Chinese expert consensus on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancies

Table 1 Molecular weight and ratio of ascites to plasma drug concentration of chemotherapy agents used for hyperthermic intraperitoneal chemotherapy[17]

Drug	Molecular weight	Ascites to plasma concentration ratio
Doxorubicin	579.99	230
Melphalan	305.20	93
Mitomycin C	334.30	23.5
Cisplatin	300.10	7.8
Gemcitabine	299.50	500.0
Mitoxantrone	517.41	115-255
Oxaliplatin	397.30	16
Etoposide	588.58	65
Paclitaxel	853.90	1000
Docetaxel	861.90	552
5-Flurouracil	130.08	250
Floxuridine	246.20	75
Carboplatin	371.25	10

Table 2 Results of phase II clinical studies on colorectal peritoneal carcinomatosis treated with hyperthermic intraperitoneal chemotherapy[35]

Ref.	Year	Patients	Mean follow-up (mo)	Overall survival in years
				1	2	3	4	5
Schneebaum et al	1996	15	15	-	-	-	-	-
Elias et al	1997	23	12	88%	55%	40%	-	-
Fujimura et al	1999	14	-	51%	-	21%	-	-
Loggie et al	2000	38	27	60%	39%	24%	-	-
Cavaliere et al	2000	14	30	-	64%	-	-	-
Witkamp et al	2000	29	38	82%	45%	23%	-	-
Beaujard et al	2000	21	12	50%	-	-	-	-
Piso et al	2001	17	39	-	-	-	75%	-
Elias et al	2001	64	36	60%	47%	36%		27%
Culliford et al	2001	47	17	-	-	-	-	28%
Zoetmulder et al	2002	35	-	-	-	-	-	20%
Shen et al	2003	40	52	60%	-	24%	-	-
Pilati et al	2003	34	14	-	31%	-	-	-
Pestieau et al	2003	99	-	100%	-	-	-	30%
Glehen et al	2004	53	-	55%	-	-	-	11%
Total	-	543	10-52	-	> 40%	-	-	20%

Table 3 International studies on gastric peritoneal carcinomatosis treatment by cytoreductive surgery + hyperthermic intraperitoneal chemotherapy

Ref.	Patients	Staging criteria	CCR0 n (%)	HIPEC	Morbidity n (%)	Mortality n (%)	Median follow-up (mo)	Median survival (mo)	Overall survival in years
									1	2	5
Yonemura et al[42]	107	Japanese General Rules for Gastric Cancer Study	47 (43.9)	Open technique, MMC 30 mg, DDP 300 mg, Etoposide 150 mg, 8 L of normal saline, 42-43 °C, 60 min	23 (15.9)	3 (2.8)	46	11.5	35.5%	13.1%	6.7%
								CCR 0: 19.2
								CCR 1-3: 7.8
Yonemura et al[50]	83	Japanese General Rules for Gastric Cancer Study	28 (33.7)	Open technique, MMC 30 mg, DDP 300 mg, Etoposide 150 mg, 8 L of normal saline, 42-43 °C, 60 min	-	-	46	CCR 0: 13.9	43.0%	-	11.0%
								CCR 1-3: 6.8
Yonemura et al[43]	48	Japanese General Rules for Gastric Cancer Study	-	Open technique, MMC 30 mg, DDP 300 mg, 8 L of normal saline, 42-43 °C, 60 min	9 (19.0)	2 (4.0)	-	-	-	-	61.0%
Scaringi et al[44]	26	Gilly's Classification	8 (30.8)	Close technique, MMC 120 mg, DDP 200 mg, 6 L of normal saline, 42-43 °C, 90-120 min	10 (38.5)	1 (3.8)	-	6.6	-	-	-
								CCR 0: 15
								CCR 1-3: 3.9
Fujimoto et al[45]	15	-	-	Close technique, MMC 30-50 mg, 44.7-48.7 °C, 120 min	2 (13.3)	0	-	7.2 ± 4.6	-	-	-
Fujimoto et al[6]	71	TNM Classification	71 (100.0)	Close technique, MMC 10 mg/mL, 44.5-45 °C, 120 min	2 (2.8)	0	7	-	88.0%	76.0%	2.0%
Hall et al[46]	34	-	7 (21.0)	Close technique, MMC 10 mg/mL, 40 °C, 120 min	12 (35.0)	0	-	8	27.0%	23.0%	6.0%
Fujimura et al[47]	31	Japanese General Rules for Gastric Cancer Study	2 (16.0)	Open technique, MMC 20 mg/m2, DDP 200 mg/m2, 6 L of normal saline, 42-52 °C, 90-120 min	6 (19.4)	0	-	9	33.3%	8.3%	0.0%
Hamazoe et al[48]	42	-	40 (95.0)	Close technique, MMC 10 μg/mL, inflow temperature 40-45 °C, outflow temperature 40-42 °C, 60 min	2 (4.8),	0	> 6	77	90.0%	80.0%	64.3%
Kim et al[49]	52	TNM Classification	-	Close technique, MMC 10 μg/mL, inflow temperature 44 °C, 20 min	19 (36.5)	0	38	36	-	-	32.7%
Yang et al[7]	68	Sugarbaker’s Classification	20 (58.5)	Open technique, MMC 30 mg, DDP 120 mg, 42 °C, 120 min	5 (14.7)	0	32	PCI ≤ 20 13.5 PCI > 20 10.2
Chen et al[40]	500	-	-	Open technique, Chlorhexidine diacetate hydrate 0.6 g, 4 L of distilled water, 43 °C, 4 min	-	-	-	-	88.7%	66.2%	63.6%
Zhu et al[41]	52	-	-	Open technique, DDP 50 mg/L, MMC 5 mg/L, 43 °C, 60 min	-	-	72	-	76.9%	69.2%	55.2%

Table 4 Results of hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma[58]

Ref.	Patients	Country	Median follow-up (mo)	Median OS (mo)	Median DFS (mo)	Morbidity	Mortality
Baratti et al	12	Italy	27	-	24	-	0%
Baratti et al	12	Italy	64	-	11	8.3%	0%
Blackham et al	34	United States	72	40.8	9.1	-	-
Brigand et al	15	France	46.7	35.6	-	-	0%
Chua et al	20	Australia	18.1	29.5	7.2	65.0%	5%
Sebbag et al	33	United States	21.3	31	-	33.0%	3%
Tudor et al	20	Australia	18	30	8	65.0%	5%
Deraco et al	61	Italy	20	-	28	23.0%	0%
Deraco et al	116	Italy	-	31.4	14.4	41.3%	2.6%
Loggie et al	12	United States	45.2	34.2	-	33.0%	8%
Ma et al	12	Turkey	10	-	-	90.0%	20%
Macuks et al	12	Turkey	-	-	-	-	-
Markman et al	19	United States	25	19	-	-	-
Feldman et al	49	United States	-	92	17	25.0%	-
Chua et al	26	Australia, Italy, France, United States, United Kingdom, Germany	54	-	-	26.9%	0%
Schaub et al	104	United States	49.4	52	20.8	-	-
Yan et al	401	Australia, Italy, France, United States, United Kingdom, Germany	33	53	-	46.0%	2%
Yano et al	17	United Kingdom	13	-	-	41.0%	12%
Yonemura et al	21	Japan	-	-	-	46.2%	-
Elias et al	26	France	54	> 100	40	54.0%	4%

OS: Overall survival; DFS: Disease-free survival.