Treatment results of peritonectomy combined with perioperative chemotherapy for colorectal cancer-patients with peritoneal carcinomatosis.

Operation results of 81 colorecatal cancer-patients with peritoneal carcinomatosis (PC) treated with peritonectomy plus perioperative chemotherapy are reported. The patients who had the following evidences are considered to be eligible for peritonectomy: 1) No evidence of N3 lymph node involvement, 2) No evidence of hematogenous metastasis, 3) No progressive disease after preoperative chemotherapy, 4) No severe co-morbidities or no poor general condition. Complete cytoreduction resection is aimed for removing all macroscopic tumors by peritonectomy using electrosurgical techniques. The completeness of cytoreduction (CC scores) after peritonectomy is classified into the following 4 criteria: CC-0-no peritoneal seeding was exposed during the complete exploration, CC-1-residual tumor nodules are less than 2.5 mm in diameter, CC-2-nodules are between 2 .5 mm and 25 mm in diameter, CC-3-nodules are greater than 25 mm in diameter, CC-2 and CC-3 are regarded as incomplete cytoreduction. Operation time and blood loss were 237 ± 124 min. (799-90 min) and 1,598 ± 1,411 mL (6,500-20 mL), respectively. Postoperative complications developed in 37( 46%) patients. The patients received CC-0/ -1 resection survived significantly longer than those of CC-2/ -3 group. The patients with PCI ≤ 10 survived significantly longer than those with PCI≥ 11. CC and PCI scores are the independent prognostic factors. The relative risk for death of CC-2/-3 group was 4.6-fold higher than that of CC-0/ -1 group. Accordingly, peritonectomy is indicated for patients with PCI score≤ 10.

Pancreatic cancer therapy with a novel pump for controlled drug release.

Enhancing antitumor activity and minimizing treatment side effects are important issues in cancer therapy. One method to deal with these issues is the utilization of a drug delivery system (DDS). In this study, we developed a novel drug administration pump, a mechanically controlled DDS (M-DDS). The antitumor activity of 5-fluorouracil (5-FU) (15 or 30 mg/kg/day) was evaluated in comparison with systemic intraperitoneal (i.p.) administration for 7 days in a rat model of human pancreatic cancer. The M-DDS was superior to i.p. administration in enhancing antitumor activity and also prolonging median survival from 69 to 85 days at the lower drug dose (15 mg/kg/day). In addition, toxicities in liver, kidney and spleen were found in animals receiving i.p. administration, whereas rats receiving M-DDS treatment did not show these toxicities. The concentration of 5-FU in tumors 1 day after the completion of treatment was considerably higher in rats receiving M-DDS treatment. These results suggest that this novel M-DDS may be a powerful tool for the treatment of pancreatic cancer in combination with conventional chemotherapeutic drugs, offering strong antitumor activity with fewer toxicities. This novel M-DDS, consisting of a control circuit and drug reservoir/pump unit, may be a useful tool for the treatment not only of pancreatic cancer but also of various other accessible cancers for which there is no effective treatment, such as bile-duct and brain tumors.