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Cytoreductive Surgery with Bidirectional Intraoperative Chemotherapy (BDIC) Using Intravenous Ifosfamide Plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Patients with Peritoneal Sarcomatosis: A Retrospective Cohort Study

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Peritoneal sarcomatosis (PS) is a rare tumor with limited therapeutic options. Bidirectional intraoperative chemotherapy (BDIC) using intravenous ifosfamide and doxorubicin-based hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) is an emerging treatment for peritoneal malignancies.

Patients and Methods

Patients with PS who underwent CRS/BDIC using intravenous ifosfamide and HIPEC from January 2017 to July 2021 were retrospectively analyzed. The last follow-up date was May 2022.

Results

A total of 29 patients were included. Overall survival (OS) rates at 6, 12, 24, and 48 months after CRS/BDIC were 93.1%, 89.2%, 81.4%, and 73.3%, respectively. As of May 2022, 6 patients (20.6%) had died, including four (13.8%) with a proven recurrent tumor and two with incomplete tumor resection [completeness of cytoreduction (CC)-2 or CC-3]. Of the 20 patients (68.9%) with CC-0 or CC-1, 7 had locoregional tumor recurrence without distant metastasis, whereas the other 13 were alive with no evidence of recurrent tumor in May 2022. Disease recurrence rates were 15% at 6 months and 35% at 12, 24, and 48 months after CRS/BDIC. Clavien–Dindo class ≥ IIIa complications developed in 9 patients (31.0%) with no deaths. Leukopenia occurred in 5 patients (17.2%) and thrombocytopenia in 12 patients (41.3%); these hematologic abnormalities resolved. A total of 9 (31.0%) patients developed nephrotoxicity; all recovered except one, who progressed to chronic kidney disease.

Conclusions

CRS/BDIC using intravenous ifosfamide and doxorubicin-based HIPEC is a potentially effective treatment for PS and has an acceptable rate of complications.

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Data Availability

The authors report that the data that support the findings of the current study are available upon request of the corresponding author. The data are not publicly available due to privacy and ethical restrictions.

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Funding

No funding was provided for this study.

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Authors and Affiliations

  1. Department of Surgery, Academic and Training Affairs, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

    Mohammed S. Almasri MBBS & Norah S. Alnajashi MBBS

  2. Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

    Hakeam A. Hakeam MS Pharm, BCPS

  3. Biostatics, Epidemiology, and Science Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

    Lana A. Alzamil BEpi

  4. Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

    Ayman Z. Azzam MBBS & Tarek M. Amin MD

Authors
  1. Mohammed S. Almasri MBBS
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  2. Hakeam A. Hakeam MS Pharm, BCPS
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  3. Norah S. Alnajashi MBBS
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  5. Ayman Z. Azzam MBBS
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Correspondence to Mohammed S. Almasri MBBS.

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Almasri, M.S., Hakeam, H.A., Alnajashi, N.S. et al. Cytoreductive Surgery with Bidirectional Intraoperative Chemotherapy (BDIC) Using Intravenous Ifosfamide Plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Patients with Peritoneal Sarcomatosis: A Retrospective Cohort Study. Ann Surg Oncol 31, 2368–2377 (2024). https://doi.org/10.1245/s10434-023-14786-5

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