Cytologic assessment before and after intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis.
OBJECTIVE
A phase I/II clinical trial of surgical cytoreduction combined with intraperitoneal hyperthermic chemotherapy (IPHC) for patients with disseminated peritoneal carcinoma was begun in December 1991. The use of peritoneal cytology to assess this treatment modality was the objective of this study.


METHODS
Adult patients with primary intraabdominal cancer with peritoneal dissemination underwent surgical debulking and intraoperative, two-hour, heated abdominopelvic perfusion with mitomycin C (MMC). Peritoneal washings were sent before and after IPHC, and the use of peritoneal cytology in this setting was reviewed retrospectively.


RESULTS
Twenty patients (9 female, 11 male) with adenocarcinoma (19) and one with epithelial mesothelioma, all with bulky peritoneal disease, were treated. Pre- and post-IPHC cytologic specimens were available for 18 cases. Cytology was tumor negative in three cases before and after IPHC. Conversion to negative post-IPHC cytology was seen in 6 of 15 cases and correlated with total or near-total tumor debulking (Fisher's exact test, P = .002). For 13 patients with follow-up > or = 6 months, 6 patients with both negative post-IPHC cytology and tumor < or = 1 g were alive at 6 months; of 7 patients with residual gross tumor or positive post-IPHC cytology, 5 had died within 6 months (P = .02).


CONCLUSIONS
Some patients undergoing IPHC with tumor-positive peritoneal cytology will convert to negative cytology following IPHC. This correlates with total or near-total tumor debulking and is associated with improved survival.
Loggie
B W
BW
Department of Internal Medicine, Wake Forest University, Bowman Gray School of Medicine, Winston-Salem, North Carolina, USA.
Fleming
R A
RA
Geisinger
K R
KR
D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D002277:Carcinoma / Q000188:drug therapy* / Q000601:surgery; D004358:Drug Therapy / Q000379:methods*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000601:surgery
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin