Pelvic intra-arterial mitomycin C infusion in previously treated patients with metastatic, unresectable, pelvic colorectal cancer and angiographic determination of tumor vascularity.

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Abstract
Patients (30) with unresectable pelvic tumors from recurrent or metastatic colorectal cancer, after failing all conventional chemotherapy or radiotherapy, were treated with mitomycin C (MMC) regional intra-arterial (IA) infusion. MMC at a dose of 20 mg/m2 in 100 ml of 5% dextrose in water was infused for a 1-h period through the regional artery (e.g., hypogastric, gluteal) approached percutaneously via the femoral artery. This treatment was repeated every 4-8 wk. Of the 26 patients who could be evaluated, 3 had objective responses, 14 had tumor stabilization and 9 had no response. Median survival time for the responders (Rs) was 435 days, for stabilized patients (Ss) was 263 days, and for nonresponders (NR) was 195 days, giving an overall survival time of 239 days. Patients (14) (2 Rs, 8 Ss and 4 NRs) had good relief of pain after the IA infusion. Pelvic arteriograms (33)(including 3 patients who had never received IA infusion) showed an avasular tumor of grade 0 in 8 patients, a hypovascular tumor of grades 1 and 2 in 16 patients and a vascular tumor of grade 3 in 9 patients. Neovasculatures were mainly derived from the hypogastric artery or its branches (e.g., gluteal, obturator and pudendal artery), and occasionally were found to be derived from the superior hemorrhoidal, lumbar and sacral arteries. The major side effect after the pelvic infusion was necrotizing cellulitis occurring in the buttock. Myelosuppression was manageable and other toxic effects were mild. Metastatic colorectal cancer occurring in the pelvis was basically a vascular-deficient tumor. Regional IA MMC infusion given intermittently was found effective in palliating pelvic pain and improving the quality of these patients'' lives.