Pelvic Perfusion for Advanced Colorectal Cancers

Begossi, Giovanni; Belliveau, James F.; Wanebo, Harold J.

doi:10.1016/j.soc.2008.04.014

Cited by 10 publications

(11 citation statements)

References 34 publications

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“…Slow flow perfusion was performed in order to reduce drug leakage and lower systemic toxicity, and an important relationship between flow and pressure was observed in the circuit [ 4 ]. Aortic pressure falls to 20 mmHg following occlusion and progressively increases with the flow rate.…”

Section: Discussionmentioning

confidence: 99%

“…In the 1950s [ 1 – 3 ], surgeons developed isolated pelvic perfusion (IPP), with the purpose of isolating the pelvic circulation by blocking blood-flow in the aorta and inferior vena cava with balloon catheters and at the level of the thigh with pneumatic cuffs, with the pelvic area subsequently perfused with antineoplastic drugs via extracorporeal blood circulation. Indeed, several IPP techniques have been published [ 4 ] and a subsequent pharmacokinetic study demonstrated that there is drug leakage from the pelvic compartment [ 5 ]. Improvements in procedure to reduce morbidity and side-effects include a simplified technique, called hypoxic pelvic perfusion, based on the use of two balloon catheters positioned by femoral vessel exposure [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…introducers [ 12 ]. A percutaneous approach employing two cannula sheaths was reported by Bonvalot et al [ 13 ], whereas Begossi et al [ 4 ] and more recently Murata et al [ 14 ] used four cannula sheaths (two 9-Fr. and two 6-Fr.).…”

Section: Introductionmentioning

confidence: 99%

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Surgical versus percutaneous isolated pelvic perfusion (IPP) for advanced melanoma: comparison in terms of melphalan pharmacokinetic pelvic bio-availability

et al. 2017

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BackgroundIsolated pelvic perfusion (IPP) can be used to treat unresectable melanoma metastases of the pelvis. IPP can be performed either by surgical or percutaneous approaches, using different balloon catheters. The aim of this study was to examine whether the surgical and percutaneous approaches were comparable with respect to tumor drug exposure in the pelvis.MethodsA pharmacokinetic study was performed in 5 melanoma patients treated with surgical IPP and five with percutaneous IPP. Both groups received melphalan at the dose of 30 mg/m2. Melphalan pharmacokinetic analyses were performed and the main parameter used to evaluate pelvic tumor drug-exposure was the ratio of areas under the melphalan plasma concentration curves in the pelvis and the systemic compartment, during the perfusion time (AUC0 to 20). Non-parametric Mann–Whitney tests were employed for statistical comparisons.ResultsThe median and interquartile range (IQR) values of the ratios between melphalan AUC0 to 20 in pelvic and systemic compartments were 7.9 (IQR 7.2 to 9.9) and 5 (IQR 4 to 7.9) for surgical and percutaneous IPPs, respectively (p = 0.209).ConclusionsTumor exposure to drug using these two methods did not statistically differ and both methods, therefore, can be adopted interchangeably, utilizing a perfusion blood flow rate of approximately 120 ml/min. The small sample size is a limitation of this study but our preliminary results can be used to calculate the effect size of a larger trial. Trial Registration Clinical Trials.gov Identifier NCT01920516; date of trial registration: August 6, 2013Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-017-2738-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical versus percutaneous isolated pelvic perfusion (IPP) for advanced melanoma: comparison in terms of melphalan pharmacokinetic pelvic bio-availability

et al. 2017

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“…Such localized chemotherapy regimens usually offer improved local disease control and reduced systemic toxicity, compared with conventional chemotherapy, therefore, they hold great promise for cancer patients. Other less widely used regional chemotherapies that are not reviewed in this article include administration of chemotherapeutics via pancreatic perfusion (pancreatic cancer) [112,113], celiac axis infusion (pancreatic cancer) [114,115], hypoxic abdominal stop-flow perfusion (gastric cancers) [116,117] and pelvic perfusion (advanced colorectal cancers) [118,119]. Nevertheless, the absolute superiority of some of the newer techniques relative to infusion chemotherapy remains controversial in terms of their improvement in patient survival rate.…”

Section: Future Perspectivementioning

confidence: 99%

Development of Regional Chemotherapies: feasibility, Safety and Efficacy in Clinical Use and Preclinical Studies

Cai

Bagby

Forrest³

2011

Therapeutic Delivery

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Conventional oral and intravenous chemotherapies permeate throughout the body, exposing healthy tissues to similar cytotoxic drug levels as tumors. This leads to significant dose-limiting toxicities that may prevent patients from receiving sufficient treatment to overcome cancers. Therefore, a number of locoregional drug-delivery strategies have been evaluated and implemented in preclinical studies, clinical trials and in practice, in the past decades to minimize systemic toxicities from chemotherapeutic agents and to improve treatment outcomes. Localized treatment is beneficial because many cancers, such as melanoma, peritoneal cancer and breast cancer, advance locally adjacent to the site of the primary tumors prior to their circulatory invasion. In this article, we will review the feasibility, safety and efficacy of multiple localized chemotherapies in clinical use and preclinical development.

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“…The rational for HPP is based upon the possibility to expose tumors to higher drug concentrations and enhance the cytotoxicity of some chemotherapeutic agents by introducing conditions of hypoxia (Guadagni et al 2006;Guadagni et al 2007). Non-homogeneous and non-comparable studies of HPP efficacy in URRC patients, unresponsive to systemic chemotherapy and/or radiotherapy, have reported median survival times, ranging from 10 to 20 months (Begossi et al 2008;Murata et al 2014). To improve the efficacy of locoregional HPP chemotherapy and post-HPP treatment, precision oncotherapy and chemosensitivity tests (Yoon and Kim 2014) employing tissue specimens are under investigation, in accordance with American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) recommendations (Sepulveda et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Precision oncotherapy based on liquid biopsies in multidisciplinary treatment of unresectable recurrent rectal cancer: a retrospective cohort study

Guadagni

Fiorentini

Simone

et al. 2019

J Cancer Res Clin Oncol

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Background Third line innovative systemic treatments and loco-regional chemotherapy by hypoxic pelvic perfusion (HPP) have both been proposed for the treatment of unresectable not responsive recurrent rectal cancer (URRC). In the present study, we have compared the safety and efficacy of HPP/target therapy, using drug regimens selected by liquid biopsy precision oncotherapy, to third-line systemic therapy based on tissue specimens precision oncotherapy. Methods HPP/target therapy regimens were selected based on precision oncotherapy, including assays for chemosensitivity and viability, and qRT-PCR for tumor-related gene expression. In the control group, systemic third-line and further lines of therapy were defined according to clinical and biological parameters. Results From 2007 to 2019, 62 URRC patients were enrolled, comprised of 43 patients in the HPP/target-therapy group and 19 patients in the systemic therapy control group. No HPP related complications were reported and the most common adverse events were skin and bone marrow toxicity. In the HPP/target-therapy group, the ORR was 41.8% whereas in the systemic therapy control group was 15.8%. DCR of the HPP/target-therapy group was significantly improved over the systemic therapy group (P = 0.001), associated with a PFS of 8 vs 4 months (P = 0.009), and OS of 20 vs 8 months (P = 0.046). Conclusions The present data indicate that in URCC patients, the integration of HPP/target-therapy and precision oncotherapy based upon liquid biopsy is as effective and efficacious as third-line treatment in local disease control and, therefore, deserves to be further assessed and compared to conventional systemic treatments in future prospective randomized trials.

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Pelvic Perfusion for Advanced Colorectal Cancers

Cited by 10 publications

References 34 publications

Surgical versus percutaneous isolated pelvic perfusion (IPP) for advanced melanoma: comparison in terms of melphalan pharmacokinetic pelvic bio-availability

Surgical versus percutaneous isolated pelvic perfusion (IPP) for advanced melanoma: comparison in terms of melphalan pharmacokinetic pelvic bio-availability

Development of Regional Chemotherapies: feasibility, Safety and Efficacy in Clinical Use and Preclinical Studies

Precision oncotherapy based on liquid biopsies in multidisciplinary treatment of unresectable recurrent rectal cancer: a retrospective cohort study

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