Toxicity and morbidity of IP drug therapy

The morbidity and mortality associated with cytoreductive surgery and heated intraperitoneal chemotherapy stems largely from the surgical part of the procedure, rather than the intraperitoneal (IP) chemotherapy. Hematologic toxicity is probably the easiest complication to ascribe to IP chemotherapy. An early report indicated a fairly low overall rate of hematologic toxicity, that is, 2.5%, but a high associated mortality with 66% of neutropenic patients dying. Subsequent reports identify varying rates of hematologic toxicity but much less mortality associated with neutropenia. Hematologic toxicity is the most common effect, with anemia, neutropenia, leukopenia, and thrombocytopenia all attributed to mitomycin C (MMC). Side effects from systemic oxaliplatin include neurotoxicity and hepatotoxicity. Like MMC, the hematologic toxicity seen with oxaliplatin can be significant and is occasionally associated with mortality. As with other drugs, the peritoneal barrier allows for higher doses of drug before toxicity is seen.