Endoscopic Injection of Mitomycin Adsorbed on Carbon Particles for Advanced Esophageal Cancer: a Pilot Study

Ortner, Maria-Anna; Taha, Alaa; Schreiber, Stefanie; Wirth, Jutta; Weber-Eibl, Jutta J.; Ernst, Heinrich; Lochs, H.

doi:10.1055/s-2004-814327

Cited by 4 publications

(3 citation statements)

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“…In clinically, injection of drug to treat advanced esophageal carcinoma was rarely reported. There was only one study showed endoscopic injection of mitomycin may release the dysphagia of patients with advanced esophageal carcinoma [28]. No study showed injection of paclitaxel can inhibit the tumor growth.…”

Section: Discussionmentioning

confidence: 99%

The effect of paclitaxel-eluting covered metal stents versus covered metal stents in a rabbit esophageal squamous carcinoma model

Zhang

Huang

et al. 2017

PLoS ONE

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BackgroundThe use of self-expanding metallic stents (SEMSs) is the current treatment of choice for malignant gastrointestinal obstructions. However, these stents can promote only drainage and have no antitumor effect. Some studies have reported that drug-eluting SEMSs may have tumor inhibition potential. The aim of this study was to evaluate the efficiency and safety of paclitaxel-eluting SEMSs (PEMSs) in rabbit esophageal cancer models.Materials and methodsA PEMS was covered with a paclitaxel-incorporated membrane, in which the concentration of paclitaxel was 10% (wt/vol). The rabbit models were created endoscopically. Then, a PEMS or SEMS was endoscopically inserted into the rabbit esophagus. Two weeks after stent placement, the rabbits were sacrificed, and we evaluated the tumor volume, area of the wall defect, area of the tumor under endoscopic ultrasound (EUS) before and after stent placement, status of the proximal esophageal obstruction, tumor metastasis food-intake and weight loss.ResultsA total of 26 rabbits received stent insertion and survived until sacrifice, and migration occurred in 4 cases, 3 in SEMS group and 1 in PEMS group. For the remaining 22 rabbits, at the sacrificed time, the average tumor volume was 7.00±4.30 cm3 in the SEMS group and 0.94±1.51 cm3 in the PEMS group (P<0.05). The area of the esophageal wall defect was 0.70±0.63 cm2 in the SEMS group and 0.17±0.16 cm2 in the PEMS group (P<0.05). The tumor area under EUS was 4.40±1.47 cm2 in the SEMS group and 1.30±1.06 cm2 in the PEMS group (P<0.05). At the time of stent placement, tumor area under EUS was comparable in the two groups. Other indices did not significantly differ between the two groups.ConclusionsSEMS and PEMS are both safe and effective to relieve dysphagia in rabbit esophageal cancer models. A PEMS can serve as an alternative tool for advanced esophageal cancer that may inhibit tumor growth by serving as a drug sustained-release platform. Clinical trials of the stent are warranted in the future.

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Section: Discussionmentioning

confidence: 99%

The effect of paclitaxel-eluting covered metal stents versus covered metal stents in a rabbit esophageal squamous carcinoma model

Zhang

Huang

et al. 2017

PLoS ONE

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“…Dysphagia is a troubling disability in advanced oesophageal carcinoma. Ortner et al [13] have reported the results of a pilot study investigating the injection of mitomycin adsorbed onto carbon particles for advanced oesophageal carcinoma. Carbon particles are unable to enter the capillaries and are therefore transported by lymphatic vessels, with relatively selective accumulation in regional lymph nodes and in the primary lesion.…”

Section: Endoscopic Injection Of Chemotherapeutic Agentsmentioning

confidence: 99%

Treatment of Oesophagogastric Tumours

Morris

Collins²

2005

Endoscopy

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IntroductionEndoscopic therapeutic interventions for oesophagogastric tumours are continuing to evolve. The indications for endoscopic therapy and the devices themselves are continuing to develop. It is important that the feasibility, safety, and efficacy of these strategies should be clearly defined, so that their role in patient management can be established. This article reviews noteworthy literature in this area published between June 2003 and 1 September 2004. Ablation of Barrett's OesophagusThere has been substantial interest in techniques that aim to ablate the metaplastic epithelium of Barrett's oesophagus to allow normal squamous reepithelialization. The question is whether an ablative strategy can reduce the progression to malignancy and reverse the increasing incidence of this disease and its associated mortality. Ackroyd et al. [1] have reported long-term follow-up data on 40 patients with long-segment, biopsy-proven Barrett's oesophagus with low-grade dysplasia (LGD) who received photodynamic therapy (PDT) using oral 5-aminolaevulinic acid (5-ALA) as the photosensitizing agent. Laser endoscopy was applied 4 h after oral 5-ALA administration. The total treatment length was 6 cm (measured from the proximal extent of the Barrett's mucosa), and the median length of Barrett's oesophagus in the treated group was 6 cm (range 3 ± 18 cm). Patients were followed up with endoscopy and random biopsies at 1, 6, and 12 months, and annually thereafter. The median length of the follow-up period was 53 months (range 18 ± 68 months). At 1 month, 88 % of patients had responded to PDT with a median reduction in the length of Barrett's mucosa of 30 % (range 0 ± 90 %). Endoscopic regression was maintained in all patients for the duration of the follow-up period. No foci of dysplasia were detected after 1 month. At 6 months, LGD was detected in one patient (but not at subsequent biopsies). In one patient, a focus of high-grade dysplasia (HGD) was identified at 3 years, and 1 month later a carcinoma in situ was diagnosed. This arose in an untreated segment of Barrett's oesophagus. There were no reports of oesophageal strictures. In one patient, mild photosensitivity to sunlight occurred several hours after treatment.This study reports longer-term follow-up data than any other previously published series and demonstrates that the regression of Barrett's mucosa is maintained after treatment. Glandular elements were seen under the squamous epithelium in one patient, demonstrating incomplete histological ablation of the Barrett's mucosa. The rate of oesophageal malignancy during the follow-up period is equivalent to one per 140 patient-years and is comparable to the rates reported in other series. Longer-term follow-up periods will be needed to allow adequate assessment of the effect of an ablative strategy on the progression to malignancy and associated mortality.Hage et al. [2] are the first group to have published data comparing two modalities for the endoscopic ablation of Barrett's mucosa. In a prospective randomized study...

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“…Sie berichten auch, dass die Dissekation des Tumors vom unterliegenden Gewebe technisch einfacher ist.Weitere Untersuchungen und der Vergleich der Methode mit anderen Resektionstechniken werden nötig sein, um die Effektivität und Sicherheit dieser neuen Technik zu bestätigen.Die Dysphagie ist ein belastendes Symptom beim fortgeschrittenen Ösophaguskarzinom. Ortner et al[8] berichteten über die Ergebnisse einer Pilotstudie, bei der die Injektion von Mitomycin, das an Kohlepartikel adsorbiert worden war, beim fortgeschrittenen Ösophaguskarzinom untersucht wurde. Kohlepartikel können nicht in Kapillaren eindringen und werden deshalb durch Lymphgefäße transportiert.…”

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Die Behandlung ösophago-gastrischer Tumoren

Morris¹,

Collins²

2005

Endo heute

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ZusammenfassungDie Arbeit referiert 13 bemerkenswerte Studien zur endoskopischen Therapie von Ösophagus-und Magentumoren, die zwischen Juni 2003 und September 2004 publiziert wurden. Langzeitergebnisse der fotodynamischen Therapie, verschiedene Modalitäten der fotodynamischen Therapie und die Kombination von fotodynamischer Therapie mit Argonplasmabehandlung werden in den ersten Arbeiten referiert. Die endoskopische Mukosaresektion kann in unterschiedlichen Modalitäten ausgeführt und zur Behandlung von frühen Adenokarzinomen im BarrettÖsophagus erfolgreich mit der fotodynamischen Therapie kombiniert werden. Die EMR kann bei ausgewählten Patienten nach Radiochemotherapie zur Behandlung rezidivierter oder residualer Plattenenpithelkarzinome eingesetzt werden. In palliativer Absicht können bei Rezidiven nach Radiochemotherapie selbst expandierende Metallstents ebenso eingesetzt werden wie zur primären palliativen Therapie. Sehr interessant ist die palliative Behandlung ausgedehnter Ösophaguskarzinome durch lokale Injektion von Mitomycin C ebenso wie die Enukleation submuköser Tumore des Ösophagus und des Magens mit einem an der Spitze isolierten elektrochirurgischen Messer. Die Übersicht demonstriert die kontinuierliche Entwicklung der endoskopischen Tumortherapie. Zur Definition neuer Standards sind jedoch weitere und umfangreichere Studien erforderlich. Schlüsselwörter Tumor · Ösophagus AbstractThe paper reviews 13 remarkable studies dealing with endoscopic treatment of esophageal and gastric tumors which haven been published between June 2003 and September 2004. Long term results of photodynamic therapy (PDT), different modalities of PDT and the combination of PDT and argon-plasma-coagulation (APC) are reported in the first papers. Endoscopic mucosa resection (EMR) can be used in different modalities and can be successfully combined with PDT of early adenocarcinoma in Barrett's esophagus. EMR can also be used after chemoradiotherapy for treatment of recurrent or residual squamous cell carcinoma of esophagus. By selected patients after chemoradiotherapy selfexpanding metal stents can be used with equal results and risks as in primary palliative intention. Very interesting are the palliative treatment of bulky esophageal cancer by local injection of mitomycin C as well as the enucleation of submucosal tumors in esophagus and stomach using an insulated tip electrosurgical knife. The review demonstrates the continuous development of endoscopic tumor therapy, but more and larger studies are necessary to define new standards.

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Endoscopic Injection of Mitomycin Adsorbed on Carbon Particles for Advanced Esophageal Cancer: a Pilot Study

Abstract: Endoluminal MMC-CH therapy appears to be an effective, inexpensive, and well-tolerated treatment for unresectable advanced squamous-cell esophageal carcinoma.

Cited by 4 publications

References 8 publications

The effect of paclitaxel-eluting covered metal stents versus covered metal stents in a rabbit esophageal squamous carcinoma model

The effect of paclitaxel-eluting covered metal stents versus covered metal stents in a rabbit esophageal squamous carcinoma model

Treatment of Oesophagogastric Tumours

Die Behandlung ösophago-gastrischer Tumoren

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