title: Initial experience with hyperthermic intra peritoneal chemotherapy and cytoreductivesurgery.
abstract: BACKGROUND
  Promising results were reported with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal carcinomatosis. Experiences in India are not published. This is a preliminary report.
  
  
  METHODS
  From eight patients with peritoneal metastasis, six patients (5 M, 1 F), aged (40-62 years) were treated with CRS and HIPEC between May 2010 and August 2011 from a single institution. Three had Mucinous Adenocarcinoma of Appendix and one each with Mesothelioma, Ovarian Cancer and Colonic Cancer. Four were earlier treated with systemic chemotherapy and recurred. Pre-operative peritoneal cancer index (PCI) was calculated based on recent computerized tomography or positron emission tomography scans. Surgical completeness cytoreduction score (CCS) was classified as macroscopically complete (CCS-0); optimal residual disease ≤2.5 mm in any region (CCS-1); or grossly incomplete: Residual disease >2.5 mm (CCS-2) or >25 mm (CCS-3). They were treated by closed perfusion technique with mitomycin-C (MCC) and cisplatin at 41-42°C, for 60 min.
  
  
  RESULTS
  Optimal cytoreduction (residual tumor nodules <2.5 mm i.e. CC0 and CC1) was performed in four patients (66.67%). There was no operative mortality or Grade 3 and 4 toxicity. Patients with PCI <11 are alive without recurrence with overall survival of 26-31 months. Those with PCI >11 had recurrence with overall survival of 3-19 months. Two patients died at 3 and 9 months.
  
  
  CONCLUSIONS
  CRS and HIPEC is a promising therapeutic option in selected patients with peritoneal carcinomatosis. These results in six patients are preliminary but encouraging. Patient with low PCI had better disease free survival.
authors.forename: N
authors.initials: N
authors.lastname: Dharmadhikari
authors.forename: R
authors.initials: R
authors.lastname: Shah
authors.affiliation: Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
authors.forename: P
authors.initials: P
authors.lastname: Jagannath
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods*; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007194:India; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000628:therapy*