Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin

No standard effective treatment exists for peritoneal carcinomatosis of gas trointestinal origin. The pharmacokinetic advantage of intraperitoneal chem otherapy and the synergy of heat and certain anticancer agents have prompte d researchers to investigate intraperitoneal hyperthermic chemotherapy in t reating disseminated peritoneal cancers. We have conducted a large Phase II trial to determine the safety and efficacy of aggressive cytoreductive sur gery and intraperitoneal hyperthermic chemotherapy (IPHC) in treating perit oneal carcinomatosis of gastrointestinal origin. Patients with disseminated peritoneal carcinomatosis of gastrointestinal origin with or without malig nant ascites were eligible. After aggressive surgical debulking, patients w ere administered a 2-hour heated (40.5 degrees C) intraperitoneal perfusion with mitomycin C. The major response variable monitored was overall surviv al. Patients were assessed for toxicity after IPHC administration using the National Cancer Institute Common Toxicity Criteria. Eighty-four patients w ith peritoneal carcinomatosis of gastrointestinal origin were evaluated for survival and toxicity (colon, n = 38; appendix, n = 22; stomach, n = 19; o ther gastrointestinal, n = 5). Thirty-nine (46%) patients had malignant asc ites at the time of therapy. The operative mortality (30-day) was 6 per cen t. Hematologic toxicity was the most common toxicity but was of mild to mod erate severity (7 and 4% of patients had grade 3/4 white blood cell or plat elet toxicity, respectively). The overall median survival was 14.3 months. The median survival of patients with peritoneal carcinomatosis of appendice al, colorectal, and gastric origins were 31.1+, 14.6, and 10.1 months, resp ectively. Significant differences in median survival were seen in patients without and with malignant ascites (27.7 vs 7.6 months; P = 0.0004) and R-0 /R-1 (complete gross tumor resection) versus R-2 (gross residual tumor) sur gical resection status (28.5+ vs 10.8 months, P = 0.0002). These data sugge st that aggressive cytoreductive surgery with IPHC using mitomycin C is saf e and effective in treating peritoneal carcinomatosis of gastrointestinal o rigin. Additional studies and broader applications of this treatment are en couraged.