Super high-dose intraarterial cisplatin infusion under percutaneous pelvicperfusion with extracorporeal chemofiltration for advanced uterine cervical carcinoma - II. Its impact on clinical response and subsequent surgery

The present pilot study was conducted to investigate the clinical efficacy of super high-dose intraarterial cisplatin infusion with percutaneous pelvi c perfusion under extracorporeal chemofiltration (PPPEC) for locally advanc ed uterine cervical carcinoma. Cisplatin (140 - 240 mg/m(2)) was infused in uterine arteries in a neoadjuvant setting in 20 patients under the PPPEC s ystem twice during a 2-week interval. Fourteen of 17 patients in whom reduc tion of the disease (tumor downstaging) was confirmed underwent radical sur gery. Despite the tumor downstaging, the remaining three patients had poor PS and the other three showed insufficient stage regression. Clinical respo nses, histologic responses, and surgical review were studied. The rate of o verall tumor response (complete response plus partial response), tumor down staging, overall histologic response, and radical surgery performance after the second course of PPPEC were 95.0%, 85.0%, 95.0%, and 70.0%, respective ly. Curative surgery, defined as negative carcinoma cells in surgical margi ns, was achieved in 85.7% of the cases, whereas the rate of complete surger y defined as negative carcinoma cells both in surgical margins and regional lymph nodes was 42.9%. With 42 months of median follow-up time, 3 of the 1 4 surgical patients died of the original disease, and the remaining 9 patie nts are in recurrence-free survival, whereas 2 patients are alive with dise ase. PPPEC achieved a high frequency of rapid tumor downstaging of locally advanced uterine cervical carcinoma without severe adverse effects and resu lted in the favorable performance of the subsequent radical surgery and pro gnosis.