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Regional Therapy of Rectal Cancer

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Book cover Regional Cancer Therapy

Part of the book series: Cancer Drug Discovery and Development ((CDD&D))

Abstract

Histopathologic examinations of resected specimens have revealed that the development of local recurrence after rectal surgery for cancer is related to the resection margin of the mesorectum. The incidence rate of local pelvic recurrence after standard “curative” surgery for rectal cancer varies widely. The treatment of local recurrence remains a challenge. Extensive resection (abdominal sacral resection with or without pelvic exenteration) gives the best chance of survival. For patients with unresectable recurrent rectal cancer, neither intravenous systemic chemotherapy nor intraarterial chemotherapy achieve desirable results in terms of pain control and tumor response. To improve clinical response, several methods of regional chemotherapy delivery have been suggested. One of these is regional pelvic perfusion. In our study, hypoxic pelvic perfusion has been proposed as palliative treatment in patients with unresectable locally recurrent rectal cancer who are nonresponders or who have disease progression after the standard modalities. The median survival time (12.2 mo) registered after one course of hypoxic pelvic perfusion is comparable to that obtained by irradiation or reirradiation in non-pretreated patients. Considering the vascular damage following radiotherapy, a different sequence in the multimodular treatment of unresectable recurrent rectal cancer could be more useful. Further studies are necessary to establish whether hypoxic pelvic perfusion improves the quality of life and survival of these patients if administered before radiotherapy with or without concomitant systemic chemotherapy. In conclusion, hypoxic pelvic perfusion is a good palliative treatment for patients with unresectable locally recurrent rectal cancer, but it should be considered as a link of a chain in a multimodular approach.

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Author information

Authors and Affiliations

  1. Department of Surgical Sciences, University of L’Aquila, Italy

    Stefano Guadagni MD, Mario Schietroma MD, Claudio Lely, Cristina Ruscitti MD, Marco Clementi MD, Evangelos Kanavos MD & Gianfranco Amicucci MD

  2. Department of Oncology, AUSL-Empoli, Italy

    Giammaria Fiorentini MD

  3. Department of Oncology, AUSL-Carrara, Italy

    Maurizio Cantore MD

Authors
  1. Stefano Guadagni MD
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  2. Mario Schietroma MD
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  3. Giammaria Fiorentini MD
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  4. Maurizio Cantore MD
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  5. Claudio Lely
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  6. Cristina Ruscitti MD
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  7. Marco Clementi MD
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  8. Evangelos Kanavos MD
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  9. Gianfranco Amicucci MD
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Editors and Affiliations

  1. Robert-Rössle-Hospital and Tumor Institute, Charité University of Medicine, Berlin

    Peter M. Schlag MD (Professor and Head of Surgical Oncology) (Professor and Head of Surgical Oncology)

  2. Max-Delbrück-Center for Molecular Medicine, Berlin, Germany

    Peter M. Schlag MD (Professor and Head of Surgical Oncology) & Ulrike Stein PhD (Assistant Professor) (Professor and Head of Surgical Oncology) &  (Assistant Professor)

  3. Tumor Metastasis and Therapy Response Program, Robert-Rössle-Hospital and Tumor Institute, Charité University of Medicine, Berlin

    Ulrike Stein PhD (Assistant Professor) (Assistant Professor)

  4. Erasmus University MC—Daniel den Hoed Cancer Center, Rotterdam, The Netherlands

    Alexander M. M. Eggermont MD, PhD (Professor and Head of Surgical Oncology) (Professor and Head of Surgical Oncology)

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© 2007 Humana Press Inc., Totowa, NJ

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Guadagni, S. et al. (2007). Regional Therapy of Rectal Cancer. In: Schlag, P.M., Stein, U., Eggermont, A.M.M. (eds) Regional Cancer Therapy. Cancer Drug Discovery and Development. Humana Press. https://doi.org/10.1007/978-1-59745-225-0_21

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  • DOI: https://doi.org/10.1007/978-1-59745-225-0_21

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-672-6

  • Online ISBN: 978-1-59745-225-0

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