Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy with lobaplatin and docetaxel improves survival for patients with peritoneal carcinomatosis from abdominal and pelvic malignancies

Abstract

BackgroundThis work was to evaluate the perioperative safety and efficacy of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) with lobaplatin and docetaxel in patients with peritoneal carcinomatosis (PC) from gastrointestinal and gynecological cancers.MethodsPatients were treated by CRS + HIPEC with lobaplatin 50 mg/m2 and docetaxel 60 mg/m2 in 6000 mL of normal saline at 43 ± 0.5 °C for 60 min. Vital signs were recorded for 6 days after CRS + HIPEC procedures. Perioperative serious adverse events (SAE), hematological, hepatic, renal, and electrolytes parameters, the changes in serum tumor markers (TM) before and after operation, patient recovery, and overall survival (OS) were analyzed.ResultsOne hundred consecutive PC patients underwent 105 CRS + HIPEC procedures and postoperative chemotherapy. The median CRS + HIPEC duration was 463 (range, 245–820) min, and the highest temperature and heart rate during six postoperative days were 38.6 °C (median 37.5 °C) and 124 bpm (median 100 bpm), respectively. The 30-day perioperative SAE occurred in 16 (15.2 %) and mortality occurred in 2 (1.9 %) patients. Most routine blood laboratory tests at 1 week after surgery turned normal. Among 82 cases with increased preoperative TM CEA, CA125, and CA199, 71 cases had TM levels reduced or turned normal. Median time to nasogastric tube removal was 5 (range, 3–23) days, to liquid food intake 6 (range, 4–24) days, and to abdominal suture removal 15 (range, 10–30) days. At the median follow-up of 19.7 (range, 7.5–89.2) months, the median OS was 24.2 (95 % CI, 15.0–33.4) months, and the 1-, 3-, and 5-year OS rates were 77.5, 32.5, and 19.8 %, respectively. Univariate analysis identified five independent prognostic factors on OS: the origin of PC, peritoneal cancer index, completeness of CRS, cycles of adjuvant chemotherapy, and SAE.ConclusionsCRS + HIPEC with lobaplatin and docetaxel to treat PC is a feasible procedure with acceptable safety and can prolong the survival in selected patients with PC.Trial registrationClinicalTrials.gov, NCT00454519

The incidence and risk factors of hepatotoxicity induced by perioperative hyperthermic intraperitoneal chemotherapy in gastrointestinal carcinoma patients: a retrospective study

“…CRS can maximally remove the visible abdominopelvic tumors, and HIPEC can eradicate invisible residual tumor nodules, micrometastases, and free cancer cells. We have finished experimental 18 and clinical 15 , 16 , 19 studies to confirm the safety and effectiveness of CRS + HIPEC for PC. In the present study, we retrospectively investigated the incidence of hepatotoxicity and analyzed the risk factors.…”

“…The detailed procedures were carried out according to previous reports. 15 , 16 Briefly, the chemotherapeutic drugs were dissolved in 3 L saline. The perfusion solution was infused at a rate of 400 mL/min when the perfusion saline was kept at 43.0°C±0.5°C and monitored with temperature sensors in real time by an automatic hyperthermia chemotherapy perfusion device (ES-6001, Wuhan E-sea Digital Engineering, Wuhan, People’s Republic of China).…”

Current Trends in Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Disease from Appendiceal and Colorectal Malignancies

“…Given the high frequency of PC recurrence, novel agents are required to make HIPEC more effective and establish curative treatment for those cancers that continue to harbor poor outcomes. New cytotoxic HIPEC agents under evaluation include MOC31PE [ 201 , 202 ], miRNA-409-3p [ 203 ], nanoparticle pegylated liposomal doxorubicin [ 204 ], Radspherin ® (NCT03732781), raltitrexed (NCT04761185), and lobaplatin (NCT04845490 and NCT04808466) [ 205 , 206 ]. Additionally, our group recently completed a phase 1 study evaluating the safety of nano-liposomal irinotecan (nal-Iri) during HIPEC for appendiceal and CRC (NCT04088786).…”

The role of chemotherapy in the treatment of advanced appendiceal cancers: summary of the literature and future directions

“… 15 , 77 , 80 Studies that provide a more detailed insight into treatment regimens confirm that perioperative chemotherapy choice was predominantly fluoropyrimidine and oxaliplatin especially in high-grade disease. 40 , 41 , 65 , 74 , 75 , 78 , 79 , 81 , 84 , 85 , 93 …”