Diffuse and gross peritoneal carcinomatosis treated by intraperitoneal hyperthermic chemoperfusion.

Abstract

Intraoperative intrapeitoneal hyperthermic chemoperfusion (IHCP) offers the following advantages: uniform distribution of heat and drugs at a high concentration in the whole intraperitoneal cavity, heat as a cytotoxic agent itself, and heat as a biomodulator of chemotherapy. Twenty-five patients suffering from diffuse and gross peritoneal carcinomatosis were enrolled into a phase II study to evaluate the feasibility and the efficacy of IHCP. IHCP was carried out with 10 micrograms mitomycin C/ml perfusate in the case of gastrointestinal malignancies or with 50 micrograms cisplatin/ml perfusate in the case of ovarian cancer with malignant ascites. Thirty-two courses of IHCP in 25 patients were eligible in for study of side effects. One patient suffered severe hematologic toxicity, WHO grade 4; two patients suffered severe impairment of renal function, WHO grade 3. Twenty-one patients were eligible for study of the response. Fifteen were classified as having a "favorable clinical response" and in three of them a pathohistologic complete remission was achieved. In only four patients was peritoneal carcinomatosis not influenced by the therapy. Ascites disappeared in 16 out of 19 patients. Tumor markers that were elevated preoperatively in 16 patients returned to normal values in 10 patients postoperatively and dropped more than 50% in three more patients. A remarkable improvement in quality of life was observed in patients who responded to the therapy.