Unresectable and locally recurrent rectal cancer treated with radiotherapy or bilateral internal iliac artery infusion of 5-fluorouracil

Abstract

Seventy-nine patients with histopathologically verified unresectable or locally recurrent rectal cancer were nonrandomly allocated to radiotherapy or regional intra-arterial infusion of 5-Fluorouracil (5-FU). Fifteen patients with unresectable and 32 with locally recurrent rectal cancer were subjected to radiotherapy. The absorbed dose was 30 Gy in patients with an unresectable tumor and 45 Gy in patients with locally recurrent rectal cancer. Six patients with unresectable and 26 with locally recurrent rectal cancer received bilateral internal iliac artery infusion of 5-FU in a median dose of 7.5 g. There was no difference in survival between the two methods of treatment. Resection of an initially unresectable tumor could be performed in 5 of 21 patients (4 after radiotherapy and 1 after chemotherapy). All except eight patients had pelvic or perineal pain before treatment. Forty of 43 (93%) patients reported pain relief after radiotherapy and 21 of 28 (75%) after infusion therapy. Ten nonresponders were subjected to alternative treatment (three to intra-arterial infusion and seven to radiotherapy). Five of these ten patients reported complete pain relief and five partial pain relief. After radiotherapy, no significant side effects or complications were observed. The infusion chemotherapy was the cause of death in one patient. In summary, similar palliation was achieved with bilateral iliac artery 5-FU-infusion and radiotherapy. Owing to the complications registered with infusion therapy, radiotherapy must be considered the treatment of choice for these patients. Patients who do not respond to radiotherapy or suffer recurrence of pelvic and perineal pain may receive further palliation from intra-arterial infusion.

Palliative pelvic radiotherapy of symptomatic incurable rectal cancer – a systematic review

“…Four prospective studies were included. Of these, two were randomized controlled trials in which the population given palliative pelvic radiotherapy served as the control group [15,16], one was non-randomized [17], and one was an observational study including patients assessed both prospectively and retrospectively, but given similar treatments [18]. The remaining 23 studies were retrospective chart reviews.…”

“…Two studies classified responders as having “complete regression of symptoms” [23,32] while two others specified best symptomatic response [16,26]. With the exception of one study [17], it remained unclear whether results reflected the best response observed during the follow-up period or the response measured at a certain time point. One study used a grading scale classifying response according to duration of palliation of symptoms rather than the degree to which the symptoms were relieved [33].…”

“…The three prospective studies reported duration of symptomatic improvement ranging from one month to more than 44 months across a range of doses from 30 to 50 Gy [15,17,18]. Over half of the retrospective studies reported responses lasting well over one year.…”

Clinical Efficacy of Chemotherapy Combined with Verapamil in Metastatic Colorectal Patients

“…Although treatment for colorectal carcinoma has improved, the recurrent metastasis rate is 30-60% after complete resection of the primary tumor [2]. The five-year survival rate in patients with recurrent metastasis is around 10% and the prognosis is very poor [3,4]. Recently, instead of solely utilizing surgery to remove the tumor, comprehensive, multidisciplinary treatments, in particular, surgery combined with interventional therapies have had promising results in recurrent metastatic carcinoma [5].…”

Isolated chemotherapeutic perfusion of the pelvis for advanced rectal cancer

“…Regional chemotherapy for pelvic tumours by isolated regional perfusion has been used by a variety of authors [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] since the initial description of regional perfusion by Creech 1959 [17]. Major interest developed in the 1960s when intravascular balloon catheters were utilized for the isolation of the pelvic bed during pump oxygenation perfusion of cancer chemotherapy [3].…”