Safety and Efficacy of Hyperthermic Intraperitoneal Chemoperfusion with High-Dose Oxaliplatin in Patients with Peritoneal Carcinomatosis

Autor: Filip De Somer, Piet Pattyn, Marc Peeters, Philippe Houtmeyers, Wim Ceelen, Christophe Breusegem
Přispěvatelé: Faculty of Psychology and Educational Sciences, Ophtalmology - Eye surgery
Rok vydání: 2007
Předmět:
Male
medicine.medical_specialty
Organoplatinum Compounds
Colorectal cancer
medicine.medical_treatment
Antineoplastic Agents
Gastroenterology
length of stay
Liver/drug effects
Ovarian Neoplasms/pathology
Internal medicine
medicine
Humans
OXALIPLATIN
Mesothelioma
Hemoperitoneum
Organoplatinum Compounds/administration & dosage
Peritoneal Neoplasms
Gastrointestinal Neoplasms
Aged
Ovarian Neoplasms
Medicine(all)
Chemotherapy
Chemotherapy
Cancer
Regional Perfusion/adverse effects
business.industry
Gastrointestinal Neoplasms/pathology
Metabolic acidosis
Hyperthermia
Induced
Middle Aged
medicine.disease
Combined Modality Therapy
Peritoneal Neoplasms/blood
Antineoplastic Agents/administration & dosage
Oxaliplatin
Surgery
Liver
Oncology
Chemotherapy
Cancer
Regional Perfusion
Female
medicine.symptom
Hyponatremia
Ovarian cancer
business
Injections
Intraperitoneal
medicine.drug
Zdroj: Annals of Surgical Oncology. 15:535-541
ISSN: 1534-4681
1068-9265
DOI: 10.1245/s10434-007-9648-5
Popis: BACKGROUND: Cytoreduction with hyperthermic intraperitoneal chemoperfusion (HIPEC) has an established role in selected patients with peritoneal carcinomatosis (PC). We analyzed the safety and efficacy of HIPEC using high-dose oxaliplatin, a cytotoxic agent commonly used in metastatic colorectal cancer and showing promising activity in ovarian cancer and mesothelioma. METHODS: Following complete cytoreduction, HIPEC was performed using 460 mg/m(2 )oxaliplatin in 5% dextrose for 30 min at a temperature of 41-42 degrees C. Open perfusion (coliseum technique) was performed in all patients. Metabolic, electrolyte, and hemodynamic changes were recorded during chemoperfusion as well as postoperative morbidity, mortality, late toxicity, and survival. RESULTS: From July 2005 to January 2007, 52 patients were treated. Chemoperfusion with 5% dextrose resulted in temporary significant hyperglycemia, hyponatremia, and metabolic acidosis. Major morbidity developed in 24% of patients, while 30-day mortality did not occur.One patient developed unexplained repeated episodes of hemoperitoneum. Chemoperfusion with oxaliplatin resulted in mild hepatic toxicity evidenced by persistent elevation of glutamyl transferase and alkaline phosphatase 1 month after surgery. After a mean follow-up time of 14.5 months, nine patients died from disease progression. In colorectal cancer patients, actuarial overall survival was 80% at 1 year. CONCLUSION: Cytoreduction with HIPEC using high-dose oxaliplatin leads to manageable metabolic and electrolyte disturbances and frequent mild hepatic toxicity without discernible impact on postoperative morbidity. Longer follow-up in a larger patient cohort will be required to assess the real risk of unexplained hemoperitoneum observed in one patient, and to establish the long-term effect on local relapse and survival.
Databáze: OpenAIRE
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