title: Incidence, risk factors, and impact of severe neutropenia after hyperthermic intraperitoneal mitomycin C.
abstract: BACKGROUND
  Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are considered the standard of care for patients with peritoneal dissemination of appendiceal cancer and are increasingly being evaluated for use in patients with carcinomatosis from colon cancer. Mitomycin C (MMC) is one of the most frequently used HIPEC agents in the management of peritoneal-based gastrointestinal malignancies. This study analyzes the incidence and risk factors for developing neutropenia following MMC-HIPEC combined with CRS.
  
  
  METHODS
  All patients undergoing CRS and MMC-HIPEC for appendiceal cancer between January 1993 and October 2006 were retrospectively reviewed. Logistic regression was used to identify risk factors for the development of neutropenia, defined as an absolute neutrophil count (ANC) <1,000/mm(3).
  
  
  RESULTS
  One hundred and twenty MMC-HIPEC were performed in 117 patients with appendiceal cancer. The incidence of neutropenia was 39%. Neutropenia occurred in 57.6% of female and 21.3% of male patients (p < 0.0001). Female gender and MMC dose per body surface area (BSA) were independent risk factors for neutropenia on multivariable logistic regression [odds ratio (OR) of neutropenia in females = 3.58 (95% confidence interval, CI: 1.52, 8.43); OR for 5 unit (mg/m(2)) increase in MMC dose per BSA = 3.37 (95% CI: 1.72, 6.63)]. Neutropenia did not increase the risk of mortality, postoperative infection or length of hospital stay.
  
  
  CONCLUSIONS
  Neutropenia is a frequent complication associated with MMC-HIPEC. Female sex and MMC dose per BSA are independent risk factors for neutropenia. These differences must be considered in the management of patients undergoing MMC-HIPEC to minimize the toxicity of the procedure.
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. laura.lambert@umassmemorial.org
authors.forename: Laura A
authors.initials: LA
authors.lastname: Lambert
authors.forename: Terri S
authors.initials: TS
authors.lastname: Armstrong
authors.forename: J Jack
authors.initials: JJ
authors.lastname: Lee
authors.forename: Suyu
authors.initials: S
authors.lastname: Liu
authors.forename: Matthew H G
authors.initials: MH
authors.lastname: Katz
authors.forename: Cathy
authors.initials: C
authors.lastname: Eng
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Tortorice
authors.forename: Pier
authors.initials: P
authors.lastname: Tansey
authors.forename: Santiago
authors.initials: S
authors.lastname: Gonzalez-Moreno
authors.forename: Donald H
authors.initials: DH
authors.lastname: Lambert
authors.forename: Paul F
authors.initials: PF
authors.lastname: Mansfield
mesh_terms: D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D001063:Appendiceal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D015994:Incidence; D007263:Infusions, Parenteral; D007274:Injections, Intraperitoneal; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000009:adverse effects*; D009367:Neoplasm Staging; D009503:Neutropenia / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D016685:Mitomycin