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20 February 2023 : Case report  Saudi Arabia

[In Press] Bidirectional Intraoperative Chemotherapy Using Cisplatin and Ifosfamide for Intraperitoneal Mesothelioma in Severe Renal Impairment: A Case Report

Unusual clinical course, Unusual setting of medical care

Razan Almesned1ADEF, Ayman Z. Azzam23ADE, Ayman Aldeheshi4E, Tarek M. Amin2ADE

DOI: 10.12659/AJCR.938192

Am J Case Rep In Press; DOI: 10.12659/AJCR.938192  

Available online: 2023-02-20, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Malignant peritoneal mesothelioma (MPM) is an aggressive neoplasm with a poor prognosis. Bidirectional intraoperative chemotherapy (BDIC) using concurrent intraperitoneal and intravenous chemotherapy in combination with cytoreductive surgery (CRS) is an emerging treatment option for selected cases of MPM. It is a locoregional treatment that involves intraoperative chemoperfusion of heated chemotherapy. The administration of systemic along with intraperitoneal chemotherapy allows for a bidirectional chemotherapy gradient in peritoneal tumor cells. The aim of this treatment is eradication of microscopic residual cancer cells after major removal of macroscopic tumor nodules. To date, there is no consensus on the chemotherapeutic regimen that can be used in BDIC to manage MPM in patients with severe renal impairment. Administering intravenous ifosfamide with hyperthermic intraperitoneal cisplatin and doxorubicin is a promising regimen in treating peritoneal mesothelioma. Nephrotoxicity is a dose-limiting adverse effect of cisplatin and ifosfamide. Therefore, dose adjustment is required in patients with renal impairment.
In this report, we describe a 46-year-old female patient with recurrent MPM and severe renal impairment. Her treatment was managed with hyperthermic intraperitoneal cisplatin and doxorubicin along with intravenous ifosfamide following CRS. The cisplatin dose was reduced to 50% and the ifosfamide dose was reduced by 25%. The patient tolerated the procedure well, without deterioration in her renal function. At her 9-month follow-up, she did not report experiencing chemotherapy-related adverse effects, and her kidney function remained stable.
Severe renal impairment might not be a contraindication to using potentially nephrotoxic chemotherapeutic agents in CRS-BDIC.

Keywords: Cytoreduction Surgical Procedures; Hyperthermic Intraperitoneal Chemotherapy; Mesothelioma, Malignant; Renal Insufficiency, Chronic


22 February 2023 : Case report  Taiwan

A 30-Year-Old Woman with an 8-Week History of Anxiety, Depression, Insomnia, and Mild Cognitive Impairment ...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938732  

22 February 2023 : Case report  Nigeria

Multidrug-Resistant Kocuria rosea and Methicillin-Resistant Staphylococcus aureus Co-Infection in a Nigeria...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938761  

In Press

17 Mar 2023 : Case report  USA

Dermoid Cyst of the Parotid Gland: Case Report of a Rare Entity and Review of the Literature

Am J Case Rep In Press; DOI: 10.12659/AJCR.939411  

17 Mar 2023 : Case report  Japan

A Case of a Refractory Bleeding Giant Vaginal Wall Cavernous Hemangioma Successfully Managed with Sclerothe...

Am J Case Rep In Press; DOI: 10.12659/AJCR.939474  

16 Mar 2023 : Case report  Indonesia

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938752  

15 Mar 2023 : Case report  USA

Thoracic Epidural as a Rescue Analgesic in a Patient with a Continuous Erector Spinae Plane Block for Rib F...

Am J Case Rep In Press; DOI: 10.12659/AJCR.938875  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923