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.

Isolated chemotherapeutic perfusion of the pelvis for advanced rectal cancer

“…Although some reduction may be related to fluid shifts, it appears that there is a real haematological toxicity because of the leak rate of 25-30% in all patients. The potential to counteract with bone marrow or stem cell support is one solution for toxicity from high dose regional infusion [20]. This is documented in one of our patients with an extensive penile melanoma involving the pelvis that received a high dose of phenylalanine mustard.…”

Removal of drugs, toxins and poisons by continuous hemofiltration

“…Anti-digoxin antibodies detoxify the drug at its tissue site of action, even though the 45-50 kd complex is not ultrafiIterable [51 J. Other examples of adequate removal by these therapies, as would be expected by known pharmacokinetics, include methotrexate [53], lithium [54], theophylline [55] and fluorouracil [56]. described the effective removal of toxic levels' of procainamide and its active metabolite Nacetyl-procainamide with either continuous hemofiltration or continuous hemodialysis [52].…”

Treatment of advanced pancreatic cancer with regional chemotherapy plus hemofiltration

“…Current treatment protocols with regional chemotherapy plus hemofiltration allow an estimated drug dosage of three to four times the systemic dose to be delivered to the tumor-bearing region. Response rates of pancreatic cancer to regional chemotherapy plus hemofiltration range from 55% to 77% and are essentially double the average response rates of 20% to 28% reported using systemic chemotherapy [24, 40,52].…”