Original Articles
Copyright ©The Author(s) 2000. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 15, 2000; 6(2): 255-258
Published online Apr 15, 2000. doi: 10.3748/wjg.v6.i2.255
A study of preoperative methionine-depleting parenteral nutrition plus chemotherapy in gastric cancer patients
Wei Xin Cao, Qin Min Cheng, Xu Feng Fei, Shu Fa Li, Hao Ran Yin, Yan Zhen Lin
Wei Xin Cao, Qin Min Cheng, Xu Feng Fei, Department of Clinical Nutrition, Shanghai Digestive Surgery Institute, Rui Jin Hospital, Shanghai Second Medical University, Shanghai 200025, China;
Shu Fa Li, Hao Ran Yin, Yan Zhen Lin Department of Surgery, Shanghai Digestive Surgery Institute, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China;
Wei Xin Cao, graduated from Shanghai Second Medical University as a postgraduate in 1985, professor of surgical nutrition, majoring parenteral and enteral nutrition support, having more than 30 papers published.
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Wei Xin Cao, Department of Clinical Nutrition, Rui Jin Hospital, Shanghai Second Medical University, 197 Ruijin Er Road, Shanghai 200025, China
Telephone: +86-21-64370045 Ext.661688, Fax. +86-21-64333548
Received: October 3, 1999
Revised: November 26, 1999
Accepted: December 3, 1999
Published online: April 15, 2000
Abstract

AIM: To investigate the interference of methionine-free parenteral nutrition plus 5-Fu (MetTPN+5-Fu) in gastric cancer cell kinetics and the side effects of the regimen.

METHODS: Fifteen patients with advanced gastric cancer were randomly divided into two groups, 7 patients were given preoperatively a seven-day course of standard parenteral nutrition in combination with a five-day course of chemotherapy (sTPN+5-Fu), while the other 8 patients were given methionine-deprived parenteral nutrition and 5-Fu (MetTPN+5-Fu). Cell cycles of gastric cancer and normal mucosa were studied by flow cytometry (FCM). Blood samples were taken to measure the serum protein, methionine (Met) and cysteine (Cys) levels, and liver and kidney functions.

RESULTS: As compared with the results obtained before the treatment, the percentage of G0/G1 tumor cells increased and that of S phase decreased in the MetTPN+5-Fu group, while the contrary was observed in the sTPN+5-Fu group. Except that the ALT, AST and AKP levels were slightly increased in a few cases receiving MetTPN+5-Fu, all the other biochemical parameters were within normal limits. Serum Cys level decreased slightly after the treatment in both groups. Serum Met level of patients receiving sTPN+5-Fu was somewhat higher after treatment than that before treatment; however, no significant change occurred in the MetTPN+5-Fu group, nor operative complications in both groups.

CONCLUSION: MetTPN+5-Fu exerted a suppressive effect on cancer cell proliferation, probably through a double mechanism of creating a state of "Met starvation" adverse to the tumor cell cycle, and by allowing 5-Fu to kill specifically cells in S phase. Preoperative short-term administration of -MetTPN+5-Fu had little undesirable effect on host metabolism.

Keywords: stomach neoplasms/drug therapy; methionine; parenteral nutrition