BACKGROUND. Intra-abdominal and retroperitoneal fibrosis has been described
as secondary to intraperitoneal (IP) administration of several chemotherap
eutic agents, including carboplatin, mitoxantrone, and the combination of 5
-fluorouracil and cisplatin. The IP administration of floxuridine (FUDR) is
an effective and minimally toxic treatment for patients with metastases to
the peritoneum. An increasing number of patients with colorectal, gastric,
or ovarian carcinoma are treated with IP chemotherapy.
METHODS. The authors report two patients with metastatic colon carcinoma wh
o experienced severe intra-abdominal fibrosis presenting as an intra-abdomi
nal mass mimicking recurrence in one patient and diffuse encasement of the
bowel in the other, after the administration of IP FUDR and leucovorin.
RESULTS. Two patients with Stage III colon adenocarcinoma received postoper
ative adjuvant 5-fluorouracil and levamisole. They subsequently presented w
ith a rise in carcinoembryonic antigen level and isolated liver metastasis.
They underwent hepatic lobectomy with postoperative intra-arterial hepatic
FUDR and systemic ti-fluorouracil and leucovorin. They each had an intra-a
bdominal recurrence, which was resected and treated with postoperative IP F
UDR and leucovorin. They then presented with a diffuse pattern of IP fibros
is with no tumor identified.
CONCLUSIONS, IP FUDR and leucovorin therapy can be associated with diffuse
IP fibrosis, which in this study caused an intra-abdominal mass that was in
distinguishable from recurrent malignancy in one patient and encasement of
the bowel in the other. (C) 2000 American Cancer Society.