Impact of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy on Systemic Toxicity

Authors: Kusamura, Shigeki; Baratti, Dario; Younan, Rami; Laterza, Barbara; Oliva, Grazia; Costanzo, Pasqualina; Favaro, Myriam; Gavazzi, Cecilia; Grosso, Federica; Deraco, Marcello1

Source: Annals of Surgical Oncology, Volume 14, Number 9, September 2007 , pp. 2550-2558(9)

Publisher: Springer

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Abstract:

The purpose of this study was to analyze the postoperative systemic toxicity and procedure-related mortality (PRM) of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal surface malignancies (PSMs).

A total of 242 (84 males/158 females) patients with PSM underwent 247 consecutive procedures. The mean age was 52 years (range 22-79). CRS was performed using peritonectomy procedures. The HIPEC technique through the closed abdomen was conducted with cisplatin (CDDP 25 mg/m2/l of perfusate)+mitomycin C (MMC 3.3 mg/m2/l perfusate) or CDDP (43 mg/l perfusate)+doxorubicin (Dx 15.25 mg/l perfusate) at 42.5°C. These dosages were reduced by 30% when the patient had received systemic chemotherapy before the CRS+HIPEC. Systemic toxicities were graded according to the NCI CTCAE v3 criteria.

G3-5 systemic toxicity rate was 11.7 % and adverse events were bone marrow suppression, 13; nephrotoxicity, 14; neutropenic infection, 2 and pulmonary toxicity, 1. Independent risk factors for G3-5 systemic toxicity after multivariate analysis were a dose of CDDP for HIPEC of 240 mg or more (OR 2.78, CI 95% 1.20-6.45) and CDDP+Dx schedule for HIPEC (OR 2.36, CI 95% 1.02-5.45). PRM was 1.2%.

CRS+HIPEC presented acceptable systemic toxicity and PRM rates. Independent risk factors for systemic toxicity were the CDDP+Dx schedule and CDDP dose for HIPEC.

Keywords: Peritonectomy; Hyperthermic Intraperitoneal Chemotherapy; Toxicity

Document Type: Research article

DOI: 10.1245/s10434-007-9429-1

Affiliations: 1: Email: marcello.deraco@istitutotumori.mi.it

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