Palliative benefit of novel cell-free and concentrated ascites reinfusion therapy (CART) for refractory ascites associated with cancerous peritonitis.

Abstract

e20591 Background: Refractory ascites associated with cancerous peritonitis causes severe abdominal distention, dyspnea and appetite loss, resulting in loss of patients’ activities of daily living (ADL) and discontinuation of their treatment for cancer such as chemotherapy. To improve the symptoms, we have developed a novel cell-free and concentrated ascites reinfusion therapy (CART) which is modified from a conventional CART approved by the Ministry of Health, Labor and Welfare in Japan and examined the efficacy in a pilot study. Methods: 87 patients with cancerous ascites were enrolled and subjected to novel CART from April 2012 to November 2012. The response was assessed by improvement of their ADL. Patients were asked in the form of questionnaires about general malaise, abdominal distention, abdominal pain, nausea, dyspnea, sleep disturbance, appetite loss, disturbance in gait, discomfort and frustration before and after treatment and each point was scored on a scale of zero to ten (ten being severe). Abdominal and thigh circumferences were also examined before and after treatment to evaluate efficacy. This study was approved by the ethics review committee of Kaname-cho hospital. Results: On average, 8.3 ± 4.4 L (range 2.3-27.0) of cancerous ascites was filtrated and concentrated to 0.69 ± 0.28 L (range 0.2-1.6) by novel CART. Any severe adverse events except fever were not observed. After treatment, the scores of all points were significantly improved. For example, abdominal distention was improved by 8.1 ± 2.4 vs. 2.0 ± 2.4 (p<0.0001), dyspnea by 3.7 ± 3.3 vs. 1.3 ± 2.1 (p<0.0001), and appetite loss by 5.3 ± 4.3 vs. 3.1 ± 3.4 (p<0.0001). Abdominal and thigh circumferences were also decreased by -13.3 ± 7.5 cm (p<0.0001) and -2.7 ± 2.6 cm (p<0.0001), respectively. Conclusions: This novel CART system is capable to process over 20 L of cancerous ascites and immediately improve their ADL and edematous lesions. Some patients also restarted anticancer treatment such as chemotherapy. Taken together, this CART is safe and effective for palliative care of patients with cancerous ascites.