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[Antineoplastic perfusion with percutaneous stop-flow control in the treatment of advanced pelvic malignant
M De Santis1, P Ariosi, G F Calò
1Dipartimento di Scienze Mediche, Oncologiche e Radiologiche, Università, Modena e Reggio Emilia.
Purpose:
The object of our study was to apply percutaneous stop-flow technique to advanced pelvic cancer in order to evaluate its feasibility, standardize the procedure and obtain preliminary results.
Material And Methods:
April to December 1997 we submitted ten patients with advanced pelvic cancer to percutaneous stop-flow technique. Seven patients had a pelvic recurrence from carcinoma of the rectum, two patients had inoperable recto-sigmoid cancer, and another one had a local recurrence of ovarian cancer. All treatments were performed under general anesthesia. A stop-flow balloon catheter was placed via a transfemoral arterial and venous access above the aortocaval bifurcation and below the emergence of renal arteries and veins. The pelvic district was isolated by filling the balloon catheters and pneumatic cuffs at the thigh, and the antineoplastic agents (cisplatinum, 80 mg/m2 followed by mitomycin C, 30 mg/m2) were sequentially infused by means of an extracorporeal circuit. Blood flow was interrupted for a maximum of 20 min to limit tissue damage, especially of the anal sphincter. Hemofiltration was run during the last 3 min of stop-flow and in the following minutes, achieving at least 5 liters of ultrafiltration. Morphological response was evaluated by CT or MR scan performed prior to and 40 days after the treatment.
Results:
Over a 2-year follow-up 2 of our 10 patients are alive and 8/10 have died (median survival 9.6 months). Death followed tumor progression in 6 cases; one patient died during the procedure and another one after 7 days, both secondary to pulmonary embolism. Complications included intra-arterial rupture of the balloon in one case and a large inguinal hematoma 10 days after the treatment, requiring hospitalization. No patient showed positive morphological response; two patients only showed stable disease.
Conclusions:
This trial supports the feasibility of using the percutaneous stop-flow procedure in an angiography room setting; the stop-flow technique failed to permit the effective control of the tumors.