DESCRIPTION
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have been proposed for treatment of peritoneal carcinomatosis of gastrointestinal origin (e.g., colorectal cancer). The cytoreduction is done in an attempt to remove visible tumor deposits, and the hyperthermic intraperitoneal chemotherapy is done in an attempt to address remaining microscopic disease. Well-developed scientific studies that evaluate this combined technology are lacking.
Cytoreductive surgery is a combination of peritoneal stripping procedures and resections. Surgical resection can be extensive, depending on the extent of disease, and may include: partial gastrectomy, splenectomy, resection of the tail of the pancreas, omentectomy, multiple small bowel resections, ileocecal resection, rectosigmoid resection, uterine resection and multiple peritonectomy procedures.
The surgical procedure is followed intraoperatively by the infusion of hyperthermic chemotherapy (e.g., mitomycin C). Inflow and outflow catheters are placed in the abdominal cavity, along with temperature probes to monitor temperature. The skin is then temporarily closed during the chemotherapy perfusion, which typically runs for 1-2 hours. The temperature at the inflow line is approximately 44°C. An esophageal temperature probe is used to monitor the individual’s core body temperature. A cooling blanket is used to prevent systemic hyperthermia.
After the intraoperative infusion is complete, the abdomen is suctioned dry of fluid. The abdomen is reopened and reconstructive surgery is performed. Following the procedure, the individual is maintained on parenteral feeding for several weeks.
POLICY
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis of gastrointestinal origin is considered investigational.
Policy with similar title: Local or Whole Body Hyperthermia
ADDITIONAL INFORMATION
Well-developed scientific studies in peer-reviewed journals regarding cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis of gastrointestinal origin are lacking. Issues such as: who should receive the treatment, comparison to other available treatments, recurrence rates, and risk verses benefit of the technology have not been answered.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. 6:2008). Cytoreduction and hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis of gastrointestinal origin (2.03.07). Retrieved June 11, 2009 from BlueWeb.
Cao, C., Yan, T., Black, D., & Morris, D. (2009). A systematic review and meta-analysis of cytoreductive surgery with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin. Annals of Surgical Oncology, 16 (8), 2152 - 2156. (Level 1 Evidence)
Cavaliere, F., Valle, M., De Simone, M., Deraco, M., Rossi, D. R., Di Filippo, F., et al. (2006). 120 peritoneal carcinomatoses from colorectal cancer treated with peritonectomy and intra-abdominal chemohyperthermia: A S.I.T.I.L.O. multicentric study. In Vivo, 20 (6A), 747-750. (Level 4 Evidence)
da Silva, E. G., & Surgarbaker, P. H. (2006). Analysis of prognostic factors in seventy patients having a complete cytoreduction plus perioperative intraperitoneal chemotherapy for carcinomatosis for colorectal cancer. Journal American College of Surgery, 203 (6), 878-886. (Level 4 Evidence)
Elias, D., Benizri, E., Di Pietrantonio, D., Menegon, P., Malka, D., & Raynard. (2007). Comparison of two kinds of intraperitoneal chemotherapy following complete cytoreductive surgery of colorectal peritoneal carcinomatosis. Annals of Surgical Oncology, 14 (2), 509-514. (Level 4 Evidence)
Gammon, D., Duttone, T., Piperdi, B., Zybert, J., Wolfe, S., Nguyen, E., et al. (2009). Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy in the treatment of peritoneal carcinomatosis. American Journal of Health-System Pharmacy, 66 (13), 1186 – 1190. (Level 4 Evidence)
Glehen, O., Kwiatkowski, F., Sugarbaker, P. H., Elias, D., Levine, E. A., De Simone, M., et al. (2004). Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. Journal of Clinical Oncology, 22 (16), 3284-3292. (Level 4 Evidence)
Hayes. Medical Technology Directory. (2006, June). Intraperitoneal hyperthermic chemotherapy for abdominopelvic cancers. Retrieved June 26, 2007 from www.Hayesinc.com/subscribers. (53 articles and / or guidelines reviewed)
Hayes. Medical Technology Directory. (2009, April). Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Carcinomatosis Resulting from Gastric Cancer. Retrieved June 11, 2009 from www.Hayesinc.com/subscribers. (54 articles and/ or guidelines reviewed)
Hayes. Medical Technology Directory. (2009, May) Intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis resulting from cancers of the lower gastrointestinal tract. Retrieved June 11, 2009 from www.Hayesinc.com/subscribers. (59 articles and/ or guidelines reviewed)
Hayes. Medical Technology Directory. (2009, May). Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Carcinomatosis Resulting from Ovarian Cancer, Peritoneal Mesothelioma, or abdominal sarcoma. Retrieved June 11, 2009 from www.Hayesinc.com/subscribers. (68 articles and /or guidelines reviewed)
Macri, A., Maugeri, I., Trimarchi, G., Caminiti, R., Saffioti, M., Incardona, S., et al. (2009). Evaluation of quality of life of patients submitted to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinosis of gastrointestinal and ovarian origin and identification of factors influencing outcome. In Vivo, 23 (1), 147 - 150. (Level 5 Evidence)
McQuellon, R. P., Danhauser, S. C., Russell, G. B., Shen, P., Fenstermaker, J., Stewart, J. H., et al. (2007). Monitoring health outcomes following cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Annals of Surgical Oncology, 14 (3), 1105-1113. (Level 5 Evidence)
McQuellon, R. P., Russell, G. B., Shen, P., Stewart, J., Saunders, W., & Levine, E. (2008). Survival and health outcomes after cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of appendiceal origin. Annals of Surgical Oncology, 15 (1), 125 - 133. (Level 5 Evidence)
National Institute of Clinical Excellence. (2005, March). Complete cytoreduction and heated intraoperative intraperitoneal chemotherapy (Sugarbaker technique) for peritoneal carcinomatosis. Retrieved June 19, 2009 from http://www.nice.org.uk/nicemedia/pdf/ip/IPG116guidance.pdf .
Nordlinger, B., Rougier, P., Arnaud, J. P., Debois, M., Wils, J., Ollier, J. D., et al. (2005). Adjuvant regional chemotherapy and systemic chemotherapy versus systemic chemotherapy alone in patients with stage II-III colorectal cancer: a multicentre randomised controlled phase III trial. Lancet Oncology, 6 (7), 459-468. (Level 1 Evidence)
Tuttle, T. M., Zhang, Y., Greeno, E., & Knutsen, A. (2006). Toxicity and quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy. Annals of Surgical Oncology, 13 (12), 1627-1632. (Level 2 Evidence )
Verwaal, V. J., van Ruth, S., de Bree, E., van Slooten, G. W., van Tinteren, H., Boot, H., et al. (2003). Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. Journal of Clinical Oncology, 21 (20), 3737-3743. (Level 4 Evidence)
Yan, T. D., Sim., J., & Morris, D. L. (2007). Selection of patients with colorectal peritoneal carcinomatosis for cytoreductive surgery and perioperative intraperitoneal chemotherapy. Annals of Surgical Oncology, 14 (6), 1807 - 1817. (Level 5 Evidence)
ORIGINAL EFFECTIVE DATE: 9/9/2007
MOST RECENT REVIEW DATE: 8/13/2009
ID_BT
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