• Complication
• Gastrointestinal function
• HIPEC
• Tube occlusion

• Humans
• Pseudomyxoma Peritonei/therapy
• Pseudomyxoma Peritonei/pathology
• Female
• Male
• Middle Aged
• Peritoneal Neoplasms/therapy
• Peritoneal Neoplasms/pathology
• Appendiceal Neoplasms/pathology
• Appendiceal Neoplasms/therapy
• Appendiceal Neoplasms/mortality
• Prognosis
• Hyperthermic Intraperitoneal Chemotherapy/methods
• Hyperthermic Intraperitoneal Chemotherapy/adverse effects
• Cytoreduction Surgical Procedures/adverse effects
• Follow-Up Studies
• Postoperative Complications/etiology
• Adult
• Retrospective Studies
• Combined Modality Therapy
• Survival Rate
• Aged
• Risk Factors
• Hyperthermia, Induced/adverse effects
• Hyperthermia, Induced/methods

• No. 2019-2-06;2023-2-18;2023-2-17;2023-1-10). Central Hospital Affiliated to Shandong First Medical University

• Cisplatin
• Doxorubicin
• Hyperthermic intraperitoneal chemotherapy
• Ifosfamide
• Sarcomatosis

• Humans
• Hyperthermic Intraperitoneal Chemotherapy
• Ifosfamide
• Combined Modality Therapy
• Cytoreduction Surgical Procedures
• Retrospective Studies
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Hyperthermia, Induced
• Neoplasm Recurrence, Local/pathology
• Doxorubicin
• Survival Rate

• Humans
• Hyperthermic Intraperitoneal Chemotherapy
• Cytoreduction Surgical Procedures/methods
• Hyperthermia, Induced/methods
• Blood Coagulation
• Neoplasms/drug therapy
• Neoplasms/surgery

• Colorectal cancer
• Gastric cancer
• Gastrointestinal cancers
• Hyperthermic intraperitoneal chemotherapy
• Side effects

The inception of cancer treatment with chemotherapeutics began in the 1940s with nitrogen mustards that were initially employed as weapons in World War II. Since then, treatment options for different malignancies have evolved over the period of last seventy years. Until the late 1990s, all the chemotherapeutic agents were small molecule chemicals with a highly nonspecific and severe toxicity spectrum. With the landmark approval of rituximab in 1997, a new horizon has opened up for numerous therapeutic antibodies in solid and hematological cancers. Although this transition to large molecules improved the survival and quality of life of cancer patients, this has also coincided with the change in adverse effect patterns. Typically, the anticancer agents are fraught with multifarious adverse effects that negatively impact different organs of cancer patients, which ultimately aggravate their sufferings. In contrast to the small molecules, anticancer antibodies are more targeted toward cancer signaling pathways and exhibit fewer side effects than traditional small molecule chemotherapy treatments. Nevertheless, the interference with the immune system triggers serious inflammation- and infection-related adverse effects. The differences in drug disposition and interaction with human basal pathways contribute to this paradigm shift in adverse effect profile. It is critical that healthcare team members gain a thorough insight of the adverse effect differences between the agents discovered during the last twenty-five years and before. In this review, we summarized the general mechanisms and adverse effects of small and large molecule anticancer drugs that would further our understanding on the toxicity patterns of chemotherapeutic regimens.

• adverse effects
• antibody
• cytochrome P450
• large molecules
• small molecules
• toxicities

Mitomycin-C (MMC) is the most commonly used chemotherapeutic agent for hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS). However, MMC has a side effect of myelosuppression. This study aimed to evaluate the clinical manifestations and impact of MMC-induced neutropenia after CRS and HIPEC in colorectal cancer patients.

A total of 124 colorectal cancer patients who underwent CRS with HIPEC between March 2015 and January 2019 were evaluated. Patients with malignancies of non-colorectal origin, hospital stay longer than 60 days, peritoneal cancer index > 30, and complete cytoreduction score > 2 were excluded. MMC 35 mg/m² was administered for 90 min at 41–43 °C. The patients were divided into three groups: no neutropenia, mild neutropenia (grade 1–2), and severe neutropenia (grade 3–4).

In total, mild and severe neutropenia occurred in 30 (24.2%) and 48 (38.7%) patients, respectively. Age and body surface area were significantly different among the neutropenia groups. Severe neutropenia developed significantly earlier than mild neutropenia (6.9 days vs. 10.4 days, p < 0.001) and also lasted significantly longer (4.6 days vs. 2.5 days, p = 0.005). The rate of major postoperative complications was significantly higher in the severe neutropenia group than in the no and mild neutropenia groups (8.3% vs. 6.7% vs. 6.5%, p = 0.015)

Severe neutropenia starts earlier and lasts longer than mild neutropenia after CRS and HIPEC using an MMC triple method. The higher rate of major postoperative complications in patients with severe neutropenia highlights the importance of postoperative management during the neutropenia period.

Cancer patients account for 15% of all admissions to intensive care unit (ICU) and 5% will experience a critical illness resulting in ICU admission. Mortality rates have decreased during the last decades because of new anticancer therapies and advanced organ support methods. Since early critical care and organ support is associated with improved survival, timely identification of the onset of clinical signs indicating critical illness is crucial to avoid delaying. This article focused on relevant and current information on epidemiology, diagnosis, and treatment of the main clinical disorders experienced by critically ill cancer patients.

• Acute respiratory failure
• Cancer
• Cardiotoxicity
• Chemotherapy
• Critical care
• Infection
• Mechanical ventilation
• Neutropenia
• Postoperative
• Sepsis

• acupuncture
• cancer
• chemotherapy
• marrow suppression
• meta-analysis
• protocol
• systematic review

• Acupuncture Therapy/methods
• Antineoplastic Agents/adverse effects
• Bone Marrow/drug effects
• Bone Marrow/pathology
• Bone Marrow Cells/drug effects
• Drug Therapy/methods
• Female
• Hemoglobins/analysis
• Humans
• Leukocyte Count/methods
• Male
• Neoplasms/drug therapy
• Neutrophils/cytology
• Platelet Count/methods
• Randomized Controlled Trials as Topic
• Safety
• Treatment Outcome
• Meta-Analysis as Topic
• Systematic Review as Topic

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a potentially curative treatment for peritoneal carcinomatosis.

The aim of this study was to determine the predictive value of postoperative inflammatory biomarkers in assessing complications after CRS and HIPEC.

A prospective database of 181 patients, who underwent CRS-HIPEC between March 2014 through April 2018 in the Erasmus MC, was retrospectively analyzed. Postoperative complications were defined according to the serious adverse event (SAE) grading system. Levels of C-reactive protein (CRP) and white blood cell (WBC) count were compared between patients with SAE grade < 3 and SAE grade ≥ 3. The area under the receiver operating characteristic curve (AUC) was calculated for CRP and WBC against SAE ≥ 3 and various intra-abdominal complications.

SAE ≥ 3 postoperative complications occurred in 50 patients. From the second until the fifth postoperative day (POD), CRP levels were significantly higher (p = 0.023, p < 0.001, p = 0.002, and p = 0.002, respectively) in these patients. CRP concentrations above 166 mg/L on POD3 (AUC 0.75) and 116 mg/L on POD4 (AUC 0.70) were associated with the highest risk of an SAE ≥ 3. Postoperative WBC levels were not significantly different between patients with SAE < 3 and SAE ≥ 3 complications.

Data from our hospital suggest that CRP levels that continue to rise after POD2 or that are ≥ 166 mg/L at POD3 or ≥ 116 mg/L at POD4, indicate a considerable risk for developing high-grade SAEs. The cut-off values we found can potentially be used as a threshold for additional diagnostic interventions, after they have been validated in external data.

The role of hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC) from colorectal cancer (CRC) is debated. Melphalan as a perfusion agent has also demonstrated survival benefit in other recurrent and chemoresistant malignancies. Thus, we hypothesize that melphalan as a HIPEC agent may improve overall survival (OS) and progression-free survival (PFS) in patients with PC from CRC.

A retrospective review of a prospective database of 48 patients who underwent optimal CRS (CC-0/1) and HIPEC from 2001-2016 was performed. Nineteen had CRS/HIPEC with melphalan (group I) and 29 with mitomycin-C (group II). Survival was estimated using the Kaplan-Meier method. Cox regression was used for multivariate analysis. Perioperative variables were compared.

Mean age at CRS/HIPEC was 53±10 years. Median peritoneal cancer index (PCI) was 17 vs 13 in groups I and II, respectively (p=0.86). PCI≥20 occurred in 9 (47%) and 13 (45%) patients in groups I and II, respectively. Positive lymph nodes were identified in 8/19 (42%) vs 12/29 (41%) in groups I and II, respectively (p=0.73). Multivariate analysis identified PCI≥20 as a predictive factor of survival (HR: 7.5). Median OS in groups I and II was 36 and 28 months, respectively (p=0.54). Median PFS in groups I and II was 10 and 20 months, respectively (p=0.05).

CRS/HIPEC with MMC had longer median PFS in PC from CRC. PCI≥20 was the only independent predictive factor for survival. Until longer follow-up is available, we recommend using MMC in CRS/HIPEC for PC from CRC. Further prospective randomized studies are necessary.