Revisiting the question of endolymphatic therapy

Abstract

Lymphotropic therapy was the first step in the development of endolymphatic therapy. Lymphotropic therapy was carried out by creating a subcutaneous depot of a contrast agent or injecting the drug directly into the lymph node. The next step was the introduction of the drug into the lymphatic system by a single puncture of the peripheral lymphatic vessel. After G. V. Bondar put his idea into action by making a special tool, it became possible to do long-term endolymphatic infusion.

Lymphatic catheterization is performed in a clean operating room. Catheterization of the thigh lymphatic vessels is the most common technique. A network of superficial lymphatic vessels extends from the medial edge of the sartorius muscle into the subcutaneous fat, reaching the lower superficial inguinal lymph nodes. The deep lymphatic vessels of the thigh are adjacent to the femoral vein. The use of a longitudinal or longitudinal-oblique skin incision is preferable. The benefits of this access are that lymphatic vessels can be catheterized more than once during chemotherapy and wounds heal faster because the skin is cut along the fibers instead of across them.

When comparing endolymphatic and intravenous methods of administration of platinum group chemotherapy drugs in combination with fluorouracil or methotrexate in 289 patients with T3N0-1 M0-1 ovarian cancer, the vast majority of whom had serous adenocarcinomas (85.62±2.77 and 84.93±3.17), a significantly higher frequency of complete and partial regressions was registered (59.63±3.87%) with the endolymphatic technique than with intravenous administration (32.03±4.14%).

Endolymphatic chemotherapy with fluorouracil 700–800 m g/m daily for 5 days in combination with intravenous administration of doxorubicin 40 mg/m in the treatment of patients with advanced, inoperable gastric cancer (n=33) increased overall efficacy to 39.4%±8.5% when compared to patients (n=32) who received the same drugs intravenously (12.5%±5.84%). The compared groups had significantly different median survival (35 and 19 weeks) and life expectancy (41.3±4.4 and 23.8±3.4 weeks).

The endolymphatic administration of cytostatics, which demonstrates less toxicity compared to the intravenous one, has the right to exist and the potential to further develop improved techniques of administration.