G. Fiorentini

Pharmacokinetics of Mitomycin C in Pelvic Stopflow Infusion and Hypoxic Pelvic Perfusion with and without Hemofiltration: A Pilot Study of Patients with Recurrent Unresectable Rectal Cancer

This pilot study was conducted to evaluate the advantage in drug delivery for regional chemotherapy in patients with unresectable recurrent rectal carcinoma by different methods. For this research, the pharmacokinetic advantages of mitomycin C delivery by four different methods were compared: intraaortic infusion with aortic stopflow; intraaortic infusion with inferior vena cava stopflow; intraaortic infusion with aortic and inferior caval vein stopflow (hypoxic pelvic perfusion); and hypoxic pelvic perfusion with hemofiltration. The results of this study indicate that pelvic stopflow infusion followed by hypoxic pelvic perfusion significantly increases mitomycin C concentrations in the blood coming from the tumor site. Also, use of hemofiltration reduces mitomycin C levels in peripheral blood after high‐dose regional chemotherapy. Further investigations involving more patients should be carried out in the future to validate these results.

Intra-arterial hepatic chemoembolization in liver metastases from neuroendocrine tumors: A phase II study

Abstract Neuroendocrine tumors, particularly those of gastrointestinal tract origin, have a predisposition for metastasizing to the liver, causing parenchymal substitution and paraneoplastic syndrome. Lipiodol embolization combined with anticancer drugs is a recent tool in regional therapy. It has been proven that chemoembolization reduces tumor bulk and hormone levels, and that it palliates the symptoms of many patients with liver-dominant neuroendocrine metastases. Beginning in December 1988, ten patients with unresectable and chemotherapy-refractory liver metastatic neuroendocrine tumors were treated with chemoembolization based on a mixture of lipiodol, mitomycin, cisplatin, epirubicin, followed by gelfoam powder and contrast media. Toxicity encountered included: upper right quadrant pain requiring narcotics, elevation of lactate dehydrogenase, alkaline phosphatase, and transaminases. One patient had liver abscess and persistent fever for 2 weeks. We obtained two complete remissions lasting 12 and 34 months and 5 partial remissions. The median survival was 22 months. Four patients had urinary elevation of 5-hydroxyindolacetic acid (5-HIAA). They showed more than a 75% decrease in urinary secretion after treatment. In a patient with transplanted liver we noticed a partial response lasting 7 months. We conclude that chemoembolization will improve the clinical condition of a significant percentage of patients with liver metastases, that future therapy of carcinoid tumors will be based on specific tumor biology and that treatment will be customized for each individual patient combining the use of cytoreductive procedures including radiofrequency ablation, laser treatment and chemoembolization.

Future Perspectives of Interstitial and Perfusional Hyperthermia

Recent developments in thermal ablation and perfusion hyperthermia have expanded the treatment options of patients with certain cancers. Initially thermal ablation was applied to liver tumor; later its application has been extended to focal malignancies confined in other organs such as: breast, kidney, adrenal glands, pancreas, bone, and lung. Metastases to localized organs, such as liver, lung, and pleura are a common event. The inoperable tumors (primary or metastatic) are generally treated by systemic chemotherapy; however toxicity is very high. Some clinicians have developed regional therapies to reduce this toxicity. Perfusional therapy permits a higher concentration of antineoplastic agents in the tumor target. Furthermore the combination of hyperthermia with appropriate antineoplastic agents has demonstrated enhancement of the single therapy and reduction of toxicity. Lung, pleura and liver perfusion in combination with hyperthermia, will briefly be described here. This review is not exhaustive; its purpose is to illustrate the applications that we hope will become routine in cancer therapy in the near future.