Evaluation of hyperthermic intraperitoneal chemotherapy efficacy through intraperitoneal free cancer cells enumeration

Gastrointestinal and gynaecological cancers often lead to peritoneal metastases (PM). Cytoreductive surgery (CRS) and hyperthermic-intraperitoneal chemotherapy (HIPEC) has improved survival inselected patients. However, recurrence following complete CRS with HIPEC is common suggesting that this may be due residual viable intraperitoneal free cancer cells (IFCCs). Hence, the enumerationof viable IFCCs in pre and post-HIPEC peritoneal wash may indicate the efficacy of HIPEC. The peritoneal pre or post-HIPEC wash of 28 patients with colorectal, appendix, ovarian cancer or peritoneal mesothelioma were analysed for detection of IFCCs via enrichment and selective cellular marker immunofluorescence staining. We employed a fully developed, label-free micro fluidic approach (i.e., Spiral Microfluidics) combined with immunocytochemistry, for the detection and enumeration of IFCCs before and after HIPEC. A comparison of IFCCs detected in pre and post-HIPEC was made to determine the efficacy of HIPEC. The overall reduction of IFCCs after HIPEC was 76.51% ± 7.75%, with individual percentage reduction of 57.75 ± 8.90, 91.65 ± 3.22 and 96.15 ± 0.37 in CRC, DPAM and appendix cancer, respectively, showing it to be more effective in the latter two cases. HIPEC is an effective method for eradicating IFCCs; however, it does not provide complete elimination. Hence, subsequent HIPEC may be necessary to achieve thorough elimination of IFCCs

Keywords:

Colon Cancer , Colorectal Cancer , Cell and Cancer , Liquid Biopsy and Cancer , Cancer Treatment and Management