Treatment of primary peritoneal mesothelioma by hyperthemic intraperitoneal chemotherapy

Perfusion of the peritoneal cavity with chemotherapy agents under hyperther mic conditions has been utilized by several investigators in the treatment of intra-abdominal malignancies. Based on the concept that hyperthermia may potentiate the cytotoxic effects of chemotherapeutic agents, we embarked o n a clinical trial of two-stage peritoneal chemotherapy for patients with p rimary peritoneal mesothelioma, a neoplasm unresponsive to traditional syst emic chemotherapeutic regimens. In stage I, patients underwent surgical deb ulking of ross disease and placement of an intraperitoneal infusion cathete r, through which intraperitoneal chemotherapy was administered for four mon ths. Stage II consisted of debulking of residual tumor, placement of two tr ansabdominal perfusion cannulae and administration of high-dose intraperito neal chemotherapy at 40 degrees C using a simple, disposable perfusion circ uit. Flow rates were maintained at 1 l/min, and inflow and outflow temperat ures maintained at 42 and 40 degrees C, respectively. To date, three patien ts have undergone both phases of the protocol, with no perioperative compli cations related to either hyperthermia or end-organ toxicity. One patient d ied of progressive disease after three months, and two patients are alive a nd well. One patient developed a small bower anastomotic leak three weeks a fter operation. In summary, intraoperative hyperthermic peritoneal chemothe rapy may play a role in novel approaches to the treatment of peritoneal mal ignancies previously unresponsive to traditional chemotherapeutic regimens.