Isolated pelvic perfusion for unresectable cancer using a balloon occlusion technique
P. S. Turk, J. F. Belliveau, J. W. Darnowski, M. C. Weinberg, L. Leenen and H. J. Wanebo
Department of Surgery, Roger Williams Medical Center, Providence, RI 02908.
Previously irradiated recurrent pelvic malignancy is refractory to most
treatment modalities. Ten patients with local recurrences (six with rectal
cancer; three, anal cancer; and one, anorectal melanoma) were treated with
a total of 17 courses of isolated pelvic perfusion chemotherapy (12 with
multiple agents) using standard hemodialysis technology. Aortic and
inferior vena caval occlusion was maintained via transfemoral balloon
catheters, with a single intraoperative balloon disruption. Mean
pelvic-systemic drug exposure ratios were 9.8:1 for fluorouracil, 4.8:1 for
cisplatin, and 4.4:1 for mitomycin C. Results were three partial responses
(two patients subsequently underwent resection) and three minor responses,
all in patients with a visible tumor. Pelvic pain was relieved in six of
eight symptomatic patients (mean duration, 4 months). Using limited access,
this procedure produces high pelvic-systemic concentration gradients,
prolonged palliation for recurrent pelvic cancers, and increased
resectability in selected patients.
