Prophylaxis and treatment of peritoneal carcinomatosis: Intraperitoneal chemotherapy with mitomycin C bound to activated carbon particles

A novel method of prophylaxis and treatment for peritoneal carcinomatosis—mitomycin C bound to activated carbon particles (MMC-CH)—was tested in patients with advanced gastric cancer in a prospective randomized study. Activated carbon particles are taken up selectively by lymphatic tissues, which seem to be a primary site of peritoneal carcinomatosis in the peritoneal cavity, and adsorb a large amount of anticancer agent mitomycin C, which is subsequently released slowly and for a protracted period. A group of 113 patients who underwent radical resection for gastric cancer with definite serosal involvement were entered in this trial. Those in the control group received no intraperitoneal anticancer drugs. Patients in the MMC-CH group were given 50 mg mitomycin C as MMC-CH, which was dispersed throughout the peritoneal cavity just before surgical closure. No other anticancer drugs were given to these patients after surgery. The 2- and 3-year survival rates for the MMC-CH group were 42% and 38%, respectively; and the rates for the control group were 28% and 20%, respectively. The difference in survival between the two groups was significant at 2 and 3 years (p<0.05). For the survival of patients with macroscopic peritoneal carcinomatosis, there was no difference between these two groups. For the survival of patients who underwent histologically curative resection, 2- and 3-year survivals for the MMC-CH group were 66% and 66%, respectively and for the control group 35% and 20%, respectively. The difference between the two groups was statistically significant (p<0.01) at both 2 and 3 years. There was no difference in morbidity after surgery between these two groups, except a bowel (colocutaneous) fistula developed in two patients given MMC-CH. There were no operative deaths in this series.