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Palliation with a multimodality treatment including hypoxic pelvic perfusion for unresectable recurrent rectal cancer: outcomes based on a retrospective study

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Abstract

Patients with unresectable recurrent rectal cancer that progresses after systemic chemotherapy and radiotherapy are 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. From a cohort of 77 patients with unresectable recurrent rectal cancer in progression after standard treatments and submitted to HPP, 21 patients underwent repeat HPP using mitomycin C (MMC) at the dose of 25 mg/m2. After the last HPP, 7 patients received a targeted-therapy with cetuximab according to overexpression of epidermal growth factor receptor in recurrence cancer cells. The median overall survival of these 21 patients from the diagnosis of unresectable recurrent rectal cancer was 23 months (iqr 18–24). After the first HPP, the median survival of the 21 patients until death or end of follow-up was 10 months (iqr 9–13). The 1-year and 2-year survival rates were 71.4%, and 4.8%, respectively. From the first HPP, age > 60 years, a recurrence shrinkage of at least 30% (partial response), and the addition of a post-HPP targeted-therapy with cetuximab significantly affected survival (P < 0.04). In conclusion, repeated MMC-HPP followed by targeted-therapy seems to be an effective palliative treatment for patients with unresectable recurrent rectal cancer in progression after systemic chemotherapy and radiation but the results of this study have to be confirmed by a larger phase III trial.

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Authors and Affiliations

  1. Department of Applied Clinical Sciences and Biotechnology, Section of General Surgery, University of L’Aquila, Via Vetoio, 67100, L’Aquila, Italy

    Stefano Guadagni

  2. Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100, L’Aquila, Italy

    Marco Clementi

  3. General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy

    Maria Bencivenga

  4. Fondazione IRCCS, Istituto Nazionale dei Tumori Milano, Via Venezian 1, 20133, Milan, Italy

    Shigeki Kusamura

  5. Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100, Siena, Italy

    Caterina Fiorentini

  6. Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100, L’Aquila, Italy

    Francesco Masedu

Authors
  1. Stefano Guadagni
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  2. Marco Clementi
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  3. Maria Bencivenga
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  4. Shigeki Kusamura
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  5. Caterina Fiorentini
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  6. Francesco Masedu
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Corresponding author

Correspondence to Stefano Guadagni.

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The Authors declare that there is no conflict of interest regarding the publication of this paper.

Research involving human participants and/or animals

The retrospective observational study was performed at the University of L’Aquila, L’Aquila, Italy, after approval from the investigational review board (n.10/CE/2018) and following the consideration that the patients had an unresectable disease with a predictable course outcome.

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Informed consent was obtained from all individual participants included in this study.

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Guadagni, S., Clementi, M., Bencivenga, M. et al. Palliation with a multimodality treatment including hypoxic pelvic perfusion for unresectable recurrent rectal cancer: outcomes based on a retrospective study. Updates Surg 70, 441–447 (2018). https://doi.org/10.1007/s13304-018-0592-7

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  • DOI: https://doi.org/10.1007/s13304-018-0592-7

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