Toxicity and Quality of Life after Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy
Annals of Surgical Oncology. 2006 Oct 1; [Epub ahead of print] [Link]
Todd M. Tuttle1, Yan Zhang2, Edward Greeno3 and Amy Knutsen1
Todd M. Tuttle1 Contact Information, Yan Zhang2, Edward Greeno3 and Amy Knutsen1
(1) Division of Surgical Oncology, University of Minnesota Medical Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA
(2) Biostatistics Core, University of Minnesota Cancer Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA
(3) Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
Received: 8 June 2006 Revised: 8 June 2006 Accepted: 14 June 2006 Published online: 1 October 2006
Background: The purpose of our study was to determine the toxicity and quality of life for patients with peritoneal metastases after cytoreductive surgery (CS) plus hyperthermic intraperitoneal chemotherapy (HIPC).
Methods: From 2001 to 2005, 35 consecutive patients with peritoneal metastases enrolled in a prospective trial approved by the University of Minnesota Institutional Review Board. Their primary cancer sites included the appendix (19 patients), colon (7), mesothelioma (3), stomach (2), small bowel (2), gallbladder (1), and unknown (1). We performed CS in an effort to remove all or nearly all peritoneal tumor nodules. Using a closed technique, we administered hyperthermic mitomycin C into the peritoneal cavity for 90 min. Before treatment and then at 4-month postoperative intervals, we used the functional assessment of cancer therapy-colon subscale (FACT-C) instrument to assess the patients’ quality of life.
Results: The median hospital stay was 9 days; 12 patients were hospitalized at least 30 days or required readmission within 30 days after treatment. The postoperative mortality rate was 0%; adverse events occurred in 18 (51%) patients. As of December 2005, 20 patients were alive; 14 had died of progressive disease and 1 of an unrelated cause. The median survival time was 21.4 months. Quality of life measurements, including trial outcome index (TOI), FACT-colon, and FACT-general, returned to baseline 4 months after treatment and were significantly improved at 8 and 12 months.
Conclusions: Despite early toxicity, CS plus HIPC may prolong the overall survival rate of patients with peritoneal metastases and improve quality of life measurements.
Keywords: Peritoneal metastases, Cytoreductive surgery, Hyperthermia, Intraperitoneal chemotherapy, Quality of life