Intraperitoneal hyperthermic chemotherapy shows promise for
colorectal cancer





Posted: February 13, 2004


NEW YORK (Reuters Health) - Patients with non-appendiceal invasive
colorectal cancer who are treated with cytoreductive surgery plus
intraperitoneal hyperthermic chemotherapy (IPHC) survived longer than
untreated patients, according to the results of a retrospective study
of 77 patients.


After 3 years, the median overall survival rate was 25%, and after 5
years, it was 17%, the investigators report in the February issue of
the Annals of Surgical Oncology. Without treatment, the average
survival for patients with peritoneal carcinomatosis is 3 to 6 months.

The findings indicate that this treatment can improve outcomes for
select colorectal cancer patients who experience a spread of the
cancer into the abdomen, especially if complete resection of all the
cancer can be achieved, lead author Dr. Perry Shen of Wake Forest
University, Winston-Salem, North Carolina, told Reuters Health.

Surgery plus IPHC has proven to be an effective treatment for
colorectal cancer that spreads to the appendix, as well as a few
other rare cancers, Dr. Shen said.

"In many cases you cannot remove the entire tumor," Dr. Shen
continued. "But if you remove as much of the bulky tumor as possible,
we observed a median overall survival of 28 months." Of the 77
patients, the surgeons were able to achieve a complete resection in
37 (48%), during procedures between 1991 and 2002.

Dr. Shen said animal studies indicate that IPHC penetrates
surrounding tissue in a radius of about 5 millimeters, potentially
eradicating cancer cells that have migrated away from the tumor site.
Delivering IPHC after the resection is completed allows higher
concentrations of the drug to go directly to the site of the tumor
while minimizing systemic toxicity. If chemotherapy is delivered
normally, it fails to achieve similar concentrations at the tumor
site, Dr. Shen said.

Other experimental evidence indicates tumor tissue is more sensitive
to heat than normal tissue. As a result, the tumor has less
resistance to chemotherapy when the temperature of the drug is raised.

Nearly 75% of the patients had received chemotherapy prior to the
surgery and IPHC treatment. The median age of the participants was 54
years old. Of the total procedures, 74 were conducted to resect a
primary site in colon and 3 in the rectum. All the patients in the
study had a histological diagnosis of adenocarcinoma.

Perioperative morbidity and mortality were 30% and 12%, respectively.
About 19% of the patients experienced hematological toxicity.

Dr. Shen's group notes that future research may include the use of
molecular markers to determine which patients would derive the most
benefit from surgery plus IPHC.