Skip to main content
Log in

Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Intraoperative Chemotherapy for Peritoneal Carcinomatosis Arising From Colon Adenocarcinoma

  • New Approaches to the Treatment of Hepatic Malignancies
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: Hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) has been recently proposed to treat peritoneal carcinomatosis arising from colon adenocarcinoma, which is usually regarded as a lethal clinical entity. The purpose of this study was to evaluate the clinical outcome of this combined treatment.

Methods: A retrospective study of 46 patients treated for peritoneal carcinomatosis from colon adenocarcinoma was performed. Thirty-four patients were treated with complete cytoreductive surgery immediately followed by intraoperative HIIC with mitomycin C and cisplatin. The clinical outcome of these 34 patients was analyzed; the median follow-up period was 14.5 months.

Results: No postoperative deaths were reported. The postoperative morbidity rate was 35%. No severe locoregional or systemic toxicity was observed. The 2-year overall survival was 31%, and the median survival time and the median time to local disease progression were 18 and 13 months, respectively. Survival and local disease control in patients with well- and moderately differentiated colon adenocarcinoma were significantly better than in those with poorly differentiated tumors.

Conclusions: Considering the dismal prognosis of this condition, HIIC seems to achieve encouraging results in a selected group of patients affected with resectable peritoneal carcinomatosis arising from colon adenocarcinoma. These findings support the conduction of formal phase III randomized trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 2000; 88: 358–63.

    PubMed  CAS  Google Scholar 

  2. Spratt J, Edwards M, Kubota T. Peritoneal carcinomatosis: anatomy, physiology, diagnosis, management. Curr Probl Cancer 1986; 10: 558–84.

    Google Scholar 

  3. Machover D. A comprehensive review of 5-fluorouracil and leucovorin in patients with metastatic colorectal carcinoma. Cancer 1997; 80: 1179–87.

    PubMed  CAS  Google Scholar 

  4. Midgley R, Kerr D. Colorectal cancer. Lancet 1999; 353: 391–9.

    Article  CAS  PubMed  Google Scholar 

  5. Markman M. Intraperitoneal chemotherapy. Semin Oncol 1991; 18: 248–54.

    PubMed  CAS  Google Scholar 

  6. Sugarbaker PH. Peritoneal carcinomatosis: natural history and rational therapeutic interventions using intraperitoneal chemotherapy. Cancer Treat Res 1996; 81: 149–68.

    CAS  PubMed  Google Scholar 

  7. Sugarbaker P. Peritoneal Carcinomatosis: Principles of Management. Boston: Kluwer, 1996.

    Google Scholar 

  8. Los G, Smals OA, van Vugt MJ, et al. A rationale for carboplatin treatment and abdominal hyperthermia in cancers restricted to the peritoneal cavity. Cancer Res 1992; 52: 1252–8.

    PubMed  CAS  Google Scholar 

  9. Sayag AC, Gilly FN, Carry PY, et al. Intraoperative chemohyperthermia in the management of digestive cancers. A general review of literature. Oncology 1993; 50: 333–7.

    Article  CAS  PubMed  Google Scholar 

  10. Jacquet P, Sugarbaker PH. Peritoneal-plasma barrier. Cancer Treat Res 1996; 82: 53–63.

    CAS  PubMed  Google Scholar 

  11. Speyer JL, Collins JM, Dedrick RL, et al. Phase I and pharmacological studies of 5-fluorouracil administered intraperitoneally. Cancer Res 1980; 40: 567–72.

    PubMed  CAS  Google Scholar 

  12. Zoetmulder FA, Sugarbaker PH. Patterns of failure following treatment of pseudomyxoma peritonei of appendiceal origin. Eur J Cancer 1996; 32A: 1727–33.

    Article  CAS  PubMed  Google Scholar 

  13. Sugarbaker P. Peritoneal Carcinomatosis: Drugs and Diseases. Boston: Kluwer, 1996.

    Google Scholar 

  14. Sugarbaker PH, Gianola FJ, Speyer JC, Wesley R, Barofsky I, Meyers CE. Prospective, randomized trial of intravenous versus intraperitoneal 5- fluorouracil in patients with advanced primary colon or rectal cancer. Surgery 1985; 98: 414–22.

    PubMed  CAS  Google Scholar 

  15. Markman M, Reichman B, Hakes T, et al. Intraperitoneal chemotherapy as treatment for ovarian carcinoma and gastrointestinal malignancies: the Memorial Sloan-Kettering Cancer Center experience. Acta Med Austriaca 1989; 16: 65–7.

    PubMed  CAS  Google Scholar 

  16. Sugarbaker TA, Chang D, Koslowe P, Sugarbaker PH. Pathobiology of peritoneal carcinomatosis from ovarian malignancy. Cancer Treat Res 1996; 81: 63–74.

    PubMed  CAS  Google Scholar 

  17. Giovanella BC, Stehlin JS Jr, Morgan AC. Selective lethal effect of supranormal temperatures on human neoplastic cells. Cancer Res 1976; 36: 3944–50.

    PubMed  CAS  Google Scholar 

  18. Barlogie B, Corry PM, Drewinko B. In vitro thermochemotherapy of human colon cancer cells with cis- dichlorodiammineplatinum(II) and mitomycin C. Cancer Res 1980; 40: 1165–8.

    PubMed  CAS  Google Scholar 

  19. Hahn GM, Braun J, Har-Kedar I. Thermochemotherapy: synergism between hyperthermia (42–43 degrees) and adriamycin (of bleomycin) in mammalian cell inactivation. Proc Natl Acad Sci U S A 1975; 72: 937–40.

    PubMed  CAS  Google Scholar 

  20. Dudar TE, Jain RK. Differential response of normal and tumor microcirculation to hyperthermia. Cancer Res 1984; 44: 605–12.

    PubMed  CAS  Google Scholar 

  21. Spratt JS, Adcock RA, Muskovin M, Sherrill W, McKeown J. Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res 1980; 40: 256–60.

    CAS  PubMed  Google Scholar 

  22. Kerr DJ, Kaye SB. Aspects of cytotoxic drug penetration, with particular reference to anthracyclines. Cancer Chemother Pharmacol 1987; 19: 1–5.

    PubMed  CAS  Google Scholar 

  23. Los G, Mutsaers PH, van der Vijgh WJ, Baldew GS, de Graaf PW, McVie JG. Direct diffusion of cis-diamminedichloroplatinum(II) in intraperitoneal rat tumors after intraperitoneal chemotherapy: a comparison with systemic chemotherapy. Cancer Res 1989; 49: 3380–4.

    CAS  PubMed  Google Scholar 

  24. Witkamp AJ, de Bree E, Van Goethem R, Zoetmulder FA. Rationale and techniques of intra-operative hyperthermic intraperitoneal chemotherapy. Cancer Treat Rev 2001; 27: 365–74.

    PubMed  CAS  Google Scholar 

  25. Fujimura T, Yonemura Y, Fushida S, et al. Continuous hyperthermic peritoneal perfusion for the treatment of peritoneal dissemination in gastric cancers and subsequent second-look operation. Cancer 1990; 65: 65–71.

    PubMed  CAS  Google Scholar 

  26. Beaujard AC, Glehen O, Caillot JL, et al. Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosis. Cancer 2000; 88: 2512–9.

    PubMed  CAS  Google Scholar 

  27. Yonemura Y, Fujimura T, Nishimura G, et al. Effects of intraoperative chemohyperthermia in patients with gastric cancer with peritoneal dissemination. Surgery 1996; 119: 437–44.

    PubMed  CAS  Google Scholar 

  28. Kober F, Heiss A, Roka R. Diffuse and gross peritoneal carcinomatosis treated by intraperitoneal hyperthermic chemoperfusion. Cancer Treat Res 1996; 82: 211–9.

    PubMed  CAS  Google Scholar 

  29. Fujimoto S, Takahashi M, Mutou T, et al. Improved mortality rate of gastric carcinoma patients with peritoneal carcinomatosis treated with intraperitoneal hyperthermic chemoperfusion combined with surgery. Cancer 1997; 79: 884–91.

    PubMed  CAS  Google Scholar 

  30. Mansvelt B, Bertrand C, Nockerman P, et al. [Study of the toxicity and results of intraperitoneal hyperthermic chemotherapy in 28 patients with peritoneal carcinomatosis]. Ann Chir 1997; 51: 60–7.

    PubMed  CAS  Google Scholar 

  31. Stephens AD, Alderman R, Chang D, et al. Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol 1999; 6: 790–6.

    PubMed  CAS  Google Scholar 

  32. Loggie BW, Fleming RA, McQuellon RP, Russell GB, Geisinger KR. Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin. Am Surg 2000; 66: 561–8.

    CAS  PubMed  Google Scholar 

  33. Elias D, Blot F, El Otmany A, et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 2001; 92: 71–6.

    Article  CAS  PubMed  Google Scholar 

  34. Witkamp AJ, de Bree E, Kaag MM, et al. Extensive cytoreductive surgery followed by intra-operative hyperthermic intraperitoneal chemotherapy with mitomycin-C in patients with peritoneal carcinomatosis of colorectal origin. Eur J Cancer 2001; 37: 979–84.

    PubMed  CAS  Google Scholar 

  35. Piso P, Bektas H, Werner U, et al. Improved prognosis following peritonectomy procedures and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from appendiceal carcinoma. Eur J Surg Oncol 2001; 27: 286–90.

    Article  CAS  PubMed  Google Scholar 

  36. Sugarbaker PH. Peritonectomy procedures. Cancer Treat Res 1996; 82: 235–53.

    PubMed  CAS  Google Scholar 

  37. Ozols RF, Young RC, Speyer JL, et al. Phase I and pharmacological studies of adriamycin administered intraperitoneally to patients with ovarian cancer. Cancer Res 1982; 42: 4265–9.

    PubMed  CAS  Google Scholar 

  38. Sugarbaker PH. Review of a personal experience in the management of carcinomatosis and sarcomatosis. Jpn J Clin Oncol 2001; 31: 573–83.

    PubMed  CAS  Google Scholar 

  39. Witkamp AJ, de Bree E, Kaag MM, van Slooten GW, van Coevorden F, Zoetmulder FA. Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei. Br J Surg 2001; 88: 458–63.

    PubMed  CAS  Google Scholar 

  40. Esquivel J, Sugarbaker PH. Second-look surgery in patients with peritoneal dissemination from appendiceal malignancy: analysis of prognostic factors in 98 patients. Ann Surg 2001; 234: 198–205.

    PubMed  CAS  Google Scholar 

  41. Zoetmulder FA, van der Vange N, Witkamp AJ, Kaag MM, Boot H, Beijnen JH. [Hyperthermic intra-peritoneal chemotherapy (HIPEC) in patients with peritoneal pseudomyxoma or peritoneal metastases of colorectal carcinoma: good preliminary results from the Netherlands Cancer Institute]. Ned Tijdschr Geneeskd 1999; 143: 1863–8.

    PubMed  CAS  Google Scholar 

  42. Zoetmulder F, Verwaal V, Ruth S. Hyperthermic intraperitoneal chemotherapy (HIPEC) with mitomycin-C significantly improves survival in patients with peritoneal carcinomatosis of colorectal origin (poster 586). Proc Am Soc Clin Oncol 2002; 21: 228.

    Google Scholar 

  43. Bartlett DL, Buell JF, Libutti SK, et al. A phase I trial of continuous hyperthermic peritoneal perfusion with tumor necrosis factor and cisplatin in the treatment of peritoneal carcinomatosis. Cancer 1998; 83: 1251–61.

    PubMed  CAS  Google Scholar 

  44. Jacquet P, Stephens AD, Averbach AM, et al. Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer 1996; 77: 2622–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carlo Riccardo Rossi MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pilati, P., Mocellin, S., Rossi, C.R. et al. Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Intraoperative Chemotherapy for Peritoneal Carcinomatosis Arising From Colon Adenocarcinoma. Ann Surg Oncol 10, 508–513 (2003). https://doi.org/10.1245/ASO.2003.08.004

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2003.08.004

Key Words

Navigation