Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in the Management of Peritoneal Carcinomatosis

Rahul Rajeev, MBBS; Kiran K. Turaga, MD

Disclosures

Cancer Control. 2016;23(1):36-46. 

In This Article

Medications

Oxaliplatin and mitomycin are the components of common HIPEC regimens for CRC-PC and comparisons of their efficacy have yielded conflicting results.[65,66] One multisite, retrospective review reported that treatment with oxaliplatin and mitomycin conferred better rates of OS than oxaliplatin alone in patients with CRC, favorable histologies, and low-tumor burden, but a separate comparison cohort trial found no difference in survival.[65,66] Both of these studies were restricted to patients with complete cytoreduction.[65,66] Glockzin et al[67] compared bidirectional oxaliplatin- and irinotecan-based HIPEC and found no differences in rates of morbidity and toxicity but did suggest that oxaliplatin may have clinical superiority on the basis of a positive survival trend after 3 years of follow-up.

Studies on animal models of CRC have shown that combination irinotecan/oxaliplatin/mitomycin/panitumumab exceeds any survival benefit from any other agent, alone or in combination.[68]

Applications of newer antineoplastic agents such as melphalan are being investigated for intraperitoneal therapy.[69–72] Sardi et al[69] reported on the successful intraperitoneal use of melphalan in patients with peritoneal carcinomatosis who failed conventional systemic chemotherapies and cytoreductive surgery/HIPEC. Their rates of OS were promising, particularly in the milieu of documented chemoresistance; however, significant postoperative myelosuppression was a noted concern.[69] Although the peritoneal–plasma barrier prevents the systemic absorption of intraperitoneal chemotherapy, systemic accumulation does occur with peritoneal stripping in cytoreductive surgery and through other routes, such as in the hepatic metabolism of oxaliplatin and mitomycin.[70,71] Rates of hematological toxicity following treatment with oxaliplatin, mitomycin, and HIPEC ranges from 27% to 40%, but grade 4 toxicity is minimal.[66,72] Kemmel et al[72] advocated the monitoring of plasma concentration with oxaliplatin and mitomycin treatment at 30 minutes after starting HIPEC to identify patients at high risk for developing neutropenia. However, neutropenia after HIPEC has not been shown to increase rates of mortality, postoperative infection, or length of hospital stay.[72]

processing....