Abstract
The prognosis of locally advanced or recurrent carcinomas of the penis (PE) and of the anal canal (AC) after conventional treatment is dismal. We report 16 patients (eight with AC carcinomas and eight with PE cancers) treated by intra-arterial (IA) chemotherapy. Fifteen of them were treated for locally advanced or recurrent disease and one in an adjuvant setting. The chemotherapy was administered via a femoral IA catheter with its tip located above the aortic bifurcation, under the inferior mesenteric artery. It consisted of eight push injections, given over a 48-h period, of the following drug combination: cisplatin 8.5 mg m–2, 5-FU 275 mg m–2, methotrexate 27.5 mg m–2, mitomycin C 1.2 mg m–2, and bleomycin 4 mg m–2. Leucovorin was given po, 4 × 15 mg day–1, during the chemotherapy and for 3 days thereafter. A total of 52 cycles of treatment were administered. Of the 15 patients evaluable for response, six obtained a CR (three PE, three AC) and eight a PR. Among the complete responders, four are alive and disease-free 2–15 years after treatment. The other patients enjoyed an objective response lasting 3–25 months (median 7 months). Four patients developed grade III/IV haematological toxicity with three episodes of febrile neutropenia, one of them with a fatal outcome due to patient's failure to obtain medical attention at the onset of his fever, one a grade III mucositis of the glans, and four a grade III/IV cutaneous toxicity, the latter caused by the IA administration of bleomycin. In conclusion, IA chemotherapy is effective and potentially curative in locoregionally advanced or recurrent carcinomas of the penis and of the anus. Its contribution in the primary management of advanced penile or anal carcinoma should be prospectively investigated. © 2000 Cancer Research Campaign http://www.bjcancer.com
Similar content being viewed by others
Article PDF
Change history
16 November 2011
This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication
References
Adamson IY and Bowden DH (1974) The pathogenesis of bleomycin-induced pulmonary fibrosis in mice. Am J Pathol 77: 185–198
Ajani JA, Carrasco CH, Jackson DE and Wallace S (1989) Combination of cisplatin plus fluoropyrimidine chemotherapy effective against liver metastases from carcinoma of the anal canal. Am J Med 87: 221–224
Cohen IS, Moseher MB, O'keefe EJ, Klaus SN and DeConti RC (1973) Cutaneous toxicity of bleomycin therapy. Arch Dermatol 107: 553–555
Collins JM (1984) Pharmacologic rationale for regional drug delivery. J Clin Oncol 2: 498–504
Connell CF and Berger NA (1994) Management of advanced squamous cell carcinoma of the penis. Urol Clin North Am 21: 745–756
Edsmyr F, Andersson L and Esposti PL (1985) Combined bleomycin and radiation therapy in carcinoma of the penis. Cancer 56: 1257–1263
Éisenberger MA (1992) Chemotherapy for carcinomas of the penis and urethra. Urol Clin North Am 19: 333–338
Flam M, John M, Pajak TF, Petrelli N, Myerson R, Doggett S, Quivey J, Rotman M, Kerman H, Coia L and Murray K (1996) Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 14: 2527–2539
Gerard JP, Romestaing P, Ardiet JM, Trillet Lenoir V, Rocher FP, Baron MH and Buatois F (1995) Current treatment of cancers of the anal canal. Ann Chir 49: 363–368
Kavanagh JJ, Jr (1984) Regional chemotherapeutic approaches to the management of pelvic malignancies. Cancer Bull 36: 52–55
Lazo JS and Humphreys CJ (1983) Lack of metabolism as the biochemical basis of bleomycin-induced pulmonary toxicity. Proc Natl Acad Sci USA 80: 3064–3068
Morrow CP, Di Saia PJ, Mangan CF and Lagasse LD (1977) Continuous pelvic arterial infusion with bleomycin for squamous carcinoma of the cervix recurrent after irradiation therapy. Cancer Treat Rep 61: 1403–1405
Patt YZ and Mavligit GM (1991) Arterial chemotherapy in the management of colorectal cancer: an overview. Semin Oncol 18: 478–490
Patt YZ (1993) Regional hepatic arterial chemotherapy for colorectal cancer metastatic to the liver: the controversy continues. J Clin Oncol 11: 815–819
Ryan DP, Compton CC and Mayer RJ (2000) Carcinoma of the anal canal. N Engl J Med 342: 792–800
Scarabelli C, Tumolo S, De Paoli A, Frustaci S, Campagnutta E, Morassut S, Franchin G, Crivellari D, Sopracordevole F and Lo Re G (1987) Intermittent pelvic arterial infusion with peptichemio, doxorubicin, and cisplatin for locally advanced and recurrent carcinoma of the uterine cervix. Cancer 60: 25–30
Smith EA, Harper FE and Le Roy EC (1985) Raynaud's phenomenon of a single digit following local intradermal bleomycin sulfate injection. Arthritis Rheum 28: 459–461
Stephens FO, Harker GJ and Crea P (1980) The intraarterial infusion of chemotherapeutic agents as ‘basal’ treatment of cancer: evidence of increased drug activity in regionally infused tissues. Aust NZ J Surg 50: 597–602
Swenerton KD, Evers JA, White GW and Boyes DA (1979) Intermittent pelvic infusion with vincristine, bleomycin, and mitomycin C for advanced recurrent carcinoma of the cervix. Cancer Treat Rep 63: 1379–1381
UKCCCR Anal Cancer Trial Working Party UK Coordinating Committee on Cancer Research (1996) Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. Lancet 348: 1049–1054
Vogelzang N, Bosl G, Johnson K and Kennedy BJ (1981) Raynaud's phenomenon: a common toxicity after combination chemotherapy for testicular cancer. Ann Intern Med 95: 288–292
Wilking N, Petrelli N, Herrera L and Mittelman A (1985) Phase II study of combination bleomycin, vincristine and high-dose methotrexate (BOM) with leucovorin rescue in advanced squamous cell carcinoma of the anal canal. Cancer Chemother Pharmacol 15: 300–302
Author information
Authors and Affiliations
Rights and permissions
From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
About this article
Cite this article
Roth, A., Berney, C., Rohner, S. et al. Intra-arterial chemotherapy in locally advanced or recurrent carcinomas of the penis and anal canal: an active treatment modality with curative potential. Br J Cancer 83, 1637–1642 (2000). https://doi.org/10.1054/bjoc.2000.1525
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1054/bjoc.2000.1525
Keywords
This article is cited by
-
Intraarterial chemotherapy as the first-line therapy in penile cancer
British Journal of Cancer (2014)
-
Successful Closure of Anal Cancer-Related Fistulas With Upfront Intra-arterial Chemotherapy: a Report of 8 Cases
Diseases of the Colon & Rectum (2011)
-
Optionen der palliativen Therapie des Peniskarzinoms
Der Urologe (2007)
-
Neoadjuvante und adjuvante Chemotherapie bei Patienten mit fortgeschrittenem Peniskarzinom
Der Urologe (2007)