Biomonitoring of the medical teams exposed to cytotoxic drugs during intraperitoneal chemotherapies (HIPEC and PIPAC)

Currently booming, hyperthermic intraperitoneal chemotherapy (HIPEC), also known as intraperitoneal hyperthermic chemoperfusion (IPHC), is a cancer treatment given in the operating theatre. It consists, after resection of the peritoneal metastatic disease, in injecting, directly into the peritoneal cavity, high concentrations of cytotoxic medication (mitomycin C, 5-fluorouracil, cisplatin, oxaliplatin…) in large quantities (2 litres per square metre of body surface area). This treatment is given at relatively high temperatures (40°C to 46°C) continuously for from 30 to 90 minutes. It offers the advantage of limiting systemic diffusion of the medication. In France HIPEC has been used as routine treatment for several years now in certain hospitals. It is administered by specially trained medical teams. A new HIPEC treatment given under pressure (PIPAC, an acronym for Pressurised Intraperitoneal Aerosol Chemotherapy) has started to be used. It enables the chemotherapy drugs to be distributed better in the peritoneal cavity. The pressure conditions used involve new risks for the medical staff. Good control of these risks, through better understanding of the exposures, is necessary for administering this treatment in fully safe manner.
The objective of this study is to assess exposure of the medical teams during HIPEC/PIPAC through biomonitoring analyses. For this purpose, a sampling campaign has been set up in order to sample the urines of the employees in a hospital. Quantification of the cytotoxic medication in the urines will also give an indication of the actual exposures of the medical teams. In parallel, samples will be taken by swabs before and after the HIPEC/PIPAC on various surfaces and on the skin (hands, neck) of the medical team. They will provide additional information on the potential sources of exposure.
Combining these analyses (urinary and surface analyses) will thus make it possible to verify the effectiveness of the prevention means (extraction system, organisation, personal protective equipment, etc.) that are used.