Med Oncol. & Tumor Phamuacother. Vol 9 No. 4 pp. 177-181, 1992 0736-0118190 $3.00 + .00 TREATMENT OF MALIGNANT PERITONEAL EFFUSION IN DIGESTIVE AND OVARIAN CANCER FRANCOIS N, GILLY, *'1'5 PIERRE Y. CARRY, 2'5 ALAIN BRACHET, L5 ANNIE C. SAYAG, 2'5 GILLES PANTEIX, 3'5 BRUNO SALLE, 1'5 JACQUES BIENVENU, 3 VINCENT BANSSILLON, 2 GERARD BURGARD, 4'5 MONIQUE MANCHON, 3 ANNE ROCHETTE 3 and GEORGES BRAILLON 1'5 2 9 . 3 - 9 1Department of General and Thoracic Surgery Department of Anesthesta and Intensive Care, Department of Biochemistry and Immunology, Centre Hospitalier Lyon Sud, Lyon, France. 4Department of Surgery, Hopttal Nord, St Etmnne, France. Laboratory Hyperthermia and Oncology MS44, CHLS, F69310. (First submitted I October 1992, accepted after revision 11 December 1992) Intra Peritoneal Chemo Hyperthermia (IPCH) with Mitomycin C (MMC) or Cisplatinum (CP) was used to treat 32 patients with far advanced digestive or ovarian cancers and peritoneal carcinomatosiso Surgical resection of the primary tumor has been possible in 18 cases. After closure of the abdominal wall~ a 90 minutes IPCH was performed under general anaesthesia and 32 ~ general hypothermia, through 3 intraperitoneal drainages realizing a closed circuit, using 10 mg/l of MMC or 15 to 25 rag/1 of CP in 6 1of peritoneal dialysate heated at the inflow temperature of 46 to 49 ~ The mortality rate was 3 % and the morbidity rate was 3%. In 11 out of 12 patients with preoperative malignant ascites, no more ascites could be found after IPCH. For peritoneal carcinomatosis from digestive origin, median survival was 11.2 months and I year survival rate was 46.9 %. These encouraging preliminary results show that IPCH is a safe and reliable treatment for peritoneal carcinomatosis in far advanced digestive or ovarian cancers. Peritoneal carcinomatosis is a conunon evolution of diges- tive or ovarian cancers and seems to be the terminal stage of the disease since most of the patients with peritoneal carcinomatosis die within 6 months) For digestive can- cers, intraperitoneal injection of anti cancer drugs like OK-432 z or Mitomycin C (MMC) absorbed on activated charcoal 3 have been attempted but without well estab- lished efficacy. For ovarian cancer, conventional systemic chemotherapy induces a lot of complete responses without avoiding later recurrences and later peritoneal effusion. Hyperthermia has been one of the first weapons against cancer since Egyptian physicians already used it 3,500 BC? Closer to our times, the effect of heat on cancers has been analyzed in vitro by Crile and Overgaard s'6 as its synergy with anti cancer drugs. 7 Regional combination of these therapies (intra perito- neal hyperthennia and intra peritoneal chemotherapy) was first reported by Koga and Fujhnoto. 8'9 We designed ,an Intraperitoneal Chemo-Hyperthennia (IPCH) device and after an experimental study in dogs, ~~ we conducted a prospective pilot study using IPCH m the treaunent of digestive and ovarian cancers with peritoneal carcinoma- tosis. MATERIAL AND METHODS Protocol Inclusion criteria in the protocol were: a) age < 65 years, b) patients with peritoneal carcinomatosis proved on cy- tological or histological examination, c) patients without extra abdominal metastasis, d) acceptable cardiorespira- tory function as judged through pre operative check-up, e) infomled consent of the patients and their family. Before inclusion m the protocol, all patients underwent pre-operative conventional check-up, cardiac scintigraphy and ultrasonography, spirometry, cerebral CT scan (to elflninate brain umtastasis), abdominal ultrasonography and CT scan (to evaluate ascites). Patients *To whom correspondence should be addressed: Department of General and Thoracic Surgery, Centre Hospitalier Lyon Sud, 69310, Lyon, Pierre Bdnite, France. First presented at the VII1 International San Rcxzco Cancer Senfinax, European Hospital and Tot Vergata University, Rtlma, September 1992. Froth June 1989 to June 1992, 32 patients (11 men and 21 women, mean age 53. I years, SD = 10.8 years, range 31-65) scheduled lbr IP('l-t were included in the study: 7 had an ovarian adcnocarcinoma with peritoneal carci- 177