ORIGINAL ARTICLE   

Minerva Chirurgica 2019 August;74(4):304-12

DOI: 10.23736/S0026-4733.19.07896-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Hypoxic pelvic perfusion with cisplatin and mitomycin C in multidisciplinary palliative treatment of patients with unresectable recurrent rectal cancer: a retrospective study

Stefano GUADAGNI ¹✉, Giammaria FIORENTINI ², Paola PALUMBO ³, Francesco MASEDU ⁴, Enrico RICEVUTO ⁵, Gemma BRUERA ⁵, Marcello DERACO ⁶, Shigeki KUSAMURA ⁶, Donatella SARTI ², Caterina FIORENTINI ⁷, Sabine GAILHOFER ⁸, Marco CLEMENTI ⁹

¹ Section of General Surgery, Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy; ² Unit of Medical Oncology, Department of Oncology and Hematology, Ospedali Riuniti Marche Nord, Pesaro, Italy; ³ Laboratory of Immunopathology, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy; ⁴ Section of Biostatistics and Epidemiology, Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy; ⁵ Section of Oncology, Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy; ⁶ Unit of Peritoneal Surface Malignancies, Colon and Rectal Surgery, National Cancer Institute Foundation, Milan, Italy; ⁷ Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy; ⁸ Department of Surgical Oncology, Medias Klinikum, Burghausen, Germany; ⁹ Section of General Surgery, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy

BACKGROUND: Patients with unresectable recurrent rectal cancer that progresses after systemic chemotherapy and radiotherapy may be candidates for palliation with hypoxic pelvic perfusion (HPP). The aim of this observational retrospective study was to evaluate if a multimodality treatment including HPP and targeted-therapy may be useful to prolong clinical responses and survival of these patients.
METHODS: Thirty-seven patients with unresectable recurrent rectal cancer in progression after standard treatments underwent repeated HPP with mitomycin C (25 mg/m2) and cisplatin (70 mg/m2). Twenty patients, exhibiting epidermal growth factor receptor (EGFR) overexpression, also received cetuximab targeted-therapy, following the ultimate HPP treatment.
RESULTS: Following initial HPP treatment, median progression-free survival was 7 months (range: 5-19 months), median time-to-death or termination of follow-up was 13 months (range: 9-18 months), one-year survival-rate was 59.45%, two-year survival rate was 10.81%, and three-year survival rate was 2.7%. Survival was significantly influenced by cetuximab targeted-therapy post-HPP and the presence of additional metastatic sites (P<0.03).
CONCLUSIONS: Repeated HPP treatments with mitomycin C plus cisplatin, followed by cetuximab targeted-therapy, may represent a safe and efficacious palliative therapy in patients with unresectable recurrent rectal cancer, in progression following standard systemic chemo- and radio-therapy, and thus warrants confirmation in a larger phase III study.

KEY WORDS: Rectal neoplasms; Local neoplasms recurrence; Perfusion; Cetuximab