Intra-abdominal fibrosis after systemic and intraperitoneal therapy containing fluoropyrimidines

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.