The role of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative treatment of neoplastic ascites from peritoneal carcinomatosis: report of a single-center experience

Our plain-English summary of The role of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative treatment of neoplastic ascites from peritoneal carcinomatosis: report of a single-center experience, by L. Orgiano, F. Pani, G. Astara, et al (Supportive Care in Cancer, 2016).

The study

• Authors: L. Orgiano, F. Pani, G. Astara, C. Madeddu, S. Marini, A. Manca, G. Mantovani
• Journal: Supportive Care in Cancer
• Published: 2016;24(10):4293-9
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: The purpose of this study was to review the results of a single-center experience in the management of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) using a sophisticated technical device (EXIPER®) in the palliative setting of neoplastic ascites from peritoneal carcinomatosis in patients with advanced cancer of different primary sites.

Patients And Methods: The study was an open, prospective, single-center, non-randomized study conducted at the Department of Medical Oncology 1, University of Cagliari, Italy, from May 2006 to October 2012. Fifteen patients with peritoneal carcinomatosis were treated with HIPEC: 5 males and 10 females (age range 51-82, median 62 years), for a total of 30 procedures (5 patients were treated more than once). Malignant ascites were from ovarian, uterine cervical, colorectal, gastric, malignant pleural mesothelioma, and unknown primary cancer. Main endpoints were increase of free interval between two consecutive procedures, progressive reduction of ascites volumes and improvement of quality of life assessed with ECOG performance status and EORTC QLQ-C30 questionnaire, and improvement of immunologic function.

Results: Twelve patients were completely evaluable while three patients were "lost" to follow-up. The treatment was well tolerated. The mean free interval between two consecutive drainages increased from 11.2 to 39.5 days. The mean ascites volume drained decreased from 7.8 to 1.8 l. ECOG PS improved in the majority of patients and EORTC QLQ-C30 scores in all patients as well as immunologic function. In September 2015, only one patient was still alive.

Conclusions: Our study shows that good results may be achieved in terms of symptom palliation and improvement of quality of life in very advanced cancer patients with MA from PC. The treatment was generally well tolerated considering the limited treatment options available for these patients.

In plain English

This open, prospective, non-randomized study at one center in Cagliari, Italy, ran from May 2006 to October 2012. It tested heated chemotherapy circulated through the closed abdomen (HIPEC) using a device called EXIPER. The aim was to relieve cancer-related fluid build-up (malignant ascites) in 15 patients whose very advanced cancer had spread to the abdominal lining. One patient had malignant pleural mesothelioma. The others had ovarian, cervical, gastric, colorectal or unknown primary cancers. The article does not discuss asbestos. Twelve patients could be evaluated. The interval between drainages rose from 11.2 to 39.5 days. In the five patients treated more than once, the mean volume drained fell from 7.8 to 1.8 litres. Physical performance scores improved in seven patients, stayed the same in three and worsened in two. All had higher quality-of-life scores after each procedure. No deaths were caused by the procedure. By September 2015, 14 of the 15 patients had died of cancer. The authors concluded that good symptom relief may be achieved. They noted the small number of patients and the lack of a control group.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Open, prospective, single-center, non-randomized clinical study with no control group
• Who was studied: 15 patients (5 males, 10 females, age range 51 to 82, median 62) with malignant ascites from peritoneal carcinomatosis, treated at the University of Cagliari, Italy, May 2006 to October 2012, with 30 procedures in total. Primary cancers: ovarian (6), uterine cervical (1), gastric (2), colorectal (4), malignant pleural mesothelioma (1), unknown primary (1).
• Exposure: No asbestos exposure is studied. The intervention was closed-abdomen HIPEC through two drainage tubes using the EXIPER device. Ovarian and cervical cancers received carboplatin (AUC 4 to 5) or paclitaxel 175 mg/m2. Gastrointestinal cancers and mesothelioma received cisplatin 50 mg/m2 or mitomycin C 7 mg/m2. Each perfusion lasted 60 minutes at about 41 to 42 °C inside the abdomen.
• Main results:
  • 12 of 15 patients were fully evaluable; 3 were lost to follow-up.
  • The interval between drainages increased from 11.2 to 39.5 days. In one woman with ovarian cancer, ascites did not return for more than 2 years.
  • In the five patients treated more than once, mean ascites volume drained at each later procedure fell from 7.8 to 1.8 litres. The authors described this as a significant decrease compared with the seven patients treated only once.
  • Mean abdominal circumference decreased from 117.1 to 108.7 cm.
  • Of the 12 evaluable patients, ECOG performance status improved in seven, stayed the same in three and worsened in two.
  • All evaluable patients had a higher EORTC QLQ-C30 quality-of-life score after each procedure.
  • In nine patients tested before and 48 hours after the procedure, serum IL-8 decreased but not significantly and TNF-alpha did not change. Lymphocytes carrying CD45, CD16 and CD56 markers increased significantly.
  • There was no procedure-related death. Adverse events: grade I nausea in 10 patients, grade II nausea in 3, grade I vomiting in 4, grade II vomiting in 5, and grade III neutropenia in 2. Six patients had abdominal pain and one had peritoneal inflammation caused by the cytotoxic drug.
  • By September 2015, 14 of the 15 enrolled patients had died of cancer and 1 was still alive.
• The authors' conclusion: The authors concluded that good results may be achieved in symptom palliation and quality of life in very advanced cancer patients with malignant ascites from peritoneal carcinomatosis. They called for larger multicenter, hopefully randomized, trials.
• Limitations the authors state:
  • The study included a small number of patients and had no control group.
  • The procedure is not easily translated into routine clinical practice.
  • The procedure is relatively expensive and needs specialized, committed staff.

Topics

Medical terms in this study, explained in our Lexicon: HIPEC, Palliative Care, Ascites, Pleural Mesothelioma, Quality of Life, ECOG Performance Status.

Related studies

• Evolution of locoregional treatment for peritoneal carcinomatosis: single-center experience of 308 procedures of cytoreductive surgery and perioperative intraperitoneal chemotherapy — T.C. Chua, W. Liauw, et al. (2011)
• Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites — R.W. Randle, K.R. Swett, et al. (2014)
• Peritoneal carcinomatosis: intraoperative parameters in open (coliseum) versus closed abdomen HIPEC — E. Halkia, A. Tsochrinis, et al. (2015)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin in pediatric patients with peritoneal mesothelioma: a single institution experience and long term follow up — P. Malekzadeh, M. Good, et al. (2021)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: the Danish experience — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for disseminated intra-abdominal malignancies in children-a single-institution experience — O. Zmora, A. Hayes-Jordan, et al. (2018)

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