No description available.

A administração intraperitoneal de 5-fluorouracil (5-FU) no pós-operatório imediato reduz a recorrência local e prolonga a sobrevida dos pacientes com câncer colônico. Contudo, esse tratamento também pode prejudicar a cicatrização das anastomoses intestinais. O objetivo deste estudo foi determinar os efeitos da quimioterapia (QT) intraperitoneal (IP) pós-operatória (PO) precoce com o 5-FU e da selagem anastomótica com o TachoSil sobre o processo de cicatrização de anastomoses colônicas. Quarenta ratos foram divididos em quatro grupos (I - IV, com dez ratos em cada) e submetidos à secção do cólon esquerdo seguida por anastomose. As anastomoses dos ratos dos grupos II e IV foram cobertas com o TachoSil. Solução salina (2 ml/dia grupos I e II) ou 5-FU (20 mg/kg/dia grupos III e IV) foi administrado por via IP uma vez ao dia, desde do procedimento cirúrgico até a morte programada dos animais no quarto dia pós-operatório. Foram realizadas medidas da pressão de ruptura e análise histopatológica das anastomoses. A perda relativa de peso foi significativamente maior nos animais do grupo III comparado a todos os demais grupos (p=0,0004). Não houve diferença significativa entre os grupos no que se refere à presença de fístulas, coleções perianastomóticas, sinais de dilatação intestinal pré-anastomótica ou aderências pós-operatórias. A pressão de ruptura foi significativamente menor no grupo III comparada a todos os demais grupos (p=0,001). A neoangiogênese foi significativamente menor no grupo III comparada aos grupos I e II (p=0,05). A infiltração fibroblástica foi significativamente maior no grupo I e em comparação ao grupo III (p=0,035). Não ocorreu diferença significativa entre os grupos no que concerne à presença de infiltração de células inflamatórias e deposição de colágeno. Os dados obtidos permitem concluir que a QT IP precoce com 5-FU afetou negativamente a fase inicial da cicatrização de anastomoses colônicas. Contudo, a selagem com o TachoSil foi capaz de reverter alguns dos efeitos adversos decorrentes da QT. / The administration of 5-fluorouracil (5-FU) during the early postoperative period can decrease local cancer recurrence but may also cause impairment of the anastomotic healing. This study examined the effects of the use of this therapy and of the anastomotic sealing with a fibrin-collagen patch (TachoSil) on the healing of colon anastomoses. Forty male rats were divided into four groups (I to IV, 10 rats each) that underwent transection and anastomosis of the left colon. The anastomoses were covered with TachoSil in groups II and IV. Saline solution (2 ml/day groups I and II) or 5-FU (20 mg/kg/day; groups III and IV) was administered intraperitoneally (IP) once daily for three days. Bursting pressure (BP) was recorded and the anastomoses were examined macroscopically and graded histologically. The relative weight loss was significantly higher in group III than in the other groups (p=0.0004). Anastomotic dehiscense, postoperative adhesion formation, perianastomotic collections, and preanastomotic dilatation did not differ significantly among groups. BP was significantly lower in group III compared to all other groups (p=0.001). Neoangiogenesis was significantly lower in group III compared to groups I and II (p=0.05). Fibroblastic activity was significantly higher in group I compared to group III (p=0.035). Inflammatory cell infiltration and collagen deposition did not differ significantly among groups. Our results shown that the early postoperative IP chemotherapy with 5-FU impaired the healing of colon anastomoses. However, anastomotic sealing with TachoSil reversed some of the negative effects of this therapy.

A administração intraperitoneal de 5-fluorouracil (5-FU) no pós-operatório imediato reduz a recorrência local e prolonga a sobrevida dos pacientes com câncer colônico. Contudo, esse tratamento também pode prejudicar a cicatrização das anastomoses intestinais. O objetivo deste estudo foi determinar os efeitos da quimioterapia (QT) intraperitoneal (IP) pós-operatória (PO) precoce com o 5-FU e da selagem anastomótica com o TachoSil sobre o processo de cicatrização de anastomoses colônicas. Quarenta ratos foram divididos em quatro grupos (I - IV, com dez ratos em cada) e submetidos à secção do cólon esquerdo seguida por anastomose. As anastomoses dos ratos dos grupos II e IV foram cobertas com o TachoSil. Solução salina (2 ml/dia grupos I e II) ou 5-FU (20 mg/kg/dia grupos III e IV) foi administrado por via IP uma vez ao dia, desde do procedimento cirúrgico até a morte programada dos animais no quarto dia pós-operatório. Foram realizadas medidas da pressão de ruptura e análise histopatológica das anastomoses. A perda relativa de peso foi significativamente maior nos animais do grupo III comparado a todos os demais grupos (p=0,0004). Não houve diferença significativa entre os grupos no que se refere à presença de fístulas, coleções perianastomóticas, sinais de dilatação intestinal pré-anastomótica ou aderências pós-operatórias. A pressão de ruptura foi significativamente menor no grupo III comparada a todos os demais grupos (p=0,001). A neoangiogênese foi significativamente menor no grupo III comparada aos grupos I e II (p=0,05). A infiltração fibroblástica foi significativamente maior no grupo I e em comparação ao grupo III (p=0,035). Não ocorreu diferença significativa entre os grupos no que concerne à presença de infiltração de células inflamatórias e deposição de colágeno. Os dados obtidos permitem concluir que a QT IP precoce com 5-FU afetou negativamente a fase inicial da cicatrização de anastomoses colônicas. Contudo, a selagem com o TachoSil foi capaz de reverter alguns dos efeitos adversos decorrentes da QT. / The administration of 5-fluorouracil (5-FU) during the early postoperative period can decrease local cancer recurrence but may also cause impairment of the anastomotic healing. This study examined the effects of the use of this therapy and of the anastomotic sealing with a fibrin-collagen patch (TachoSil) on the healing of colon anastomoses. Forty male rats were divided into four groups (I to IV, 10 rats each) that underwent transection and anastomosis of the left colon. The anastomoses were covered with TachoSil in groups II and IV. Saline solution (2 ml/day groups I and II) or 5-FU (20 mg/kg/day; groups III and IV) was administered intraperitoneally (IP) once daily for three days. Bursting pressure (BP) was recorded and the anastomoses were examined macroscopically and graded histologically. The relative weight loss was significantly higher in group III than in the other groups (p=0.0004). Anastomotic dehiscense, postoperative adhesion formation, perianastomotic collections, and preanastomotic dilatation did not differ significantly among groups. BP was significantly lower in group III compared to all other groups (p=0.001). Neoangiogenesis was significantly lower in group III compared to groups I and II (p=0.05). Fibroblastic activity was significantly higher in group I compared to group III (p=0.035). Inflammatory cell infiltration and collagen deposition did not differ significantly among groups. Our results shown that the early postoperative IP chemotherapy with 5-FU impaired the healing of colon anastomoses. However, anastomotic sealing with TachoSil reversed some of the negative effects of this therapy.

No description available.

Grâce au progrès de la chimiothérapie systémique, la prise en charge de la carcinose péritonéale a connu une révolution avec le développement de la chirurgie de cytoréduction. L'association d'une chirurgie de cytoréduction à une chimiothérapie systémique et intra-péritonéale a permis de proposer à certains patients sélectionnés un traitement à visée curative et représente le traitement de référence pour la plupart des carcinoses d'origine non gynécologique. Toutes les carcinoses et tous les patients sont différents, c'est pourquoi de nombreux travaux ont permis de préciser les facteurs permettant la sélection des patients pouvant bénéficier d'un tel traitement. Le principal facteur pour proposer un traitement curatif d'une carcinose péritonéale est la possibilité de réaliser une résection complète. Malgré ces progrès dans le traitement et la sélection des patients, les résultats restent insuffisants et trop peu de patients présentent une maladie résécable accessible à un traitement curatif. L'apparition des biothérapies et notamment les anti-VEGF offre une nouvelle voie de recherche. Le bevacizumab, anticorps anti-VEGF, a montré une efficacité significative dans le traitement des maladies métastatiques. Il augmente l'efficacité du traitement par chimiothérapie systémique. Le VEGF semble également présenter un rôle important dans le développement et l'agressivité des carcinoses péritonéales. Pour permettre d'augmenter l'efficacité du traitement curatif des carcinoses péritonéales, se discute d'associer du bevacizumab. Cependant, administré par voie systémique il peut majorer la morbidité faisant contre-indiquer son association avec une chirurgie abdominale lourde déjà grevée d'une morbidité importante. L'hypothèse qui a justifié ce travail est que l'administration intra-péritonéale de bevacizumab pourrait augmenter la résécablité et la survie des patients atteints par une carcinose péritonéale d'origine non gynécologique en limitant la morbidité. Le but de ce travail est au travers d'études cliniques et expérimentales d'évaluer la faisabilité et l'efficacité d'un traitement par bevacizumab intra-péritonéale en association au traitement chirurgical de référence pour la prise en charge des CP d'origine non gynécologique / Advances in systemic chemotherapy permitted revolution in the management of peritoneal carcinomatosis with the development of cytoreductive surgery. The combination of cytoreductive surgery with systemic and intraperitoneal chemotherapy offer to selected patients a hope of cure and is considered as the treatment of choice for most carcinomatosis of non-gynecological origin. All carcinomatosis and all patients are different and numerous studies tried to determine factors for selecting patients eligible for such treatment. The mains prognostic factor for curative treatment is the ability to perform a complete cytoreduction. Despite these advances in the treatment and selection of patients, the results are still insufficient and few patients have resectable disease accessible to a cure. The development of biotherapies including anti -VEGF provides a new way of research. Bevacizumab, anti - VEGF antibody, showed significant efficacy in the treatment of metastatic diseases. It increases the efficiency of treatment by systemic chemotherapy. VEGF appears to have an important role in the development and aggressiveness of peritoneal carcinomatosis. To increase the effectiveness of curative treatment of peritoneal carcinomatosis, the combination of bevacizumab to the current standard treatment can be proposed. The bevacizumab administered intravenously may increase morbidity prohibiting its association with major abdominal surgery already burdened with significant morbidity. The hypothesis of this work is that the intraperitoneal administration of bevacizumab may increase resectability and survival of patients with peritoneal carcinomatosis of non- gynecologic origin and limit the morbidity. The aim is through clinical and experimental studies to evaluate the feasibility and the efficacy of treatment with intraperitoneal bevacizumab in combination with standard surgical treatment of peritoneal surface malignancy

Ovarian cancer is one of the five most common causes of cancer death in women in the USA and UK. It is usually diagnosed when it is well established beyond the ovary in the peritoneum. Intravenous injection of cisplatin is a common palliative therapy for ovarian cancer patients. Intraperitoneal therapy has been shown to improve survival for patients. Poly(lactide-co-glycolide) (PLGA) is a biodegradable polyester which has been proven safe for medical implantation. PLGA microspheres or fibres have been considered in this work as depots for delivering intraperitoneal cisplatin directly to the tumour site. The aims of this work were (1) to develop microsphere depot formulations with improved drug release profiles compared to previous work; (2) Novel cisplatin containing solid and hollow fibres were to be developed and investigated as alternative structures for depot devices; (3) The drug release profiles were to be examined using mathematical models to allow rational comparison of the devices. It was found that cisplatin containing PLGA 65:35 solid and hollow fibres represent a novel, reproducible formulation for encapsulating higher amounts of cisplatin for an equivalent mass of excipient than other polymer formulations. The fibres developed in this study were able to maintain elevated concentrations of unbound cisplatin in the presence of a biological matrix for approximately 100 hours in vitro.

Nanopartículas poliméricas biodegradáveis têm recebido atenção como carreadores de fármacos ao longo dos últimos anos. Em muitos casos, a segurança destes nanocarreadores não foi demonstrada e pouco se sabe sobre a relação entre as suas características físico-químicas e suas propriedades toxicocinéticas e toxicodinâmicas. A nanotoxicologia está emergindo como uma especialidade importante da nanotecnologia e/ou toxicologia, e refere-se ao estudo da interação de nanoestruturas com sistemas biológicos. Nos últimos anos, a maioria das pesquisas foi centrada em estudos in vitro, entretanto, os resultados destes estudos necessitam também ser avaliados em experimentos in vivo para o avanço na utilização de nanocarreadores na área biomédica. Com isso, o objetivo deste trabalho foi avaliar a toxicidade de nanocápsulas de núcleo lipídico (LNC), de poli(-caprolactona), após administração intraperitoneal (i.p.) e intradérmica (i.d.) em ratos Wistar. Para a avaliação toxicológica aguda, foi administrada dose única em que se observaram sinais clínicos e fisiológicos, em ambas as vias. Após 14 dias, os animais foram eutanasiados e análises macroscópicas e histopatológicas foram realizadas. Além disso, sangue e urina foram coletados para análises laboratoriais e avaliação de funções teciduais. A avaliação toxicológica subcrônica foi procedida da mesma forma, exceto pela administração de doses repetidas diárias durante 28 dias. As suspensões de nanocápsulas foram preparadas pelo método de precipitação do polímero pré-formado, as quais apresentaram tamanho médio de partícula inferior a 250 nm, índice de polidispersão (IPD) < 1, potencial zeta negativo e pH em torno de 6,7. Os animais tratados pela via i.p. (n=6/grupo) receberam para avaliação da toxicidade aguda: solução salina ou polissorbato 80 (PS80) (12 ml/kg), utilizados como controles e diferentes doses de LNC (18,03, 36,06, e 72,12 × 1012 LNC/kg); no teste de toxicidade subcrônica foram utilizados os mesmos controles porém com doses de 3mL/kg e 6,01, 12,02 ou 18,03 × 1012 LNC/kg. Nos testes de toxicidade aguda, nos animais administrados pela via i.p., foi observada diminuição significativa de peso nos grupos tratados com LNC mesmo após 14 dias da administração (p<0,05). Entretanto no teste subcrônico esta alteração foi transitória, e ocorreu apenas no grupo que recebeu a maior dose até o quinto dia de administração (p<0,05). Houve aumento no peso relativo do baço nos animais que receberam a dose mais alta de LNC (p<0,05) no tratamento agudo. A análise histopatológica em ambos os tratamentos, demonstrou a presença de um granuloma de tipo corpo estranho no fígado e no baço dos animais que receberam a dose mais alta, provavelmente devido ao volume de LNC administrado. Não houve alteração nas análises bioquímicas de dano hepático, renal, dentre outros em todos os grupos tratados. Os dados hematológicos apresentaram uma leve alteração, entretanto foi demonstrada interferência metodológica, evidenciada por testes preliminares in vitro. Além disso, foram avaliados biomarcadores do estresse oxidativo (EO), marcadores inflamatórios e de genotoxicidade. Os resultados dos biomarcadores de oxidação de proteínas e lipídios não foram suficientes para iniciar um processo oxidativo, visto que não houve peroxidação lipídica. Ainda, não houve depleção de antioxidantes, dano ao DNA ou alteração nos marcadores inflamatórios. Nos ratos tratados pela via i.d., foi utilizada solução salina 1,2 ml/kg como grupo controle e uma dose de 7,2 × 1012 LNC/kg de LNC, para um estudo preliminar agudo e solução salina ou PS 80 (0,9ml/kg) e três doses de LNC (1,8, 3,6 ou 5,4 × 1012 LNC/kg) para avaliação da toxicidade subcrônica. No teste de toxicidade aguda, não houve alteração do peso corpóreo, entretanto no teste de toxicidade subcrônica houve uma diminuição reversível do peso no grupo que recebeu PS80 (p<0,05). Os dados histopatológicos não apresentaram alteração. Não houve alteração nos parâmetros bioquímicos, exceto uma leve diminuição da atividade da butirilcolinesterase no grupo que recebeu a dose mais alta (p<0,05). Por outro lado, houve aumento nos leucócitos no grupo que recebeu LNC, no teste de toxicidade aguda e nos grupos que receberam PS 80 e 5,4 × 1012 LNC/kg (p<0,05) após doses repetidas. Em relação à avaliação sanguínea e tecidual dos biomarcadores do EO e dos marcadores inflamatórios, foi observada uma indução nos marcadores de oxidação de proteínas juntamente com uma indução enzimática nos ratos que receberam a dose mais alta, além de uma diminuição dos níveis do IL-10 nos grupos que receberam PS80 e a dose mais alta (p<0.05). Pode-se concluir que nas condições dos experimentos, tanto pela via i.p. quanto pela via i.d., não foram demonstrados danos teciduais, pois os achados laboratoriais foram condizentes com os achados histopatológicos. Além disso, os mecanismos de reparo foram suficientes para contrabalançar eventuais danos oxidativos ou inflamatórios. Assim, o presente trabalho contribui para futuras avaliações toxicológicas de nanocápsulas poliméricas, visto que foram realizadas avaliações agudas e subcrônicas sistemáticas, com marcadores de dano renal precoce e possíveis mecanismos de toxicidade envolvidos após administração por ambas as vias. O aumento na utilização destas nanocápsulas e as lacunas nas informações toxicológicas fazem com que desafios importantes devam ser superados para permitir sua incorporação segura. Com isso, estudos nesta linha podem embasar a avaliação da resposta tóxica e, consequentemente, levar ao estabelecimento de regulamentações para avaliação da toxicidade da maioria das nanopartículas poliméricas biodegradáveis utilizadas como carreadoras de fármacos. / Biodegradable polymeric nanoparticles have received attention as drug carriers over the past years. In many cases, the safety of nanocarriers has not been demonstrated and little is known about the relationship of its physicochemical characteristics and their toxicokinetic and toxicodynamic properties. Nanotoxicology is emerging as an important field of nanotechnology and toxicology, and refers to the study of the interaction of nanostructures with biological systems. In recent years, most research has focused on in vitro studies; however, the results of these studies should also be evaluated trough in vivo experiments, in order to advance in biomedical application of nanocarriers. Thus, the objective of this study was to evaluate the toxicity of lipid-core nanocapsules (LNC), prepared with poly(ɛ-caprolactone), after intraperitoneal (i.p.) and intradermal (i.d.) administration in rats. For acute toxicological evaluation, it was administered a single dose, i.p. and i.d., clinical signs and physiological effects were observed. After 14 days, animals were euthanized and macroscopic and histopathological analyses were done. In addition, blood and urine were collected for laboratory analysis and evaluation of tissue functions. Subchronic toxicological evaluation was similar, except for the administration of repeated doses for 28 days. The suspension of nanocapsules were prepared by interfacial deposition of polymer, which had particle size less than 250 nm, polydispersity index (IPD) <1, negative zeta potential and pH around 6.7. Animals were treated via i.p. (N = 6/group), the doses used for acute toxicity test were: saline or polysorbate 80 (PS80) (12 ml/kg) as controls or three different doses of LNC (18.03, 36.06, e 72.12 × 1012 LNC/kg); for subchronic toxicity test, same controls were used but the doses were 3 ml/kg and 6.01, 12.02 ou 18.03 × 1012 LNC/kg administered daily for 28 days. In acute toxicity test, with i.p. administration, groups treated with LNC presented a significant reduction in relative weight even after 14 days of administration (p<0.05); however in the subchronic test, this change was transient, and occurred only in the group receiving the highest dose until the fifth day of administration (p<0.05). There was an increase in relative weight of spleen in animals that received the highest dose of LNC (p<0.05) in acute treatment. Histopathological analysis in both the treatments, showed a granulomatous foreign body reaction in liver and spleen of animals receiving the highest dose, probably because the volume of LNC administered. There were no changes in biochemical parameters of liver or kidney damage, among all treated groups. Hematological data showed a slight change; however it was demonstrated an interference of the methodology, further evidenced by preliminary in vitro tests. Furthermore, we evaluated biomarkers of oxidative stress (OS), inflammatory and genotoxicity markers. The results of the oxidation of proteins and lipids biomarker were not sufficient to initiate an oxidative process, since no lipid peroxidation occurred. Still, no depletion of antioxidants, DNA damage or change in inflammatory markers was observed. In rats treated via i.d., saline was used as control (1.2 ml/kg) and a dose of 7.2 × 1012 LNC/kg of LNC to a preliminary acute study, and saline or PS 80 (0.9ml/kg) used as controls or three doses of LNC (1.8, 3.6 ou 5.4 × 1012 LNC/kg) for subchronic toxicity evaluation. In acute toxicity test, there was no change in relative body weight, however, a decreased was found for the group receiving PS 80 in subchronic test (p <0.05). No histopathological alteration was found. Also, there was no change in biochemical parameters, except a slight decrease of butyrylcholinesterase activity in the group receiving the highest dose (p<0.05). Moreover, in acute toxicity test, it was found an increase in white blood cells in group receiving LNC; these increasing also occurred after repeate dose test, in PS 80 and 5.4 × 1012 LNC/kg of LNC groups (p <0.05). Regarding blood and tissue biomarkers of OS and inflammatory markers, an induction in protein oxidation marker along with antioxidant induction in rats which received the highest dose were observed, also reduced levels of IL-10 in rats that received the higher dose and PS80 (p <0.05). It can be concluded that, under the experimental conditions, for i.p. and i.d. administration, tissue damage was not found, since laboratorial analysis results were consistent with histopathological findings. Furthermore, mechanisms of repair were sufficient to offset oxidative damage or inflammation.Thus, this study contributes to future toxicological evaluations of polymeric nanocapsules, since a systematic acute and subchronic evaluation with early renal damage markers and possible mechanisms of toxicity involved after ip and id routes were performed. The increase in the use of these nanocapsules and the gaps in toxicological information make important to overcome these challenges in order to allow its safe incorporation. Thus, studies in this line are important to evaluate toxic response, and lead to establishing rules for evaluating the toxicity of most biodegradable polymer nanoparticles used as carrier of drugs.

La Chimiothérapie IntraPéritonnéale (CIP) est utilisée couramment pour traiter le cancer colorectal métastatique. Cependant il n'existe pas de protocole standardisé.Le but de ce projet a été de modéliser cette chimiothérapie in vitro et de comprendre le rôle de l'hypotonie dans ce modèle et son impact sur la mort des cellules cancéreuses.Nous avons déterminé les conditions optimales de traitement sur les cellules cancéreuses coliques humaines HCT116 à savoir une exposition des cellules pendant 30 minutes à 400µM d'oxaliplatine en conditions hypotoniques (G2.5%) à 37°C. Ces résultats ont été validés sur différentes lignées cancéreuses coliques humaines et murine. Nous avons également montré que ces conditions de traitements étaient également capables d’augmenter la cytotoxixité d’autres dérivés du platine comme le cisplatine et le carboplatine.La mort cellulaire induite par ce traitement en hypotonie est de type apoptotique, Et peut s’expliquer par une augmentation de l’incorporation intracellulaire d'oxaliplatine, en partie due à l'activation et à la trimérisation du transporteur du cuivre CTR1.Le traitement par l'oxaliplatine et le cisplatine (mais pas par le carboplatine) en hypotonie entraine également les stigmates de la mort immunogène, à savoir l'exposition de la calréticuline à la membrane, la libération d'ATP et le relargage d'HMGB1, suggérant que l'hypotonie permettrait d'entrainer la mort immunogène et une réponse du système immunitaire lors de cette modélisation de CIP.Enfin, in vivo nous avons pu mettre en évidence que le traitement de métastases intrapéritonéales de souris Balb/c par une injection intrapéritonéale d'oxaliplatine en hypotonie permettait un ralentissement de l’apparition de nodules tumoraux et une augmentation de la survie des souris.Ainsi, nous avons pu mettre en évidence dans ce travail que l'hypotonie est un des paramètres fondamentaux de la CIP et suggère que son utilisation pourrait permettre d'augmenter l’efficacité de la CIP et de prolonger la survie des patients. / IntraPeritoneal Chemotherapy (IPEC) is commonly used to treat colorectal cancer metastases. However there is no standardized protocol.The aim of this work was to model this chemotherapy in vitro and to understand the role of hypotonic conditions in this model and its impact on cell death.We determined that the optimal treatment parameters on HCT116 human colon cancer cells, were an exposure of the cells for 30 minutes to 400μM of oxaliplatin under hypotonic conditions (G2.5%) at 37 °C. These results have been validated on various human and murine colic cancer cell lines. We have also shown that these treatment conditions are also able to increase the cytotoxicity of other platinum derivatives such as cisplatin and carboplatin.The cell death induced by this treatment in hypotonia is apoptosis, and can be explained by an increase in the intracellular incorporation of oxaliplatin, partly due to the activation and trimerization of the CTR1 copper transporter.Treatment with oxaliplatin and cisplatin (but not carboplatin) in hypotonia also leads to the stigmata of immunogenic death, e.i. exposure of calreticulin at the membrane, release of ATP and HMGB1 in the supernatant, suggesting that hypotonia would entail immunogenic death and an immune system response during this IPEC modeling.Finally, we have been able to demonstrate in vivo that the treatment of intraperitoneal metastases of Balb/c mice by an intraperitoneal injection of oxaliplatin in hypotonia slowed down tumor nodules appearance and increased survival of the mice.Thus, in this work we highlighted that hypotonia is one of the fundamental parameters of IPEC which suggests that its use could make it possible to increase the efficacy of IPEC and maybe to prolong the survival of patients.

<p>Background:Pancreas cancer is a most aggressive malignancy. More than 80% of patients diagnosed with pancreas cancer, exhibit such advanced disease, that curative surgery is impossible. Systemic chemotherapy prolongs survival to 5-9 months. High concentrations of chemotherapeutic agents in the abdominal cavity and in the lymphatics draining the area is achieved by intraperitoneal administration. Vasopressin decreases splanchnic blood flow, reducing the intraperitoneal uptake of drugs, thus raising the local and lymphatic dose intensity.</p><p>Aim: The aim of the study was to investigate the feasibility and tumour response of intraperitoneal 5-Fluorouracil (5-FU) treatment in non-resectable pancreas cancer, using vasopressin to improve the pharmacokinetic profile. Further, to study the effect of vasopressin on peritoneal blood flow, altered by intraperitoneal 5-FU or the presence of peritoneal carcinomatosis.</p><p>Methods: In the animal experiments, the 133Xe-clearance technique and as a comparison Laser doppler flow, were used to identify changes of peritoneal blood flow caused by vasopressin in unmanipulated animals and in animals with peritoneal carcinomatosis or animals given intraperitoneal 5-FU. In the clinical studies, 68 (39 women/29 men) patients, with a non-resectable ductal pancreas cancer and a Karnovsky Index ≥70 were included. Patients were treated with 750-1500 mg/m2 5-FU intraperitoneally through a Port-a-cath and Leucovorin 100 mg/m2 intravenously on two consecutive days every 21 days until progression. Seventeen patients, receiving 750 mg/m2 5-FU, were given concomitant vasopressin 0.1 IU/min during 180 minutes, alternatively day 1 or 2.</p><p>Results: In the animal experiments, vasopressin 0.07 IU/kg/min significantly reduced the 133Xe-clearance. Intraperitoneal 5-FU decreased the basal peritoneal blood flow and abrogated the vasopressin effect for 1-2 days. The presence of peritoneal carcinomatosis did not influence the basal peritoneal blood flow, nor the reduction of peritoneal blood flow caused by vasopressin. In the clinical studies, the treatment with intraperitoneal 5-FU was well tolerated, with no WHO Grade 3 or 4 toxicity with doses up to 1250 mg/m2. Thirty patients achieved at least stable disease at three months. The median survival time was 8.0 (range 0.8-54.1) months. There was a significant reduction of 5-FU Cmax on day 2, but no significant reduction of AUC, when vasopressin was given.</p><p>Conclusion: Peritoneal blood flow changes caused by vasopressin can be estimated with the 133Xe-clearance technique. Intraperitoneal 5-FU but not peritoneal carcinomatosis decreases the vasopressin induced 133Xe-clearance reduction, 1-2 days after administration. In patients with non-resectable pancreas cancer, intraperitoneal 5-FU up to 1250 mg/m2 for two days every third week can be given without WHO grade 3 and 4 toxicity. The treatment is well tolerated with few and minor side effects. Tumour responses were observed. Addition of vasopressin does not significantly enhance the pharmacokinetics of intraperitoneal 5-Flurorouracil, but adds toxicity.</p>

Background:Pancreas cancer is a most aggressive malignancy. More than 80% of patients diagnosed with pancreas cancer, exhibit such advanced disease, that curative surgery is impossible. Systemic chemotherapy prolongs survival to 5-9 months. High concentrations of chemotherapeutic agents in the abdominal cavity and in the lymphatics draining the area is achieved by intraperitoneal administration. Vasopressin decreases splanchnic blood flow, reducing the intraperitoneal uptake of drugs, thus raising the local and lymphatic dose intensity. Aim: The aim of the study was to investigate the feasibility and tumour response of intraperitoneal 5-Fluorouracil (5-FU) treatment in non-resectable pancreas cancer, using vasopressin to improve the pharmacokinetic profile. Further, to study the effect of vasopressin on peritoneal blood flow, altered by intraperitoneal 5-FU or the presence of peritoneal carcinomatosis. Methods: In the animal experiments, the 133Xe-clearance technique and as a comparison Laser doppler flow, were used to identify changes of peritoneal blood flow caused by vasopressin in unmanipulated animals and in animals with peritoneal carcinomatosis or animals given intraperitoneal 5-FU. In the clinical studies, 68 (39 women/29 men) patients, with a non-resectable ductal pancreas cancer and a Karnovsky Index ≥70 were included. Patients were treated with 750-1500 mg/m2 5-FU intraperitoneally through a Port-a-cath and Leucovorin 100 mg/m2 intravenously on two consecutive days every 21 days until progression. Seventeen patients, receiving 750 mg/m2 5-FU, were given concomitant vasopressin 0.1 IU/min during 180 minutes, alternatively day 1 or 2. Results: In the animal experiments, vasopressin 0.07 IU/kg/min significantly reduced the 133Xe-clearance. Intraperitoneal 5-FU decreased the basal peritoneal blood flow and abrogated the vasopressin effect for 1-2 days. The presence of peritoneal carcinomatosis did not influence the basal peritoneal blood flow, nor the reduction of peritoneal blood flow caused by vasopressin. In the clinical studies, the treatment with intraperitoneal 5-FU was well tolerated, with no WHO Grade 3 or 4 toxicity with doses up to 1250 mg/m2. Thirty patients achieved at least stable disease at three months. The median survival time was 8.0 (range 0.8-54.1) months. There was a significant reduction of 5-FU Cmax on day 2, but no significant reduction of AUC, when vasopressin was given. Conclusion: Peritoneal blood flow changes caused by vasopressin can be estimated with the 133Xe-clearance technique. Intraperitoneal 5-FU but not peritoneal carcinomatosis decreases the vasopressin induced 133Xe-clearance reduction, 1-2 days after administration. In patients with non-resectable pancreas cancer, intraperitoneal 5-FU up to 1250 mg/m2 for two days every third week can be given without WHO grade 3 and 4 toxicity. The treatment is well tolerated with few and minor side effects. Tumour responses were observed. Addition of vasopressin does not significantly enhance the pharmacokinetics of intraperitoneal 5-Flurorouracil, but adds toxicity.