2005 Abstracts: Limited Survival in Patients with Peritoneal Carcinomatosis (PC) From Gastric, Duodenal or Pancreatic Cancer After Tumor Debulking and Continuous Hyperthermic Peritoneal Perfusion (CHPP) with Cisplatin
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Limited Survival in Patients with Peritoneal Carcinomatosis (PC) From Gastric, Duodenal or Pancreatic Cancer After Tumor Debulking and Continuous Hyperthermic Peritoneal Perfusion (CHPP) with Cisplatin
Jeffrey M. Farma, James F. Pingpank, Steven K. Libutti, National Cancer Institute, Bethesda, MD; David L. Bartlett, University of Pittsburgh Medical Center, Pittsburgh, PA; Susan C. Ohl, Tatiana Beresneva, H. Richard Alexander, National Cancer Institute, Bethesda, MD
Introduction:
PC is a frequent mode of metastasis in patients with primary gastric, duodenal, or pancreatic adenocarcinoma. Survival in this clinical setting is short and therapeutic or palliative options are limited. This analysis examines the outcomes of 18 patients with PC from one of these cancers treated with operative tumor debulking and CHPP with cisplatin. Methods: From September 1993 through April 2002, 18 patients (M: 6 F: 12, mean age: 48 y [range: 32-72]) with PC from gastric, duodenal or pancreatic adenocarcinoma were treated on 1 of 4 IRB approved clinical protocols utilizing CHPP. Patients underwent operative exploration with optimal tumor debulking (complete gross resection: 11, minimal residual disease: 7) followed by a 90 minute CHPP (flow rates: 1.5 L/min; average peritoneal T: 41.4o C) with 250 mg/M2 cisplatin (mean dose: 453 mg, range 186-676 mg). Clinical and demographic parameters, as well as tumor and treatment characteristics were analyzed. Survival curves were estimated using the Kaplan-Meier method. Results: Eighteen patients with gastric (n=9), pancreatic (n=7), and duodenal adenocarcinoma (n=2) were treated. Previous treatment included surgery alone (n=7), chemotherapy (n=4), or radiation (n=1). Operations performed included subtotal or total gastrectomy (n=8), pancreaticoduodenectomy (n=3), and right hemi-colectomy (n=2). Patients were debulked down to no residual evidence of disease (n=11), less than 100 implants all less than 5 mm (n=1), greater than 100 implants with a size of 5-10mm (n=3), and multiple implants greater than 1 cm (n=3). Five patients (28%) received a single intraperitoneal dwell with 800 mg/M2 5-fluorouracil and 125 mg/M2 paclitaxel between post-operative days 8 to 12. There was 1 operative mortality (6%) and postoperative complications occurred in 10 patients (56%). The median progression-free survival was 8 months (mean 10, range 1-47 mos.) with a median overall survival of 8 months (mean 18, range 1-74 mos.). One patient with gastric carcinoma was lost to follow up, with last known survival at 74 months. One patient with duodenal carcinoma is still alive at 46 months. Conclusion: In this small cohort, CHPP with cisplatin as a regional treatment strategy for PC from foregut malignancies has a high incidence of complications and does not appear to significantly alter the natural history of the disease. Investigation of alternative therapeutic approaches should be considered.
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