After thirty years of experience with early postoperative intraperitoneal 5-fluorouracil now saying goodbye. (June 2022)

• Record Type: Journal Article
• Authors: Sugarbaker, Paul H.
• Is Part Of: Surgical oncology. Volume 42(2022)
• Publication Date: 2022-06
• Subjects: HIPEC -- EPIC -- NIPEC -- Intraperitoneal port -- Paclitaxel -- Cisplatin -- Gemcitabine -- Pemetrexed -- Tumor cell entrapment; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2022.101757
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: In the management of colorectal and appendiceal peritoneal metastases, intraperitoneal 5-fluorouracil (5-FU) has been used in 3 different ways. It has been used as part of an early postoperative intraperitoneal chemotherapy (EPIC) regimen along with EPIC mitomycin C. This EPIC mitomycin C plus EPIC 5-FU has been shown to be equivalent or inferior to HIPEC. Because it is more work intensive than HIPEC and not superior, its use should be abandoned if HIPEC is available. A second way to use intraperitoneal 5-FU is along with HIPEC. Several studies suggest a survival advantage for the combination of HIPEC with EPIC 5-FU. However, patient ineligibility for EPIC 5-FU in high-risk CRS is more likely the cause for the alleged survival advantage attributed to the combination. A third use of intraperitoneal 5-FU is long-term through a peritoneal access device. This plan for 5-FU use has shown favorable results in three randomized controlled studies. Normothermic intraperitoneal chemotherapy (NIPEC) with 5-FU should be considered as a regional chemotherapy component of a randomized trial for prevention or treatment of peritoneal metastases from colorectal or appendiceal cancer. Intravenous oxaliplatin combined with NIPEC 5-FU has been suggested as a bidirectional adjuvant regimen. Highlights: The pharmacologic rationale for use of EPIC 5-FU is strong. Exclusion of EPIC 5-FU from use in high risk groups may explain its supposed benefits. A low incidence of class 4 adverse events may result from EPIC 5-FU. HIPEC alone shows the same benefits as HIPEC plus EPIC 5-FU with less risk.