Combining Surgery With Inserting Heated Chemotherapy Drugs May Improve Survival Rates in Peritoneal Carcinomatosis

Researchers at Wake Forest University Baptist Medical Center report in the February issue of Annals of Surgical Oncology that surgery combined with inserting heated chemotherapy drugs directly into the abdomen can improve survival rates and quality of life in patients with cancer of the abdominal cavity that has spread from the colon.

Patients participating in the research study had a median overall survival of 16 months, with 17 percent surviving five years or more. Traditionally, patients with this condition, called peritoneal carcinomatosis, survive only 3 to 6 months without treatment.

Peritoneal cancer is the most common cause of death in patients with cancers in the abdomen. Surgery alone has proven to be ineffective, as have external beam radiation therapy, brachytherapy and systemic chemotherapy.
Perry Shen, M.D., assistant professor of surgical oncology, was lead author of the study, which involved a retrospective review of 77 patients between 1991 and 2002 with peritoneal disease that had spread from colorectal cancer.

“As surgical techniques and perioperative care have improved, there has been a greater trend towards more aggressive surgical treatment of solid tumors,” said Shen. “This study, combined with reports from other institutions, indicates that selected patients can achieve long- term survival with complete removal of peritoneal disease from colorectal cancer, which is the second leading cause of cancer death in the United States.”

All patients underwent surgery to remove as much of the tumor and surrounding cancerous tissue as possible, followed immediately with a treatment called intraperitoneal hyperthermic chemotherapy (IPHC). With IPHC, the patient’s core temperature was cooled to just over 93 degrees Fahrenheit. Immediately after surgery, catheters were placed in the abdomen to deliver the chemotherapy directly into the abdominal cavity. The chemotherapy agent, heated to a maximum temperature of 105 degrees Fahrenheit, was delivered through the catheters. The abdomen was gently massaged throughout the two-hour procedure to improve drug distribution.

Delivering chemotherapy in this manner has the benefit of getting higher concentrations of the drug directly to the site of the tumor while minimizing toxicity to the rest of the body.

Experimental evidence suggests that tumor tissue is more sensitive to heat than normal tissue and has less resistance to chemotherapy when the temperature of the drug is raised.

Since IPHC is essentially a palliative procedure, alleviating the symptoms without curing the disease, an important factor to consider besides overall survival is the effect of the procedure on the patient’s quality of life. The quality of life was preserved for the majority of patients, both in the short term and long term.

“A prospective randomized study in Europe recently reported the benefit of intraperitoneal heated chemotherapy compared to surgery and systemic chemotherapy alone. A larger, phase III prospective trial is planned,” said Shen. “Although it is clearly not a treatment for all patients with peritoneal cancer, selected patients may benefit from improved quality of life and extended survival,” he said.