Feasibility study of chemotherapeutic efficacy assessment in hyperthermic intraperitoneal chemotherapy (HIPEC)

Abstract Purpose CRS-HIPEC serves as the primary treatment for peritoneal cancers. Although CRS-HIPEC frequently yields positive outcomes, some patients may experience a swift recurrence of cancer. Consequently, a technique to detect any remaining viable tumor cells post-treatment would be advantageous. We propose to explore the feasibility of employing flow cytometry to differentiate viable tumor cells following CRS-HIPEC treatment. Patients and methods During the CRS-HIPEC procedure, peritoneal fluid was collected at two distinct time points: pre-HIPEC perfusion and post-HIPEC. The cells were then concentrated. After in vitro culture, the cells underwent staining. In summary, anti-tumor marker antibodies were used to gate tumor cells. Apoptotic and viable cells were distinguished using Annexin V and Zombie dyes, respectively. Fluorescence minus one (FMO) control were implemented to establish gate boundaries, while unstained cells used as negative controls. A flow cytometer was used for data collection. Results This feasibility study encompassed six patients (with colorectal, colorectal, gastric, appendix, appendix, and peritoneum cancers, respectively) who underwent CRS-HIPEC between October and December 2023. Through this feasibility study, we demonstrated that evaluating the efficacy of HIPEC drug on pre- and post-HIPEC samples is achievable. The data indicated an increase in apoptotic cells by 30.6, 13.2, 12.8, 66.1, 3.9, and 8.1%, following HIPEC treatment with MMC, MMC, MMC & Cisplatin, Cisplatin, MMC, and Carboplatin, respectively. Conclusion This feasibility study offers initial insights into the capability of a flow cytometry approach to identify and differentiate viable tumor cells from apoptotic and necrotic cells in samples obtained from HIPEC patients.