Adjuvant Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for patients at High-Risk of Peritoneal Metastases

Mackenzie C Morris; Vikrom K Dhar; Megan A Stevenson; Leah K Winer; Tiffany C Lee; Jiang Wang; Syed A Ahmad; Sameer H Patel; Jeffrey J Sussman; Daniel E Abbott

doi:10.1016/j.suronc.2019.09.002

Adjuvant Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for patients at High-Risk of Peritoneal Metastases

Surg Oncol. 2019 Dec:31:33-37. doi: 10.1016/j.suronc.2019.09.002. Epub 2019 Sep 5.

Authors

Affiliations

¹ Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
² Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
³ Department of Pathology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
⁴ Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Electronic address: abbott@surgery.wisc.edu.

PMID: 31518971
DOI: 10.1016/j.suronc.2019.09.002

Abstract

Background: Selection of patients for hyperthermic intraperitoneal chemotherapy (HIPEC) continues to evolve. We hypothesized that adjuvant HIPEC for patients at high-risk of peritoneal progression is safe and associated with favorable outcomes.

Methods: The institutional database of a high-volume center was queried for patients with high-risk disease undergoing HIPEC with a peritoneal carcinomatosis index (PCI) of 0. High-risk patients were defined as those with ruptured primary tumors or locally advanced (T₄) disease.

Results: 37 patients underwent adjuvant HIPEC, with a median follow-up of 5.2 years. 54% had low-grade (LG) tumors while 46% had high-grade (HG) tumors. No patients underwent neoadjuvant chemotherapy, while eleven patients (32.4%) received adjuvant chemotherapy. There were no perioperative mortalities, and the overall complication rate was 43%. For the entire cohort, five year recurrence-free survival (RFS) and overall survival (OS) were 77% and 100%, respectively. Five year RFS and OS were 75% and 100% for LG patients and 81% and 100% for HG patients, respectively.

Conclusions: Adjuvant HIPEC for patients at high-risk of peritoneal progression, with PCI 0, is safe and associated with favorable long-term survival. Additional prospective investigation is needed to identify patient populations who may benefit most from HIPEC.

Keywords: Adjuvant perfusion; HIPEC; Peritoneal carcinomatosis; Tumor rupture.

MeSH terms

Adult
Aged
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Chemotherapy, Adjuvant
Chemotherapy, Cancer, Regional Perfusion / mortality*
Combined Modality Therapy
Cytoreduction Surgical Procedures / mortality*
Female
Follow-Up Studies
Humans
Hyperthermia, Induced / mortality*
Male
Middle Aged
Neoplasm Recurrence, Local / pathology
Neoplasm Recurrence, Local / therapy*
Neoplasms / pathology
Neoplasms / therapy*
Peritoneal Neoplasms / secondary
Peritoneal Neoplasms / therapy*
Prognosis
Retrospective Studies
Survival Rate