Abstract
PurposeHyperthermic intrathoracic chemotherapy (HITOC) is an additive, intraoperative treatment for selected malignant pleural tumors. To improve local tumor control, the thoracic cavity is perfused with a cisplatin-containing solution after surgical cytoreduction. Since cisplatin is probably carcinogenic to humans, potential contamination of surfaces and pathways of exposure should be systematically investigated to enable risk assessments for medical staff and thus derive specific recommendations for occupational safety.MethodsWipe sampling was performed at pre-selected locations during and after ten HITOC procedures, including on the surgeon's gloves, for the quantitation of surface contaminations with cisplatin. After extraction of the samples with hydrochloric acid, platinum was determined as a marker for cisplatin by voltammetry.ResultsHigh median concentrations of cytostatic drugs were detected on the surgeons’ (1.73 pg Cis-Pt/cm2, IQR: 9.36 pg Cis-Pt/cm2) and perfusionists’ (0.69 pg Cis-Pt/cm2, IQR: 1.73 pg Cis-Pt/cm2) gloves. The display of the perfusion device showed partially elevated levels of cisplatin up to 4.92 pg Cis-Pt/cm2 and thus could represent an origin of cross-contamination. In contrast, cisplatin levels on the floor surfaces in the area of the surgeon and the perfusion device or in the endobronchial tube were relatively low.ConclusionWith a correct use of personal protective equipment and careful handling, intraoperative HITOC appears to be safe to perform with a low risk of occupational exposure to cisplatin.
Highlights
Hyperthermic intrathoracic chemotherapy (HITOC) is an innovative, additive treatment for selected patients with primary or secondary malignant pleural tumors
In the hospital setting an incorporation by administering employees could be observed, since it has been demonstrated that the urine of healthcare workers after occupational exposure to chemotherapeutic agents was mutagenic to indicator organisms like Escherichia coli and Salmonella typhimurium (Falck et al 1979)
It has been previously demonstrated that intraoperative chemotherapy methods, e.g. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC), can result in substantial contamination of operating room (OR) surfaces with the applied cytostatic drugs
Summary
Hyperthermic intrathoracic chemotherapy (HITOC) is an innovative, additive treatment for selected patients with primary or secondary malignant pleural tumors. International Archives of Occupational and Environmental Health (Falck et al 1979; International Agency for Research on Cancer; Pethran et al 2003; Dranitsaris et al 2005) For this reason, occupational exposure should always be avoided and a cautious handling and the use of protective equipment is mandatory. A meta-analysis showed a 46% increase in the risk of spontaneous abortion for female medical personal after exposure to chemotherapeutic agents (Dranitsaris et al 2005). These results urge caution, but dermal contact can be prevented by taking the appropriate safety measures (Landeck et al 2015). To prevent the exposure of the operating room (OR) personnel, specific safety regulations must be applied (safety instruction, gloves compatible with cytostatic drugs, protective surgical gowns, safety glasses, dedicated containers for disposal of cytostatic agents) (Ried et al 2018)
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