A new drug dosage form compromising activated carbon particles adsorbing mitomycin C (MMC-CH) was designed to slowly release its components, and has affinity for the tumor surface and lymph nodes and a tendency to stay long in the local portion.
Intracavitary MMC-CH delivered a much higher level of MMC selectively to the intraperitoneal tissue, with a much lower level of MMC in the whole body, in comparison with MMC solution.
Acitivated charcoal particles adsorbing mitomycin-C(MMC-CH) was administrated to 49 year old male patients with stage IV gastric cancer that was judged to be unresectable. At laparotomy, there were a diffuse serosal involvement along the entire
lesser
curvature and multiple peritoneal metastases and metastatic huge mass on the serosal surface of the ascending colon that was classified AMC HoP₃according to the general rules for gastric cancer study. There were not considered resectable. Bypass
ileotransverse colostomy was performed, and biopsy were taken form intraperitoneal metastatic masses. Activated carbon particles adsorbing mitomycin-C were prepared for 10 minutes with mixing charcoal(C-5385, Sigma Chemical) 1.0 gram and MMC 50
mg
for
the use of an intracavitary administration, and was administrated intraperitoneally before the peritoneum was closed. The patients was uneventful except weight in postoperative period.
6 months later the operation, the patients was readmitted to our department due to intestinal obstruction. The 2nd laparotomy was under taken to relieve the obctruction, and then the closed loop was found around the long axis of ileotransverse
colostomy. And multiple peritonea metastatic masses(P₃) were found to completely regressed grossly and histologically. Gastric cancer remained to be palpable, but decreased in size and serosal surface became smooth compared with previous uneven
surface. The dark charcoal particles were principally attached to previous metastatic masses-located area and serosa of stomach. The stomach resection was thought to be feasible, but the resection was not carried out because of poor general
condition.
In the thirteen postoperative day of 2nd laparotomy, sudden massive UGI bleeding occurred, the third lapartomy was undertaken urgently. The giant malignant ulcer that was located in posterior wall of body was found to be bleeding. R1 resection
was
carried out with curative intent.
In summary, with a new dosage form compromising charcoal adsorbing large dose MMC(MMC CH), multiple peritoneal metastatic masses(P₃)and serosal involvement were completely regressed and replaced by multiple disseminated charcoal granuloma, and
otherwise unresectable primary gastric lesion could be resected with curative intent 6 months later after intracavitary MMC-CH.
It is suggested that intracavitary chemotherapy with charcoal adsorbing large dose MMC would be useful to treat preitoneal seeding mess and lymph node metastases.
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