Researchers at Wake Forest University Baptist Medical Center report in the January issue of Archives of Surgery that surgery combined with inserting heated chemotherapy drugs directly into the abdomen can improve survival rates in patients with disseminated cancer of the abdominal cavity. Patients participating in the research study had a median overall survival of 16 months. Traditionally, patients with this condition, known as peritoneal carcinomatosis, survive only 3-6 months without treatment.
Peritoneal cancer is the most common cause of death in patients with intra-abdominal cancers. Surgery alone has proven to be ineffective, as have external beam radiation therapy, brachytherapy and systemic chemotherapy.
Perry Shen, M.D., assistant professor of surgical oncology, was lead author of the study, which treated 109 patients with peritoneal carcinomatosis between 1991 and 1997. The study was open to patients with peritoneal disease that had spread both from gastrointestinal and non-gastrointestinal primary sites.
“As surgical techniques and perioperative care have improved, there has been a greater trend towards more aggressive surgical treatment of solid tumors,” said Shen. “This trial and available data indicated that a multimodality approach to treating patients with peritoneal carcinomatosis can significantly alter the natural history of the disease, alleviate symptoms and even produce long-term survivors.”
All patients underwent surgery to remove as much of the tumor and surrounding cancerous tissue as possible, followed immediately with intraperitoneal hyperthermic chemotherapy (IPHC). With IPHC, the patient’s core temperature was cooled to just over 93 degrees Fahrenheit. Once surgery was completed, catheters were placed in the abdomen to deliver the chemotherapy directly into the abdominal cavity. The chemotherapy agent, heated to a maximum temperature of 105 degrees Fahrenheit, was delivered through the catheters. The abdomen was gently massaged throughout the two-hour procedure to improve drug distribution to all peritoneal surfaces.
Experimental evidence suggests that tumor tissue is more sensitive to heat than normal tissue and has less resistance to chemotherapy under hyperthermic conditions.
Since IPHC is essentially a palliative procedure, alleviating the symptoms without curing the disease, an important factor to consider besides overall survival is the effect of the procedure on the patient’s quality of life. A follow-up study of 17 patients surviving more than three years after surgery and IPHC reported more than 90 percent of them with minimal to no limitations of activity, with functional assessments comparable to the national norms for their respective age groups.
“Surgery combined with IPHC is an aggressive, multi-disciplinary approach to treating a difficult cancer with few meaningful therapeutic options,” said Shen.
Although it is clearly not a treatment for all patients with peritoneal carcinomatosis, selected patients may benefit from improved quality of life and extended survival, he said.
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