Abstract

In gastrointestinal malignancies such as cancer of stomach, large bowel and ovary, peritoneal involvement with metastatic tumor is a common finding at the time of initial operation or following initial curative resection of the tumor. Intraperitoneal administration of chemotherapeutic agents offers an opportunity to deliver high concentration of drug to local intraperitoneal surfaces and also to liver as most of drug administered intraperitoneally is cleared via the portal vein. Thus, Intraperitoneal (IP) chemotherapy should permit more effective treatment of peritoneal surfaces and liver while reducing systemic toxicities of the chemotherapeutic 'agents. In an effort to evaluate the efficacy and safety of IP chemotheray, we have treated 6 advanced stomach cancer patients (including 2 stage IV stomach cancer patients) and I colon cancer patient who had undergone surgery at Department of Surgery, Seoul National University HapitaL Each cycle of treatment consisted of daily intraperitoneal administration of 5-fluorouracil through Tenckhoff peritoneal dialysis catheter for 5 days in every four weeks. Initial dose of IP 5-FU was 20 ml/kg body wt, with dosage increment each cycle until toxicity was experienced by the patient. The following results were obtained: 1) Mean daily dose of 5-FU administered was 1500 mg, and maximal daily dose administered to each patient ranged from 1100 to 2030 mg (21 to 30 mg/kg body wt.) with a mean maximal dose of 1567 mg (28mg/kg body wt.) 2) Most common toxicities related to 5-FU were nausea, vomiting, and diarrhea which were self -limited. Hepatotoxicity appeared in 3 patient, but only in one patient was it severe enough to discontinue therapy. Hematotoxicity appeared in 1 patient as manifested by leukopenia (WBC< 4000/ mm(3)) but was able to continue therapy after dosage reduction. 3) Complications related to Tenckhoff catheter were catheter obstruction, leakage of fluid around the catheter and intestinal obstruction which occurred in one patient respectively. There was no incidence of skin infectian or bacterial peritonitis. 4) Common discomfort after IP administration of 5-FU was abdominal fullness and self-limited ahdominal pain, but there was no inicidence of chemical peritonitis. 5) Three advanced stomach cancer patients died at 4 months, S months and 12months postoperatively, but one patient who had peritoneal seeding at the time of operation remained disease free for 32 months after 12 cycles of 5-FU IP therapy. Remaining 3 patients are free of recurrence at 20 months postoperatively. IP chemotherapy is a relatively safe method of administrating a large dose of 5-FU to intraperitoneal space as well as to the hepatic parenchyme. Further clinical testing of this route of administration is clearly warranted both for prevention and treatment of peritoneal and hepatic metastasis of gastrointestinal cancers.

• Keywords: Intraperitoneal chemotherapy