Bone and Soft Tissue Sarcomas

Annals of Surgical Oncology

, Volume 14, Issue 8, pp 2309-2318

Toxicity and Outcomes Associated with Surgical Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Patients with Sarcomatosis

  • Sherry J. LimAffiliated withDepartment of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center
  • , Janice N. CormierAffiliated withDepartment of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center
  • , Barry W. FeigAffiliated withDepartment of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center
  • , Paul F. MansfieldAffiliated withDepartment of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center
  • , Robert S. BenjaminAffiliated withDepartment of Medical Oncology, The University of Texas M.D. Anderson Cancer Center
  • , Janet R. GriffinAffiliated withDepartment of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center
  • , Judy L. ChaseAffiliated withDivision of Pharmacy, The University of Texas M.D. Anderson Cancer Center
  • , Peter W. T. PistersAffiliated withDepartment of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center
  • , Raphael E. PollockAffiliated withDepartment of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center
    • , Kelly K. HuntAffiliated withDepartment of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center Email author 

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Abstract

Background

Treatment of peritoneal recurrence following surgical resection of intra-abdominal sarcomas presents a significant challenge to clinicians. Historically, treatment with systemic chemotherapy has been ineffective and surgical resection alone has not been durable. We prospectively evaluated the feasibility of cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin (CDDP) alone or in combination with mitoxantrone (MITOX) for the treatment of sarcomatosis.

Methods

Two phase I trials of HIPEC were conducted (1998–2003). Eligible patients with evidence of sarcomatosis underwent cytoreductive surgery followed by HIPEC. In the first trial, CDDP dosing was established as 90 mg/m2 with a perfusate time of 90 minutes and temperature of 41°C. In the second trial, MITOX (20 mg/m2) was instilled following perfusion with CDDP. Toxicity, efficacy, and quality of life (QOL) were evaluated.

Results

A total of 28 patients were enrolled in the two trials. We noted a higher overall toxicity score and complication rate with combination CDDP/MITOX versus CDDP alone and shorter overall survival duration (5.5 months vs 16.9 months, respectively). In addition, local recurrence rates were similar in both groups (CDDP 79% vs CDDP/MITOX 68%). As expected, QOL scores at 6–8 weeks following HIPEC were 15–25% lower than the baseline scores; however, they returned to baseline at 3–6 months.

Conclusions

Although the HIPEC technique is feasible for patients with sarcomatosis, it is associated with significant toxicity and limited clinical benefit. Combination CDDP/MITOX failed to demonstrate any benefit over CDDP alone; moreover, there was an increase in toxicity.

Keywords

Sarcomatosis Hyperthermic intraperitoneal chemotherapy Cytoreduction Cisplatin Mitoxantrone