CHEMOTHERAPY TARGETING REGIONAL LYMPH-NODES BY GASTRIC SUBMUCOSAL INJECTION OF LIPOSOMAL ADRIAMYCIN IN PATIENTS WITH GASTRIC-CARCINOMA

We investigated the delivery of adriamycin (ADR) to the regional lymph nodes of the stomach following the gastric submucosal injection of li posomal adriamycin (Lipo-ADR) in 34 gastric carcinoma patients, as wel l as following intravenous administration of free ADR (F-ADR) in anoth er 18 patients. Prior to radical gastrectomy, Lipo-ADR was endoscopica lly injected into the gastric submucosa adjacent to the primary tumor via a needle-tipped catheter. After Lipo-ADR injection, the ADR concen tration in the primary and secondary drainage lymph nodes was higher t han in the other regional lymph nodes. Thus, the regional nodes more s usceptible to metastasis showed higher levels of ADR. In contrast, the intravenous administration of F-ADR produced a similar and far lower ADR concentration in all the nodes. Delivery of ADR to the primary dra inage lymph nodes following injection of 5 ml of Lipo-ADR was compared with delivery to the left gastric artery lymph nodes after intravenou s administration of an equal dose of F-ADR. The ADR levels (mu g/g) af ter gastric submucosal injection were 15.1 +/- 8.30 on day 1 (n = 4); and 11.9 +/- 4.80 on day 4 (n = 6). Those after intravenous administra tion were 0.29 +/- 0.10 on day 1 (n = 4); and 0.36 +/- 0.0 on day 4 (n = 2). The differences between the two groups were significant (P < 0. 05). The ADR levels after the gastric submucosal injection were far hi gher than those after intravenous administration. These findings indic ate that the gastric submucosal injection of Lipo-ADR can specifically deliver ADR to the regional lymph nodes at high concentrations. Such preoperative adjuvant chemotherapy targeting the regional lymph nodes may be useful for preventing the lymph node recurrence of gastric carc inoma.