Intraperitoneal hyperthermic chemotherapy for advanced gastrointestinal and ovarian cancers

A limited phase I pilot study of intraperitoneal hyperthermic chemotherapy (IPHC) in patients with carcinomatosis peritonei is reported. Seven adult patients with extensive carcinomatosis peritonei from gastrointestinal (n=6) or ovarian (n=1) primary cancer confined to the abdominopelvic cavity were treated. Bowel resection with anastomosis was done in 4 patients, and all had gross residual disease. The heated peritoneal perfusion with Mitomycin C (MMC), 30 mg, lasted 2-hours. No postoperative deaths, wound infections, subphrenic abscesses, or bowel leaks occurred. Two patients had self-limited serous wound leaks. Grade 3 neutropenia and grade 1 thrombocytopenia occurred; in one patient. Patients were discharged 9 to 23 days (median 11 days) postoperatively and median survival was 123 days (45 to 185). Malignant ascites present in 5 patients pre-IPHC was no longer present in 3 of those patients at discharge. Maximal mean MMC levels (μg/ml±SD; n=5) in perfusion fluid were 5.33±1.37, falling to 2.30±1.34 at 2 hours. Based on this limited trial, IPHC appears technically feasible, relatively safe, and warrants further clinical study in the treatment of disseminated intraperitoneal malignant disease.