Title Page | Introduction | Principles of Intraperitoneal Chemotherapy | Current Indications for Cytoreductive Surgery and Intraperitoneal Chemotherapy
Heated Intraoperative Intraperitoneal Chemotherapy by the Coliseum Technique
Immediate Postoperative Abdominal Lavage in Preparation for Early Postoperative Intraperitoneal 5-Fluorouracil
Early Postoperative Intraperitoneal Chemotherapy for Adenocarcinoma | Induction Intraperitoneal Chemotherapy for Debilitating Ascites
Cytoreductive Surgery for Peritoneal Surface Malignancy - Peritonectomy Procedures | Results of Treatment of Peritoneal Surface Malignancy
Conclusions | References




V. EARLY POSTOPERATIVE INTRAPERITONEAL CHEMOTHERAPY FOR ADENOCARCINOMA



Intraperitoneal chemotherapy following complete cytoreduction in patients with appendiceal, colonic, rectal, gastric, or other gastrointestinal adenocarcinomas has utilized early postoperative intraperitoneal 5-fluorouracil. In pretreated ovarian cancer patients who have neurologic toxicities from systemic cisplatin, additional cisplatin should not be used. These patients are also treated with 5-fluorouracil.

The standardized orders for early postoperative administration of intraperitoneal 5-fluorouracil are shown in Table 7.


TABLE 7

Early postoperative intraperitoneal chemotherapy with 5-fluorouracil

Postoperative Days 1-5
  1. Add to _____ ml 1.5% dextrose peritoneal dialysis solution:
    (a) _____ mg 5-fluorouracil (650 mg/m2, maximum dose 1300 mg)
    (b) 50 mEq sodium bicarbonate.
  2. Intraperitoneal fluid volume:
    1 liter for patients < 2.0m2, 1.5 liter for > 2.0 m2.
  3. Drain all fluid from the abdominal cavity prior to instillation; then clamp all drains.
  4. Run the chemotherapy solution into the abdominal cavity through the Tenckhoff
    catheter as rapidly as possible.
    Dwell for 23 hours and drain for 1 hour prior to next instillation.
  5. Use gravity to maximize intraperitoneal distribution of the 5-fluorouracil.
    Instill the chemotherapy with the patient in a full right lateral position.
    After 1/2 hour, direct the patient to turn to the full left lateral position.
    Change position right to left every 1/2 hour. If tolerated, use 10 degrees
    of Trendelenburg position. Continue turning for the first 6 hours after
    instillation of chemotherapy solution.
  6. Continue to drain abdominal cavity after final dwell until Tenckhoff catheter is removed.
  7. Use 33% dose reduction for heavy prior chemotherapy, age greater than 60, or prior radiotherapy.




Title Page | Introduction | Principles of Intraperitoneal Chemotherapy | Current Indications for Cytoreductive Surgery and Intraperitoneal Chemotherapy
Heated Intraoperative Intraperitoneal Chemotherapy by the Coliseum Technique
Immediate Postoperative Abdominal Lavage in Preparation for Early Postoperative Intraperitoneal 5-Fluorouracil
Early Postoperative Intraperitoneal Chemotherapy for Adenocarcinoma | Induction Intraperitoneal Chemotherapy for Debilitating Ascites
Cytoreductive Surgery for Peritoneal Surface Malignancy - Peritonectomy Procedures | Results of Treatment of Peritoneal Surface Malignancy
Conclusions | References