Heated chemotherapy prolongs survival in abdominal cancer
Last Updated: March 07, 2005



NEW YORK (Reuters Health) - Intraperitoneal injection of hyperthermic
chemotherapy (IPHC) following cytoreductive surgery lengthens overall
survival in patients with peritoneal dissemination of GI neoplasms,
according to studies reported at the Society of Oncology Surgeons
national meeting in Atlanta.


In one of the presentations, co-investigator Dr. Perry Shen and his
colleagues at Wake Forest University in Winston-Salem, North
Carolina, reported the results of six patients with peritoneal
carcinomatosis secondary to small bowel adenocarcinoma who underwent
IPHC after cytoreductive surgery.

"We first do surgery to reduce the bulk of the tumor, ideally to less
than 5 mm deposits or just microscopic deposits," Dr. Shen said in an
interview with Reuters Health.

Patients are cooled to a core temperature of 34 to 35 degrees C. Then
mitomycin C heated to 39 degrees Centigrade is perfused through
inflow and outflow catheters placed percutaneously into the abdominal
cavity, at a flow rate of approximately 800 mL/min for approximately
2 hours.

Heating the drug serves two purposes, Dr. Shen explained: "It
potentiates the effect of chemotherapy and decreases tumor resistance
to chemotherapy." Intraperitoneal perfusion also increases the
concentration of the drug delivered to the tumor compared with
conventional systemic chemotherapy, he added.

Median survival after IPHC was 45.1 months, the investigators report.
In comparison, median survival is 3.1 months when patients are
treated conventionally.

In a second presentation, Dr. Shen, working with another team at the
same institution, described 110 cases of peritoneal dissemination of
appendiceal neoplasms treated with cytoreductive surgery and IPHC
between 1993 and 2004.

The 1-year survival rate was 83.8%, and the 5-year survival rate was
56.8%.

A third presentation illustrated the benefit of cytoreductive surgery
and IPHC in treating peritoneal carcinomatosis arising from multiple
sites, including the appendix, colon/rectum, mesothelium, ovary and
stomach.

Assessments performed for 86 patients every 3 months for up to 1 year
showed significant improvements in overall quality of life, with
physical functioning improved at 6 months.

With these data, Dr. Shen hopes that clinicians will be more likely
to refer patients for cytoreductive surgery and IPHC when they first
present with peritoneal spread of primary cancers.

"For those people who have a good performance status and have disease
localized to abdomen, if you can surgically debulk that tumor down to
minimal size, this procedure would be the treatment of choice," he
said.