT. Thirty-nine percent of all lesions increased in size immediately after treatment. Gross reduction in size with scar formation was seen in 50% of the lesions and cavitation in 13%. Local tumour control was achieved in 51 lesions. Progression after therapy was seen in 9% of lesions <1.5 cm but in more than 11% of larger lesions. Progression was also more frequent in lesions located in the basal parts of the lung (47%). Sixteen patients died due to systemic progression. Our results suggest that successful laser ablation of lung lesions is possible with a miniaturized applicator.

[Percutaneous laser-induced thermotherapy of lung metastases: experience gained during 4 years]

We perform laser ablation of lung metastases for four years. In the following we report on technical success, ablation results and follow-up. 30 patients with a total of 42 lung metastases were treated. Patients were aged between 42 and 74 years. Primary tumors were mostly colorectal carcinomas, head and neck and uro-genital tumors. Technical success was achieved in 40, complete ablation in 14 metastases (33%); however, in 8 metastases follow-up was too short for a valid evaluation (4-8 weeks). Further analysis may improve the overall results: metastases located in the central parts of the lungs were more easily treated than those located peripherally, best results were achieved in metastases not larger than 3 cm, percutaneous ablation of lung metastases has potential as an additional therapeutic option if surgery is not possible.