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 degrees 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 degrees 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.
|
Authors | Dominique Elias, Diane Goere, François Blot, Valérie Billard, Marc Pocard, Niaz Kohneh-Shahri, Bruno Raynard |
Journal | Annals of surgical oncology
(Ann Surg Oncol)
Vol. 14
Issue 6
Pg. 1818-24
(Jun 2007)
ISSN: 1068-9265 [Print] United States |
PMID | 17356950
(Publication Type: Clinical Trial, Phase II, Journal Article)
|
Chemical References |
- Antimetabolites, Antineoplastic
- Antineoplastic Agents
- Antineoplastic Agents, Phytogenic
- Organoplatinum Compounds
- Topoisomerase I Inhibitors
- Oxaliplatin
- Vitamin B Complex
- Irinotecan
- Leucovorin
- Fluorouracil
- Camptothecin
|
Topics |
- Adolescent
- Adult
- Aged
- Antimetabolites, Antineoplastic
(administration & dosage)
- Antineoplastic Agents
(administration & dosage)
- Antineoplastic Agents, Phytogenic
(administration & dosage)
- Antineoplastic Combined Chemotherapy Protocols
(therapeutic use)
- Blood Loss, Surgical
- Camptothecin
(administration & dosage, analogs & derivatives)
- Carcinoma
(drug therapy, surgery)
- Female
- Fluorouracil
(administration & dosage)
- Humans
- Hyperthermia, Induced
(methods)
- Injections, Intraperitoneal
- Irinotecan
- Leucovorin
(administration & dosage, therapeutic use)
- Male
- Middle Aged
- Neoadjuvant Therapy
- Organoplatinum Compounds
(administration & dosage)
- Oxaliplatin
- Peritoneal Neoplasms
(drug therapy, surgery)
- Postoperative Complications
- Prospective Studies
- Survival Rate
- Topoisomerase I Inhibitors
- Vitamin B Complex
(administration & dosage, therapeutic use)
|