Cytoreductive surgery combined with intraperitoneal insertion of hyperthermic mitomycin C can improve survival rates for patients with carcinomatosis due to colorectal cancer, according to an article in the February issue of the Annals of Surgical Oncology.

A total of 77 patients (median age, 54 years) were treated with the technique between 1991 and 2002, including 58 patients who had previously received conventional chemotherapy. Median overall survival for the treated patients was 16 months, with 17 percent of patients surviving for at least 5 years. In contrast, the historical survival rate for patients with peritoneal carcinomatosis is 3 to 6 months without treatment.

Perry Shen, MD, lead author of the study, said “As surgical techniques and perioperative care have improved, there has been a greater trend towards more aggressive surgical treatment of solid tumors. This study, combined with reports from other institutions, indicates that selected patients can achieve long- term survival with complete removal of peritoneal disease from colorectal cancer, which is the second leading cause of cancer death in the United States.”

Peritoneal cancer is the most common cause of death in patients with cancers in the abdomen. Surgery alone had proven to be ineffective, as had external beam radiation therapy, brachytherapy, and systemic chemotherapy.

All patients in the prospective trial had undergone surgery to remove as much of the tumor and surrounding cancerous tissue as possible, followed immediately with intraperitoneal hyperthermic chemotherapy with mitomycin C. The first step in drug infusion was to cool each patient’s core temperature to just over 93 degrees Fahrenheit. Catheters were placed into the abdomen to deliver the chemotherapeutic agent directly into the cavity. The mitomycin C, heated to a maximum temperature of 105 degrees Fahrenheit, was delivered through the catheters. The abdomen was gently massaged throughout the 2-hour procedure to improve drug distribution.

Direct delivery of chemotherapy has the benefit of getting higher concentrations of the drug directly at the site of the tumor while minimizing toxicity to the rest of the body. Experimental evidence suggests that tumor tissue is more sensitive to heat than normal tissue and that the cancerous tissue has less resistance to chemotherapy when the temperature of the drug is raised.

Because such intraperitoneal use of chemotherapy has been considered essentially a palliative procedure, an important factor to consider beside overall survival is the effect on quality of life. The quality of life was preserved for the majority of patients in the study, both in the short term and long term.

“A prospective randomized study in Europe recently reported the benefit of intraperitoneal heated chemotherapy compared to surgery and systemic chemotherapy alone. A larger, phase III prospective trial is planned," said Shen. “Although it is clearly not a treatment for all patients with peritoneal cancer, selected patients may benefit from improved quality of life and extended survival.”