Hyperthermic intraperitoneal chemotherapy using a combination of mitomycin C,5-fluorouracil, and oxaliplatin in patients at high risk of colorectal peritoneal metastasis: A Phase I clinical study.

INTRODUCTION: The drugs and protocols used for hyperthermic intraperitoneal chemotherapy (HIPEC) vary among institutions. Here we show the efficacy of the 3-drug combination of mitomycin C (MMC), 5-fluorouracil (5FU), and oxaliplatin (OHP) in an in vitro simulation of HIPEC and the safety of HIPEC with these drugs during a Phase I study of patients at high risk of developing colorectal peritoneal metastasis. METHODS: To simulate HIPEC, we used HCT116 and WiDr cells to assess the growth inhibitory efficacy of MMC 2 µg/mL, 5FU 200 µg/mL, and OHP 40 µg/mL as single drugs or their combination after an exposure time of 30 min at 37 or 42 °C. In addition, nine patients underwent surgical resection of tumors and HIPEC with MMC, 5FU, and an escalating dose of OHP (90/110/130 mg/m²). Dose-limiting toxicity was monitored. RESULTS: In the simulation, the 3-drug combination showed marked tumor-suppressive effects compared with those from ten times higher dose of OHP 400 µg/mL, with significant augmentation under hyperthermic conditions. No dose-limiting toxicity occurred in the clinical study. Dose escalation was completed at the final level of OHP. CONCLUSIONS: The MMC-5FU-OHP combination showed marked growth inhibition against colorectal cancer cells under hyperthermic conditions in vitro. In the phase I study, the recommended dose of OHP was determined as 130 mg/m² when used with MMC and 5FU; HIPEC using MMC-5FU-OHP appears to be safe and feasible for patients at high risk of colorectal peritoneal metastasis.

[Tumor ablation with MRI navigation--a novel method of microwave coagulation therapy for hepatic tumor].

Fifty-eight patients with hepatic tumor which consisted of 22 hepatocellular carcinomas and 36 metastatic liver tumors were treated by microwave coagulation therapy with MRI navigation. The tumors were located in all segments of liver except S1. In 24 cases among them, the abdominal approach was difficult, because the tumors were located just below the diaphragm. These cases were selected for thoracoscope-assisted microwave ablation under MR-guidance across the diaphragm. All MR data were collected on a vertically oriented open MRI system (0.5 T SIGNA SP/i system: GE Medical Systems). The microwave electrode was introduced into the liver through a 14G needle via a percutaneous puncture with real-time MR image navigation. Microwave ablations at 60 W for 60 seconds were repeated several times depending on the tumor size. MR imaging may be employed as a reliable guide for percutaneous puncture. Moreover, sufficient safety margin could be obtained for hepatic tumor ablation. MR-guided microwave thermoablation therapy is a feasible method of treatment for hepatic tumors.

Kinetics of cytokine gene expression during the in vitro CTL induction against a murine nonimmunogenic tumor.

BACKGROUND: The study of the local environment around tumors, including cellular and endogenous cytokine kinetics may improve our understanding of the biological process occurring during the CTL induction. MATERIALS AND METHODS: The expression kinetics of ten cytokine genes and immune cell subsets were examined by a RT-PCR and immunohistochemistry using a nonimmunogenic murine tumor and its immunogenic variant (A7). RESULTS: In a mixed lymphocyte-parent tumor cell culture (MLTC) using in vivo A7-immunized spleen cells, where CTL induction was confirmed on day 5 of cultivation, IL-6 gene expression was promptly activated at 12 h, IL-2 and IL-4 gene expression was prominently up-regulated on days 1 and 2, and then IL-10 and TGF-beta gene expression was down-regulated from day 2 onward. In contrast, in a MLTC using non-immunized spleen cells (a CTL non-induction model), no prominent upregulation of the IL-6, IL-2 or IL-4 gene was detected, and expression of the IL-10 and TGF-beta genes increased steadily. Although numerous dendritic cells were observed in the A7 immunized spleen tissue, lower numbers of dendritic cells were evident in the non-immunized spleen tissue. CONCLUSIONS: A cellular environment that includes the presence of dendritic cells and a cytokine environment that involves the timely production of IL-6, IL-2, and IL-4, and subsequent inhibition of the immunosuppressive cytokines IL-10 and TGF-beta, appear to play an important role in induction of CTL in this model.

[Histologic occurrence of Barrett's carcinoma].

It is generally agreed that the diagnosis of Barrett's esophagus is justified when the columnar epithelium 3 cm or more from the E-C junction is involved. Microscopically, the epithelium has three distinct appearances: (1) gastric fundic type; (2) junctional type: and (3) specialized columnar type. In mucin histochemistry in 6 cases of Barrett's carcinoma, 5 cases of Barrett's esophagus were positive for HID-AB. Four cases of Barrett's carcinoma were also positive. These results suggest that Barrett's carcinoma developed from the specialized columnar type of Barrett's esophagus.

Familial hyperparathyroidism: report of a case.

We report herein a case of familial primary hyperparathyroidism diagnosed in a 23-year-old woman who presented with hypercalcemia and urolithiasis. The parathyroid gland was removed, and pathological examination revealed chief cell adenoma. The proband's younger sister had undergone surgery for parathyroid adenoma at the age of 19, and her aunt had a history of urolithiasis with a high level of serum parathyroid hormone. We have not yet found evidence of any other endocrine disorders suggesting multiple endocrine neoplasia (MEN) type 1 in this pedigree.

[TNF-alpha gene therapy for nonimmunogenic tumor using immunogenic variant induced with mutagen (N-methyl-N'-nitro-N-nitrosoguanidine)].

We have already reported that a combination of TNF-alpha and immunogenic variant was effective for immunotherapy of nonimmunogenic tumor. Immunogenic variants (A2 and A7) were obtained from nonimmunogenic fibrosarcoma (parent cell: 1767-3) by mutagen treatment with N-methyl-N'-nitro-N-nitrosoguanidine (MNNG). In this study, we studied about the possibility of TNF-alpha gene immunotherapy for nonimmunogenic tumor. We established two types of TNF-alpha producing cell lines. One is TNF-alpha producing nonimmunogenic variant (1767 TR 2), and another is TNF-alpha producing immunogenic variant (A7 TR3). We compared them about the ability of producing specific immunity against parent tumor. TNF-alpha producing immunogenic variant (A7TR3) could induce strong specific immunity to parental cell compared to TNF-alpha producing nonimmunogenic variant (1767TR2). Immunogenicity of tumor is very important when we want to perform TNF-alpha gene immunotherapy against cancer.