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




VI. INDUCTION INTRAPERITONEAL CHEMOTHERAPY AND TREATMENT FOR DEBILITATING ASCITES



There are two instances in which intraperitoneal chemotherapy is not used along with cytoreductive surgery. This may be desirable in an attempt to prepare patients for subsequent surgery. Also, some patients may not be candidates for surgery but may benefit from a resolution of large volume ascites.

The preferred method for peritoneal access for chemotherapy induction or treatment for debilitating ascites is catheter placement by paracentesis. The adequacy of chemotherapy distribution is assessed radiologically. To maximize distribution, chemotherapy is administered through a temporary catheter that is placed under radiologic control by paracentesis (8.3 French All Purpose Drain Catheter, Meditech, Watertown, MA 02272). Routinely, we have used a CT with intraperitoneal contrast to demonstrate uniform distribution of fluid within the abdomen (Figure 9).

Access to the peritoneal cavity can be maintained by repeated paracenteses or by using a subcutaneous infusion port and a curled Tenckhoff catheter. Access to the catheter is through the implanted port. The intraperitoneal catheter is positioned surgically in the left upper quadrant with the tip of the catheter as close to the ligament of Treitz as is possible. The jejunum is a portion of the small bowel that is in the most active peristalsis and assists to prevent Tenckhoff catheter entrapment by intestinal fibrosis.



FIGURE 9


CT with intraperitoneal contrast. The radiologist performs a paracentesis and placement of a temporary catheter. Intraperitoneal contrast shows wide distribution of fluid to the abdominal and pelvic surfaces.


The standardized orders for delivery of induction intraperitoneal chemotherapy or treatment of debilitating ascites for adenocarcinoma are shown in Table 9. Chemotherapy orders for delivery of induction intraperitoneal chemotherapy or treatment of debilitating ascites from sarcomatosis, ovarian cancer or mesothelioma are in Table 10.


TABLE 9

Intraperitoneal 5-fluorouracil and intravenous mitomycin C for induction chemotherapy
or treatment of debilitating ascites from adenocarcinoma.

Cycle # _______
  1. CBC, Platelets, Profile A, and appropriate tumor marker prior to treatment; and CBC, platelets 10 days after initiation of treatments.
  2. 5-Fluorouracil _____ mg (750 mg/m2)(maximum dose 1500 mg) and 50 mEq sodium bicarbonate in 1000 cc 1.5% dextrose dialysis solution via intraperitoneal catheter q day x 5 days. Last dose _______. Dwell for 23 hours, drain for one hour. Continue with next administration even if no drainage is obtained.
  3. On Day 3 (Date _______): 1000 cc lactated Ringer's solution intravenously over 2 hours prior to mitomycin infusion. Mitomycin C _____ mg (10 mg/m2 x _______ m2)(maximum dose 20 mg) in 200 cc 5% dextrose and water intravenously over 2 hours.
  4. Follow routine procedure for peripheral extravasation of a vesicant if extravasation should occur.
  5. Compazine 25 mg per rectum every 4 hours as necessary for nausea. OUTPATIENT ONLY: May dose x 4 for use at home.
  6. Percocet 1 tablet by mouth every 3 hours as necessary for pain. OUTPATIENT ONLY: May dose x 4 for use at home.
  7. Routine vital signs.
  8. Out of bed at lib.
  9. Diet: Regular as tolerated.
  10. Daily dressing change to intraperitoneal catheter skin exit site.
  11. Use 33% dose reduction for age greater than 60 or prior radiotherapy.




TABLE 10

Intraperitoneal cisplatin and doxorubicin chemotherapy for induction chemotherapy
or treatment of debilitating ascites (Breast cancer, peritoneal mesothelioma, ovarian cancer, etc.).

Cycle # _______
  1. CBC, Platelets, Profile A, and appropriate tumor marker prior to treatment; and CBC, platelets 10 days after initiation of treatments.
  2. Cisplatin _____ mg (20 mg/m2) (maximum dose 40 mg) in 1000 cc 1.5% dextrose dialysis solution via intraperitoneal catheter q day x 5 days. Last dose _______. Dwell for 23 hours, drain for one hour. Continue with next administration even if no drainage is obtained.
  3. Doxorubicin _____ mg (3 mg/m2) (maximum dose 6 mg) added to the same 1000 cc 1.5% dextrose dialysis solution q day x 5 days.
  4. On Days 1-5 (Dates _______): 500 cc lactated Ringer's solution intravenously over 2 hours prior to cisplatin and doxorubicin infusion.
  5. Compazine 25 mg per rectum every 4 hours as necessary for nausea.
  6. OUTPATIENT ONLY: May dose x 4 for use at home.
  7. Percocet 1 tablet by mouth every 3 hours as necessary for pain.
  8. OUTPATIENT ONLY: May dose x 4 for use at home.
  9. Routine vital signs.
  10. Out of bed at lib.
  11. Diet: Regular as tolerated.
  12. Daily dressing change to intraperitoneal catheter skin exit site.
  13. Use 33% dose reduction for 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