Impact of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy on systemic toxicity.
BACKGROUND
The purpose of this study was to analyze the postoperative systemic toxicity and procedure-related mortality (PRM) of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal surface malignancies (PSMs).


METHODS
A total of 242 (84 males/158 females) patients with PSM underwent 247 consecutive procedures. The mean age was 52 years (range 22-79). CRS was performed using peritonectomy procedures. The HIPEC technique through the closed abdomen was conducted with cisplatin (CDDP 25 mg/m(2)/l of perfusate)+mitomycin C (MMC 3.3 mg/m(2)/l perfusate) or CDDP (43 mg/l perfusate)+doxorubicin (Dx 15.25 mg/l perfusate) at 42.5 degrees C. These dosages were reduced by 30% when the patient had received systemic chemotherapy before the CRS+HIPEC. Systemic toxicities were graded according to the NCI CTCAE v3 criteria.


RESULTS
G3-5 systemic toxicity rate was 11.7 % and adverse events were bone marrow suppression, 13; nephrotoxicity, 14; neutropenic infection, 2 and pulmonary toxicity, 1. Independent risk factors for G3-5 systemic toxicity after multivariate analysis were a dose of CDDP for HIPEC of 240 mg or more (OR 2.78, CI 95% 1.20-6.45) and CDDP+Dx schedule for HIPEC (OR 2.36, CI 95% 1.02-5.45). PRM was 1.2%.


CONCLUSIONS
CRS+HIPEC presented acceptable systemic toxicity and PRM rates. Independent risk factors for systemic toxicity were the CDDP+Dx schedule and CDDP dose for HIPEC.
Kusamura
Shigeki
S
Department of Surgery, National Cancer Institute of Milan, Via Venezian 1, 20133, Milano, Italy.
Baratti
Dario
D
Younan
Rami
R
Laterza
Barbara
B
Oliva
Grazia Daniela
GD
Costanzo
Pasqualina
P
Favaro
Myriam
M
Gavazzi
Cecilia
C
Grosso
Federica
F
Deraco
Marcello
M
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009017:Morbidity; D009364:Neoplasm Recurrence, Local; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D016896:Treatment Outcome
D016685:Mitomycin; D004317:Doxorubicin; D002945:Cisplatin