Association of peritonectomy and intraperitoneal chemohyperthermia (IPCH) for the treatment of peritoneal carcinomatosis. A phase II study

Peritoneal carcinomatosis (PC) prognosis is extremely poor, as itwas demonstrated by our prospective study EVOCAPE 1 (Cancer2000). Since 1989, 216 patients have been included in phase II orIII trials, evaluating the association of surgical treatment with intraperitonealchemohyperthermia (IPCH) for the treatment of PC. Theassociation of IPCH with surgical resection of primary tumor achieveda 3-year actuarial survival rate of 40% for stage 1 or 2 PC(malignant granulations less than 5 mm). But this beneficial effectwas not observed for stage 3 or 4 PC. This is the reason why wehave performed peritonectomy procedures described by P Sugarbakersince 1995 (Annals of Surgery)From January 1998 to September 2001, 56 patients (including 35women, mean age :49.3 years) were included in a phase II studyand were treated by the combination of IPCH (with Mitomycin C atthe dose of 0.7 mg/kg and/or Cisplatin at the dose of 1 mg/kg) withperitonectomy procedures, for colorectal PC (n=26), ovarian PC(n=7), gastric PC(n=6), mesothelioma (n=5), pseudomyxoma (n=7),and miscellaneous (n=5). In 36 cases, PC were synchronous. Fourpatients had liver metastasis at the time of surgery and 7 patientshad more than 1 liter of ascitis. After the cytoreductive surgery, theresection was considered R0 or R1 in 27 cases and R2 in 29 cases.In 4 cases, the PC was stage 3 or 4 after the cytoreductive surgeryand was considered as a failure of downstaging. IPCH was performedduring 90 mn by the mean of a closed sterile circuit. Thirty twopatients received palliative postoperative systemic chemotherapy.The mortality and morbidity rates were 1/56 and 16/56, respectively,with 2 digestive fistula. In September 2001, 12 patients had died(1 myocardial necrosis and 11 from peritoneal recurrence). Six patientswho had an important preoperative ascitis had no recurrenceof ascitis after the treatment. The 3-year overall survival rate was38%. Median survival of R0 patients and R2 patients were 490 and236 days, respectively (p=0.002). The combination of peritonectomyprocedures with downstaging surgery may achieve prolongatedsurvival for important CP, when the cytoreductive surgery is possible.The selection of patients has to be strict for this aggressive therapeuticapproach which retains an important morbidity, even whenpractised by experienced teams.