Harold J Wanebo1*, Giovanni Begossi2, James Belliveau1 and Eric Gustafson1
1Department of Surgical Oncology, Boston University, USA
2Alta Bates Summit Medical Center, Canada
Introduction: Previous chemo radiation (CRT) usually precludes neoadjuvant therapy for advanced pelvic malignancy. Neoadjuvant isolated pelvic perfusion (IPP) provides higher tissue drug levels with less toxicity than systemic therapy and may enhance resectability of advanced pelvic malignancy. We have performed 113 IPP in 75 such patients (pts) 59 for pre operative therapy and 16 palliative.Methods: There were 50 pts with advanced, irradiated recurrent rectal cancer (34 pre-op and 16 palliative), 8 pts had advanced anal squamous cancer (SCC), 6 pts with pelvic sarcoma; 4 pts with pelvic/perineal melanoma (MEL), and 7 other advanced cancers (endometrial (2), ovarian cancer (3), and bladder cancer (BC) 2 pts. Hyperthermic IPP for (60 minutes) utilized regimens targeted to malignancy type. High dose IPP with stem cell support was utilized in 3 advanced chemo resistant pts.Results: Neoadjuvant IPP in 26 recurrent rectal cancer pts rendered 15 potentially resectable achieving a complete path CR in 2 patients and facilitating curative pelvic resection in 7 pts. The remaining 8 pts were non-resected because of disease/medical status (5 pts) or patient refusal (3 pts). Median overall survival (OS) post IPP was 24 mos in 15 resectable pts, 30 mos in the 7 resected pts (2 survived >5 yrs) and 8 mos in 11 non-resectable pts. It was 23 and 8 mos (resected vs. non resected) months in 8 advanced SCC anal pts and 28 and 24 mo in advanced gyn cancer pts (endometrial/ ovarian), 13 mos in 4 advanced melanoma pts and was only 5 mos in 6 sarcoma pts (only 1 resectable). High dose IPP with stem cell support induced significant regression (with resection) in 2 of 3 pts with advanced chemo resistant (Endometrial/Melanoma) malignancy. Overall of 59 neoadjuvant pts, 34 (58%) responded to IPP, 21 (36%) were resected, and the remaining 25 pts (42%) were considered reasonably palliated.
Conclusion: IPP has promise in augmenting resectability (or palliating) selected patients with advanced pelvic malignancy not amenable to p or previously treated with conventional chemo RT. IPP responsive tumors included recurrent rectal and anorectal cancers, and localized gyn cancers and melanoma, whereas sarcomas were quite resistant. Biologic therapy or stem cell supports are viable future options to enhance outcome of IPP.
Pelvic malignancy as neoadjuvant therapy; Pelvic Perfusion; Neoadjuvant; Perfusion; Chemoperfusion
Wanebo HJ, Begossi G, Belliveau J, Gustafson E. Isolated Chemotherapeutic Perfusion as Neoadjuvant Therapy for Advanced/Unresectable Pelvic Malignancy. Clin Surg. 2016; 1: 1282.