title: Complications and toxicity after abdominal and pelvic hypoxic stop-flow perfusion chemotherapy: incidence and assessment of risk factors.
abstract: BACKGROUND
  Controversial results regarding the efficacy and toxicity of hypoxic abdominal and pelvic stop-flow perfusion chemotherapy (SFP) have been reported in relatively small series. Hence, because adequate assessment of its benefit in large homogenous cohorts is missing, acceptable morbidity should initially be assured in a series of adequate size. Additionally, risk factors should be assessed for eventual patient selection.
  
  
  METHODS
  The morbidity of abdominal and pelvic SFP performed on a miscellaneous group of patients in our institute was analyzed and potential risk factors for adverse events were evaluated.
  
  
  RESULTS
  Seventy abdominal (n = 42) and pelvic (n = 28) SFP were performed on 55 patients. In total, 28 adverse effects were observed after 30% of the procedures. Severe (grade 3) adverse events were recorded only after 4% of the procedures, while treatment-related life-threatening events and deaths were not present. Abdominal procedures when compared with pelvic ones were associated with increased systemic toxicity (36 vs. 7%, p = 0.005). Advanced age, gender, prior chemotherapy and/or radiotherapy, limited experience, repeated procedure, drug choice and omission of hemofiltration after SFP completion were not associated with statistically significant increase of procedures with overall or systemic adverse events.
  
  
  CONCLUSIONS
  In the present series, abdominal and pelvic SFP was associated with an acceptable morbidity, which was mostly mild or moderate. Abdominal procedures were associated with increased toxicity. This procedure seems to be repeatable and also well tolerated both by elderly patients and by patients who had undergone prior chemotherapy and/or radiotherapy, while hemofiltration does not appear to decrease the incidence of systemic toxicity.
authors.affiliation: Department of Surgical Oncology, Medical School of Crete University Hospital, Herakleion, Greece. debree@edu.uoc.gr
authors.forename: Eelco
authors.initials: E
authors.lastname: de Bree
authors.forename: John
authors.initials: J
authors.lastname: Romanos
authors.forename: John
authors.initials: J
authors.lastname: Tsogkas
authors.forename: John
authors.initials: J
authors.lastname: Askoxylakis
authors.forename: Maria
authors.initials: M
authors.lastname: Metaxari
authors.forename: John
authors.initials: J
authors.lastname: Michalakis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Volakakis
authors.forename: John
authors.initials: J
authors.lastname: Melissas
authors.forename: Dimitris D
authors.initials: DD
authors.lastname: Tsiftsis
mesh_terms: D000008:Abdominal Neoplasms / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007970:Leukopenia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000009:adverse effects; D009325:Nausea / Q000209:etiology; D010386:Pelvic Neoplasms / Q000188:drug therapy*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D014839:Vomiting / Q000209:etiology; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D016685:Mitomycin; D004317:Doxorubicin; D002945:Cisplatin; D000093542:Gemcitabine