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INTRODUCTION:
Pelvic recurrence of rectal cancer is a persisting therapeutic challenge in spite of wide spread use of adjuvant/neoadjuvant chemo radiation and wide resection isolated pelvic perfusion (IPP) may facilitate pelvic resection in selected high-risk patients.
PATIENTS:
IPP was done in 42 patients with locally advanced previously irradiated rectal cancer, 26 as a preoperative therapy and 16 for palliation. A comparative larger non-perfused group included 63 patients with pelvic resection only for recurrent rectal cancer.
METHODS:
Isolated pelvic perfusion (60 min) using pump oxygenation (Temp>41°c), Chemo agents - 5FU 1500mg/m², Cisplatin/Oxalipolatin 10 of 150mg/m², Mitomycin as 10mg/m², was done in 42 patients (67 IPP).
RESULTS Follow up surgery:
Palliative IPP in 16 advanced rectal cancer patients resulted in significant relief (1-4 months) of narcotic resistant pain (in 70%). Preoperative IPP in 26 locally advanced rectal cancer achieved a clinical path (CR) in 2 patients, and significant regression in 11 patients rendering them resectable. 7 had RO pelvic resections, of 6 other patients, 4 refused surgery, 2 were medically excluded. Median survival was 24 months in 12 resectable and 30mos in resected pts (2 pts were 5year survivors). This is compared to outcome in 63 pts amenable to having pelvic resection alone: 57% had RO resection(median OS 36 mos), 28% had R1 resection (med OS = 15 mos) and 15% had R2 resection (med OS 21 mos).
CONCLUDE:
Neoadjuvant IPP may facilitate selection of recurrent rectal cancer by identifying therapeutic responders likely to benefit from major pelvic resection and excluding non-responders most likely to benefit from non-surgical therapy.The potential to induce regression and facilitate RO resection merits further exploration