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Radiotherapy is one of the three main treatments for tumors. Almost 70% of tumor patients undergo radiotherapy at different periods. Although radiotherapy can enhance the local control rate of tumors and patients' quality of life, normal tissues often show radiation damage following radiotherapy. In recent years, several studies have shown that exosomes could be biomarkers for diseases and be involved in the treatment of radiation damage. Exosomes are nanoscale vesicles containing complex miRNAs and proteins. They can regulate the inflammatory response, enhance the regeneration effect of damaged tissue, and promote the repair of damaged tissues and cells, extending their survival time. In addition, their functions are achieved by paracrine signaling. In this review, we discuss the potential of exosomes as biomarkers and introduce the impact of exosomes on radiation damage in different organs and the hematopoietic system in detail.

Purpose: A phase I/II study of intrathecal pemetrexed (IP) combined with involved-field radiotherapy (IFRT) was performed to determine feasibility, safety, and antitumor activity for leptomeningeal metastases (LM) from solid tumors. Methods: Participants first received induction IP administration, followed by concomitant radiotherapy within 3 days. The concomitant regimen consisted of IP (pemetrexed 10 mg, dexamethasone 5 mg, once per week, 4 times in 4 weeks) and IFRT (40 Gy in 20 fractions). Six participants were recruited to assess feasibility in phase I, and then 28 patients were recruited further. All patients were assessed to investigate safety, efficacy, and outcomes. Results: Between April 2018 and December 2018, 34 patients (male: 15; female: 19; median age: 56 years) were enrolled, including non-small-cell lung cancer (21), small-cell lung cancer (5), breast cancer (4), and others (4). Thirty-two patients received concurrent therapy and 25 (74%) patients completed the treatment. Major adverse events (AEs) consisted of myelosuppression, the elevation of hepatic aminotransferases, and radiculitis. Total AEs rate was 53% (18/34), including 6 (18%) patients with grade 3 and 1 (3%) with grade 4 AEs. The response rate was 68% (23/34). The median overall survival was 5.5 (0.3–16.6) months. Median neurological progression-free survival (NPFS) was 3.5 (0.3–15.2) months. Six-month NPFS rate was 47%. One-year survival rate was 21.6%. Conclusion: IP at a 10 mg dose on a schedule of 1–2 times per week presented good efficacy and safety in CSF. The concomitant regimen is an efficacious therapeutic option for LM patients with solid tumors. Trial Registration: This study (IPLM) was registered at https://register.clinicaltrials.gov [ClinicalTrials.gov identifier: NCT03507244].

Pulmonary large-cell neuroendocrine carcinoma (LCNEC) is a rare and malignant form of lung cancer with a poor prognosis for patients. The common sites of metastases are the liver, adrenal glands, bone and brain. LCNEC rarely metastasizes to the small intestine, ovaries, tonsils, mandible, vulva or spine. To the best of our knowledge, there have been no reports of leptomeningeal metastasis of LCNEC to date. The present case report describes an unusual case of leptomeningeal metastasis from pulmonary LCNEC alongside a review of the literature. Biopsies of pulmonary lesions and cervical lymph nodes confirmed the diagnosis of LCNEC in a 39-year-old male patient. At 2 months after chemotherapy, the patient began to experience hoarseness, epileptic seizures and blurred vision. Furthermore, the patient presented with radiating pain and numbness in his lower left limb. Imaging findings and cytological examination of cerebral spinal fluid supported the diagnosis of leptomeningeal metastasis. The patient's neurological symptoms were markedly alleviated following receipt of radiation and intrathecal chemotherapy. The patient survived for 4.9 months after diagnosis with leptomeningeal metastasis. To the best of our knowledge, the present case report is the first to describe leptomeningeal metastasis from pulmonary LCNEC confirmed by neuroimaging and cerebral spinal fluid cytology. It suggests that leptomeningeal metastasis does occur in this rare disease, and aggressive treatment may result in improved symptoms and possibly survival times.

BACKGROUND: To determine toxicities, maximally tolerated dose (MTD), and potential antitumor activity of intrathecal pemetrexed (IP). MATERIAL AND METHODS: Pulmonary adenocarcinoma patients with recurrent or progressive leptomeningeal metastases (LM) after intrathecal chemotherapy and other LM-related therapy were included. IP doses escalated from 10 mg to 15 mg, and even 20 mg. Protocol schema of IP was twice per week for 2 weeks (induction therapy), followed by once per week for 2–4 weeks (consolidation therapy). The primary endpoints were MTD and safety. The secondary endpoint was efficacy. Plasma and cerebrospinal fluid (CSF) samples were collected and analyzed for drug concentration. RESULTS: Nine patients (male: 3; female: 6; age: 37–71 years; median: 55) were enrolled between March 2017 and March 2018. All cases received total 50 times of IP (2–8 times, median: 6). Incidence of >grade III adverse events was 50%, including 4 cases with hematological toxicities and 2 with radiculitis. One patient received 15 mg IP dose expired due to hematological toxicities. Then protocol was revised. The dose was decreased to 10 mg. B12 and folic acid supplementation was indispensable. Three more cases were enrolled subsequently. No case showed severe hematological toxicities. Total clinical response rate was 80%. For the cohort of 10 mg dose, clinical response rate was 88%. All cases were followed up until May 1, 2018. Six cases died from cancer or related complications. No acute or subacute CNS toxicity was observed. The median overall survival was 2.5 (0.3–12) months from enrollment of this study. Pemetrexed was not cumulative in CSF. Times of plasma concentration peak were 6 h in 3 cases, 9 h in 1 case, and 12 h in 1 case after IP. CONCLUSION: Pemetrexed is suitable for intrathecal use. A dose of 10 mg shows well safety and high clinical response rate, which is worth for subsequent trials.

In this study, we examined the characteristics and aimed to increase the knowledge of clinical features of leptomeningeal metastasis (LM). The clinical data, including initial diagnosis and treatment of primary tumor, clinical manifestations, neuroimaging findings, cerebrospinal fluid (CSF) examination, were analyzed. For the patients with adenocarcinoma/breast cancer, the incidence of cranial lesions and cranial nerve paralysis was obviously higher than patients with small cell lung cancer. Whereas, the incidence of involvement of intravertebral canal was obviously lower than that of small cell lung cancer. Patients with adenocarcinoma/breast cancer showed more incidence of leptomeningeal enhancement compared to those with small cell lung cancer. Persistent severe headache was noticed in those with squamous carcinoma, and usually showed absence of abnormally LM-related neuroimaging and CSF cytological findings, which resulted in a challenge in the diagnosis of LM from squamous carcinoma. Patients with different primary tumors showed differential clinical features. Significant differences were observed in clinical features between patients with adenocarcinoma/breast cancer and small cell lung cancer. Our study contributes to the understanding of clinical characteristics of LM, and contributes to improvement of LM diagnosis in clinical practice.

The present study reports the case of a 53-year-old man with leptomeningeal metastasis from early glottic laryngeal cancer. The patient had been diagnosed with squamous cell carcinoma of the glottic larynx 9 years previously. The current symptoms included a recurring headache that had persisted for 1 month and vomiting for 1 week. A magnetic resonance imaging scan of the head revealed multiple enhancing lesions in the brain and multiple line-like enhancements in the brain fold. Computed tomography scans of the head, neck, chest and abdomen showed no nodular lesions. Cytological examination of the cerebral spinal fluid (CSF) revealed malignant cells with a scattered distribution pattern. The patient received intra-CSF methotrexate chemotherapy concurrent with whole-brain radiotherapy, which relieved the neurological symptoms. To the best of our knowledge, this is the first case of cytologically-confirmed LM from early glottic laryngeal cancer.

Low-dose ionizing radiation (LDIR) induces hormesis, exerts an adoptive effect on normal mammalian cells and stimulates cell proliferation; however, this effect is absent in cancer cells. Little is known on the molecular mechanisms underlying this differential response between normal and cancer cells. In the present study, it was demonstrated that the human prostate cancer cell line PC-3 and the normal prostate cell line RWPE-1 exhibited differential biological responses to LDIR. Through cell cycle analyses, it was demonstrated that LDIR inhibited cell growth and arrested the cell cycle at the S and G2/M phases in PC-3 cells, but not in RWPE-1 cells. Using western blotting, it was demonstrated that LDIR at 75 mGy induced the expression of ataxia-telangiectasia mutated (ATM) protein in PC-3 as well as RWPE-1 cells. However, the ATM̸p21 pathway was activated in PC-3, but not in RWPE-1 cells. Although the expression of p53 was not affected by 75 mGy LDIR in RWPE-1 cells, the ATM̸p21 pathway was activated when RWPE-1 cells lost p53 function. In addition, when using ATM inhibitors, the ATM̸p21 pathway was inactivated in both cell lines, and the LDIR-induced cell proliferation inhibition was also abolished. These findings suggested that the ATM/p21 pathway directly participated in the LDIR-induced cell proliferation inhibition in p53null type prostate tumor cells, whereas this mechanism was absent in normal prostate cells. Thus, p53 may affect cell stability following LDIR, and plays a crucial role in regulating the ATM/p21 pathway activated by LDIR.

The prognosis of glioblastoma (GBM), a major subtype of grade IV glioma, is rather poor nowadays. The efficiency of chemotherapy serving as the adjunct to radiotherapy (RT) for treating GBM is still controversial. In this study, we aim to investigate the overall survival (OS) and progression-free survival (PFS) in patients with newly diagnosed GBM received RT plus chemotherapy or with RT alone. Literatures were searched from the PubMed, Embase, and Cochrane Library between January 2001 and June 2015. Study selection was conducted based on the following criteria: randomized clinical trial (RCT) of adjuvant RT plus chemotherapy versus RT alone; studies comparing OS and/or PFS; and studies including cases medically confirmed of newly diagnosed GBM. Five RCTs (1655 patients) were eligible in this study. The meta-analysis showed a significant improvement in OS of patients treated with RT plus oral chemotherapy compared with that of RT alone (hazard ratio 0.70; 95% confidence interval, 0.56–0.88, P = .002). Adjuvant chemotherapy confers a survival benefit in patients newly diagnosed with GBM.

BACKGROUND: We hope to identify leptomeningeal metastasis (LM)-related cerebrospinal fluid (CSF) miroRNAs as potential molecular markers contributing to diagnosis of LM patients with lung adenocarcinoma. MATERIAL AND METHODS: CSF samples were collected from lung adenocarcinoma patients with LM (positive group) and non-LM patients (negative group). Meanwhile, matching CSF samples from other lung adenocarcinoma LM patients were collected before and after effective LM-related treatment. Samples were screening using Agilent Human microRNA arrays. Differentially expressed microRNAs in both of two sets as well as significantly expressed microRNAs in either one set were selected as targets. Whereafter, expression of target CSF miRNAs was determined using quantitative real-time PCR (qRT-PCR). Differential microRNAs expression was analyzed by Mann-Whitney Test. Receiver Operating Characteristic (ROC) curve analysis was used to determine sensitivity and specificity. RESULTS: Twenty samples obtained from 10 LM patients and 10 non-LM controls (5 brain metastasis from lung adenocarcinoma and 5 nonneoplastic disease) were subjected to microRNA arrays. Meanwhile, 6 couples of matching samples were subjected to microRNA arrays.The intersection of significantly differential expression, miR-7977, miR-7975 and miR-4800-5p, were significantly up-regulated in positive group, and down-regulated after effective LM-related treatment. These three microRNAs were selected as targets and subjected to qRT-PCR. Significant increase was noticed in expression of miR-7977 (P=0.001), miR-7975 (P=0.001) and miR-4800-5p (P=0.024) in newly collected samples of 17 LM cases compared with 14 non-LM controls (9 brain metastasis from lung adenocarcinoma and 5 benign brain tumor). ROC analysis indicated that area under curve for miR-7977, miR-7975 and miR-4800-5p was 0.849(P=0.001, 95%CI 0.694–1.0), 0.840(P=0.001, 95%CI 0.688–0.992), and 0.739(P=0.024, 95%CI 0.564–0.915), respectively. The cutoff value, sensitivity and specificity were 48.3, 0.824 and 0.857 for miR-7977, 29.4, 0.824 and 0.929 for miR-7975, and 44.9, 0.765 and 0.643 for miR-4800-5p, respectively. CONCLUSION: MiR-7977, miR-7975 and miR-4800-5p may serve as molecular markers for diagnosis of LM from lung adenocarcinoma.

Signal transducers and activators of transcription (STAT) family proteins transduce pivotal biological effects of various cytokines and hormones. STAT3 proteins are known to play a central role in the regulation of growth, differentiation, and survival of many types of cells. However, the function of STAT3 in myogenesis still remains largely unknown. We now provided direct evidence that STAT3 could induce myogenic differentiation and this effect might be mediated by interaction with MyoD—the essential transcription factor during myogenic differentiation. Furthermore, leukemia inhibitory factor (LIF) might be the upstream factor which activated JAK2/STAT3 pathway to stimulate muscle cell differentiation. Taken together, these results provide a molecular basis for further understanding of the muscle regeneration mechanism.

The prognosis of leptomeningeal metastasis (LM) from solid tumors is extremely poor, especially for patients with adverse prognostic factors. In this phase II clinical trial, we evaluated the efficacy and safety of intrathecal chemotherapy (IC) combined with concomitant involved‐field radiotherapy (IF‐RT) for treating LM from solid tumors with adverse prognostic factors. Fifty‐nine patients with LM from various solid tumors were enrolled between May 2010 and December 2014. Concurrent therapy consisted of concomitant IC (methotrexate 12.5–15 mg and dexamethasone 5 mg, weekly) and IF‐RT (whole brain and/or spinal canal RT, 40 Gy/20f). For patients with low Karnofsky performance status (KPS) score and radiotherapy intolerance, induction IC (1–3 times) was given before concurrent therapy. Thirty‐eight patients (64.4%) received subsequent treatments. All patients were followed up at least 6 months after LM diagnosis or until death. Primary endpoint evaluated was clinical response rate. Secondary endpoints were overall survival (OS) and safety. The pathological types included lung cancer (n = 42), breast cancer (n = 11) and others (n = 6). Median KPS score was 40 (range 20–70). Fifty‐one patients (86.4%) completed concurrent therapy. The overall response rate was 86.4% (51/59). OS ranged from 0.4 to 36.7 months (median 6.5 months), and 1‐year‐survival rate was 21.3%. Treatment‐related adverse events mainly included acute meningitis, chronic‐delayed encephalopathy, radiculitis, myelosuppression and mucositis. Twelve patients (20.3%) had grade III–V toxic reactions. We concluded that IC combined with concomitant IF‐RT, with significant efficacy and acceptable toxicity, may be an optimal therapeutic option for treatment of LM from solid tumors with adverse prognostic factors. LM, in which cancer cells spread to membranes enveloping the brain and spinal cord, is a devastating complication of solid cancers. Existing LM therapies center on IC. In this prospective clinical study, the authors combined intrathecal methotrexate with involved‐field radiotherapy in a concomitant regimen, showing that the approach can potentially improve quality of life for patients with adverse prognostic factors. Concurrent radiotherapy‐bolstered IC by contributing to prolonged remission of neurological symptoms and increasing OS. The findings suggest that the concomitant regimen could be an optimal treatment option for LM., What's new? Leptomeningeal metastasis (LM), in which cancer cells spread to membranes enveloping the brain and spinal cord, is a devastating complication of solid cancers. Existing LM therapies center on intrathecal chemotherapy (IC). In this prospective clinical study, the authors combined intrathecal methotrexate with involved‐field radiotherapy in a concomitant regimen, showing that the approach can potentially improve quality of life for patients with adverse prognostic factors. Concurrent radiotherapy bolstered IC by contributing to prolonged remission of neurological symptoms and increasing overall survival. The findings suggest that the concomitant regimen could be an optimal treatment option for LM.

// Guozi Yang 1, 2, * , Dehai Yu 1, * , Wei Li 1 , Yuguang Zhao 1 , Xue Wen 1 , Xinyue Liang 1 , Xiaoying Zhang 1 , Lei Zhou 1 , Jifan Hu 1 , Chao Niu 1 , Huimin Tian 1 , Fujun Han 1 , Xiao Chen 1 , Lihua Dong 2 , Lu Cai 1, 3 , Jiuwei Cui 1 1 Cancer Center, The First Hospital of Jilin University, Changchun 130021, China 2 Department of Radiation-Oncology, The First Hospital of Jilin University, Changchun 130021, China 3 Kosair Children’s Hospital Research Institute, Departments of Pediatrics, Radiation Oncology, Pharmacology and Toxicology, University of Louisville, Louisville, KY 40292, USA * These authors contributed equally to this work Correspondence to: Jiuwei Cui, email: cuijw@jlu.edu.cn Lu Cai, email: L0cai001@louisville.edu Keywords: low-dose radiation, normal lung cells, lung cancer cells, biological effects, ATM Received: February 03, 2016 Accepted: September 25, 2016 Published: September 30, 2016 ABSTRACT Low-dose radiation (LDR) induces hormesis and adaptive response in normal cells but not in cancer cells, suggesting its potential protection of normal tissue against damage induced by conventional radiotherapy. However, the underlying mechanisms are not well established. We addressed this in the present study by examining the role of the ataxia telangiectasia mutated (ATM) signaling pathway in response to LDR using A549 human lung adenocarcinoma cells and HBE135-E6E7 (HBE) normal lung epithelial cells. We found that LDR-activated ATM was the initiating event in hormesis and adaptive response to LDR in HBE cells. ATM activation increased the expression of CDK4/CDK6/cyclin D1 by activating the AKT/glycogen synthase kinase (GSK)-3β signaling pathway, which stimulated HBE cell proliferation. Activation of ATM/AKT/GSK-3β signaling also increased nuclear accumulation of nuclear factor erythroid 2-related factor 2, leading to increased expression of antioxidants, which mitigated cellular damage from excessive reactive oxygen species production induced by high-dose radiation. However, these effects were not observed in A549 cells. Thus, the failure to activate these pathways in A549 cells likely explains the difference between normal and cancer cells in terms of hormesis and adaptive response to LDR.

It has been generally accepted that both natural and man-made sources of ionizing radiation contribute to human exposure and consequently pose a possible risk to human health. However, accumulating evidence has shown that the biological effects of low-dose radiation (LDR) are different from those of high-dose radiation. LDR can stimulate proliferation of normal cells and activate their defense systems, while these biological effects are not observed in some cancer cell types. Although there is still no concordance on this matter, the fact that LDR has the potential to enhance the effects of cancer therapeutics and reduce the toxic side effects of anti-cancer therapy has garnered significant interest. Here, we provide an overview of the current knowledge regarding the experimental data detailing the different responses of normal and cancer tissues to LDR, the underlying mechanisms, and its significance in clinical application.

Background The ‘hot cross bun’ (HCB) sign refers to a cruciform-shaped hyperintensity within the pons found on T2-weighted magnetic resonance imaging (MRI). It is commonly associated with atrophy of the pons, cerebellum, and putamen in multiple system atrophy (MSA). In this report, we describe a rare case of the HCB sign in an adult female patient with leptomeningeal metastases of breast cancer without any signs of brain atrophy. Case presentation The patient was a 58-year-old woman diagnosed with grade 2 ductal breast carcinoma, who had undergone a right mastectomy, followed by chemotherapy treatments and chest wall radiotherapy. The tumor had metastasized to the skin, and the patient presented with vomiting, drowsiness, and intermittent episodes of confusion, slurred speech, and involuntary movements. Immunohistochemical staining demonstrated a triple-negative status of the tumor. Axial T1-weighted MRI showed a linear enhancement in the cerebellar sulcus. A diagnosis of leptomeningeal metastases of breast cancer was confirmed by detection of tumor cells in the cerebrospinal fluid. Axial T2-weighted MRI indicated a cruciform hyperintensity in the pons without any atrophy of the pons, cerebellum, or putamen. Conclusion The HCB sign can occur with leptomeningeal metastases of solid tumors, though the underlying mechanisms remain unknown.

Background The present study was designed to determine whether the Thinprep plus Papanicolaou stain (Thinprep) method is more sensitive than the Cytospin-coupled Wright-Giemsa (WG) stain (Cytospin) method in diagnosis of leptomeningeal metastasis (LM) from malignant solid tumors in cerebrospinal fluid (CSF). We also explored if the Thinprep method could be used in the differential diagnosis of the type of primary tumor cells based on the morphology of tumor cells in CSF samples. Methods The morphological features of tumor cells in fresh CSF samples were analyzed using both methods. The tumor cell detection rates were compared between the two methods. Results Using the Thinprep method, we found that each type of tumor cells in the CSF samples had specific identifiable morphological features linked to their primary cancer origins, such as adenocarcinomas originated from the lungs, breast, and stomach, and lung squamous cell carcinomas, small cell lung cancer, large-cell neuroendocrine lung cancer, hepatocellular carcinoma, and malignant melanoma. In a retrospective study with 88 LM patients, cancer cells were detected in 80 out of the 88 CSF samples. In the comparative study with 45 LM patients, the initial detection rate of the Thinprep method was significantly higher than that of the Cytospin method (73.3% vs. 57.8%, P

Recent evidence indicates that limited availability and cytotoxicity have restricted the development of natural killer (NK) cells in adoptive cellular immunotherapy (ACI). While it has been reported that low-dose ionizing radiation (LDIR) could enhance the immune response in animal studies, the influence of LDIR at the cellular level has been less well defined. In this study, the authors aim to investigate the direct effects of LDIR on NK cells and the potential mechanism, and explore the application of activation and expansion of NK cells by LDIR in ACI. The authors found that expansion and cytotoxicity of NK cells were markedly augmented by LDIR. The levels of IFN-γ and TNF-α in the supernatants of cultured NK cells were significantly increased after LDIR. Additionally, the effect of the P38 inhibitor (SB203580) significantly decreased the expanded NK cell cytotoxicity, cytokine levels, and expression levels of FasL and perforin. These findings indicate that LDIR induces a direct expansion and activation of NK cells through possibly the P38-MAPK pathway, which provides a potential mechanism for stimulation of NK cells by LDIR and a novel but simplified approach for ACI.

Background Leptomeningeal metastasis, which results from metastasis of tumors to the arachnoid and pia mater, can lead to the dissemination of tumor cells throughout the subarachnoid space via the cerebral spinal fluid, and frequently with a poor prognosis. The primary tumor in adults is most often breast cancer, lung cancer, or melanoma. Although leptomeningeal metastasis due to cholangiocarcinoma has been reported, to the best of our knowledge there is no cytologically confirmed report of leptomeningeal metastasis from hepatocellular carcinoma. Case presentation We herein report a case of leptomeningeal metastasis from hepatocellular carcinoma in a 53-year-old woman with concomitant systemic metastases to the lung, bone, brain, kidney, adrenal gland, subcutaneous tissues, and abdominal pelvis. The neurological symptoms of the patient were relieved after treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy. Conclusion To our knowledge this is the first report of leptomeningeal metastasis from hepatocellular carcinoma confirmed by cytology. Treatment with methotrexate intra-cerebral spinal fluid chemotherapy concurrent with whole brain radiotherapy was effective.

Primary central nervous system (CNS) melanoma is a type of rare and aggressive tumor that can easily spread to the leptomeninges, and in fact, leptomeningeal metastasis is one of the most serious complications in patients with this carcinoma. Prognosis is extremely poor if a CNS melanoma has metastasized, and there are no effective treatments. Here, we present a case of a 37-year-old woman who presented with horizontal diplopia and progressive headache. Magnetic resonance imaging findings were consistent with the diagnosis of melanoma. The results of cytological examination of cerebrospinal fluid (CSF) showed malignant cells characteristic of melanoma. No extracranial lesions were observed. All of the available evidence confirmed a diagnosis of leptomeningeal metastases from a primary CNS melanoma. The patient received aggressive treatment, which consisted of concurrent radiotherapy and weekly intra-CSF methotrexate (MTX) followed by adjuvant monthly intra-CSF MTX. Her survival time was 13 months after diagnosis. This case report suggests that the modality of concurrent radiotherapy and weekly intra-CSF MTX followed by adjuvant monthly intra-CSF MTX may be used as the mainstay of treatment for such patients.

The interrelationship between ionizing radiation and the immune system is complex, multifactorial, and dependent on radiation dose/quality and immune cell type. High-dose radiation usually results in immune suppression. On the contrary, low-dose radiation (LDR) modulates a variety of immune responses that have exhibited the properties of immune hormesis. Although the underlying molecular mechanism is not fully understood yet, LDR has been used clinically for the treatment of autoimmune diseases and malignant tumors. These advancements in preclinical and clinical studies suggest that LDR-mediated immune modulation is a well-orchestrated phenomenon with clinical potential. We summarize recent developments in the understanding of LDR-mediated immune modulation, with an emphasis on its potential clinical applications.

e20556 Background: The prognosis of leptomeningeal metastases (LM) from solid tumors is extremely poor, especially for patients with adverse prognostic factors. Previous studies indicate that intra...

15633 Background: Peritoneal carcinomatosis (PC) is an end-stage problem gastrointestinal and the pelvic cancers with median survival of less than 6 mon. Cytoreductive surgery (CRS) plus intraoperative peritoneal hyperthermic chemotherapy (IPHC) may improve clinical outcomes in selected pts. This study was to evaluate the safety and efficacy CRS plus IPHC using mitomycin C (MMC) and hydroxycamptothecin (HCPT) in treating PC. Methods: Eligibility criteria were: (1) pts with PC from abdominal or pelvic cancers without evidence of distant metastasis and with expected survival of over 3 mon; (2) 25–70 years old; (3) laboratory workup found no abnomalities limiting aggressive intervention; (4) pts can tolerate big surgery; and (5) written informed consent obtained. 21 pts with PC (12 from gastric cancer, 5 colorectal cancer, 2 ovarian cancer, 1 pseudomyxoma peritonei and 1 malignant mesothelioma) were treated with CRS plus IPHC using HCPT 20 mg and MMC 30 mg in 12,000 ml of normal saline at 43±0.5°C for 60∼90 ...