Heated chemotherapy prolongs survival in abdominal cancer

Intraperitoneal injection of hyperthermic chemotherapy (IPHC) following cytoreductive surgery lengthens overall survival in patients with peritoneal dissemination of GI neoplasms, according to studies reported at the Society of Oncology Surgeons national meeting in Atlanta.

In one of the presentations, co-investigator Dr. Perry Shen and his colleagues at Wake Forest University in Winston-Salem, North Carolina, reported the results of six patients with peritoneal carcinomatosis secondary to small bowel adenocarcinoma who underwent IPHC after cytoreductive surgery.”We first do surgery to reduce the bulk of the tumor, ideally to less than 5 mm deposits or just microscopic deposits,” Dr. Shen said in an interview with Reuters Health. Patients are cooled to a core temperature of 34 to 35 degrees C. Then mitomycin C heated to 39 degrees Centigrade is perfused through inflow and outflow catheters placed percutaneously into the abdominal cavity, at a flow rate of approximately 800 mL/min for approximately 2 hours.Heating the drug serves two purposes, Dr. Shen explained: “It potentiates the effect of chemotherapy and decreases tumor resistance to chemotherapy.” Intraperitoneal perfusion also increases the concentration of the drug delivered to the tumor compared with conventional systemic chemotherapy, he added.Median survival after IPHC was 45.1 months, the investigators report. In comparison, median survival is 3.1 months when patients are treated conventionally.In a second presentation, Dr. Shen, working with another team at the same institution, described 110 cases of peritoneal dissemination of appendiceal neoplasms treated with cytoreductive surgery and IPHC between 1993 and 2004.The 1-year survival rate was 83.8%, and the 5-year survival rate was 56.8%.A third presentation illustrated the benefit of cytoreductive surgery and IPHC in treating peritoneal carcinomatosis arising from multiple sites, including the appendix, colon/rectum, mesothelium, ovary and stomach. Assessments performed for 86 patients every 3 months for up to 1 year showed significant improvements in overall quality of life, with physical functioning improved at 6 months.With these data, Dr. Shen hopes that clinicians will be more likely to refer patients for cytoreductive surgery and IPHC when they first present with peritoneal spread of primary cancers.”For those people who have a good performance status and have disease localized to abdomen, if you can surgically debulk that tumor down to minimal size, this procedure would be the treatment of choice,” he said.(Source: Society of Oncology Surgeons: Reuters Health: Karla Gale: Oncolink: March 2005.)