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Panminerva Medica 2001 December;43(4):243-8


lingua: Inglese

Limits of aortic stop flow infusion chemotherapy in the treatment of advanced cancer

Zanon C., Goss M., Nicola F., Alabiso O., Zai S., Aymele A. G., Castagneto B. *, Grosso M. **, Mancini A. **, Gazzera C. **, Pacitti A. ***, Martina G. ***, Vaj M. °, Mattalia A. °

From the Division of Surgical Oncology ASO S. Giovanni Battista, Molinette Hospital, University of Turin, Turin, Italy *Division of Oncology S. Spirito Hospital Casale Monferrato (AL), Italy **Department of Surgical and Medical Sciences Section of Radiology University of Turin, Turin, Italy ***Division of Nephrology Molinette Hospital, University of Turin, Turin, Italy °Service of Anaesthesiology Molinette Hospital, University of Turin, Turin, Italy


Back­ground. ­Advanced and ­relapsed ­tumors ­remain a chal­leng­ing dis­ease ­with a ­poor and dis­mal prog­no­sis. Our ­choice for inop­er­able ­tumors con­sists in a per­cut­ane­ous treat­ment strat­e­gy involv­ing ­intra-arte­ri­al chem­o­ther­a­py and hemo­fil­tra­tion, ­with pre­vi­ous ­blood ­stop-­flow, ­which ­allows ­high dos­es of ­Cisplatin-cisplatinum, cis-diammine-dichloroplatinum (CDDP) and Mitomycin C (MMC) in the ­tumor-bear­ing ­area ­with min­i­mal system­ic tox­ic­ity.
Meth­ods. We ana­lyse the mor­bid­ity and mor­tal­ity asso­ciat­ed ­with ­stop-­flow in 20 ­patients ­with unre­sect­able and/or met­a­stat­ic tho­ra­co- abdom­i­nal ­tumors, non respond­ers to ­prior system­ic chem­o­ther­a­py.
­Results. In our expe­ri­ence, the ­rate of ­major ­side ­effects of the pro­ce­dure was 31% ­with a mor­tal­ity of 5%. The ­side ­effects ­were relat­ed to the radio­log­i­cal pro­ce­dure and to the chem­o­the­rap­ic treat­ment. A 74-­year-old ­patient ­died for ­acute kid­ney tox­ic­ity with­in 15 ­days ­after the pro­ce­dure. The oth­er tran­sient tox­ic­ity symp­toms record­ed ­were: nau­sea, vom­it­ing, increas­ing of crea­ti­nine lev­els, diplo­pia and appear­ance of necrot­ic ­ulcer asso­ciat­ed to chem­o­the­rap­ic ­drugs. Con­cern­ing the com­pli­ca­tions relat­ed to the radio­log­i­cal tech­nique, the ­main prob­lem was the rup­ture of the bal­loon ­stop-­flow cath­e­ter in four ­patients.
Con­clu­sions. ­Stop-­flow is a new pro­ce­dure ­that ­could devel­op in the ­future, ­thanks to the pos­sibil­ity of obtain­ing a high­er ­dose inten­sity of chem­o­the­rap­ic ­drugs in dis­tricts or ­organs affect­ed by ­advanced ­tumors, ­with ­less system­ic ­side ­effects. Unfor­tu­nate­ly, the uncer­tain ­results in ­terms of increas­ing sur­vi­val and the ­default of effec­tive devic­es are to be ­resolved for a wid­er appli­ca­tion of the pro­ce­dure.

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