LOCAL-DELIVERY OF CHEMOTHERAPY - A SUPPLEMENT TO EXISTING CANCER TREATMENTS - A CASE FOR SURGICAL PASTES AND COATED STENTS

Local application or direct tumor injection of chemotherapeutic drugs has been proposed as a method by which local drug concentrations can b e maximized in the immediate tumor environment while systemic exposure and non-target organ toxicity is minimized. Multiple opportunities ar e available to combine local drug delivery with widely practised, exis ting medical and surgical therapies. Surgical interventions, including both open and laparoscopic procedures, allow the physician to directl y visualize and manipulate pathological tissues. Intraoperative placem ent of implantable therapeutic compounds (barriers to prevent adhesion s, sustained-release antibiotics, tissue 'glues' and hemostatic agents ) at or near the disease site is increasingly common in surgical pract ice. Less invasive therapies assisted by diagnostic imaging (fluorosco py, ultrasound, CT and MRI scanning) have made accurate needle or cath eter placement for drainage (abscesses, cysts, obstructions), injectio n (contrast media, pharmacological agents, embolic agents) and therape utic purposes (endoluminal stents, venous filters) widely practised in terventional medical procedures. This article describes a chemotherape utic polymer-based paste we have developed for application at the time of surgery to reduce local recurrence of disease at tumor resection s ites and a chemotherapeutic polymer-coated stent for use in the pallia tive management of malignant obstruction to improve the effective life span of the device (e.g. esophagal, biliary, prostate, and pulmonary d isease). Despite the growth of local therapy in other disease states, regional cytotoxic drug therapy has not been widely deployed in the ma nagement of malignancy due to a clinical bias that local therapy will have limited utility in what is considered to be a systemic disease. I n the above manner, local drug delivery could be incorporated into the rapeutic protocols designed to enhance, not replace, the efficacy of e xisting treatment options. (C) 1997 Elsevier Science B.V.