Korean J Gastroenterol.  2022 Dec;80(6):273-280. 10.4166/kjg.2022.099.

A Pilot Study of Peritumor Administration of 5-FU for Preventing Bleeding in Advanced Gastric Cancer

• Kim NH
• Park JH
• Koo DH
• Jung YS
• Yang JY
• Lee HY

• KMID: 2537099
• DOI: http://doi.org/10.4166/kjg.2022.099

Abstract

Five-FU is a potent chemotherapeutic agent for suppressing endothelial cell growth. The purpose of this study was to investigate the usefulness of local peritumor injection of 5-FU for patients with advanced gastric cancer (AGC) for the prevention of anemia. Between January 2020 and January 2022, patients aged 18 years or older with AGC and moderate anemia were included. A total of 200 mg of 5-FU was injected per session at ten points of the lesion (20 mg at each point) every 7 days for 4 to 12 weeks. Patients received a blood test for toxicity at every cycle. From one of these patients, endoscopic biopsy specimens were taken from gastric cancer before and after injecting 5-FU for immunostaining. A total of five AGC patients participated in this study. For most patients, hemoglobin levels were maintained without transfusions during 5-FU injection, and expression levels of thrombospondin-1 was increased after injection compared to those before injection. Blood test results during 5-FU injection showed no significant change in serum glutamic oxalacetic transaminase/glutamic pyruvic transaminase, total bilirubin, or creatinine level. The results of this study showed the possibility of local peritumor 5-FU injection as a treatment for relieving anemia of patients with gastric cancer.

Keyword

Stomach neoplasms; Fluorouracil; Anemia; Endoscopy; Thrombospondin 1

Figure

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  Fig. 1 Schematic of 5-FU peritumor injection. A total of 200 mg of 5-FU was injected per session at ten points of the lesion (20 mg at each point) every 7 days for 4 to 12 weeks.

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  Fig. 2 Endoscopy pictures before and 1 month after peritumor 5-FU injection. Hyperemia of gastric mucosa was significantly reduced after 5-FU injection compared to before injection.

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  Fig. 3 (A-D) Comparison of hemoglobin level and transfusion volume before, during, and after treatment for each patient. In most patients, levels of hemoglobin were maintained during 5-FU injection treatment without transfusion. *p<0.05.

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  Fig. 4 Comparison of transfusion volume before and during treatment in patients. When transfusion volumes of all patients were compared before and during treatment, a significant decrease was seen after treatment (*p<0.05).

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  Fig. 5 Immunostaining of thrombospondins 1 (TSP-1) before and after 5-FU injection and expression of TSP-1 induced by 5-FU in human gastric cancer cell line. Expression levels of TSP-1 was increased after injection compared to those before injection (A) and the expression increased significantly in proportion to the concentration of 5-FU (p<0.05, n=5; ×200). *p<0.05, n=5 (B). VEGF, vascular endothelial growth factor.

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  Fig. 6 Changes in blood test results during 5-FU injection treatments. Blood test results during 5-FU injection showed no significant change in SGOT (A)/SGPT (B), total bilirubin (C), or creatinine level (D) (p>0.05). SGOT, serum glutamic oxalacetic transaminase; SGPT, serum glutamic pyruvic transaminase; T.bil, total bilirubin.

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