Turk P S, Belliveau J F, Darnowski J W, Weinberg M C, Leenen L, Wanebo H J
Department of Surgery, Roger Williams Medical Center, Providence, RI 02908.
Arch Surg. 1993 May;128(5):533-8; discussion 538-9. doi: 10.1001/archsurg.1993.01420170067009.
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.
先前接受过放疗的复发性盆腔恶性肿瘤对大多数治疗方式均难有反应。10例局部复发患者（6例直肠癌；3例肛管癌；1例肛管直肠黑色素瘤）接受了总共17个疗程的单纯盆腔灌注化疗（12例使用多种药物），采用标准血液透析技术。通过经股动脉球囊导管维持腹主动脉和下腔静脉闭塞，术中进行单次球囊破裂。氟尿嘧啶的平均盆腔-全身药物暴露比为9.8:1，顺铂为4.8:1，丝裂霉素C为4.4:1。结果有3例部分缓解（2例患者随后接受了切除术）和3例轻度缓解，均见于有可见肿瘤的患者。8例有症状的患者中有6例盆腔疼痛得到缓解（平均持续时间4个月）。通过有限的通路，该手术产生了高盆腔-全身浓度梯度，延长了复发性盆腔癌的缓解期，并提高了部分患者的可切除性。
