Neutropenia following perioperative intraperitoneal chemotherapy

Introduction: The purpose of this retrospective report was to evaluate clin ical features associated with profound neutropenia in patients with periton eal carcinomatosis who were treated with heated intraoperative intraperiton eal chemotherapy (HIIC) followed by early postoperative intraperitoneal che motherapy (EPIC). Common clinical denominators for significant neutropenia were analyzed, Materials and Methods: A retrospective study of all available clinical data of six patients with postoperative neutropenia out of a total of 242 was u ndertaken. All patients underwent cytoreductive surgery, HIIC with mitomyci n C (n = 4) or cisplatin (n = I) and EPIC with B-fluorouracil (5-FU) for 4 (n = 1) or 5 (n = 5) days. Results: All six patients presented with hematologic toxicity of WHO criter ia grade 4; four of them died postoperatively. Two of the patients who died , and one who did not die, developed bowel perforations. Five patients had prior chemotherapy with 5-FU; three of them had toxic side effects, All pat ients were overweight, and three patients were anemic preoperatively. The n eutropenia presented with fever, leukopenia and thrombocytopenia on postope rative days 10-15, The leukocyte count courses showed a pattern suggesting the 5-FU as the cause of leukopenia, There was no consistent warning signal for predicting severe neutropenia. Discussion: Neutropenia following cytoreductive surgery combined with HIIC and EPIC has a high mortality (66%), Patients who are at special risk and s hould have a dose reduction include patients who had toxicities from prior chemotherapy, who present with obesity and anemia, The groups have an incre ased risk of developing postoperative profound neutropenia. This condition can result in a prohibitively high mortality and morbidity rate. Therefore, reduced doses of chemotherapy in selected patients are necessary to preven t this condition from developing.