Super high-dose intraarterial cisplatin infusion under percutaneous pelvicperfusion with extracorporeal chemofiltration for advanced uterine cervical carcinoma - I. Analysis for pharmacokinetics, tumor response, and toxicity of platinum

The present study was designed to elucidate the clinical feasibility of a n ew intraarterial infusion system with an extracorporeal charcoal chemofiltr ation circuit, which is expected to achieve a super high-dose cisplatin pel vic perfusion with a limited systemic exposure to platinum. After inferior vena cava isolation was percutaneously achieved by balloon catheter techniq ue, cisplatin (140-240 mg/m(2)) was administered by selective intrauterine arterial infusion, with inferior and superior gluteal arterial embolization . The platinum-containing blood was pumped through an extracorporeal charco al chemofiltration circuit. Pharmacokinetics, tumor response, and toxicity of platinum under this system were studied in 14 patients with locally adva nced uterine cervical carcinoma. Extracorporeal charcoal filters significan tly (p < 0.05) reduced the prefilter area under concentration-time curve of plasma-free platinum by 86.7 +/- 5.2% at postfilter site and 76.3 +/- 6.6% at peripheral circulation, respectively. Although all adverse effects were mild under this system, tumor response and tissue platinum concentrations were augmented dose dependently with the administration of cisplatin. The e xtracorporeal chemofiltration system achieved a super high-dose cisplatin p elvic perfusion with the minimal adverse effects, allowing further cisplati n dose escalation with further augmented tumor response. This will contribu te to the reduction in the extent of disease of locally advanced uterine ce rvical carcinoma.