Hypothesis: To evaluate the role of hypoxic pelvic perfusion in providing therapeutic options for palliation without relevant complications in a homogeneous group of patients with unresectable locally recurrent rectal cancer who are nonresponders or have disease progression after the standard treatments. Design: Nonrandomized and noncontrolled phase II experimental study. Setting: University hospital, L'Aquila, and the National Cancer Institute, Naples and Milan, Italy. Patients: Eleven patients had symptomatic unresectable pelvic recurrent rectal cancer. The mean ± SD product of the 2 maximum perpendicular diameters of the recurrent cancer was 24.2 ± 11.0 cm2 (range, 10-48 cm2). Tumor fixation to the pelvic side walls or proximal sacrum were the main criteria for unresectability. All patients were free from extrapelvic disease and had a life expectancy longer than 3 months. Intervention: Patients were submitted to one course of pelvic perfusion with mitomycin C (MMC) (25 mg/m2) by means of a simplified balloon occlusion technique. A pharmacokinetic evaluation of the procedure was also performed. Main Outcome Measures: Response rate and time to disease progression were the primary endpoints; overall survival was the secondary endpoint. Results: Mean ± SD value of the ratios of pelvic MMC area under the plasma concentration curve (0 to 20 minutes) (AUC0-20) to systemic MMC AUC0-20 was 13.30 ± 6.52. During the procedures there were no technical, hemodynamic, or vascular complications, and no deaths occurred during surgery or in the postoperative period. The response rate was 36.3% (95% confidence interval [CI], 6.5%-66.1%). Pain response rate was 45.4% (95% CI, 16.6%-76.2%). Median survival was 12.2 months (range, 5.7-19.5 months). Median time to disease progression was 6 months (range, 3-8 months). Two-year overall survival was 9.1%. Conclusions: Hypoxic pelvic perfusion with MMC is a safe and good palliative treatment for patients with unresectable locally recurrent rectal cancer. Further studies are necessary to establish if a different sequence in the multimodular treatment of these patients could be more useful.
|Number of pages||8|
|Journal||Archives of Surgery|
|Publication status||Published - 2001|
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