PERITONEAL CARCINOMATOSIS TREATMENT WITH CURATIVE INTENT - THE INSTITUT GUSTAVE-ROUSSY EXPERIENCE

The prognosis of peritoneal carcinomatosis (PC), classically treated w ith intravenous chemotherapy, is very poor (mean survival of 6 months) , The aim of this study is to report the results of a phase II study i n which PC was treated with complete cytoreductive surgery, with the r esidual microscopic disease treated by immediate intraperitoneal post- operative chemotherapy (IIPC) for 5 days (mitomycin(R) with fluorourac il(R) or Adriamycin(R) with Platinol(R)), Fifty-four patients with PC from miscellaneous origins were treated between January 1993 and April 1996, The PC was important (clinically evident) but with no extraperi toneal localization in 29 cases, The PC was moderate or minor in 25 ca ses having been fortuitously discovered during a laparotomy for extrap eritoneal cancer localization. Operating time was 7:21 h, associated f requently with extensive peritonectomies, and with resection of invade d organs (four organs per patient), IIPC was complete (5 days) in 91 p er cent of patients, Three post-operative deaths (5.5%) occurred. Morb idity was present in 61 per cent of patients, and was related to surgi cal extension (P<0.001), A 2-year survival of 50% was mainly correlate d with the importance of the PC (P<0.01), and was the same for both gr oups of patients (isolated major PC vs moderate (or minor) PC associat ed with extraperitoneal localization), PC recurrence rates were 30 per cent at 2 years, Complete cytoreductive surgery associated with IIPC is a logical and promising treatment of moderate and minor PC, However , it appears that it is a heavy treatment for patients (and physicians ), and its efficacy will be proved only after a randomized study for s urvival, quality of life, and cost (currently ongoing).