Initial experience with hyperthermic intra peritoneal chemotherapy and cytoreductivesurgery

Our plain-English summary of Initial experience with hyperthermic intra peritoneal chemotherapy and cytoreductivesurgery, by N. Dharmadhikari, R. Shah, P. Jagannath (Indian Journal of Cancer, 2014).

The study

• Authors: N. Dharmadhikari, R. Shah, P. Jagannath
• Journal: Indian Journal of Cancer
• Published: 2014;51(2):189-92
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Promising results were reported with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal carcinomatosis. Experiences in India are not published. This is a preliminary report.

Materials And Methods: From eight patients with peritoneal metastasis, six patients (5 M, 1 F), aged (40-62 years) were treated with CRS and HIPEC between May 2010 and August 2011 from a single institution. Three had Mucinous Adenocarcinoma of Appendix and one each with Mesothelioma, Ovarian Cancer and Colonic Cancer. Four were earlier treated with systemic chemotherapy and recurred. Pre-operative peritoneal cancer index (PCI) was calculated based on recent computerized tomography or positron emission tomography scans. Surgical completeness cytoreduction score (CCS) was classified as macroscopically complete (CCS-0); optimal residual disease ≤2.5 mm in any region (CCS-1); or grossly incomplete: Residual disease >2.5 mm (CCS-2) or >25 mm (CCS-3). They were treated by closed perfusion technique with mitomycin-C (MCC) and cisplatin at 41-42°C, for 60 min.

Results: Optimal cytoreduction (residual tumor nodules <2.5 mm i.e. CC0 and CC1) was performed in four patients (66.67%). There was no operative mortality or Grade 3 and 4 toxicity. Patients with PCI <11 are alive without recurrence with overall survival of 26-31 months. Those with PCI >11 had recurrence with overall survival of 3-19 months. Two patients died at 3 and 9 months.

Conclusion: CRS and HIPEC is a promising therapeutic option in selected patients with peritoneal carcinomatosis. These results in six patients are preliminary but encouraging. Patient with low PCI had better disease free survival.

In plain English

This was a report from a single hospital in Mumbai, India, on the first six patients its surgeons treated with cytoreductive surgery (removing visible tumor from the abdomen), followed in the same operation by heated chemotherapy (mitomycin C, then cisplatin) circulated through the abdomen. Eight patients with cancer spread to the abdominal lining were considered between May 2010 and August 2011. Two were excluded during surgery because their disease was more extensive than scans had shown. Of the six treated (five men and one woman, aged 40 to 62), three had cancer that started in the appendix, and one each had cancer starting in the peritoneum, ovary and colon. The abstract lists one patient as having mesothelioma. The article does not mention asbestos. No Grade 3 or 4 chemotherapy toxicity was seen. Patients were followed to March 2013. The four with lower tumor-spread scores (5 to 12) were alive at 19 to 31 months. The two with scores of 16 and 19 died at 9 and 3 months. The patient whose cancer began in the peritoneum was alive without recurrence at 31 months. The authors called the results preliminary but encouraging.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-institution case series (preliminary report of six patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy)
• Who was studied: Six patients (5 men, 1 woman, aged 40 to 62) with peritoneal metastasis or peritoneal carcinomatosis, treated May 2010 to August 2011 at Lilavati Hospital and Research Centre, Mumbai, India. Eight were initially considered and two were excluded during surgery. The cancer started in the appendix in three patients and in the peritoneum, ovary and colon in one each. The abstract lists one patient as having mesothelioma. Four had earlier systemic chemotherapy and recurred.
• Exposure: No asbestos exposure is reported. The treatment studied was cytoreductive surgery followed by closed-abdomen heated intraperitoneal chemotherapy: mitomycin C at 15 mg per square meter and cisplatin at 80 mg per square meter, each circulated at 41 to 42 degrees C for 60 minutes.
• Main results:
  • Optimal cytoreduction (residual nodules under 2.5 mm) was achieved in four of the six patients (66.67%).
  • Among the six patients, two had Grade 1 chemotherapy toxicity and four had Grade 2. No Grade 3 or 4 toxicity was observed.
  • Patients with peritoneal cancer index 5 to 11 had no recurrence. Disease recurred after 8 months in the patient with index 12, after 7 months with index 16, and after 1 month with index 19.
  • The two patients with incomplete cytoreduction (CCS-2) and peritoneal cancer index 16 and 19 died, at 9 and 3 months.
  • The patient with cancer of peritoneal origin (peritoneal cancer index 5, CCS-1) was alive without recurrence at 31 months of follow-up.
• The authors' conclusion: The authors concluded that cytoreductive surgery with heated intraperitoneal chemotherapy is a promising option in highly selected patients with peritoneal carcinomatosis. They called the results in six patients preliminary but encouraging, and said patients with a low peritoneal cancer index had better disease-free survival.
• Limitations the authors state:
  • The report comes from a single institution with a small number of patients.
  • The extent of disease is hard to assess before surgery. Two patients were excluded during the operation because their spread had not shown on PET scans.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Cytoreductive Surgery, HIPEC, Metastasis, Adenocarcinoma, Mesothelioma, Ovarian Cancer, Peritoneal Cancer Index (PCI).

Related studies

• What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: A 25-year experience with 1,125 procedures — G. Passot, D. Vaudoyer, et al. (2016)
• Evaluation of the cost-effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (peritonectomy) at the St George Hospital peritoneal surface malignancy program — T.C. Chua, S. Martin, et al. (2010)
• Peritoneal carcinomatosis from unusual cancer origins: Is there a role for hyperthermic intraperitoneal chemotherapy? — C. Honoré, D. Goéré, et al. (2016)
• Preoperative Thrombocytosis Predicts Shortened Survival in Patients with Malignant Peritoneal Mesothelioma Undergoing Operative Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy — Y.C. Li, T. Khashab, et al. (2017)
• Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1,000 patients — E.A. Levine, J.H. Stewart, et al. (2014)
• Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy — E. Nizri, D. Baratti, et al. (2018)

Browse return to medical research.