PREOPERATIVE INTRAARTERIAL MITOMYCIN-C IN THE MANAGEMENT OF SIGMOID ADENOCARCINOMA - LONG-TERM RESULTS OF A PILOT-STUDY

Aims and Background: In patients undergoing potentially curative surge ry for colorectal adenocarcinoma, the presence of occult disease is th ought to be responsible for distant metastases, particularly of the li ver. During the 1980's preoperative intra-arterial chemotherapy was us ed in patients with adenocarcinoma of the sigmoid colon since it was t hought that the biological effects induced by radiation in rectal lesi ons could be induced by cytotoxic agents in sigmoid cancer which was f ound to be less sensitive to radiation. The aim of the present paper i s to report long-term results of an early pilot study on 20 patients w ith sigmoid colon adenocarcinoma treated with a 6 preoperative intra-a rterial infusion of mitomycin-C followed by curative surgery. Methods: From January 1980 to December 1986, 20 patients with adenocarcinoma o f the sigmoid colon were treated with a 6 hours preoperative intra-art erial infusion of mitomycin-C followed by potentially curative surgery (Group A). Eighteen hours prior to surgery the patients underwent sel ective arteriography of the inferior mesenteric artery through punctur e of the femoral artery at the inguinal fold. The Seldinger technique was applied and Cook BP6 catheter was used. At the end of the examinat ion, the catheter was positioned in the inferior mesenteric artery and mitomycin-C, 10 mg/m(2), was infused in 500 ml of normal saline over a 6 hours period after which the catheter was definitively removed. Wi thin 18 hours following intra-arterial mitomycin-C infusion all 20 pat ients underwent potentially curative surgery of their sigmoid adenocar cinoma. During the same period, 48 comparable sigmoid colon cancer pat ients underwent potentially curative resection alone (Group B). Result s: At 5 years overall recurrence rate was 30% and 39.6% in Group A and B patients, respectively (P = n.s.). In patients with Stage C disease , recurrence was less frequently observed in Group A (44.4%) than in G roup B (77.7%) (P = n.s.). Overall survival at 5 years was comparable in the two groups of patients (70% and 64% for Group A and B, respecti vely) and median survival was >60 months in both groups. In patients w ith Stage C lesions, there was a trend for improved survival at 5 year s in Group A patients (55%; median >60 months) compared to Group B (22 %; median 27 months) patients (P = n.s.). Conclusions: Although the di fference indicating decreased recurrences and improved survival for St age C patients treated with preoperative intra-arterial mitomycin-C we re not statistically significant, the long term results of this small pilot study are encouraging.