Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Intraoperative Chemotherapy for Peritoneal Carcinomatosis Arising From Colon Adenocarcinoma
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Background: Hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) has been recently proposed to treat peritoneal carcinomatosis arising from colon adenocarcinoma, which is usually regarded as a lethal clinical entity. The purpose of this study was to evaluate the clinical outcome of this combined treatment.
Methods: A retrospective study of 46 patients treated for peritoneal carcinomatosis from colon adenocarcinoma was performed. Thirty-four patients were treated with complete cytoreductive surgery immediately followed by intraoperative HIIC with mitomycin C and cisplatin. The clinical outcome of these 34 patients was analyzed; the median follow-up period was 14.5 months.
Results: No postoperative deaths were reported. The postoperative morbidity rate was 35%. No severe locoregional or systemic toxicity was observed. The 2-year overall survival was 31%, and the median survival time and the median time to local disease progression were 18 and 13 months, respectively. Survival and local disease control in patients with well- and moderately differentiated colon adenocarcinoma were significantly better than in those with poorly differentiated tumors.
Conclusions: Considering the dismal prognosis of this condition, HIIC seems to achieve encouraging results in a selected group of patients affected with resectable peritoneal carcinomatosis arising from colon adenocarcinoma. These findings support the conduction of formal phase III randomized trials.
- Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 2000; 88: 358–63.
- Spratt J, Edwards M, Kubota T. Peritoneal carcinomatosis: anatomy, physiology, diagnosis, management. Curr Probl Cancer 1986; 10: 558–84.
- Machover D. A comprehensive review of 5-fluorouracil and leucovorin in patients with metastatic colorectal carcinoma. Cancer 1997; 80: 1179–87.
- Midgley R, Kerr D. Colorectal cancer. Lancet 1999; 353: 391–9. CrossRef
- Markman M. Intraperitoneal chemotherapy. Semin Oncol 1991; 18: 248–54.
- Sugarbaker PH. Peritoneal carcinomatosis: natural history and rational therapeutic interventions using intraperitoneal chemotherapy. Cancer Treat Res 1996; 81: 149–68.
- Sugarbaker P. Peritoneal Carcinomatosis: Principles of Management. Boston: Kluwer, 1996.
- Los G, Smals OA, van Vugt MJ, et al. A rationale for carboplatin treatment and abdominal hyperthermia in cancers restricted to the peritoneal cavity. Cancer Res 1992; 52: 1252–8.
- Sayag AC, Gilly FN, Carry PY, et al. Intraoperative chemohyperthermia in the management of digestive cancers. A general review of literature. Oncology 1993; 50: 333–7. CrossRef
- Jacquet P, Sugarbaker PH. Peritoneal-plasma barrier. Cancer Treat Res 1996; 82: 53–63.
- Speyer JL, Collins JM, Dedrick RL, et al. Phase I and pharmacological studies of 5-fluorouracil administered intraperitoneally. Cancer Res 1980; 40: 567–72.
- Zoetmulder FA, Sugarbaker PH. Patterns of failure following treatment of pseudomyxoma peritonei of appendiceal origin. Eur J Cancer 1996; 32A: 1727–33. CrossRef
- Sugarbaker P. Peritoneal Carcinomatosis: Drugs and Diseases. Boston: Kluwer, 1996.
- Sugarbaker PH, Gianola FJ, Speyer JC, Wesley R, Barofsky I, Meyers CE. Prospective, randomized trial of intravenous versus intraperitoneal 5- fluorouracil in patients with advanced primary colon or rectal cancer. Surgery 1985; 98: 414–22.
- Markman M, Reichman B, Hakes T, et al. Intraperitoneal chemotherapy as treatment for ovarian carcinoma and gastrointestinal malignancies: the Memorial Sloan-Kettering Cancer Center experience. Acta Med Austriaca 1989; 16: 65–7.
- Sugarbaker TA, Chang D, Koslowe P, Sugarbaker PH. Pathobiology of peritoneal carcinomatosis from ovarian malignancy. Cancer Treat Res 1996; 81: 63–74.
- Giovanella BC, Stehlin JS Jr, Morgan AC. Selective lethal effect of supranormal temperatures on human neoplastic cells. Cancer Res 1976; 36: 3944–50.
- Barlogie B, Corry PM, Drewinko B. In vitro thermochemotherapy of human colon cancer cells with cis- dichlorodiammineplatinum(II) and mitomycin C. Cancer Res 1980; 40: 1165–8.
- Hahn GM, Braun J, Har-Kedar I. Thermochemotherapy: synergism between hyperthermia (42–43 degrees) and adriamycin (of bleomycin) in mammalian cell inactivation. Proc Natl Acad Sci U S A 1975; 72: 937–40.
- Dudar TE, Jain RK. Differential response of normal and tumor microcirculation to hyperthermia. Cancer Res 1984; 44: 605–12.
- Spratt JS, Adcock RA, Muskovin M, Sherrill W, McKeown J. Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res 1980; 40: 256–60.
- Kerr DJ, Kaye SB. Aspects of cytotoxic drug penetration, with particular reference to anthracyclines. Cancer Chemother Pharmacol 1987; 19: 1–5.
- Los G, Mutsaers PH, van der Vijgh WJ, Baldew GS, de Graaf PW, McVie JG. Direct diffusion of cis-diamminedichloroplatinum(II) in intraperitoneal rat tumors after intraperitoneal chemotherapy: a comparison with systemic chemotherapy. Cancer Res 1989; 49: 3380–4.
- Witkamp AJ, de Bree E, Van Goethem R, Zoetmulder FA. Rationale and techniques of intra-operative hyperthermic intraperitoneal chemotherapy. Cancer Treat Rev 2001; 27: 365–74.
- Fujimura T, Yonemura Y, Fushida S, et al. Continuous hyperthermic peritoneal perfusion for the treatment of peritoneal dissemination in gastric cancers and subsequent second-look operation. Cancer 1990; 65: 65–71.
- Beaujard AC, Glehen O, Caillot JL, et al. Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosis. Cancer 2000; 88: 2512–9.
- Yonemura Y, Fujimura T, Nishimura G, et al. Effects of intraoperative chemohyperthermia in patients with gastric cancer with peritoneal dissemination. Surgery 1996; 119: 437–44.
- Kober F, Heiss A, Roka R. Diffuse and gross peritoneal carcinomatosis treated by intraperitoneal hyperthermic chemoperfusion. Cancer Treat Res 1996; 82: 211–9.
- Fujimoto S, Takahashi M, Mutou T, et al. Improved mortality rate of gastric carcinoma patients with peritoneal carcinomatosis treated with intraperitoneal hyperthermic chemoperfusion combined with surgery. Cancer 1997; 79: 884–91.
- Mansvelt B, Bertrand C, Nockerman P, et al. [Study of the toxicity and results of intraperitoneal hyperthermic chemotherapy in 28 patients with peritoneal carcinomatosis]. Ann Chir 1997; 51: 60–7.
- Stephens AD, Alderman R, Chang D, et al. Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol 1999; 6: 790–6.
- Loggie BW, Fleming RA, McQuellon RP, Russell GB, Geisinger KR. Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin. Am Surg 2000; 66: 561–8.
- Elias D, Blot F, El Otmany A, et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 2001; 92: 71–6. CrossRef
- Witkamp AJ, de Bree E, Kaag MM, et al. Extensive cytoreductive surgery followed by intra-operative hyperthermic intraperitoneal chemotherapy with mitomycin-C in patients with peritoneal carcinomatosis of colorectal origin. Eur J Cancer 2001; 37: 979–84.
- Piso P, Bektas H, Werner U, et al. Improved prognosis following peritonectomy procedures and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from appendiceal carcinoma. Eur J Surg Oncol 2001; 27: 286–90. CrossRef
- Sugarbaker PH. Peritonectomy procedures. Cancer Treat Res 1996; 82: 235–53.
- Ozols RF, Young RC, Speyer JL, et al. Phase I and pharmacological studies of adriamycin administered intraperitoneally to patients with ovarian cancer. Cancer Res 1982; 42: 4265–9.
- Sugarbaker PH. Review of a personal experience in the management of carcinomatosis and sarcomatosis. Jpn J Clin Oncol 2001; 31: 573–83.
- Witkamp AJ, de Bree E, Kaag MM, van Slooten GW, van Coevorden F, Zoetmulder FA. Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei. Br J Surg 2001; 88: 458–63.
- Esquivel J, Sugarbaker PH. Second-look surgery in patients with peritoneal dissemination from appendiceal malignancy: analysis of prognostic factors in 98 patients. Ann Surg 2001; 234: 198–205.
- Zoetmulder FA, van der Vange N, Witkamp AJ, Kaag MM, Boot H, Beijnen JH. [Hyperthermic intra-peritoneal chemotherapy (HIPEC) in patients with peritoneal pseudomyxoma or peritoneal metastases of colorectal carcinoma: good preliminary results from the Netherlands Cancer Institute]. Ned Tijdschr Geneeskd 1999; 143: 1863–8.
- Zoetmulder F, Verwaal V, Ruth S. Hyperthermic intraperitoneal chemotherapy (HIPEC) with mitomycin-C significantly improves survival in patients with peritoneal carcinomatosis of colorectal origin (poster 586). Proc Am Soc Clin Oncol 2002; 21: 228.
- Bartlett DL, Buell JF, Libutti SK, et al. A phase I trial of continuous hyperthermic peritoneal perfusion with tumor necrosis factor and cisplatin in the treatment of peritoneal carcinomatosis. Cancer 1998; 83: 1251–61.
- Jacquet P, Stephens AD, Averbach AM, et al. Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer 1996; 77: 2622–9. CrossRef
- Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Intraoperative Chemotherapy for Peritoneal Carcinomatosis Arising From Colon Adenocarcinoma
Annals of Surgical Oncology
Volume 10, Issue 5 , pp 508-513
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Peritoneal carcinomatosis
- Colon adenocarcinoma
- Cytoreductive surgery
- Hyperthermic intraperitoneal intraoperative chemotherapy
- Industry Sectors
- Author Affiliations
- 1. Surgery Branch, Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy
- 2. Università di Padova, Dipartimento di Scienze Oncologiche e Chirurgiche, Sezione di Clinica Chirurgica II, Via Giustiniani, 2, 35128, Padova, Italy