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Impact of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy on Systemic Toxicity

¹ Department of Surgery, National Cancer Institute of Milan, Via Venezian 1, 20133, Milano, Italy
² Department of Anesthesiology, National Cancer Institute of Milan, Milano, Italy
³ Department of Critical Care, National Cancer Institute of Milan, Milano, Italy
⁴ Nutritional Care Unit, National Cancer Institute of Milan, Milano, Italy
⁵ Department of Medical Oncology, National Cancer Institute of Milan, Milano, Italy
⁶ Department of Surgery – Surgical Oncology Unit, CHUM, University of Montreal Health Centre, Montreal, Canada

Correspondence: Address correspondence and reprint requests to: Marcello Deraco, MD; E-mail: marcello.deraco{at}istitutotumori.mi.it

Introduction: 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).

Patients and 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/m²/l of perfusate)+mitomycin C (MMC 3.3 mg/m²/l perfusate) or CDDP (43 mg/l perfusate)+doxorubicin (Dx 15.25 mg/l perfusate) at 42.5°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.

Key Words: Peritonectomy • Hyperthermic Intraperitoneal Chemotherapy • Toxicity

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