title: Treatment of peritoneal carcinomatosis from colon or appendiceal cancer with induction intraperitoneal chemotherapy.
abstract: Colorectal cancer patients may present with peritoneal seeding of the abdominal cavity or develop it as recurrent disease. Peritoneal carcinomatosis has been regarded as a uniformly lethal clinical entity with no specific plan for management. Twenty-six patients with an established diagnosis of isolated spread of adenocarcinoma or cystadenocarcinoma of colorectal or appendiceal origin to peritoneal surfaces were treated with a combination of intraperitoneal 5-fluorouracil and intravenous mitomycin C. Three cycles of chemotherapy of 5 days each in duration were given once a month for 3 months. Two to 4 months after completion of chemotherapy, exploratory surgery and a cytoreductive procedure occurred. Responses to intraperitoneal chemotherapy were recorded at the time of cytoreductive surgery. Four of five patients with low-volume intraperitoneal adenocarcinoma had complete responses to induction chemotherapy. None of 18 patients with moderate- or large-volume cystadenocarcinoma had complete responses. The surgical procedure was facilitated by chemotherapy responses in patients with moderate-volume peritoneal carcinomatosis but not if large-volume disease was recorded. Surgical complications in patients treated by the induction approach were more frequent (p = 0.01) when compared with matched patients without intraperitoneal chemotherapy prior to cytoreductive surgery. This data may suggest that patients with low- or moderatevolume peritoneal carcinomatosis should be treated with induction chemotherapy because of a high rate of responsiveness. Large-volume peritoneal carcinomatosis from grade I cancer should have cytoreductive surgery prior to chemotherapy because of less responsiveness and the frequent surgical morbidity observed with the induction approach.
authors.affiliation: Washington Cancer Institute, DC 20010, USA.
authors.forename: P H
authors.initials: PH
authors.lastname: Sugarbaker
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001063:Appendiceal Neoplasms / Q000188:drug therapy*; D003110:Colonic Neoplasms / Q000188:drug therapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D010534:Peritoneal Neoplasms / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents; D016685:Mitomycin; D005472:Fluorouracil