Annals of Surgical Oncology

, Volume 14, Issue 6, pp 1818–1824

Optimization of Hyperthermic Intraperitoneal Chemotherapy With Oxaliplatin Plus Irinotecan at 43°C After Compete Cytoreductive Surgery: Mortality and Morbidity in 106 Consecutive Patients

  • Dominique Elias
  • Diane Goere
  • François Blot
  • Valérie Billard
  • Marc Pocard
  • Niaz Kohneh-Shahri
  • Bruno Raynard
Hepatic and Pancreatic Tumors

Abstract

Background

Peritoneal carcinomatosis (PC), which has hitherto been regarded as a lethal entity, can now be cured with surgery (treating macroscopic tumor seeding) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) (treating residual microscopic disease). The purpose of this study was to analyze the morbidity and mortality of a particular approach associating optimal (R0–R1) cytoreduction, optimal HIPEC combining oxaliplatin and irinotecan, and an optimal homogeneous intraperitoneal temperature of 43°C.

Methods

A total of 106 consecutive patients were included in this prospective phase 2 study. After complete resection of the PC, HIPEC was performed by the Coliseum technique with oxaliplatin (360 mg/m2) combined with irinotecan (360 mg/m2) in 2 L/m2 of 5% dextrose, over 30 minutes at a real intraperitoneal temperature of 43°C. During the hour preceding HIPEC, patients received 5-fluorouracil (400 mg/m2) and leucovorin (20 mg/m2) intravenously, resulting in tritherapy.

Results

Postoperative mortality and morbidity rates were 4% and 66%, respectively. The most frequent complications were digestive fistula (24%), lung infection (16%), and severe hematological toxicity (11%). Statistical correlation was evidenced between morbidity and the carcinomatosis score (P = .0008), the number of resected organs (P = .0001), the duration of surgery (P = .0001), and blood loss (P = .0001).

Conclusions

This new approach, optimized in three respects (complete cytoreduction, combination oxaliplatin with irinotecan, and high temperature) has resulted in a relatively high but acceptable incidence of adverse events considering the expected advantage for survival.

Keywords

Morbidity Mortality Peritoneal carcinomatosis Intraperitoneal chemotherapy Hyperthermia Cytoreductive surgery Oxaliplatin Irinotecan 

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Dominique Elias
    • 1
  • Diane Goere
    • 1
  • François Blot
    • 2
  • Valérie Billard
    • 3
  • Marc Pocard
    • 1
  • Niaz Kohneh-Shahri
    • 1
  • Bruno Raynard
    • 2
  1. 1.Department of Surgical OncologyInstitut Gustave RoussyVillejuifFrance
  2. 2.Intensive Care UnitInstitut Gustave RoussyVillejuifFrance
  3. 3.Department of AnesthesiologyInstitut Gustave RoussyVillejuifFrance

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