Toxicity and outcomes associated with surgical cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with sarcomatosis.
BACKGROUND
Treatment of peritoneal recurrence following surgical resection of intra-abdominal sarcomas presents a significant challenge to clinicians. Historically, treatment with systemic chemotherapy has been ineffective and surgical resection alone has not been durable. We prospectively evaluated the feasibility of cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin (CDDP) alone or in combination with mitoxantrone (MITOX) for the treatment of sarcomatosis.


METHODS
Two phase I trials of HIPEC were conducted (1998-2003). Eligible patients with evidence of sarcomatosis underwent cytoreductive surgery followed by HIPEC. In the first trial, CDDP dosing was established as 90 mg/m2 with a perfusate time of 90 minutes and temperature of 41 degrees C. In the second trial, MITOX (20 mg/m2) was instilled following perfusion with CDDP. Toxicity, efficacy, and quality of life (QOL) were evaluated.


RESULTS
A total of 28 patients were enrolled in the two trials. We noted a higher overall toxicity score and complication rate with combination CDDP/MITOX versus CDDP alone and shorter overall survival duration (5.5 months vs 16.9 months, respectively). In addition, local recurrence rates were similar in both groups (CDDP 79% vs CDDP/MITOX 68%). As expected, QOL scores at 6-8 weeks following HIPEC were 15-25% lower than the baseline scores; however, they returned to baseline at 3-6 months.


CONCLUSIONS
Although the HIPEC technique is feasible for patients with sarcomatosis, it is associated with significant toxicity and limited clinical benefit. Combination CDDP/MITOX failed to demonstrate any benefit over CDDP alone; moreover, there was an increase in toxicity.
Lim
Sherry J
SJ
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Cormier
Janice N
JN
Feig
Barry W
BW
Mansfield
Paul F
PF
Benjamin
Robert S
RS
Griffin
Janet R
JR
Chase
Judy L
JL
Pisters
Peter W T
PW
Pollock
Raphael E
RE
Hunt
Kelly K
KK
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000633:toxicity*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage / Q000633:toxicity*; D017321:Clinical Trials, Phase I as Topic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage / Q000633:toxicity*; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D012509:Sarcoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D008942:Mitoxantrone; D002945:Cisplatin