Effect of neoadjuvant pelvic perfusion on symptom control and resection of pelvic recurrent rectal cancer.

723 Background: Isolated pelvic perfusion (IPP) may improve disease control and facilitate pelvic resection in selected high-risk patients with advanced recurrent rectal cancer by reducing painful tumor burden and lessening chances of recurrence. Methods: IPP was done in 42 patients with locally advanced previously irradiated rectal cancer, 26 as preoperative therapy and 16 for palliation. A comparative larger non-perfused group included 63 patients with pelvic resection only via abdominal sacral resection (ABSR) for recurrent rectal cancer. Isolated pelvic perfusion (IPP) with a pump oxygenator, (temp > 41ºc), delivered sequential (q 10 minutes) chemotherapy:– 5FU (5fluorouracil) 1,500 mg/m2, cisplatin/oxaliplatin 100/150 mg/m2, mitomycin 10mg/m2, for 60 minutes in 42 patients. Results: Palliative IPP in 16 advanced rectal cancer patients resulted in significant relief (1–4 months) of narcotic resistant pain (in 70%). Pre-operative IPP in 26 locally advanced rectal cancer patients achieved a clinical path (CR) in 2 patients, and significant regression in 11 patients rendering them resectable. Seven had RO pelvic resections. Of 6 other patients, 4 refused surgery, 2 were medically excluded. Median survival was 30 months in 7 resected patients (all had RO resections) and 2 were 5-year survivors. This is compared to outcome in 63 patients having pelvic resection alone for recurrence: 57 % had RO resection (median OS = 36 months), 28% had R1 resection (median OS = 15 months) and 15% had R2 resection (marrow invasion) (median OS = 21 months). Conclusions: Neoadjuvant IPP may facilitate resection of advanced or (borderline resectable) recurrent rectal cancer by reducing tumor bulk and identifying therapeutic responders likely to benefit from major pelvic resection while excluding non-responders mostly likely to benefit from non-surgical therapy. The potential to induce regression and facilitate RO resection merits further exploration

Neoadjuvant pelvic perfusion may facilitate resection of pelvic recurrent rectal cancer.

e14599 Background: Pelvic recurrence of rectal cancer is a persisting therapeutic challenge in spite of wide spread use of adjuvant/neoadjuvant chemo radiation and wide resection isolated pelvic perfusion (IPP) may facilitate pelvic resection in selected high-risk patients.IPP was done in 42 patients with locally advanced previously irradiated rectal cancer, 26 as a preoperative therapy and 16 for palliation. A comparative larger non-perfused group included 63 patients with pelvic resection only for recurrent rectal cancer. Methods: Isolated pelvic perfusion (60 min) utilized pump oxygenation (Temp>41°C)with chemo agents – 5 FU 1500mg/m2, Cisplatin/Oxaliplatin 100/ 150mg/m2, Mitomycin 10-20 mg/m2, which was done in 42 patients (26 as preoperative and 16 as palliative therapy). Results: Palliative IPP in 16 advanced rectal cancer patients (pts)resulted in significant relief (1-4 months) of narcotic resistant pain (in 70%). Preoperative IPP in 26 locally advanced rectal cancer pts achieved a clinical pathologic complete response (CR) in 2 patients, and significant regression in 11 patients rendering them resectable. Seven pts had R0 pelvic resections,(6 abdominal sacral resection (ABSR) and 1 extended APR).Of 8 other patients, 3 responders refused surgery, 5 were excluded.(medical or disease related ). Median survival was 22.5 months in 15 resectable and 32 mos in 7 resected pts (2 pts were 5 year survivors). This is compared to outcome in 63 patients amenable to having pelvic resection alone: 57% had R0 resection (median OS 36 mos), 28% had R1 resection (med OS = 15 mos) and 15% had R2 resection (med OS 21 mos). Conclusions: Neoadjuvant IPP may facilitate selection of recurrent rectal cancer by identifying therapeutic responders likely to benefit from major pelvic resection and excluding non-responders most likely to benefit from non-surgical therapy. The potential to induce regression and facilitate R0 resection merits further exploration.

Isolated chemotherapeutic perfusion as neoadjuvant therapy for advanced/unresectable plevic malignancy.

e13561 Background: Isolated pelvic perfusion (IPP) may have value in therapy of recurrent pelvic malignancy following previous surgery and chemoradiation. We performed 113 IPP in 78 such pts (34 palliation, and 44 pre op) using a simplified balloon occlusion technique. Methods: Of 42 patients (pts) with recurrent rectal cancer (ca), 26 had preop and 16 had palliative IPP. Other pelvic cancers included anal canal (8 pts), pelvic sarcoma (5 pts), melanoma (M) (4 pts), endometrial ca (EC) 2 pts, ovarian ca (OC) 2 pts, and bladder ca (BC) 1 pt. Chemo agents included Paclitaxel, 5FU, cisplatinum, or Oxaliplatin and mitomycin for epithelial cancer and (Doxorubicin, Ifosamide, Phenyl Alanine Mustard (PAM) for remaining tumors. High dose IPP with PAM, Paclitaxel and Cisplatin was given in 6 pts, 3 with stem cell support. Results: Palliative IPP in advanced rectal cancer (AdRca) pts relieved narcotic resistant pain (2-4 mos) in 11/16 pts (69%). Preop IPP in 26 AdRca achieved path CR in 2 pts and partial regression in 11 pts; 7 had RO resection. Of 5 other pts, 3 refused resection, 2 were inoperable. Median survival was 17 mos in 12 resectable pts and 30 mos in 7 resected pts and 8 mos in 12 non resectable pts. It was 30 months in 8 pts with anorectal ca (1>90 mos), 20 mos in 4 endometrial/ovarian ca pts, (1 died NED >48 mos), 13 mos in 4 M pts and 5 (4-34) mos in 5 pelvic sarcoma pts. Overall 17 of 44 (39%) were resected and 24 were palliated with IPP. Conclusions: IPP has value in palliating or augmenting resectability and survival in advanced pelvic cancer patients not amenable to conventional chemoradiation and surgery.