title: Limited survival in patients with carcinomatosis from foregut malignancies after cytoreduction and continuous hyperthermic peritoneal perfusion.
abstract: Peritoneal carcinomatosis is a frequent mode of metastasis in patients with gastric, duodenal, or pancreatic cancer. Survival in this setting is short and therapeutic options are limited. This analysis examines the outcomes of 18 patients treated with operative cytoreduction and continuous hyperthermic peritoneal perfusion. Eighteen patients (6 males and 12 females) with gastric (n = 9), pancreatic (n = 7), or duodenal (n = 2) cancer were treated on protocol. Patients underwent optimal cytoreduction (complete gross resection, 11; minimal residual disease, 7) and a 90-minute perfusion with cisplatin. Clinical parameters and tumor and treatment characteristics were analyzed. Survival curves were estimated using the Kaplan-Meier method. Procedures included gastrectomy (n = 8), pancreaticoduodenectomy (n = 3), and hemicolectomy (n = 2). After cytoreduction, patients had no evidence of residual disease (n = 11), fewer than 100 implants less than 5 mm (n = 1), more than 100 implants between 5-10 mm (n = 3), or multiple implants with greater than 1 cm (n = 3). Five patients received a postoperative intraperitoneal dwell with 5-fluorouracil and paclitaxel. There was one perioperative mortality, and complications occurred in 10 patients. The median progression-free survival was 8 months (mean, 10 months; range, 1-47 months) with a median overall survival of 8 months (mean, 18 months; range, 1-74 months). In this cohort, peritoneal perfusion with cisplatin used to treat foregut malignancies has a high incidence of complications and does not significantly alter the natural history of the disease. Investigation of novel therapeutic approaches should be considered.
authors.affiliation: Surgery Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1201, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Farma
authors.forename: James F
authors.initials: JF
authors.lastname: Pingpank
authors.forename: Steven K
authors.initials: SK
authors.lastname: Libutti
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: Susan
authors.initials: S
authors.lastname: Ohl
authors.forename: Tatiana
authors.initials: T
authors.lastname: Beresneva
authors.forename: H Richard
authors.initials: HR
authors.lastname: Alexander
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000295:instrumentation; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004379:Duodenal Neoplasms / Q000401:mortality* / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D013274:Stomach Neoplasms / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin