PELVIC PERFUSION IN THE ADJUVANT THERAPY OF LOCALLY ADVANCED RECTAL-CANCER - FEASIBILITY TRIAL AND INITIAL CLINICAL-EXPERIENCE

PURPOSE: The increased risk of pelvic recurrence in patients with loca lly advanced rectal cancer seems to justify a more aggressive regional therapeutic approach. In this attempt a feasibility study has been re cently activated on hyperthermochemotherapeutic pelvic wash in patient s with resectable, locally advanced, cancer of the distal rectum. METH ODS: Two alternative methods of hyperthermochemotherapeutic pelvic was h have been used in sequence. In the first method 3000 ml of warm (45 degrees C) saline solution containing 30 mg of mitomycin C were inject ed into the pelvis both intraoperatively and in the immediate postoper ative period. In the second method a GO-minute perfusion of the pelvic space with 2000 mi of heated (45 degrees C) saline solution with 40 m g of mitomycin C was provided intraoperatively using an extracorporeal circuit. RESULTS: Four patients submitted to abdominoperineal amputat ion with pelvic lymph node dissection have been treated following one of the two methods. No complications related to the treatment occurred . Either the first or the second hyperthermochemotherapeutic pelvic wa sh method showed a high regional pharmacokinetic advantage with a perf usate/ blood ''AUCs'' ratio of 576 and 374, respectively. CONCLUSIONS: The potential role of hyperthermochemotherapeutic pelvic wash as an a dditional regional treatment in locally advanced rectal cancer and the differences between the two methods, in our limited experience, are d iscussed.