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Treatment of Abdominal Malignant Neoplasms Using Regional Chemotherapy With Hemofiltration

Treatment of Abdominal Malignant Neoplasms Using Regional Chemotherapy With Hemofiltration Abstract • The regional delivery of high-dose chemotherapy for malignant neoplasms of the limb with the isolated regional perfusion technique was first described in the late 1950s. Recently, the use of concomitant hemofiltration for rapid systemic drug removal permits the use of higher regional drug levels in treating patients with advanced abdominal malignant neoplasms without complete vascular isolation. Twenty-five patients successfully underwent 42 treatments of high-dose intra-arterial chemotherapy with concomitant hemofiltration at Tulane University Medical Center Hospital, New Orleans, La, from 1989 through 1990. One patient (4%) achieved a complete response. Two patients (8%) had partial responses following high-dose intra-arterial chemotherapy with concomitant hemofiltration and their residual disease was resected for cure. Seven patients (28%) achieved a partial response, 11 (44%) had stable disease, and four (16%) had progression of disease. (Arch Surg. 1991;126:1390-1396) References 1. Dedrick RL, Oldfield EH, Collins JM. Arterial drug infusion with extracorporeal removal, I: theoretical basis with particular reference to the brain . Cancer Treat Rep . 1984;68:373-380. 2. Molina R, Fabian C, Cowley B. Use of charcoal hemoperfusion with sequential hemodialysis to reduce serum methotrexate levels in patients with acute renal insufficiency . Am J Med . 1987;82:350-352.Crossref 3. Relling MV, Stapleton FB, Ochs J, et al. Removal of methotrexate by combined hemodialysis and hemoperfusion . Cancer . 1988;62:884-888.Crossref 4. Winchester JF. Active methods for detoxification: oral sorbents, forced diuresis, hemoperfusion and hemodialysis . In: Haddad LM, Winchester JF, eds. Clinical Management of Poisoning and Drug Overdose . Philadelphia, Pa: WB Saunders Co; 1983:154-169. 5. Winchester JF, Rahman A, Tilstone WJ, et al. Will hemoperfusion be useful for cancer chemotherapeutic drug removal? Clin Toxicol . 1980;17:557-569.Crossref 6. Aigner KR, Muller H, Walther H, Link KH. Drug filtration in high-dose regional chemotherapy . Contr Oncol . 1988; 29:261-280. 7. Muchmore JH, Preslan J, Meyer M, et al. Pharmacokinetics of high-dose intra-arterial chemotherapy with concomitant hemofiltration (HICCH) . Proc Annu Meet Am Assoc Cancer Res . 1989;30:A1138. 8. Muchmore JH, Krementz ET, Carter RD, Meyer GM, Preslan J, George WJ. Management of advanced intra-abdominal malignancy using high-dose intra-arterial chemotherapy with concomitant hemofiltration . Reg Cancer Treat . 1990;3:211-215. 9. Krementz ET. Regional perfusion: current sophistication, what next? Cancer . 1986;57:416-432.Crossref 10. Muchmore JH, Carter RD, Krementz ET. Regional perfusion for malignant melanoma and soft tissue sarcoma: a review . Cancer Invest . 1985;3:129-143.Crossref 11. Link KH, Aigner KR, Kuehn W, Schwemmle K, Kern DH. Prospective correlative chemosensitivity testing in high-dose intraarterial chemotherapy for liver metastases . Cancer Res . 1986;46:4837-4840. 12. Schroy PC III, Cohen A, Winawer SJ, Friedman EA. New chemotherapeutic drug sensitivity assay for colon carcinomas in monolayer culture . Cancer Res . 1988;48:3236-3244. 13. Ratantharathorn V, Karanes C, Franklin R, et al. Highdose mitomycin C and autologous bone marrow infusion in refractory malignancies . In: Ogawa M, Rozencwig M, Staquet MJ, eds. Mitomycin C: Current Impact on Cancer Chemotherapy . Princeton, NJ: Excerpta Medica; 1982:176-188. 14. Bartlett RH, Bosch J, Geronemus R, Paganini E, Ronco C, Swartz R. Continuous arteriovenous hemofiltration for acute renal failure . Trans Am Soc Artif Intern Organs . 1988;34:67-77. 15. Stephens FO, Adams BG, Crea P. Intra-arterial chemotherapy given preoperatively in the management of carcinoma of the stomach . Surg Gynecol Obstet . 1986;162:370-374. 16. Kemeny N, Daly J, Reichman B, Geller N, Botet J, Oderman P. Intrahepatic or systemic infusion of fluorodeoxyuridine in patients with liver metastases from colorectal carcinoma . Ann Intern Med . 1987;107:459-465.Crossref 17. Stewart DJ. Pros and cons of intra-arterial chemotherapy . Oncology . 1989;3:20-26. 18. Muller H, Aigner KR, Walter H. Isolated pelvic perfusion for nonresectable pelvic tumors: a pilot study . Reg Cancer Treat . 1989;2:92-97. 19. De Brauw LM. Isolated Liver Perfusion: An Experimental Modality in the Treatment of Hepatic Metastases. Leiden, Holland: University of Leiden; 1989. Thesis. 20. Aigner KR, Walther H, Link KH. Isolated liver perfusion with MMC/5-FU: surgical technique, pharmacokinetics, clinical results . Contr Oncol . 1988;29:229-246. 21. Chaudhuri PK, Arredondo MA, Crist KA, Thomford NR. Method of isolated perfusion of pancreas-duodenum in humans . Reg Cancer Treat . 1990;3:7-9. 22. Van Heerden JA, Mcllrath DC, Ilstrup DM, Weiland LH. Total pancreatectomy for ductal adenocarcinoma of the pancreas: an update . World J Surg . 1988;12:658-662.Crossref 23. van Putten LM, Sluijter EA, Smink T, Mulder JH. Why do colon tumours respond poorly to chemotherapeutic agents? Recent Results Cancer Res . 1981;79:10-18. 24. Daly JM, Williams NN, Torosian MH. Hepatic regional chemotherapy . In: Lokich JJ, ed. Cancer Chemotherapy by Infusion . Chicago, Ill: Precept Press Inc; 1990:587-598. 25. Ensminger WD, Gyves JW. Clinical pharmacology of hepatic arterial chemotherapy . Semin Oncol . 1983;10:176-182. 26. Khayat D, Bastian G, Bodin L, et al. Preliminary report of a phase I/pharmacokinetic study of high-dose hepatic arterial chemotherapy (HIAC) with extracorporeal cavo-auricular hemofiltration. Berchtesgaden, Germany: Abstracts International Conference on Advances in Regional Cancer Treatment; 1989;L47:124. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Treatment of Abdominal Malignant Neoplasms Using Regional Chemotherapy With Hemofiltration

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1991.01410350080012
Publisher site
See Article on Publisher Site

Abstract

Abstract • The regional delivery of high-dose chemotherapy for malignant neoplasms of the limb with the isolated regional perfusion technique was first described in the late 1950s. Recently, the use of concomitant hemofiltration for rapid systemic drug removal permits the use of higher regional drug levels in treating patients with advanced abdominal malignant neoplasms without complete vascular isolation. Twenty-five patients successfully underwent 42 treatments of high-dose intra-arterial chemotherapy with concomitant hemofiltration at Tulane University Medical Center Hospital, New Orleans, La, from 1989 through 1990. One patient (4%) achieved a complete response. Two patients (8%) had partial responses following high-dose intra-arterial chemotherapy with concomitant hemofiltration and their residual disease was resected for cure. Seven patients (28%) achieved a partial response, 11 (44%) had stable disease, and four (16%) had progression of disease. (Arch Surg. 1991;126:1390-1396) References 1. Dedrick RL, Oldfield EH, Collins JM. Arterial drug infusion with extracorporeal removal, I: theoretical basis with particular reference to the brain . Cancer Treat Rep . 1984;68:373-380. 2. Molina R, Fabian C, Cowley B. Use of charcoal hemoperfusion with sequential hemodialysis to reduce serum methotrexate levels in patients with acute renal insufficiency . Am J Med . 1987;82:350-352.Crossref 3. Relling MV, Stapleton FB, Ochs J, et al. Removal of methotrexate by combined hemodialysis and hemoperfusion . Cancer . 1988;62:884-888.Crossref 4. Winchester JF. Active methods for detoxification: oral sorbents, forced diuresis, hemoperfusion and hemodialysis . In: Haddad LM, Winchester JF, eds. Clinical Management of Poisoning and Drug Overdose . Philadelphia, Pa: WB Saunders Co; 1983:154-169. 5. Winchester JF, Rahman A, Tilstone WJ, et al. Will hemoperfusion be useful for cancer chemotherapeutic drug removal? Clin Toxicol . 1980;17:557-569.Crossref 6. Aigner KR, Muller H, Walther H, Link KH. Drug filtration in high-dose regional chemotherapy . Contr Oncol . 1988; 29:261-280. 7. Muchmore JH, Preslan J, Meyer M, et al. Pharmacokinetics of high-dose intra-arterial chemotherapy with concomitant hemofiltration (HICCH) . Proc Annu Meet Am Assoc Cancer Res . 1989;30:A1138. 8. Muchmore JH, Krementz ET, Carter RD, Meyer GM, Preslan J, George WJ. Management of advanced intra-abdominal malignancy using high-dose intra-arterial chemotherapy with concomitant hemofiltration . Reg Cancer Treat . 1990;3:211-215. 9. Krementz ET. Regional perfusion: current sophistication, what next? Cancer . 1986;57:416-432.Crossref 10. Muchmore JH, Carter RD, Krementz ET. Regional perfusion for malignant melanoma and soft tissue sarcoma: a review . Cancer Invest . 1985;3:129-143.Crossref 11. Link KH, Aigner KR, Kuehn W, Schwemmle K, Kern DH. Prospective correlative chemosensitivity testing in high-dose intraarterial chemotherapy for liver metastases . Cancer Res . 1986;46:4837-4840. 12. Schroy PC III, Cohen A, Winawer SJ, Friedman EA. New chemotherapeutic drug sensitivity assay for colon carcinomas in monolayer culture . Cancer Res . 1988;48:3236-3244. 13. Ratantharathorn V, Karanes C, Franklin R, et al. Highdose mitomycin C and autologous bone marrow infusion in refractory malignancies . In: Ogawa M, Rozencwig M, Staquet MJ, eds. Mitomycin C: Current Impact on Cancer Chemotherapy . Princeton, NJ: Excerpta Medica; 1982:176-188. 14. Bartlett RH, Bosch J, Geronemus R, Paganini E, Ronco C, Swartz R. Continuous arteriovenous hemofiltration for acute renal failure . Trans Am Soc Artif Intern Organs . 1988;34:67-77. 15. Stephens FO, Adams BG, Crea P. Intra-arterial chemotherapy given preoperatively in the management of carcinoma of the stomach . Surg Gynecol Obstet . 1986;162:370-374. 16. Kemeny N, Daly J, Reichman B, Geller N, Botet J, Oderman P. Intrahepatic or systemic infusion of fluorodeoxyuridine in patients with liver metastases from colorectal carcinoma . Ann Intern Med . 1987;107:459-465.Crossref 17. Stewart DJ. Pros and cons of intra-arterial chemotherapy . Oncology . 1989;3:20-26. 18. Muller H, Aigner KR, Walter H. Isolated pelvic perfusion for nonresectable pelvic tumors: a pilot study . Reg Cancer Treat . 1989;2:92-97. 19. De Brauw LM. Isolated Liver Perfusion: An Experimental Modality in the Treatment of Hepatic Metastases. Leiden, Holland: University of Leiden; 1989. Thesis. 20. Aigner KR, Walther H, Link KH. Isolated liver perfusion with MMC/5-FU: surgical technique, pharmacokinetics, clinical results . Contr Oncol . 1988;29:229-246. 21. Chaudhuri PK, Arredondo MA, Crist KA, Thomford NR. Method of isolated perfusion of pancreas-duodenum in humans . Reg Cancer Treat . 1990;3:7-9. 22. Van Heerden JA, Mcllrath DC, Ilstrup DM, Weiland LH. Total pancreatectomy for ductal adenocarcinoma of the pancreas: an update . World J Surg . 1988;12:658-662.Crossref 23. van Putten LM, Sluijter EA, Smink T, Mulder JH. Why do colon tumours respond poorly to chemotherapeutic agents? Recent Results Cancer Res . 1981;79:10-18. 24. Daly JM, Williams NN, Torosian MH. Hepatic regional chemotherapy . In: Lokich JJ, ed. Cancer Chemotherapy by Infusion . Chicago, Ill: Precept Press Inc; 1990:587-598. 25. Ensminger WD, Gyves JW. Clinical pharmacology of hepatic arterial chemotherapy . Semin Oncol . 1983;10:176-182. 26. Khayat D, Bastian G, Bodin L, et al. Preliminary report of a phase I/pharmacokinetic study of high-dose hepatic arterial chemotherapy (HIAC) with extracorporeal cavo-auricular hemofiltration. Berchtesgaden, Germany: Abstracts International Conference on Advances in Regional Cancer Treatment; 1989;L47:124.

Journal

Archives of SurgeryAmerican Medical Association

Published: Nov 1, 1991

References