Hyperthermic pelvic isolation-perfusion in the treatment of refractory pelvic cancer
A. Wile and M. Smolin
Department of Surgery, University of California Irvine Medical Center, Orange 92668.
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.
