Perioperative Locoregional Application of Mitoxantrone in Patients with Early Breast Carcinoma

Abstract

The aim of this study was to investigate the clinical and morphological aspects of drug diffusion and efficacy after perioperative locoregional application of mitoxantrone in patients with early breast cancer. Mitoxantrone was injected at a dose of 0.5 ml (1.0 mg) in two sites around the tumor in 37 patients. Intraoperative inspection of mitoxantrone diffusion in breast and axillary tissues was carried out by blue color of the chemotherapeutic drug. Investigations of reactive morphological changes in axillary nodes were determined intraoperatively by blue stained lymph capillaries identified 2-4 cm laterally from the application sites and in 30 patients a mean of 1.5 stained axillary nodes was found. The light microscopy in the metastatic blue lymph nodes showed circulatory changes, dilatation of marginal sinus and inflammatory alterations. It was concluded that lymphotropic locoregional application of mitoxantrone results in diffusion of the drug in the regional lymph drainage and in cytotoxic effects on axillary nodes.

Intratumoural chemotherapy of lung cancer for diagnosis and treatment of draining lymph node metastasis

“…That study clearly established that preoperative bronchoscopic injection of tracer/marker agents into the tumour and adjacent normal bronchial mucous membrane results in their transport to sentinel and regional lymph nodes within 6 h. The migration of cytotoxic drugs injected similarly should follow the same pathway and kill malignant metastatic cells without systemic drug toxicity. The clinical findings of Baitchev et al [59] . with intratumoural injection of blue mitoxantrone in early breast cancer also supports our hypothesis that a chromophoric cancer drug such as mitoxantrone (with a molecular weight comparable with staining dyes) will be transported to the sentinel and regional lymph nodes through lymphatic drainage immediately following the bronchoscopic injection into either the tumour or the tissue adjacent to the tumour site.…”

“…Such first‐pass transport of drug to the regional lymph nodes therefore has important implications for locoregional therapy of metastasis. Indeed, Baitchev et al [59] . in their clinical study in early breast cancer, have observed the first‐pass transport of the blue‐staining mitoxantrone to the regional lymph nodes.…”

“…[58] Such first-pass transport of drug to the regional lymph nodes therefore has important implications for locoregional therapy of metastasis. Indeed, Baitchev et al [59] in their clinical study in early breast cancer, have observed the first-pass transport of the blue-staining mitoxantrone to the regional lymph nodes. These authors investigated the clinical and morphological behaviour of drug diffusion and efficacy after perioperative locoregional application of mitoxantrone in patients with early breast cancer.…”

Bronchoscopic intratumoral chemotherapy of lung cancer

“…The sentinel nodes represent the initial lymphatic site for tumor migration and therefore the locus of initial malignant cell dissemination [76][77][78]. e. An immuno-therapeutic effect due to antigenic expression by a large mass of tumor cell debris [79,80]. f. The local radio-sensitizing effect of intratumoral cisplatin which enhances the efficacy of the radiotherapy [81][82][83].…”

Percutaneous Tumor Ablation

“…Although we have related the localized necrosis to the EPI distribution during the Co-CACH procedure, we didn't actually label the EPI and therefore we could have used a colored anthracycline cytotoxic. 46 Finally, we didn't compare the ablative effect of ''conservative'' CA with our Co-CACH technique, since CA without safety margin has long been demonstrated unable to fully eradicate a solid tumor. 47,48 We purposely didn't use a prefreezing IT administration of the therapeutic fluid, given that previous in vitro 16 and clinical applications had shown that an LMW cytotoxic-tracer drug solution or emulsion-injected intratumoral immediately before a cryoablative procedure is not displaced by the ice ball.…”