[Hyperthermic intra-peritoneal chemotherapy (HIPEC) in patients with peritoneal pseudomyxoma or peritoneal metastases of colorectal carcinoma; good preliminary results from the Netherlands Cancer Institute].
OBJECTIVE
To apply (HIPEC) using mitomycin in patients with peritoneal carcinomatosis.


METHODS
Descriptive.


METHODS
The HIPEC treatment includes cytoreductive surgery and subsequent peritoneal lavage with exposure of the superficial tumour residues to a high concentration of a cytostatic drug at an intra-abdominal temperature of 40-42 degrees C. The HIPEC treatment was given to 24 patients with pseudomyxoma peritonei and to 29 patients with peritoneal carcinomatosis of colorectal origin. The adequate dose of mitomycin was determined in the Netherlands Cancer Institute in 26 patients: doses of 15 mg/m2 (n = 8), 25 mg/m2 (n = 3), 35 mg/m2 (n = 7) and 40 mg/m2 (n = 8) were administered.


RESULTS
The maximal tolerable dose of mitomycin appeared to be 35 mg/m2, while unacceptable toxicity was recorded at a dose of 40 mg/m2. Therefore 35 mg/m2 was used in subsequent cases. Among the patients with pseudomyxoma peritonei 8 developed severe complications, two of which were fatal. After a median follow-up of 12 months, 21 patients were alive of whom 18 were free of disease. Among the patients with peritoneal carcinomatosis of colorectal origin one patient died from a treatment-related complication. After a median follow-up of 18 months, 18 patients were alive of whom 11 were free of disease. The actuarial 2 year survival was 59%.


CONCLUSIONS
In the Netherlands Cancer Institute HIPEC treatment is considered the treatment of choice for pseudomyxoma peritonei. The results in cases of peritoneal carcinomatosis of colorectal origin are promising, but the results of a randomized trial are awaited.
Zoetmulder
F A
FA
Nederlands Kanker Instituut/Antoni van Leeuwenhoek Ziekenhuis, Amsterdam.
van der Vange
N
N
Witkamp
A J
AJ
Kaag
M M
MM
Boot
H
H
Beijnen
J H
JH
D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D006801:Humans; D006979:Hyperthermia, Induced; D016685:Mitomycin / Q000008:administration & dosage* / Q000627:therapeutic use; D009426:Netherlands; D010533:Peritoneal Lavage; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D011553:Pseudomyxoma Peritonei / Q000188:drug therapy* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin