Wanebo Harold J, DiSiena Michael, Begossi Giovanni, Belliveau James, Gustafson Eric
Division of Surgical Oncology, Roger Williams Medical Center, Affiliated with Boston University, Providence, Rhode Island, USA.
Ann Surg Oncol. 2008 Apr;15(4):1107-16. doi: 10.1245/s10434-007-9652-9. Epub 2007 Dec 22.
Previously irradiated recurrent rectal cancer is a formidable patient threat with limited treatment options. Isolated pelvic perfusion (IPP) by the balloon-occlusion technique provides high-dose regional chemotherapy that may facilitate resection if appropriate or palliate pain and fungating tumor mass in the symptomatic patient. We currently report our results in 49 recurrent rectal cancer patients (26 had neoadjuvant IPP with intent to resect and 23 had IPP for palliation).
IPP was done for 1 hour with paclitaxel 30 mg/m(2), 5 fluorouracil 1500 mg/m(2), cisplatin/oxaliplatin 60-130 mg/m(2), and mitomycin C 10 to 15 mg/m(2) (the latter three achieving pelvic-to-systemic drug ratios of 6-9:1).
Neoadjuvant perfusion in 26 patients achieved a response in 14 patients (made resectable). Seven had R0 resections (clear margins), six by abdominal sacral resection (ABSR), and one by an extended APR. Of seven other patients, one had a complete pathologic response negating planned resection, one had >50% tumor regression in pelvis (but developed distant metastases), and three refused ABSR. Planned ABSR in two patients was aborted because of complicating cardiovascular issues. A variety of medical and cancer issues precluded resection in the remaining 12 of these 26 neoadjuvant patients. Within the neoadjuvant group, median survival was 24 months in the responding (made resectable) group (14 patients) and it was 8 months in the non-resectable group (12 patients), p = 0.0001. In the responding (made resectable) group, seven patients had R0 resections (median survival 26 months) and seven patients were not resected (median survival 18 months), p = 0.0198. In the IPP group for palliation, 17 of 23 patients (74%) had significant relief of pain, and other tumor-related symptoms (mean survival 11 months).
Isolated pelvic perfusion using a simplified balloon-occlusion technique has promise in palliation of or augmenting resectability of advanced rectal malignancy in patients not amenable to treatment with conventional modalities.
既往接受过放疗的复发性直肠癌对患者构成巨大威胁，治疗选择有限。通过球囊阻断技术进行的孤立盆腔灌注（IPP）可提供高剂量区域化疗，若时机合适，可能有助于切除肿瘤，或缓解有症状患者的疼痛及减轻肿瘤肿块。我们目前报告了49例复发性直肠癌患者的治疗结果（26例接受新辅助IPP以期切除肿瘤，23例接受IPP以缓解症状）。
使用紫杉醇30mg/m²、5-氟尿嘧啶1500mg/m²、顺铂/奥沙利铂60 - 130mg/m²和丝裂霉素C 10至15mg/m²进行1小时的IPP（后三种药物的盆腔与全身药物比达到6 - 9:1）。
26例患者接受新辅助灌注，14例有反应（可切除）。7例实现R0切除（切缘阴性），6例通过腹骶切除术（ABSR），1例通过扩大的腹会阴联合切除术（APR）。另外7例患者中，1例有完全病理反应，无需计划切除；1例盆腔肿瘤消退>50%（但发生远处转移）；3例拒绝ABSR。2例计划进行ABSR的患者因心血管并发症而中止手术。这26例新辅助治疗患者中的其余12例因各种医学和癌症问题无法进行切除。在新辅助治疗组中，有反应（可切除）组（14例患者）的中位生存期为24个月，不可切除组（12例患者）为8个月，p = 0.0001。在有反应（可切除）组中，7例患者实现R0切除（中位生存期26个月），7例患者未切除（中位生存期18个月），p = 0.0198。在缓解症状的IPP组中，23例患者中有17例（74%）疼痛及其他肿瘤相关症状得到显著缓解（平均生存期11个月）。
使用简化球囊阻断技术的孤立盆腔灌注有望缓解晚期直肠恶性肿瘤患者的症状或提高其可切除性，这些患者不适用于传统治疗方式。
