title: Isolated pelvic perfusion for unresectable cancer using a balloon occlusion technique.
abstract: Previously irradiated recurrent pelvic malignancy is refractory to most treatment modalities. Ten patients with local recurrences (six with rectal cancer; three, anal cancer; and one, anorectal melanoma) were treated with a total of 17 courses of isolated pelvic perfusion chemotherapy (12 with multiple agents) using standard hemodialysis technology. Aortic and inferior vena caval occlusion was maintained via transfemoral balloon catheters, with a single intraoperative balloon disruption. Mean pelvic-systemic drug exposure ratios were 9.8:1 for fluorouracil, 4.8:1 for cisplatin, and 4.4:1 for mitomycin C. Results were three partial responses (two patients subsequently underwent resection) and three minor responses, all in patients with a visible tumor. Pelvic pain was relieved in six of eight symptomatic patients (mean duration, 4 months). Using limited access, this procedure produces high pelvic-systemic concentration gradients, prolonged palliation for recurrent pelvic cancers, and increased resectability in selected patients.
authors.affiliation: Department of Surgery, Roger Williams Medical Center, Providence, RI 02908.
authors.forename: P S
authors.initials: PS
authors.lastname: Turk
authors.forename: J F
authors.initials: JF
authors.lastname: Belliveau
authors.forename: J W
authors.initials: JW
authors.lastname: Darnowski
authors.forename: M C
authors.initials: MC
authors.lastname: Weinberg
authors.forename: L
authors.initials: L
authors.lastname: Leenen
authors.forename: H J
authors.initials: HJ
authors.lastname: Wanebo
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000188:drug therapy*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy; D002404:Catheterization / Q000009:adverse effects; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage / Q000097:blood; D003606:Dacarbazine / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000188:drug therapy; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000097:blood; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D010166:Palliative Care; D010388:Pelvis; D012004:Rectal Neoplasms / Q000188:drug therapy*; D012074:Remission Induction
chemical_list: D016685:Mitomycin; D003606:Dacarbazine; D002945:Cisplatin; D005472:Fluorouracil