Hyperthermic pelvic isolation-perfusion in the treatment of refractory pelvic cancer

Hyperthermic isolation-perfusion (I-P) was used to treat 27 patients with refractory pelvic cancer. All patients except one achieved pelvic isolation as manifested by selective pelvic heating and by pharmacologic monitoring. Patient response was good, with rapid pain relief in 75% and tumor control as detected by physical examination, computed tomographic scan, and decline in carcinoembryonic antigen levels. Pelvic drug exposure averaged 7.8 times that of systemic drug exposure. Of the 20 patients with recurrent rectal adenocarcinoma, one complete response (duration, eight months), seven partial responses (average duration, greater than or equal to 10 months), four patients with stable disease (average duration, greater than or equal to 12 months), and five with disease progression were observed. Three patients could not be evaluated due to late deaths as a consequence of their disease. There were two postoperative deaths in the remaining seven patients, one due to drug toxicity and one due to probable cardiac arrhythmia. Pelvic I-P has evolved with the avoidance of laparotomy and increased drug dose. We conclude that hyperthermic I-P for pelvic cancer is a safe, effective procedure and an excellent therapeutic option for patients with persistent pelvic cancer.