Exposure to cisplatin in the operating room during hyperthermic intrathoracic chemotherapy

• Published in: International archives of occupational and environmental health 2022-03, Vol.95 (2), p.399-407
• Main Authors: Markowiak, Till, Ried, Michael, Larisch, Christopher, Nowak, Dennis, Hofmann, Hans-Stefan, Rakete, Stefan
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents; Carcinogens; Chemotherapy; Cisplatin; Contamination; Display devices; Earth and Environmental Science; Environment; Environmental Health; Exposure; Gloves; Humans; Hydrochloric acid; Hyperthermia, Induced; Occupational exposure; Occupational Exposure - prevention & control; Occupational health; Occupational Medicine/Industrial Medicine; Occupational safety; Operating Rooms; Original; Original Article; Perfusion; Pleural Neoplasms; Protective equipment; Quantitation; Rehabilitation; Risk assessment; Surgeons; Thorax; Tumors
• ISSN: 0340-0131; 1432-1246
• DOI: 10.1007/s00420-021-01738-3

Purpose Hyperthermic 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. Methods Wipe 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. Results High median concentrations of cytostatic drugs were detected on the surgeons’ (1.73 pg Cis-Pt/cm 2 , IQR: 9.36 pg Cis-Pt/cm 2 ) and perfusionists’ (0.69 pg Cis-Pt/cm 2 , IQR: 1.73 pg Cis-Pt/cm 2 ) gloves. The display of the perfusion device showed partially elevated levels of cisplatin up to 4.92 pg Cis-Pt/cm 2 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. Conclusion With 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.