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Objective: To investigate the effect of activated charcoal-epirubicin suspension (Epi-CH) for treatment of breast cancer and clearance of axillary lymph node metastasis., Methods: Sixty patients with breast cancer of stages II-III were randomized into Epi-CH group (n=40) receiving injection with 10 mg Epi-CH in the tissue around the primary tumor 72 h before modified radical resection and control group (n=20) with 10 mg of aqueous epirubicin injection in the same region. The dissected axillary lymph nodes and the staining lymph nodes were counted. The concentration of epirubicin in the lymph nodes was detected by high-performance liquid chorography, and the specimens of lymph nodes were observed microscopically., Results: In comparison with the control group, Epi-CH injection allowed dissection of 4.04 more lymph nodes (P<0.01) and resulted in the staining rate of the axillary lymph nodes of 86.9% (565/650). The proportion of the staining lymph nodes with diameter>1.0 cm was significantly lower than that with diameter 0.05). In Epi-CH group, the concentration of epirubicin in the stained lymph nodes was significantly higher than that in non-stained ones (443.0-/+123.1 vs 31.8-/+11.9 ng/g, P<0.01). Remarkable degeneration and necrosis could be observed microscopically in the stained lymph nodes., Conclusion: Epi-CH allows more effective treatment of breast cancer and clearance of axiliary metastasis by increasing the dissected lymph nodes and raising the concentration of epirubicin in the axillary lymph nodes.

Background & Objective: Although it is reported that lymphatic chemotherapy could raise drug concentrations in local lymph nodes and prolong survival time of patients with gastrointestinal tumors, its effect on breast cancer has not been explored. This study was to explore the impact of lymphatic chemotherapy on relapse and metastasis of breast cancer, and to investigate the mechanism., Methods: Sixty patients with breast cancer of stage II-III were randomized into 2 groups: 40 patients in Epi-CH (carbon activated absorbing epirubicin) group were injected with 10 mg of Epi-CH in the tissue around primary tumor 72 h before modified radical resection; 20 patients in control group were injected with 10 mg of aqueous epirubicin in the same region. The stained nodes full of tumor cells in Epi-CH group and non-stained nodes in control group were selected. The apoptotic index (AI) of cancer cells in metastatic axillary lymph node was calculated by TUNEL method; the expression of Fas/Fas-L proteins was examined by SP immunohistochemistry; the relapse and metastatic rate was compared., Results: The AI of cancer cells in metastatic axillary lymph node was significantly higher in Epi-CH group than in control group [(9.5+/-2.7)% vs. (3.8+/-1.4)%, P<0.01]. The expression of Fas protein was significantly higher in Epi-CH group than in control group (P<0.05), but the expression of Fas-L protein had no difference between the 2 groups (P>0.05). No chemotherapy-related local and whole body reaction occurred in both groups. The relapse and metastatic rate was significantly lower in Epi-CH group than in control group (P<0.05)., Conclusion: Preoperative Epi-CH lymphatic chemotherapy could suppress relapse and metastasis of breast cancer, which might through up-regulating expression of Fas protein and inducing apoptosis of axillary metastasis cells.

Objective: To observe the expression of Bcl-2 and Bax proteins and cell apoptosis induced by preoperative lymphatic chemotherapy with epirubicin-activated carbon suspension (Epi-CH) in the cells of axillary metastatic lymph node of breast cancer and investigate the mechanism., Methods: Sixty patients with breast cancer of stages II-III were randomly divided into two groups. Forty patients in Epi-CH group were injected with 10 mg Epi-CH in the tissue around the primary tumor or biopsy excision 72 h before operation. Twenty patients in the control group were injected with 10 mg epirubicin solution in the same region. The stained lymph nodes full of tumor cells in Epi-CH group and the non-stained nodes in the control group were selected for apoptotic detection by TUNEL method. The expression of Bcl-2 and Bax proteins were examined by SP immunohistochemistry., Results: The apoptotic index of the metastatic cancer cells in Epi-CH group was increased remarkably in comparison with that in the control group [(9.5+/-2.7) % vs (3.8+/-1.4) %, P<0.01). Compared with the control group, the expression of Bcl-2 and Bax proteins were up-regulated significantly in Epi-CH group (P<0.05 and P<0.01, respectively), resulting in decreased ratio of Bcl-2/Bax., Conclusion: Lymphatic chemotherapy can promote cell apotosis in axillary metastasis of breast cancer, which may result from decreased ratio of Bcl-2/Bax.