ISOLATED PELVIC PERFUSION FOR UNRESECTABLE CANCER USING A BALLOON OCCLUSION TECHNIQUE

Previously irradiated recurrent pelvic malignancy is refractory to mos t treatment modalities. Ten patients with local recurrences (six with rectal cancer; three, anal cancer; and one, anorectal melanoma) were t reated with a total of 17 courses of isolated pelvic perfusion chemoth erapy (12 with multiple agents) using standard hemodialysis technology . Aortic and inferior vena caval occlusion was maintained via transfem oral balloon catheters, with a single intraoperative balloon disruptio n. Mean pelvic-systemic drug exposure ratios were 9.8:1 for fluorourac il, 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 p ain was relieved in six of eight symptomatic patients (mean duration, 4 months). Using limited access, this procedure produces high pelvic-s ystemic concentration gradients, prolonged palliation for recurrent pe lvic cancers, and increased resectability in selected patients.