The addition of sodium thiosulphate to hyperthermic intraperitoneal chemotherapy with cisplatin in ovarian cancer

Kate Glennon; Karen Mulligan; Kirsten Carpenter; Ruth Mooney; Jurgen Mulsow; Orla McCormack; William Boyd; Tom Walsh; Ruaidhri McVey; Claire Thompson; Brid Ryan; Katie Padfield; Patrick Murray; Donal J Brennan

doi:10.1016/j.gore.2021.100796

The addition of sodium thiosulphate to hyperthermic intraperitoneal chemotherapy with cisplatin in ovarian cancer

Gynecol Oncol Rep. 2021 May 26:37:100796. doi: 10.1016/j.gore.2021.100796. eCollection 2021 Aug.

Authors

Kate Glennon¹, Karen Mulligan¹, Kirsten Carpenter¹, Ruth Mooney², Jurgen Mulsow^{3

4}, Orla McCormack^{3

4}, William Boyd¹, Tom Walsh¹, Ruaidhri McVey¹, Claire Thompson¹, Brid Ryan⁵, Katie Padfield², Patrick Murray^{6

7}, Donal J Brennan^{1

8}

Affiliations

¹ Department of Gynaecological Oncology, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland.
² Department of Anaesthesia and Peri-operative Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland.
³ Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.
⁴ National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital, Dublin 7, Ireland.
⁵ Department of Pharmacy, Mater Misericordiae University Hospital, Dublin 7, Ireland.
⁶ St. Vincent's University Hospital, Dublin 4, Ireland.
⁷ University College Dublin Clinical Research Centre, Belfield, Dublin 4, Ireland.
⁸ Systems Biology Ireland, UCD School of Medicine, Belfield, Dublin 4, Ireland.

Abstract

Cisplatin based hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to prolong recurrence free and overall survival of women with ovarian cancer who have responded to neoadjuvant chemotherapy. The aim of this study was to assess the impact of cytoreductive surgery with or without the addition of HIPEC on renal function.

Method: This is a retrospective case-controlled study at a tertiary teaching hospital in Dublin, Ireland. All patients who had interval cytoreductive surgery (CRS) and HIPEC from October 2017 to October 2020 were included. A cohort of patients who had interval CRS without HIPEC were included as a control. Sodium thiosulphate (ST) was added to the HIPEC protocol in 2019. In order to assess the impact of ST as a renal protectant, renal function and post-operative outcomes were compared between the groups.

Results: Sixty patients who had interval CRS were included, thirty of whom received cisplatin-based HIPEC. Seven received cisplatin 50 mg/m² without the addition of ST. Twenty three patients received cisplatin 100 mg/m² and ST. There were no statistically differences in age, body mass index BMI, American society of anaesthesia score, estimated blood loss or peritoneal cancer index between the cohorts (p > 0.05). The only episode of acute kidney injury (AKI) was within the HIPEC cohort, after cisplatin 50 mg/m² (without ST) and this was sustained at three months. In contrast, no patients within the CRS cohort or cisplatin 100 mg/m² that received the addition of ST, sustained a renal injury and all had a creatinine within the normal range at three days post operatively.

Conclusion: The renal toxicity associated with cisplatin HIPEC and major abdominal surgery can be minimised with careful preoperative optimisation, intra operative fluid management and attention to renal function. The addition of sodium thiosulphate is a safe and effective method to minimise toxicity and should be added to any cisplatin HIPEC protocol.

Keywords: Cisplatin; Epitheal Ovarian Cancer; HIPEC; Renal toxicity.

Publication types

Case Reports