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    Intraperitoneal Chemotherapy

    Last Updated 8/20/02

    Historically considered "uncurable", Dr. Paul Sugarbaker (Washington, DC) has had 5-year survival rates running 50% for "selected" stage IV patients with peritoneal metastases from colon cancer. The combination of intraperitoneal chemotherapy with hyperthermia following cytoreductive surgery in which all visible disease is removed MAY be enough to "tip the balance" towards "cure" for some. One patient I know who actually contacted Sugarbaker said "I called Sugarbaker regarding a consult. The way they work is that you send them copies of operative reports, pathology reports, and a summary of your history, along with the films from most recent ct scan. Dr. Sugarbaker will review and call you to say if you are a candidate or not".

    Wake Forest in North Carolina also seems to be involved in Heated Intraperitoneal Chemotherapy research and treatment.

    You might also try checking the NCI database for intraperitoneal trials. For example, I was able to quickly locate this Phase II Study of Continuous Hyperthermic Peritoneal Perfusion With Cisplatin Plus Intraperitoneal Paclitaxel and Fluorouracil After Cytoreductive Surgery in Patients With Peritoneal Carcinomatosis (Summary Last Modified 06/2002) (Protocol ID: NCI-00-C-0069), and there may be more out there.

    Even without the Intraperitoneal Chemo (which can only increase the survival time/cure rate), this Abstract (PMID: 12072633) suggests that SURGERY improves survival time: "Patients with isolated retroperitoneal recurrences of colorectal cancer generally have a poor prognosis. However, a longer disease-free interval, complete negative-margin resection, and smaller tumor size are associated with long-term survival in selected patients". This is apparently contrary to the belief of "most" surgeons that peritoneal disease is "not worth resecting".

  1. 8/3/02 It's What the Surgeon Doesn't see that Kills the Patient by Paul Sugarbaker

  2. 8/3/02 Is Peritoneal Carcinomatosis an Incurable Disease or a Controllable Locoregional Condition? Editorial - Japanese Journal of Clinical Oncology

  3. 8/20/02 Review of a Personal Experience in the Management of Carcinomatosis and Sarcomatosis -FULL TEXT PAPER- Japanese Journal of Clinical Oncology 2001 (31) 12 573-583 "Carcinomatosis from colon cancer has an overall survival rate of 50% with seleted patients... in all malignancies, early aggressive treatment of minimal peritoneal surface dissemination showed greatest benefit"

  4. 8/3/02 Experimental and Unconventional Search on "Peritoneal"

  5. 8/3/02 Colon Cancer Support Search on "Peritoneal"

  6. 7/18/01 Sugerbaker Oncology Associates We are the Center for Surgical Oncology at the Washington Cancer Institute, Washington Hospital Center, in Washington, D.C. We specialize in the surgical treatment of cancers that arise in the gastrointestinal tract (stomach cancer, appendix cancer, and colorectal cancer); and other areas of the abdomen and pelvis. Specialty Section for the Treatment of Peritoneal Carcinomatosis Our advanced services include specialty treatment programs for gastric cancer, pseudomyxoma peritonei, peritoneal carcinomatosis (cancers that have spread to the intraabdominal surfaces), hepatobiliary (primary and metastatic liver cancer), pancreas cancer, as well as primary peritoneal surface malignancies such as peritoneal mesothelioma and abdominopelvic sarcoma.

  7. 7/18/01 MANAGEMENT OF PERITONEAL SURFACE MALIGNANCY USING INTRAPERITONEAL CHEMOTHERAPY AND CYTOREDUCTIVE SURGERY A Manual for Physicians and Nurses Paul H. Sugarbaker, M.D., F.A.C.S. Washington Cancer Institute 110 Irving Street NW Washington, DC 20010

  8. 7/7/01 HEATED INTRAOPERATIVE INTRAPERITONEAL CHEMOTHERAPY BY THE COLISEUM TECHNIQUE

  9. 7/7/01 Complications and tolerance of heated intraperitoneal chemotherapy and cytoreductive surgery for peritoneal carcinomatosis: results of a phase I-II study of peritoneal carcinomatosis from different sources

  10. 7/7/01 Cytoreductive Surgery with Intraperitoneal Hyperthermic Chemotherapy for Disseminated Peritoneal Cancer of Gastrointestinal Origin BRIAN W. LOGGIE, M.D.,* RONALD A. FLEMING, Pharm.D.,† RICHARD P. MCQUELLON, Ph.D.,† GREGORY B. RUSSELL, M.S.,‡ KIM R. GEISINGER, M.D.§ From the Departments of *General Surgery; †Internal Medicine, Section on Hematology/Oncology; ‡Public Health Sciences; and §Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina

  11. 8/18/02 Rationale and techniques of intra-operative hyperthermic intraperitoneal chemotherapy. Cancer Treat Rev 2001 Dec;27(6):365-74 PMID: 11908929 Pharmacokinetic studies have shown an important dose advantage for intraperitoneal versus intravenous application. Hyperthermia enhances the penetration of cytostatic drugs into tumour tissue and also shows synergism with various cytostatic drugs. The penetration depth of drugs into tissue is limited, therefore HIPEC can only be effective in patients with minimal residual disease after (aggressive) surgery. HIPEC can be conducted in various ways, without clear proven advantage of one method over the others. Local complications after this combined treatment approach are mainly surgery related. Intraperitoneal chemotherapy may cause systemic toxicity, dependent on the drug used. In randomised studies cytoreductive surgery followed by HIPEC has proven its value in the prevention of peritoneal dissemination in gastric cancer. Phase II data on HIPEC in peritoneal carcinomatosis of colorectal origin and pseudomyxoma peritonei are promising, but randomised studies are still not available.

  12. 7/7/01 TITLE: Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors. AUTHOR: Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC SOURCE: Cancer; 63(2):364-7 1989 UI: 89089543

  13. 7/7/01 Title: Phase II Trial of Continuous Hyperthermic Peritoneal Perfusion (CHPP) with Cisplatin Plus Early Postoperative Intraperitoneal Paclitaxel and 5-Fluorouracil for Peritoneal Carcinomatosis Number: 00-C-0069

  14. 7/19/01 TITLE: Cytoreductive surgery and peri-operative intraperitoneal chemotherapy as a curative approach to pseudomyxoma peritonei syndrome. AUTHOR: Sugarbaker PH SOURCE: Eur J Surg Oncol; 27(3):239-43 2001 UI: 21266900 Cytoreductive surgery and peri-operative intraperitoneal chemotherapy is the current standard treatment for selected patients with peritoneal surface spread of appendiceal primary tumours. Similar strategies for other patients with peritoneal surface malignancy such as peritoneal carcinomatosis from colon or gastric cancer, peritoneal sarcomatosis, or peritoneal mesothelioma should be pursued

  15. 7/19/01 TITLE: Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. AUTHOR: Stephens AD, Alderman R, Chang D, Edwards GD, Esquivel J, Sebbag G, Steves MA, Sugarbaker PH SOURCE: Ann Surg Oncol; 6(8):790-6 1999 UI: 20086221

  16. 7/19/01 TITLE: Quality of life after intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal carcinomatosis. AUTHOR: McQuellon RP, Loggie BW, Fleming RA, Russell GB, Lehman AB, Rambo TD SOURCE: Eur J Surg Oncol; 27(1):65-73 2001 UI: 21135584 CONCLUSIONS: Cytoreductive surgery followed by IPHC was well tolerated. Most patients returned to baseline or better levels of functioning within 3 months post-treatment.

  17. 7/19/01 TITLE: [Experimental study on intraperitoneal versus intravenous CPT-11 for peritoneal seeding and liver metastasis] SOURCE: Gan To Kagaku Ryoho; 27(12):1855-7 2000 UI: 20539004 AUTHOR: Maruyama M, Nagahama T, Ebuchi M, Yuasa Y Intraperitoneal administration of CPT-11 may be a more efficient form of adjuvant chemotherapy for prevention of both peritoneal seeding and liver metastasis in patients with gastrointestinal cancer.

  18. 7/19/01 TITLE: Treatment of primary colon cancer with peritoneal carcinomatosis: comparison of concomitant vs. delayed management. SOURCE: Dis Colon Rectum; 43(10):1341-6; discussion 1347-8 2000 UI: 20505694 AUTHOR: Pestieau SR, Sugarbaker PH CONCLUSIONS: In patients with peritoneal seeding occurring at the time of resection of the primary malignancy, peritonectomy procedures and perioperative intraperitoneal chemotherapy should be performed concomitantly. By use of a quantitative scoring system, the mass of cancer present in the abdomen and pelvis at the time of treatment of carcinomatosis correlated directly with survival. Aggressive treatment of patients with peritoneal carcinomatosis requires consideration in the management of colorectal cancer.

  19. 7/19/01 TITLE: Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin. AUTHOR: Loggie BW, Fleming RA, McQuellon RP, Russell GB, Geisinger KR SOURCE: Am Surg; 66(6):561-8 2000 UI: 20344045 These data suggest that aggressive cytoreductive surgery with IPHC using mitomycin C is safe and effective in treating peritoneal carcinomatosis of gastrointestinal origin. Additional studies and broader applications of this treatment are encouraged.

  20. 7/19/01 TITLE: Successful management of microscopic residual disease in large bowel cancer. AUTHOR: Sugarbaker PH SOURCE: Cancer Chemother Pharmacol; 43 Suppl:S15-25 1999 UI: 99284446 The surgeon must be aware that there are no long-term survivors unless complete cytoreduction occurs. With a combination of proper techniques for the resection of primary disease, peritonectomy procedures for the removal of all visible peritoneal implants, intraoperative and early postoperative chemotherapy for the eradication of microscopic residual disease, and quantitative tools for proper patient selection, one can optimize the surgical treatment of patients with large bowel cancer

  21. 7/19/01 TITLE: Second-look surgery after cytoreduction and intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer: analysis of prognostic features. AUTHOR: Portilla AG, Sugarbaker PH, Chang D SOURCE: World J Surg; 23(1):23-9 1999 UI: 99058114 We concluded that second-look surgery with potential curative intent should be considered in patients who had a complete initial cytoreduction and those in whom total removal of the recurrence is judged possible at the time of the second look

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