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Intraperitoneal chemohyperthermia for peritoneal carcinomatosis: original modeling, clinical tolerance and results
J Porcheron1, J N Talabard, C Breton
1Department of General Surgery, Centre hospitalier de Saint-Etienne, France.
Background/Aims:
The authors' objective is to report their experience of the intraperitoneal chemohyperthermia after a thermal modeling study which has allowed the optimization the intraperitoneal chemohyperthermia circuit and its running parameters and to evaluate the intraperitoneal chemohyperthermia tolerance. Intraperitoneal chemohyperthermia is considered more and more as an interesting therapeutic option in cases of some abdominal carcinomatosis, particularly of digestive origin. However, the main technical problem of this treatment is the homogenization of the temperature distribution in the abdominal cavity.
Methodology:
A thermal modeling has allowed us to finalize a reliable and well-tolerated intraperitoneal chemohyperthermia technique. The achievement of a physical model of the abdomen has allowed us to make an experimental study of the temperature distribution in a given liquid volume. Two steps were carried out. The first step was the characterization of the model with a thermal study carried out on the physical model and which has led to dynamic data about the heat balance leading to a knowledge model. The second step was the identification of a theoretical model of the thermal behavior which would correlate best with the experimental data. Between January 1995 and January 1998, 30 patients with peritoneal carcinomatosis were studied. Twenty-six patients underwent maximal cytoreductive surgery with abdominal evisceration, intraperitoneal chemohyperthermia. Intraperitoneal chemohyperthermia was carried out for 1 hour, at 42 degrees C, with a flow rate of 0.9 L/min in the 30 patients. The thermal modeling has shown the main purpose of a high flow rate of 0.9 L/min in the homogenization of temperature distribution.
Results:
The 2 steps are shown to converge. This coherency between the 2 models proves that the thermal aspects of the process have been properly identified. Our initial results have shown that intraperitoneal chemohyperthermia was properly tolerated. Major intraoperative complications occurred for 1 patient.
Conclusions:
The experimental study with thermal modeling results should help to optimize the intraperitoneal chemohyperthermia circuit and its running parameters for human treatment, with an acceptable morbidity in 30 patients.
