Intra-arterial chemotherapy in locally advanced or recurrent carcinomas ofthe penis and anal canal: an active treatment modality with curative potential

The prognosis of locally advanced or recurrent carcinomas of the penis (PE) and of the anal canal (AC) after conventional treatment is dismal. We repo rt 16 patients (eight with AC carcinomas and eight with PE cancers) treated by intra-arterial (IA) chemotherapy. Fifteen of them were treated for loca lly advanced or recurrent disease and one in an adjuvant setting. The chemo therapy was administered via a femoral IA catheter with its tip located abo ve the aortic bifurcation, under the inferior mesenteric artery. It consist ed of eight push injections, given over a 48-h period, of the following dru g combination: cisplatin 8.5 mg m(-2), 5-FU 275 mg m(-2), methotrexate 27.5 mg m-2, mitomycin C 1.2 mg m(-2), and bleomycin 4 mg m(-2). Leucovorin was given pc, 4 x 15 mg day(-1), during the chemotherapy and for 3 days therea fter. A total of 52 cycles of treatment were administered. Of the 15 patien ts evaluable for response, six obtained a CR (three PE, three AC) and eight a PR. Among the complete responders, four are alive and disease-free 2-15 years after treatment. The other patients enjoyed an objective response las ting 3-25 months (median 7 months). Four patients developed grade III/IV ha ematological toxicity with three episodes of febrile neutropenia, one of th em with a fatal outcome due to patient's failure to obtain medical attentio n at the onset of his fever, one a grade III mucositis of the glans, and fo ur a grade III/IV cutaneous toxicity, the latter caused by the IA administr ation of bleomycin. In conclusion, IA chemotherapy is effective and potenti ally curative in locoregionally advanced or recurrent carcinomas of the pen is and of the anus. Its contribution in the primary management of advanced penile or anal carcinoma should be prospectively investigated. (C) 2000 Can cer Research Campaign.