Complications and Toxicity After Abdominal and Pelvic Hypoxic Stop-Flow Perfusion Chemotherapy: Incidence and Assessment of Risk Factors

• Published in: Annals of surgical oncology Vol. 19; no. 11; pp. 3591 - 3597
• Main Authors: de Bree, Eelco, Romanos, John, Tsogkas, John, Askoxylakis, John, Metaxari, Maria, Michalakis, John, Volakakis, Evangelos, Melissas, John, Tsiftsis, Dimitris D.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-10-2012; Springer Nature B.V
• Subjects: Abdominal Neoplasms - drug therapy; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Chemotherapy, Cancer, Regional Perfusion - adverse effects; Cisplatin - administration & dosage; Cisplatin - adverse effects; Deoxycytidine - administration & dosage; Deoxycytidine - adverse effects; Deoxycytidine - analogs & derivatives; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Female; Humans; Leukopenia - etiology; Male; Medicine; Medicine & Public Health; Middle Aged; Mitomycin - administration & dosage; Mitomycin - adverse effects; Nausea - etiology; Oncology; Pancreatic Tumors; Pelvic Neoplasms - drug therapy; Risk Factors; Surgery; Surgical Oncology; Surgical Wound Infection - etiology; Vomiting - etiology; Systemic Toxicity; Gemcitabine; Balloon Catheter; Isolate Limb Perfusion; Ampullary Cancer
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-012-2383-6

Background
Controversial results regarding the efficacy and toxicity of hypoxic abdominal and pelvic stop-flow perfusion chemotherapy (SFP) have been reported in relatively small series. Hence, because adequate assessment of its benefit in large homogenous cohorts is missing, acceptable morbidity should initially be assured in a series of adequate size. Additionally, risk factors should be assessed for eventual patient selection.
Methods
The morbidity of abdominal and pelvic SFP performed on a miscellaneous group of patients in our institute was analyzed and potential risk factors for adverse events were evaluated.
Results
Seventy abdominal (
n
 = 42) and pelvic (
n
 = 28) SFP were performed on 55 patients. In total, 28 adverse effects were observed after 30 % of the procedures. Severe (grade 3) adverse events were recorded only after 4 % of the procedures, while treatment-related life-threatening events and deaths were not present. Abdominal procedures when compared with pelvic ones were associated with increased systemic toxicity (36 vs. 7 %,
p
 = 0.005). Advanced age, gender, prior chemotherapy and/or radiotherapy, limited experience, repeated procedure, drug choice and omission of hemofiltration after SFP completion were not associated with statistically significant increase of procedures with overall or systemic adverse events.
Conclusions
In the present series, abdominal and pelvic SFP was associated with an acceptable morbidity, which was mostly mild or moderate. Abdominal procedures were associated with increased toxicity. This procedure seems to be repeatable and also well tolerated both by elderly patients and by patients who had undergone prior chemotherapy and/or radiotherapy, while hemofiltration does not appear to decrease the incidence of systemic toxicity.