| The recurrence rate of resected gastric cancer with curative intent is around 20--30 percent. Peritoneal dissemination accounted for half of the recurrences, and followed by hematogenous metastasis, including hepatic metastasis. Chemotherapy was main treatment modality because the possibility of curative resection is very low. Recently, Loco-regional therapty like intraperitoneal administration has been also applied.A number of experimental and clinical studies indicated that intraperitoneal administration of chemotherapy could result in greater total drug exposure of the tumor, higher drug concentration in portal system, greater AUC, and minimized systemic drug side effects.Cisplatin is one of the most effective drug used in intraperitoneal chemotherapy. In order to prove it, we examined the accumulation of cisplatin in different tissues by different routes of adm inistration.Materials and Methods1.Patients: From 1999.10-2000.10.58 patients each withadvanced, respectable gastric cancer were collected. 2.Drug: Cisplatin injection (Qilu-Pharmaceutical Factory,ShanDong,China). 3.Experimental design:50 patients with advanced, resectable gastric cancer were randomly divided into 2 groups(A,B group). A group were treated by preoperative intraperitoneal cisplatin (ip group), which contained 26 cases. The B group were treated by preoperative intravenous cisplatin (iv group), which contained 24 cases. 60mg/m' cisplatin was given to each patient intraperitoneally or intravenously. Peritoneal fluid, blood from left gastric vein and peripheral vein were taken at about 180-190 minutes after the drug was administrated. Cancer tissues and gastric normal tissues were collected during operation at about 270-280 minutes after the drug given. In addition, 8 cases were randomly divided into 2 groups too(group C,D), which used as pharmacokinetics study. Group C were treated by intraperitoneal cisplatin (ip group), which contained 5 cases. The D group was treated by intravenous cisplatin (iv group), which contained 3 cases. 60mg/m1 cisplatin was given to each patient intraperitoneally or intravenously. Peritoneal fluid, peripheral blood were taken at 0, 15 minutes ,30 minutes, Ihr,2 hrs,4 hrs,6 hrs,12 hrs,24 hrs,48 hrs, after intraperitoneal administration respectively; peripheral blood were taken at 0, 15 minutes, 30minutes,! hr,2 hrs,4 hrs,6 hrs,12 hrs, 24 hrs, 48 hrs, after intravenous administration respectively. The concentrations of cisplatin in different samples were measured by a type of atomic absorption spectrometry.4.Statistical analysis: Values were expressed as mean 盨D and data were input into computer and statistic by one-way ANONA of SPSS8.0 for windows. P<0.05 was considered significant.Results1. The cisplatin concentration of the peritoneal fluid, left gastric vein blood, and peripheral blood taken at 160-170 minutes after the drug was givenin the group A were 1.17 + 0.43 u g/ml, 0.48 + 0.08U g/ml,0.26 + 0.09U g/ml; andthegroupB were0.05 + 0.02ti g/ml, 0.19 + 0.08U g/ml, 0.24 + 0.06U g/ml. The cisplatin concentration of the peritoneal fluid,left gastric vein blood in the group A were 24.8, 2.35 times higher than those in the group B respectively ( P<0.001).2. The cisplatin concentration in cancer tissues by ip administration was higher than those by iv administration(P<0.05).3. Cancer tissues had higher drug concentration than did peritumor normal tissues, but no statistical difference (P>0.05).4. Ip agministration, AUC oftheperitoneal fluid is 31.245 and AUC of the peripheral blood is 13.501 ; Iv agministration,, AUC of the peripheral blood is 7.171.Conclusion1. The cisplatin concentration of the peritoneal fluid, left gastric vein blood in the group A were higher than those in the group B respectively.2. The cisplatin concentration in cancer tissues by ip administration was higher than those by iv administration, Cancer tissues had higher drug concentration than did peritumor normal tissues, but no statistical difference.3...
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