Isolated chemotherapeutic perfusion of the pelvis for advanced rectal cancer.
OBJECTIVE
Isolated pelvic perfusion exposes tissue to high doses of drug without the toxicity of high-dose systemic therapy and may benefit patients with advanced malignancy.


METHODS
There were 32 patients with locally advanced, previously irradiated cancer of the rectum and 5 patients with anal canal cancer. These patients underwent a total of 65 isolated pelvic perfusions using 5-Fu (1500 mg/m2) for 60 min; cisplatinum (100 mg/m2) and mitomycin (10-20 mg/m2) were added to some perfusions. Hospital stay averaged 3-5 days.


RESULTS
Palliative perfusion in 15 patients with advanced rectal cancer resulted in symptomatic relief from 1 to 4 months in 11 of 14 with pelvic pain and limited benefit in 6 patients with mass, but no pain. Pre-operative perfusion in 16 rectal cancer patients achieved a complete response (no tumour in pelvis) in 1 patient and significant tumour regression in 8 patients rendering them potentially resectable. Five were resected with clear margins. Three patients with recurrent epidermoid cancer had significant tumour regression and were resected with clear margins.


CONCLUSIONS
Isolated chemotherapeutic perfusion of the pelvis provides excellent palliation for patients with advanced or pelvic recurrence of rectal cancer or epidermoid cancer of anorectum and may potentiate resection in selected patients.
Wanebo
H J
HJ
Roger Williams Medical Center, Boston University School of Medicine, Providence, Rhode Island, USA. c.delmonico@rwmc.org
Belliveau
J
J
Begossi
G
G
Levy
A
A
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002404:Catheterization; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D008937:Mitomycins / Q000008:administration & dosage; D010166:Palliative Care; D010388:Pelvis; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
D008937:Mitomycins; D002945:Cisplatin; D005472:Fluorouracil