Peritoneal carcinomatosis treatment with curative intent: The Institut Gustave-Roussy experience

The prognosis of peritoneal carcinomatosis (PC), classically treated with intravenous chemotherapy, is very poor (mean survival of 6 months). The aim of this study is to report the results of a phase II study in which PC was treated with complete cytoreductive surgery, with the residual microscopic disease treated by immediate intraperitoneal post-operative chemotherapy (IIPC) for 5 days (mitomycin® with fluorouracil® or Adriamycin® with Platinol®). Fifty-four patients with PC from miscellaneous origins were treated between January 1993 and April 1996. The PC was important (clinically evident) but with no extraperitoneal localization in 29 cases. The PC was moderate or minor in 25 cases having been fortuitonsly discovered during a laparotomy for extraperitoneal cancer localization. Operating time was 7:21 h, associated frequently with extensive peritonectomies, and with resection of invaded organs (four organs per patient). IIPC was complete (5 days) in 91 per cent of patients. Three post-operative deaths (5.5%) occurred. Morbidity was present in 61 per cent of patients, and was related to surgical extension (P < 0.001). A 2-year survival of 50% was mainly correlated with the importance of the PC (P < 0.01), and was the same for both groups of patients (isolated major PC vs moderate (or minor) PC associated with extraperitoneal localization). PC recurrence rates were 30 per cent at 2 years. Complete cytoreductive surgery associated with IIPC is a logical and promising treatment of moderate and minor PC. However, it appears that it is a heavy treatment for patients (and physicians), and its efficacy will be proved only after a randomized study for survival, quality of life, and cost (currently ongoing).