Wang Han, Tang Xiaodong, Xie Lu, Dong Sen, Chen Chen, Guo Wei
Musculoskeletal Tumor Centre, Peking University People's Hospital, Beijing, China.
Department of Radiology, Peking University People's Hospital, Beijing, China.
Orthop Surg. 2020 Jun;12(3):741-748. doi: 10.1111/os.12666. Epub 2020 Apr 3.
To preliminarily study the efficacy and safety of stop-flow pelvic chemoperfusion, a novel therapeutic strategy for treating pelvic malignancies.
Stop-flow chemoperfusion was performed six times in 5 patients with primary pelvic malignancies. Aortic and vena cave balloons and tourniquets were used to isolate pelvic blood flow from systemic circulation. Cisplatin was then perfused through a transarterial catheter to achieve exposure to a higher drug concentration. Pelvic and peripheral blood samples were collected to determine drug concentration during perfusion. The efficacy of stop-flow pelvic perfusion was assessed by measuring the change in tumor size, the visual analogue scale, and the tumor necrosis rate after perfusion. Safety was assessed by classifying adverse events according to CTCAE v4.03.
The mean area under the curve (AUC) and maximum drug concentration in the pelvis during perfusion were 246.23 min μg/mL and 17.29 μg/mL, respectively. These measures were significantly higher than the peripheral mean AUC and maximum drug concentration of 52.08 min μg/mL and 5.14 μg/mL, respectively. All 5 patients showed stable disease in response, with changes in tumor size of -4.7%, -5.4%, +4.7%, -8.4%, and 0.0%. Among the 5 patients, 3 (60%) experienced significant pain relief after perfusion. Three patients underwent surgery, with tumor necrosis of 63%, <60%, and 93%. No severe complications were observed in this study.
Stop-flow pelvic chemoperfusion resulted in exposure to drug higher concentration with fewer serious complications. These preliminary results suggest that further studies are required to comprehensively assess the therapeutic potential of stop-flow pelvic chemoperfusion in pelvic malignancies.
初步研究停止血流盆腔化疗灌注这一治疗盆腔恶性肿瘤的新策略的疗效和安全性。
对5例原发性盆腔恶性肿瘤患者进行了6次停止血流化疗灌注。使用主动脉和腔静脉球囊及止血带将盆腔血流与体循环隔离开。然后通过动脉导管灌注顺铂，以实现更高的药物浓度暴露。在灌注过程中采集盆腔和外周血样本以测定药物浓度。通过测量灌注后肿瘤大小的变化、视觉模拟评分和肿瘤坏死率来评估停止血流盆腔灌注的疗效。根据CTCAE v4.03对不良事件进行分类来评估安全性。
灌注期间盆腔的平均曲线下面积（AUC）和最大药物浓度分别为246.23分钟·微克/毫升和17.29微克/毫升。这些指标显著高于外周平均AUC和最大药物浓度，外周平均AUC和最大药物浓度分别为52.08分钟·微克/毫升和5.14微克/毫升。所有5例患者病情均稳定，肿瘤大小变化分别为-4.7%、-5.4%、+4.7%、-8.4%和0.0%。5例患者中，3例（60%）灌注后疼痛明显缓解。3例患者接受了手术，肿瘤坏死率分别为63%、<60%和93%。本研究未观察到严重并发症。
停止血流盆腔化疗灌注可实现更高药物浓度暴露且严重并发症较少。这些初步结果表明，需要进一步研究以全面评估停止血流盆腔化疗灌注在盆腔恶性肿瘤中的治疗潜力。
