REGIONAL PERFUSION WITH HEMOFILTRATION (CHEMOFILTRATION) FOR THE TREATMENT OF PATIENTS WITH REGIONALLY ADVANCED CANCER

BACKGROUND. Regionally advanced cancer is a common, often unresolved p roblem. Effective local control with chemotherapy is limited by the to xicity following systemic administration. Chemofiltration (CF) is a fo rm of regional perfusion that enables the administration of cytotoxic drugs into one body area while limiting systemic toxicity. The drug is infused into the artery supplying the involved area. The venous efflu ent of the same organ is pumped out into a hemofiltration unit at a hi gh Bow rate. The drug is then filtered away and the blood returned to systemic circulation. METHODS. Forty-one patients underwent 45 CF. Twe nty-four patients had CF of the pelvis for advanced rectal carcinoma ( 10), malignant melanoma (6), and cancers of the uterine cervix (3), ov ary (2), vulva (1), endometrium (1), and anus (1). Seventeen patients underwent CF of the liver for metastatic colon (10), breast (4), pancr eas (1), ovary (1), and unknown primary (1) cancer. 5-fluorouracil (1 g/m2) and mitomycin-C (30 mg/m2); cisplatinum (200 mg/m2) alone or com bined with bleomycin (50 mg/m2) and mitomycin-C (20 mg/m2); or melphal an (1 mg/kg) were the combinations used. RESULTS. Generally the proced ure was well tolerated. Complications included transient leukopenia (1 8), paralytic ileus (2), hair loss (2), renal failure (1). Two patient s died within 40 days following CF. Of 36 evaluable patients, 16 (44%) had partial response, 14 (38%) had stable disease, and 6 (18%) had di sease progression. A decrease of at least 30% in carcinoembryonic anti gen levels occurred in 12 of 24 patients (50%). Median time to progres sion was 7 months. Ten of 13 patients (77%) achieved good symptomatic palliation. CONCLUSIONS. The results of CF in our study are not superi or to alternative methods of drug delivery to the liver and pelvis. Ho wever, considering that previous systemic chemotherapy had failed two- thirds of the patients, some benefit may be attributed to this regiona l delivery modality. Furthermore, pelvic CF afforded very significant symptomatic relief which was definitely superior to other methods. (C) 1996 American Cancer Society.