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

Hai-Tao Wu, Xiao-Jun Yang, Chao-Qun Huang, Jian-Hua Sun, Zhong-He Ji, Kai-Wen Peng, Qian Zhang, Yan Li, Hai-Tao Wu, Xiao-Jun Yang, Chao-Qun Huang, Jian-Hua Sun, Zhong-He Ji, Kai-Wen Peng, Qian Zhang, Yan Li

Abstract

Background: This 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.

Methods: Patients were treated by CRS + HIPEC with lobaplatin 50 mg/m(2) and docetaxel 60 mg/m(2) 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.

Results: One 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.

Conclusions: CRS + 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 registration: ClinicalTrials.gov, NCT00454519.

Keywords: Cytoreductive surgery; Docetaxel; Hyperthermic intraperitoneal chemotherapy; Lobaplatin; Peritoneal carcinomatosis.

Figures

Fig. 1
Fig. 1
The Kaplan-Meier OS curves for the whole patients treated by CRS + HIPEC (a), and comparisons of OS among different primary diseases (b). mo months, OC ovarian cancer, PPC primary peritoneum carcinomatosis, GC gastric cancer, CRC colorectal cancer, PMP pseudomyxoma peritonei, CRS cytoreductive surgery, HIPEC hyperthermic intraperitoneal chemotherapy
Fig. 2
Fig. 2
Kaplan-Meier survival curves. The statistical significance in overall survival (OS) comparisons stratified by PCI (a), CC (b), postoperative adjuvant chemotherapy (c), and SAE (d). mo months, PCI peritoneal cancer index, CC completeness of cytoreduction, SAE serious adverse events

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