A total of 31 patients with gastric cancer showing peritoneal dissemination received continuous hyperthermic peritoneal perfusion (CHPP) in combination with the administration of cisplatin (CDDP) and mitomycin C (MMC). The authors developed a new special device named the peritoneal cavity expander (PCE) for sufficient perfusion and direct temperature measurement in the peritoneal cavity. As complications of CHPP three patients presented with bone marrow suppressions (leukocytes less than or equal to 3000/mm3 and/or platelets less than or equal to 30,000/mm3): one, leakage of intestinal anastomosis; one, intestinal perforation; and one, acute renal failure. But none of them was lethal. Twelve of 31 patients who had received CHPP during the initial operation underwent second-look operation (SLO) for the assessing the effects of CHPP and for resecting residual or recurrent tumors. Among 12 patients who received SLO complete response (CR) was observed in four patients, partial response (PR) in one, no change (NC) in three, and progressive disease (PD) in four, with the overall response rates (%CR + %PR) standing at 41%. Two-year survival rate of the complete and partial responders was 50%, which was significantly higher than 0% of the other responders (NC + PD). The survival curves of the two groups were significantly different (P less than 0.05, generalized Wilcoxon test). These results supported that CHPP was well tolerated and effective for the treatment of patients with peritoneal dissemination in gastric cancer when combined with anti-cancer drugs having synergism with hyperthermia. Since the outcome of SLO was one of prognostic factors it was important to follow up these patients by SLO.

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Forty-five patients with inoperable cancer of the liver were treated by the one shot administration of 15-40 mg of Mitomycin C into the hepatic artery, either by the superselective or by the selective ofie shot method. Fourteen of the patients had primary cancers of the liver, and 31 had metastases to the liver from primary cancers of the stomach, or from the colorectal or other organs. Subjective symptoms improved in 7370, and objective signs improved in 60%.Nineteen patients who received this treatment more than twice showed a mean survival time of 10 months and a 50% survival time of 7.8 months. Therapeutic effects of the selective one shot method were recognized mostly in patients with tumors which were rich in vessels. However, a fairly good result was obtained using the superselective one shot method, even in patients with tumors having relatively few vessels.Cancer 41:1720-1727, 1978.HE SURVIVAL TIME OF PATIENTS WITH INOP-T erable cancer of the liver has been known to be short. Purves et a1." showed that the mean survival time of 93 patients with primary cancers of the liver was 75.9 days, and Jaffe et al.13 reported that a 50% survival time of 390 patients with metastatic cancers of the liver was 75 days. In our previous report,I4 a 50% survival time of 53 patients with inoperable primary or metastatic cancers of the liver was 2.5 months.The therapy for these patients recently has been conservative, including chemotherapy, radiotherapy and other methods. Local administration of antineoplastic agents via the arterial route was performed by Klopp et for the first time in 1950. Thereafter, this intra arterial continuous infusion of antineoplastic agents has been carried out in patients with inoperable cancers of the 1iver.3--7.9~18~24 Recently, the one shot method, in which massive doses of antineoplastic agents are given by one shot, has been widely performed inThe purpose of

Forty seven patients with early gastric cancer received a 30-minute intravenous injection of bromodeoxyuridine (BrdU), 1000 mg each 1 hour before laparotomy, to label tumor cells in the S phase. In 13 of 47 patients, specimens obtained by endoscopic biopsy were cultured in vitro at 37 degrees C for 1 hour under three times the atmospheric pressure in a vial with 400 microM BrdU. Labeled cells were detected in the resected specimen and the cultured specimen by immunohistochemical staining procedure. The BrdU labeling index (LI, defined as the percentage of labeled cells in relation to the 1000 tumor cells) was calculated for each specimen. All patients without lymph node metastasis had an in vivo BrdU LI of less than 12%. In contrast, 31% of patients with early gastric cancer with an in vivo BrdU LI greater than 12% had lymph node metastasis. There was a correlation between the in vivo and the in vitro LI. Therefore, the in vitro BrdU LI of specimens obtained by endoscopic biopsy may be a useful indicator of lymph node status in patients with individual early gastric cancers before operations. If the in vitro BrdU LI is less than 12% lymph node dissection may not be necessary.