Pohlen U, Rieger H, Kunick-Pohlen S, Berger G, Buhr H J
Department of Surgery, University of Berlin, Charité Campus Benjamin Franklin, Berlin, Germany.
Anticancer Res. 2007 Jan-Feb;27(1B):667-74.
The aim of this study was to verify the rationale of a hypoxic abdominal perfusion (HAP) technique for the perfusion of 5-FU, mitomycin C and cisplatin in patients with inoperable, recurrent abdominal cancer.
In a phase II study, 59 patients with various non-resectable abdominal tumours were treated with 102 perfusions by the HAP-technique. The HAP-technique was performed by using double-balloon arterial-venous catheters that selectively isolated the abdominal vascular section and perfusion was provided by an extracorporal pump for 20 min. Thirty-four patients with unresectable colorectal cancer, 11 with unresectable gastric cancer, eight with unresectable pancreatic cancer and six with cancer of the gall bladder were included. They were treated with a combination of 5-fluorouracil (5-FU 1 g/m(2)), mitomycin C (MMC, 10 mg/m(2)) plus cisplatin (50 mg/m(2)) infused into the isolated abdominal compartment. The cytostatic concentration of 5-FU was determined intrainterventionally within the systemic and regional compartment. Toxicity- and procedure-related complications were documented. Tumour responses were assessed by computer tomography.
5-FU concentration was 16.3-fold higher within the regional compared to the systemic compartment at its maximum, and the area under the curve (AUC) was 7.9 times larger. During the procedure two major complications were experienced (1x perforation of the A. iliaca, lx deep vein thrombosis), no deaths occurred during surgery or in the postoperative period. Minimal systemic and local toxicities were observed (WHO grade III-IV 1%, grade I-II 33%). No complete response but 22 partial responses were observed. Median survival was 15.5 months for colorectal cancer, 12. 5 months for gastric cancer, 12.7 months for pancreatic cancer and 7.8 months for gall bladder cancer.
The hypoxic abdominal perfusion is a safe and effective palliative treatment for patients with unresectable advanced colorectal, gastric and pancreatic carcinoma. The HAP has not shown promising results for advanced gall bladder cancer. These encouraging clinical results require further evaluation.
本研究的目的是验证低氧腹腔灌注（HAP）技术用于向无法手术的复发性腹腔癌患者灌注5-氟尿嘧啶、丝裂霉素C和顺铂的合理性。
在一项II期研究中，59例患有各种不可切除腹腔肿瘤的患者接受了102次HAP技术灌注治疗。HAP技术通过使用双球囊动静脉导管进行，该导管选择性地隔离腹腔血管段，由体外泵进行20分钟的灌注。纳入了34例不可切除的结直肠癌患者、11例不可切除的胃癌患者、8例不可切除的胰腺癌患者和6例胆囊癌患者。他们接受了将5-氟尿嘧啶（5-FU 1 g/m²）、丝裂霉素C（MMC，10 mg/m²）和顺铂（50 mg/m²）联合注入隔离腹腔的治疗。在干预期间测定了全身和局部区域内5-FU的细胞毒性浓度。记录了毒性和与操作相关的并发症。通过计算机断层扫描评估肿瘤反应。
区域内5-FU浓度在最大值时比全身区域高16.3倍，曲线下面积（AUC）大7.9倍。在操作过程中发生了2例主要并发症（1例髂动脉穿孔，1例深静脉血栓形成），手术期间或术后无死亡发生。观察到最小的全身和局部毒性（世界卫生组织III-IV级1%，I-II级33%）。未观察到完全缓解，但观察到22例部分缓解。结直肠癌的中位生存期为15.5个月，胃癌为12.5个月，胰腺癌为12.7个月，胆囊癌为7.8个月。
低氧腹腔灌注对于无法切除的晚期结直肠癌、胃癌和胰腺癌患者是一种安全有效的姑息治疗方法。HAP对晚期胆囊癌未显示出有前景的结果。这些令人鼓舞的临床结果需要进一步评估。
