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Ruff SM. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer Peritoneal Metastases. Surg Oncol Clin N Am 2025; 34:241-251. [PMID: 40015802 DOI: 10.1016/j.soc.2024.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2025]
Abstract
Gastric cancer with peritoneal metastases (GC-PM) carries a poor prognosis and estimated survival is less than 6 to 12 months. One potential treatment of GC-PM is cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Success of this treatment largely relies on tumor biology and patient selection. These operations carry a high risk of morbidity and mortality and their efficacy in GC-PM remains controversial. This study will review the updated literature for CRS ± HIPEC in patients with GC-PM.
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Affiliation(s)
- Samantha M Ruff
- Department of Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
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Kitaguchi D, Park EJ, Baik SH, Sasaki S, Tsukada Y, Ito M. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus R0 resection for resectable colorectal cancer with peritoneal metastases and low peritoneal cancer index scores: a collaborative observational study from Korea and Japan. Int J Surg 2024; 110:45-52. [PMID: 37800569 PMCID: PMC10793799 DOI: 10.1097/js9.0000000000000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The benefits of hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) for colorectal cancer with peritoneal metastasis (CPM) remain controversial. R0 resection without peritoneal stripping might be as effective as CRS plus HIPEC. The authors aimed to compare the long-term oncological outcomes of patients with CPM and peritoneal cancer index (PCI) scores less than or equal to 6 who underwent R0 resection in Japan with those who underwent CRS plus HIPEC in Korea. MATERIALS AND METHODS This international, retrospective cohort study was conducted in Korea and Japan using a prospectively collected clinical database. Patients who underwent surgery from July 2014 to December 2021 for CPM with a PCI score of less than or equal to 6 and completeness of the cytoreduction score-0 were included. The primary outcome was relapse-free survival (RFS), and the secondary outcomes were overall survival, peritoneal RFS (PRFS), and postoperative outcomes. RESULTS The 3-year RFS was significantly longer in the CRS+HIPEC group than in the R0 resection group: 35.9% versus 6.9% ( P <0.001); 31.0% versus 6.7% ( P =0.040) after propensity score matching. The median PRFS was significantly longer in the CRS+HIPEC group than in the R0 resection group: 24.5 months versus 17.2 months ( P =0.017). The 3-year overall survival and postoperative complications did not significantly differ between the two groups. CONCLUSIONS RFS and PRFS rates were significantly prolonged after CRS plus HIPEC, whereas postoperative complications and length of hospital stay were not increased. Therefore, curative CRS plus HIPEC may be considered a treatment strategy for selected patients with resectable CPM and low PCI scores.
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Affiliation(s)
- Daichi Kitaguchi
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Eun Jung Park
- Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Seung Hyuk Baik
- Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
- Mirae Medical Check-up Hospital, Seoul, Korea
| | - Shoma Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
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Manzanedo I, Pereira F, Cascales-Campos P, Muñoz-Casares C, Asensio E, Torres-Melero J, Prada-Villaverde A, Caravaca-García I, Gutiérrez-Calvo A, Vaqué J, Ortega G, Titos-García A, González-Sánchez L, Pérez-Viejo E, Serrano Á, Martínez-Torres B. Treatment of Peritoneal Surface Malignancies by Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Spain: Results of the National Registry of the Spanish Group of Peritoneal Oncologic Surgery (REGECOP). J Clin Med 2023; 12:3774. [PMID: 37297969 PMCID: PMC10253421 DOI: 10.3390/jcm12113774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Treatment of Peritoneal Surface Malignancies (PSM) with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has achieved results never seen before in these patients, which classically have a poor prognosis. The possibility of conducting clinical trials in these diseases is complicated, since some of them are rare, so the analysis of large databases provides very valuable scientific information. The aim of this study is to analyze the global results of the National Registry of the Spanish Group of Peritoneal Oncologic Surgery (REGECOP), whose objective is to register all patients scheduled for HIPEC nationwide. METHODS This is a retrospective analysis of the data recorded in the REGECOP from 36 Spanish hospitals from 2001 to 2021. There were 4159 surgical interventions in 3980 patients. RESULTS 66% are women and 34% are men with a median age of 59 years (range 17-86). 41.5% of the patients were treated for Peritoneal Metastases (PM) of colorectal cancer (CRC); 32.4% were women with ovarian cancer (OC) with PM; 12.8% were treated for pseudomyxoma peritonei (PMP); 6.2% had PM from gastric cancer (GC); 4.9% had PM of non-conventional origin; and, finally, 2.1% of cases were patients diagnosed with peritoneal mesothelioma. The median Peritoneal Cancer Index (PCI) was 9 (0-39), and complete cytoreduction was achieved in 81.7% of the procedures. Severe morbidity (Dindo-Clavien grade III-IV) was observed in 17.7% of surgeries, with 2.1% mortality. Median hospital stay was 11 days (0-259). Median overall survival (OS) was 41 months for CRC patients, 55 months for women with OC, was not reached in PMP patients, was 14 months for GC patients, and 66 months in mesothelioma patients. CONCLUSIONS large databases provide extremely useful data. CRS with HIPEC in referral centers is a safe treatment with encouraging oncologic results in PSM.
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Affiliation(s)
- Israel Manzanedo
- Peritoneal Carcinomatosis Unit, Department of General and Digestive Surgery, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (F.P.); (E.P.-V.); (Á.S.); (B.M.-T.)
- Department of Surgery, Rey Juan Carlos University (URJC), 28933 Madrid, Spain
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
| | - Fernando Pereira
- Peritoneal Carcinomatosis Unit, Department of General and Digestive Surgery, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (F.P.); (E.P.-V.); (Á.S.); (B.M.-T.)
- Department of Surgery, Rey Juan Carlos University (URJC), 28933 Madrid, Spain
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
| | - Pedro Cascales-Campos
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
- Peritoneal Oncologic Surgery Unit, Department of Surgery, Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, 30120 Murcia, Spain
| | - Cristobal Muñoz-Casares
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
- Department of Surgery, Hospital Virgen del Rocío, 41013 Sevilla, Spain
| | - Enrique Asensio
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
- Advanced Oncologic Surgery Unit, Department of General and Digestive Surgery, Hospital Río Hortega, 47012 Valladolid, Spain
| | - Juan Torres-Melero
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
- Department of General and Digestive Surgery, Hospital Universitario de Torrecárdenas, 04009 Almería, Spain
| | - Arancha Prada-Villaverde
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
- Department of General and Digestive Surgery, Hospital Infanta Cristina, 06080 Badajoz, Spain
| | - Ibán Caravaca-García
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
- Department of General and Digestive Surgery, Hospital General Universitario de Elche, 03203 Alicante, Spain
| | - Alberto Gutiérrez-Calvo
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
- Department of General and Digestive Surgery, Hospital Príncipe de Asturias de Alcalá de Henares, 28805 Madrid, Spain
| | - Javier Vaqué
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
- Department of General and Digestive Surgery, Hospital de La Fe, 46026 Valencia, Spain
| | - Gloria Ortega
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
- Department of General and Digestive Surgery, Hospital MD Anderson Cancer Center, 28033 Madrid, Spain
| | - Alberto Titos-García
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
- Department of General and Digestive Surgery, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Laura González-Sánchez
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
- Department of General and Digestive Surgery, Hospital Insular, 35016 Las Palmas de Gran Canaria, Spain
| | - Estíbalitz Pérez-Viejo
- Peritoneal Carcinomatosis Unit, Department of General and Digestive Surgery, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (F.P.); (E.P.-V.); (Á.S.); (B.M.-T.)
- Department of Surgery, Rey Juan Carlos University (URJC), 28933 Madrid, Spain
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
| | - Ángel Serrano
- Peritoneal Carcinomatosis Unit, Department of General and Digestive Surgery, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (F.P.); (E.P.-V.); (Á.S.); (B.M.-T.)
- Department of Surgery, Rey Juan Carlos University (URJC), 28933 Madrid, Spain
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
| | - Beatriz Martínez-Torres
- Peritoneal Carcinomatosis Unit, Department of General and Digestive Surgery, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain; (F.P.); (E.P.-V.); (Á.S.); (B.M.-T.)
- Department of Surgery, Rey Juan Carlos University (URJC), 28933 Madrid, Spain
- Spanish Group of Peritoneal Oncologic Surgery (GECOP), 28001 Madrid, Spain; (P.C.-C.); (C.M.-C.); (E.A.); (J.T.-M.); (A.P.-V.); (I.C.-G.); (A.G.-C.); (J.V.); (G.O.); (A.T.-G.); (L.G.-S.)
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Gastric Cancer with Peritoneal Metastases: Current Status and Prospects for Treatment. Cancers (Basel) 2023; 15:cancers15061777. [PMID: 36980663 PMCID: PMC10046173 DOI: 10.3390/cancers15061777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Gastric cancer (GC) has a poor prognostic and only one in four patients will have survived by 5 years after diagnosis. These poor results are due to the fact that most patients are diagnosed in advanced stages; peritoneal metastases (PM) are especially frequent and are difficult to treat. Currently, PM are considered a terminal stage of GC with a poor survival rate and are treated with palliative systemic chemotherapy. Since the beginning of the century, the treatment of PM from different origins has evolved; cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have become the treatment of choice for many malignant diseases that affect the peritoneum. CRS and HIPEC have also been used for patients with GC and PM, achieving survival results that have never been achieved when using systemic chemotherapy alone. The use of HIPEC can even prevent the development of peritoneal recurrences in patients with locally advanced GC as adjuvant therapy, can reduce the volume of peritoneal disease as neoadjuvant therapy, and can control symptoms in a palliative setting. The aim of this review is to collate the current scientific evidence regarding the treatment of PM of GC origin with surgery and intraperitoneal chemotherapy.
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Ihemelandu C. The Landmark Series: Scoring Systems for Primary Peritoneal Surface Malignancy. Ann Surg Oncol 2023; 30:1832-1837. [PMID: 36550329 DOI: 10.1245/s10434-022-12941-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) represents an innovative approach to treat or prevent peritoneal metastasis. However, given the morbidity that can be associated with this procedure, adequate patient selection facilitated by scoring systems for primary peritoneal surface malignancy (PSM) is paramount to ensure equitable morbidity as well as acceptable survival outcome. METHODS Seminal studies on scoring systems for PSM that have laid the foundation for adequate patient selection and prognostication are spotlighted. RESULTS Quantitative prognostic indicators have been defined for patients with PSM that enable the surgeon to make sound clinical judgements as to who may or may not benefit from CRS/HIPEC. These prognostic indicators include the histopathology of the tumor, findings on the preoperative abdominal and pelvic computerized axial tomography, the Peritoneal Cancer Index, completeness of cytoreduction score, and prior surgical score. CONCLUSIONS Scoring systems for primary peritoneal surface malignancy reviewed in this article highlight the utility of these systems for patient selection for CRS/HIPEC and prognostication.
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Ihemelandu C. ASO Author Reflections: Prognosticating the Treatment Outcome for Primary Peritoneal Surface Malignancy: Time for an Overhaul of Scoring Systems? Ann Surg Oncol 2023; 30:1838-1839. [PMID: 36629992 DOI: 10.1245/s10434-022-13062-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023]
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HIPEC as a risk factor for postoperative coagulopathy after cytoreductive surgery for peritoneal metastases. Updates Surg 2022; 74:1715-1723. [PMID: 35932406 DOI: 10.1007/s13304-022-01340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
AIM OF THE STUDY Postoperative coagulopathy is a poorly investigated condition after Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). This study aims to evaluate the occurrence and risk factors of coagulative disorders after surgery for peritoneal metastases. PATIENTS AND METHODS The records were extracted from a prospectively maintained database of consecutive patients who underwent CRS between January 2018 and September 2020. The study was approved by the local Ethics Committee. For each patient, the coagulation profile (CP), which included international normalized ratio (INR), partial thromboplastin time (aPTT), and platelets (PLTS) before surgery, intensive care unit admission,1st, 3rd, 5th postoperative day (POD) and the day before discharge was collected. Risk factors for postoperative coagulopathy were identified at multivariate analysis. RESULTS During the study period, 125 patients were included in the study. Among these, 48 (38.4%) underwent CRS only, and 77 (61.6%) CRS followed by HIPEC. Twenty-one patients (16.8%) developed severe coagulopathy, 5 (10.4%) after CRS and 16 (20.8%) after CRS-HIPEC. At multivariate analysis, HIPEC and blood loss ≥ 500 ml represented independent risk factors for severe alteration of INR > 1.5 (p = 0.05, OR 1.2) and PLTS < 75 109/L (p = 0.03, OR 1.3), respectively. CONCLUSION HIPEC is an independent risk factor for postoperative coagulopathy after CRS. Further studies are necessary to assess the usefulness of the point-of-care test in patients treated with CRS-HIPEC.
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Pereira F, Serrano A, Manzanedo I, Pérez-Viejo E, González-Moreno S, González-Bayón L, Arjona-Sánchez A, Torres J, Ramos I, Barrios ME, Cascales P, Morales R, Boldó E, García-Fadrique A, Arteaga X, Gutierrez-Calvo A, Sánchez-García S, Asensio E, Ramírez CP, Artiles M, Vaqué J, Parra PA, Villarejo P, Muñoz-Casares C, Turienzo E, Calero A, Torrejimeno IJ, Prieto I, Galindo J, Borrego V, Marcello ME, Rihuete C, Carrasco J, Gomez-Quiles L. GECOP-MMC: phase IV randomized clinical trial to evaluate the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) with mytomicin-C after complete surgical cytoreduction in patients with colon cancer peritoneal metastases. BMC Cancer 2022; 22:536. [PMID: 35549912 PMCID: PMC9097342 DOI: 10.1186/s12885-022-09572-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/19/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The French PRODIGE 7 trial, published on January 2021, has raised doubts about the specific survival benefit provided by HIPEC with oxaliplatin 460 mg/m2 (30 minutes) for the treatment of peritoneal metastases from colorectal cancer. However, several methodological flaws have been identified in PRODIGE 7, specially the HIPEC protocol or the choice of overall survival as the main endpoint, so its results have not been assumed as definitive, emphasizing the need for further research on HIPEC. It seems that the HIPEC protocol with high-dose mytomicin-C (35 mg/m2) is the preferred regime to evaluate in future clinical studies. METHODS GECOP-MMC is a prospective, open-label, randomized, multicenter phase IV clinical trial that aims to evaluate the effectiveness of HIPEC with high-dose mytomicin-C in preventing the development of peritoneal recurrence in patients with limited peritoneal metastasis from colon cancer (not rectal), after complete surgical cytoreduction. This study will be performed in 31 Spanish HIPEC centres, starting in March 2022. Additional international recruiting centres are under consideration. Two hundred sixteen patients with PCI ≤ 20, in which complete cytoreduction (CCS 0) has been obtained, will be randomized intraoperatively to arm 1 (with HIPEC) or arm 2 (without HIPEC). We will stratified randomization by surgical PCI (1-10; 11-15; 16-20). Patients in both arms will be treated with personalized systemic chemotherapy. Primary endpoint is peritoneal recurrence-free survival at 3 years. An ancillary study will evaluate the correlation between surgical and pathological PCI, comparing their respective prognostic values. DISCUSSION HIPEC with high-dose mytomicin-C, in patients with limited (PCI ≤ 20) and completely resected (CCS 0) peritoneal metastases, is assumed to reduce the expected risk of peritoneal recurrence from 50 to 30% at 3 years. TRIAL REGISTRATION EudraCT number: 2019-004679-37; Clinicaltrials.gov: NCT05250648 (registration date 02/22/2022, ).
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Affiliation(s)
- Fernando Pereira
- Hospital Universitario de Fuenlabrada, Camino del Molino 2, Fuenlabrada, 28942, Madrid, Spain.
| | - Angel Serrano
- Hospital Universitario de Fuenlabrada, Camino del Molino 2, Fuenlabrada, 28942, Madrid, Spain
| | - Israel Manzanedo
- Hospital Universitario de Fuenlabrada, Camino del Molino 2, Fuenlabrada, 28942, Madrid, Spain
| | - Estibalitz Pérez-Viejo
- Hospital Universitario de Fuenlabrada, Camino del Molino 2, Fuenlabrada, 28942, Madrid, Spain
| | | | - Luis González-Bayón
- Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, 46 -, 28007, Madrid, Spain
| | | | - Juan Torres
- Hospital Universitario Torrecárdenas, Calle Hermandad de Donantes de Sangre s/n, 04009, Almería, Spain
| | - Isabel Ramos
- Hospital Sant Joan Despi Moises Broggi, Carrer de Jacint Verdaguer, 90, 08970 Sant Joan Despí, Barcelona, Spain
| | - Maria E Barrios
- Hospital Clinico Universitario de Valencia, Avenida de Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Pedro Cascales
- Hospital Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120, El Palmar, Murcia, Spain
| | - Rafael Morales
- Hospital Universitario Son Espases, Carretera de Valldemossa, 79. 07210 Palma, Mallorca, Spain
| | - Enrique Boldó
- Consorcio Hospitalario Provincial De Castellón, Avenida del Doctor Clarà 19, 12006, Castellón de la Plana, Spain
| | | | - Xabier Arteaga
- Hospital Universitario Donostia, Begiristain Doktorea Pasealekua 109, 20014, Donostia, Gipuzkoa, Spain
| | - Alberto Gutierrez-Calvo
- Hospital Universitario Principe de Asturias, Carretera Alcalá-Meco, s/n - 28805 Alcalá de Henares, Madrid, Spain
| | - Susana Sánchez-García
- Hospital General Universitario de Ciudad Real, C/ Obispo Rafael Torija s/n - Pol. Larache, 13005, Ciudad Real, Spain
| | - Enrique Asensio
- Hospital Universitario Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Cesar P Ramírez
- Hospital Quirónsalud Málaga, Avenida de Imperio Argentina, 1, 29004, Málaga, Spain
| | - Manuel Artiles
- Hospital Universitario de Gran Canaria Doctor Negrín, Barranco de la Ballena, 0, 35010, Las Palmas de Gran Canaria, Spain
| | - Javier Vaqué
- Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Pedro A Parra
- Hospital General Universitario Reina Sofía, Avda. Intendente Jorge Palacios, 1, 30003, Murcia, Spain
| | - Pedro Villarejo
- Fundación Jiménez Díaz, Avda. Reyes Católicos 2, 28040, Madrid, Spain
| | | | - Estrella Turienzo
- Hospital Universitario Central de Asturias, Avenida de Roma, 0, 33011, Oviedo, Spain
| | - Alicia Calero
- Hospital General Universitario de Elche, Camí de la Almazara, 11, 03203 Elche, Alicante, Spain
| | | | - Isabel Prieto
- Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Julio Galindo
- Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km. 9,100, 28034, Madrid, Spain
| | - Vicente Borrego
- Hospital Clínico Universitario "Lozano Blesa", Avda. San Juan Bosco, 15, 50009, Zaragoza, Spain
| | - Manuel E Marcello
- Hospital Universitario Fundación Alcorcón, Calle de Budapest, 1, 28922 Alcorcón, Madrid, Spain
| | - Cristina Rihuete
- Hospital Universitario Infanta Elena, Avenida de los Reyes Católicos 21, 28340 Valdemoro, Madrid, Spain
| | - Joaquin Carrasco
- Hospital Regional Universitario de Málaga, Avda. Carlos Haya 82-88, 29010, Málaga, Spain
| | - Luis Gomez-Quiles
- Hospital General Universitario De Castellón, Avenida de Benicassim, 128, 12004, Castellón, Spain
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Yap DRY, Wong JSM, Tan QX, Tan JWS, Chia CS, Ong CAJ. Effect of HIPEC on Peritoneal Recurrence in Peritoneal Metastasis Treated With Cytoreductive Surgery: A Systematic Review. Front Oncol 2021; 11:795390. [PMID: 34926311 PMCID: PMC8678115 DOI: 10.3389/fonc.2021.795390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/15/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Peritoneal metastasis (PM) is a late-stage manifestation of intra-abdominal malignancies. The current standard of care indicates that cure can only be achieved with cytoreductive surgery (CRS) which is often indicated with concurrent adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC). However, the utility of HIPEC within subsets of PM is not fully understood. We seek to compare the effectiveness of HIPEC in improving peritoneal recurrence rates in PM of different origins. METHODS We conducted a systematic review of trials on the PubMed, EMBASE, and Cochrane databases, last searched in August 2021. Biases were assessed using the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials as well as the Methodological Index for Non-Randomized Studies (MINORS) framework. RESULTS 7 gastric PM studies, 3 ovarian PM studies, and 3 colorectal PM studies were included. Recurrence-free survival was improved in the HIPEC + CRS cohort in 5 gastric trials but only 1 ovarian trial and none of colorectal origin. DISCUSSION Our findings indicate decent effectiveness of HIPEC in gastric PM, but limited utility in ovarian and colorectal PM. Limitations in the current literature are attributed to the paucity of data available, a lack of homogeneity and consideration of novel and personalised treatment regimens. We implore for further studies to be conducted with a focus on patient selection and stratification, and suggest a reframing of approach towards modern molecular and targeted therapeutic options in future studies of HIPEC. SYSTEMATIC REVIEW REGISTRATION https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/60c1ffff0c1b78001e8efbe3/, identifier reviewregistry1166.
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Affiliation(s)
- Daniel Ren Yi Yap
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Qiu Xuan Tan
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Joey Wee-Shan Tan
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Chin-Ann Johnny Ong
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore, Singapore
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10
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Marano L, Marrelli D, Sammartino P, Biacchi D, Graziosi L, Marino E, Coccolini F, Fugazzola P, Valle M, Federici O, Baratti D, Deraco M, Di Giorgio A, Macrì A, Pasqual EM, Framarini M, Vaira M, Roviello F. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer with Synchronous Peritoneal Metastases: Multicenter Study of 'Italian Peritoneal Surface Malignancies Oncoteam-S.I.C.O.'. Ann Surg Oncol 2021; 28:9060-9070. [PMID: 34057569 PMCID: PMC8590997 DOI: 10.1245/s10434-021-10157-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/29/2021] [Indexed: 12/20/2022]
Abstract
Background The development of multimodality treatment, including cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC), has led to promising results in selected patients with peritoneal disease of gastric origin. The aim of this study was to investigate the short- and long-term outcomes of CRS/HIPEC in the treatment of synchronous peritoneal metastasis in gastric cancer. Methods The Italian Peritoneal Surface Malignancies Oncoteam—S.I.C.O. retrospective registry included patients with synchronous peritoneal malignancy from gastric cancer submitted to gastrectomy with CRS and HIPEC between 2005 and 2018 from 11 high-volume, specialized centers. Results A total of 91 patients with a median age of 58 years (range 26–75) were enrolled. The median overall survival (OS) time for the whole group of patients was 20.2 months (95% confidence interval [CI] 11.8–28.5] and the median recurrence-free survival (RFS) was 7.3 months (95% CI 4–10.6). The completeness of cytoreduction score (CCS) of 0 and Peritoneal Cancer Index (PCI) score of ≤ 6 groups showed a significantly better long-term survival (median OS 40.7 and 44.3 months, respectively) compared with the incomplete resected groups (median OS 10.7 months, p = 0.003) and PCI score of > 6 group (median OS 13.4 months, p = 0.005). A significant difference was observed in the survival rate according to neoadjuvant treatment (untreated patients: 10.7 months, 95% CI 5.1–16.2; treated patients: 35.3 months, 95% CI 2.8–67.8; p = 0.022). Conclusions In referral centers, CRS and HIPEC after neoadjuvant treatment significantly improved survival in selected patients. Patients with a PCI score ≤ 6, complete cytoreduction, negative nodal involvements, and negative cytology had encouraging results, showing a clinically meaningful survival.
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Affiliation(s)
- Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy.
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Paolo Sammartino
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Daniele Biacchi
- Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Luigina Graziosi
- General and Emergency Surgery, University of Perugia, Perugia, Italy
| | - Elisabetta Marino
- General and Emergency Surgery, University of Perugia, Perugia, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.,General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Paola Fugazzola
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Mario Valle
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Orietta Federici
- Department of Digestive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Dario Baratti
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Peritoneal Surface Malignancies Unit, Milan, Italy
| | - Marcello Deraco
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Peritoneal Surface Malignancies Unit, Milan, Italy
| | - Andrea Di Giorgio
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Macrì
- Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, Messina University Medical School Hospital, Messina, Italy
| | - Enrico Maria Pasqual
- Department of Medical Area, University of Udine, Santa Maria della Misericordia University Hospital Udine, Udine, Italy
| | | | - Marco Vaira
- Candiolo Cancer Institute, Unit of Surgical Oncology, FPO-IRCCS, Candiolo, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
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11
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Lopes A, Genta MLND, da Costa Miranda V, Aranha A, Lopez RVM, Piato DSAM, Anton C, Carvalho FM, Del Pilar Esteves Diz M, Carvalho JP. Role of systematic pelvic and para-aortic lymphadenectomy in delayed debulking surgery after six neoadjuvant chemotherapy cycles for high-grade serous ovarian carcinoma. J Obstet Gynaecol Res 2021; 47:2737-2744. [PMID: 33998104 DOI: 10.1111/jog.14838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/14/2021] [Accepted: 05/03/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION We analyzed the role of systematic pelvic and para-aortic lymphadenectomy in delayed debulking surgery after six neoadjuvant chemotherapy (NACT) cycles for advanced high-grade serous ovarian carcinoma. MATERIALS AND METHODS We retrospectively reviewed patients with advanced ovarian carcinoma who underwent NACT with carboplatin-paclitaxel between 2008 and 2016. Patients were included only if they had FIGO IIIC-IVB high-grade serous carcinoma with clinically negative lymph nodes after six NACT cycles (carboplatin-paclitaxel) and underwent complete or near complete cytoreduction. Patients with partial lymphadenectomy or bulky nodes were excluded. Patients who underwent systematic pelvic and aortic lymphadenectomy and those who did not undergo lymph node dissection were compared. Progression-free and overall survivals were analyzed using the Kaplan-Meier method. RESULTS Totally, 132 patients with FIGO IIIC-IVB epithelial ovarian carcinoma were surgically treated after NACT. Sixty patients were included (39 and 21 in the lymphadenectomy and nonlymphadenectomy group, respectively); 40% had suspicious lymph nodes before NACT. Patient characteristics, blood transfusion numbers, and complication incidence were similar between the groups. In the lymphadenectomy group, 12 patients (30.8%) had histologically positive lymph nodes and the surgical time was longer (229 vs. 164 min). The median overall survival in the lymphadenectomy and nonlymphadenectomy groups, respectively, was 56.7 (95% CI 43.4-70.1) and 61.2 (21.4-101.0) months (p = 0.934); the corresponding disease-free survival was 8.1 (6.2-10.1) and 8.3 (5.1-11.6) months (p = 0.878). Six patients exclusively presented with lymph node recurrence. CONCLUSIONS Systematic lymphadenectomy after six NACT cycles may have no influence on survival.
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Affiliation(s)
- Andre Lopes
- Discipline of Gynecology, Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Gastroenterology Department, Digestive Surgery Division, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria L N D Genta
- Discipline of Gynecology, Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vanessa da Costa Miranda
- Department of Radiology and Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Andrea Aranha
- Department of Radiology and Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rossana V M Lopez
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Dariane S A M Piato
- Discipline of Gynecology, Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Cristina Anton
- Discipline of Gynecology, Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Filomena M Carvalho
- Department of Pathology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria Del Pilar Esteves Diz
- Department of Radiology and Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jesus P Carvalho
- Discipline of Gynecology, Department of Obstetrics and Gynecology, Instituto do Cancer do Estado de Sao Paulo ICESP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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12
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Manzanedo I, Pereira F, Serrano Á, Pérez-Viejo E. Review of management and treatment of peritoneal metastases from gastric cancer origin. J Gastrointest Oncol 2021; 12:S20-S29. [PMID: 33968423 DOI: 10.21037/jgo-20-232] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Gastric cancer (GC) is the third cause of cancer-related deaths in the world, with less than 25% survivors at 5 years. These results are largely related to the high incidence of peritoneal metastases (PM) in these patients. Nowadays, the standard treatment for GC with PM is palliative systemic chemotherapy (SCT) with a survival of 6 months. From the 2000s, the combination of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has been gaining popularity for different neoplastic diseases that involve the peritoneal surface. The use of CRS and HIPEC has been studied for GC with PM, with promising results in selected patients, obtaining survival rates never seen before. Moreover, HIPEC and other intraperitoneal chemotherapy techniques have been used to prevent peritoneal recurrences in patients diagnosed on locally advanced GC without macroscopic PM (adjuvant or prophylactic HIPEC). Even, intraperitoneal chemotherapy [laparoscopic HIPEC and neoadjuvant intraperitoneal and systemic chemotherapy (NIPS)] has been used as neoadjuvant treatment to reduce peritoneal disease burden in order to improve the rate of patients in whom complete cytoreduction can be achieved. Finally, patients with high volume peritoneal disease can be treated by palliative intraperitoneal chemotherapy to control the symptoms resulting from malignant ascites, using laparoscopic HIPEC or pressurized intraperitoneal aerosol chemotherapy (PIPAC). This review aims to update the management of PM from GC origin in these different clinical scenarios, based on the literature and the experience of the authors.
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Affiliation(s)
- Israel Manzanedo
- Department of General and Digestive Surgery, Peritoneal Carcinomatosis Unit, Hospital of Fuenlabrada, Fuenlabrada, Madrid, Spain.,Rey Juan Carlos University (URJC), Madrid, Spain
| | - Fernando Pereira
- Department of General and Digestive Surgery, Peritoneal Carcinomatosis Unit, Hospital of Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Ángel Serrano
- Department of General and Digestive Surgery, Peritoneal Carcinomatosis Unit, Hospital of Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - Estíbalitz Pérez-Viejo
- Department of General and Digestive Surgery, Peritoneal Carcinomatosis Unit, Hospital of Fuenlabrada, Fuenlabrada, Madrid, Spain
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13
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Effect of Cilastatin on Cisplatin-Induced Nephrotoxicity in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy. Int J Mol Sci 2021; 22:ijms22031239. [PMID: 33513824 PMCID: PMC7865672 DOI: 10.3390/ijms22031239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/24/2022] Open
Abstract
Cisplatin is one of the most widely used chemotherapeutic agents in oncology, although its nephrotoxicity limits application and dosage. We present the results of a clinical study on prophylaxis of cisplatin-induced nephrotoxicity in patients with peritoneal carcinomatosis undergoing cytoreduction and hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC-cisplatin). Prophylaxis was with imipenem/cilastatin. Cilastatin is a selective inhibitor of renal dehydropeptidase I in the proximal renal tubule cells that can reduce the nephrotoxicity of cisplatin. Unfortunately, cilastatin is not currently marketed alone, and can only be administered in combination with imipenem. The study has a retrospective part that serves as a control (n = 99 patients receiving standard surgical prophylaxis) and a prospective part with imipenem/cilastatin prophylaxis corresponding to the study group (n = 85 patients). In both groups, we collected specific data on preoperative risk factors of renal damage, fluid management, hemodynamic control, and urine volume during surgery (including the hyperthermic chemotherapy perfusion), as well as data on hemodynamic and renal function during the first seven days after surgery. The main finding of the study is that cilastatin may exert a nephroprotective effect in patients with peritoneal carcinomatosis undergoing cytoreduction and hyperthermic intraperitoneal cisplatin perfusion. Creatinine values remained lower than in the control group (ANOVA test, p = 0.037). This translates into easier management of these patients in the postoperative period, with significantly shorter intensive care unit (ICU) and hospital stay.
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14
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Tonello M, Barina A, Turchet F, De Simoni O, Alfieri R, Franzato B, Gruppo M, Dengo B, Deffenu D, Di Pasquale D, Fiore T, Pietropaoli C, Munaron S, Zanardo G, Sommariva A, Pilati P. Clinical and predictive value of blood lactate levels during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC): a comparative analysis. Updates Surg 2020; 73:313-319. [PMID: 33146888 DOI: 10.1007/s13304-020-00908-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/21/2020] [Indexed: 12/26/2022]
Abstract
Postoperative outcome after cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is strongly related to surgical and anesthesiologic expertise. This study aims to evaluate the clinical significance and prognostic value of lactate levels (LL) measured during CRS-HIPEC on postoperative outcome compared to similar major surgical procedures. Patients who were treated between January and September 2019 at our Institute and met the inclusion criteria were selected. Patients were divided into three groups: group 1: patients who underwent major surgical procedures; group 2: patients who underwent CRS without HIPEC; group 3: patients who underwent CRS with HIPEC. Intraoperative LL were analyzed and correlated with surgical procedure and postoperative outcome. We observed a significant increase of LL during surgical/CRS phase (group 1: p = 0.0001; group 2: p = 0.001; group 3: p = 0.057), rather than during the HIPEC phase in group 3 (p = ns). In patients undergoing CRS and peritonectomies, the mean LL were significantly higher compared to group 1 (p = 0.05). Although not statistically significant, the complication rate was higher in patients with end-CRS lactate values > 2 mMol/l, especially in the group undergoing CRS plus HIPEC. Our pilot study shows that higher LL during peritoneal cancer surgery are expected compared to major surgical procedures. Cytoreductive phase, rather than HIPEC, is related to an increase of LL. The role of LL as an early marker of postoperative complications after CRS-HIPEC should be further verified in properly designed studies.
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Affiliation(s)
- Marco Tonello
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy.
| | - Andrea Barina
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
| | - Federica Turchet
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Ottavia De Simoni
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
| | - Rita Alfieri
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
| | - Boris Franzato
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
| | - Mario Gruppo
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
| | - Bruno Dengo
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Davide Deffenu
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Daniele Di Pasquale
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Tania Fiore
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Claudia Pietropaoli
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Susanna Munaron
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Giorgio Zanardo
- Anesthesia and Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Antonio Sommariva
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
| | - Pierluigi Pilati
- Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy
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15
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Munoz-Zuluaga C, King MC, Gushchin V, Sardi A. ASO Author Reflections: Time to Change: Redefining "Complete Cytoreduction" in Appendiceal Carcinomatosis. Ann Surg Oncol 2020; 27:5037-5038. [PMID: 32935268 DOI: 10.1245/s10434-020-09090-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Carlos Munoz-Zuluaga
- Department of Surgical Oncology, The Institute for Cancer Care at Mercy, Mercy Medical Center, Baltimore, MD, USA
| | - Mary Caitlin King
- Department of Surgical Oncology, The Institute for Cancer Care at Mercy, Mercy Medical Center, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care at Mercy, Mercy Medical Center, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care at Mercy, Mercy Medical Center, Baltimore, MD, USA.
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16
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Munoz-Zuluaga CA, King MC, Diaz-Sarmiento VS, Studeman K, Sittig M, MacDonald R, Nieroda C, Zambrano-Vera K, Gushchin V, Sardi A. Defining "Complete Cytoreduction" After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) for the Histopathologic Spectrum of Appendiceal Carcinomatosis. Ann Surg Oncol 2020; 27:5026-5036. [PMID: 32705513 DOI: 10.1245/s10434-020-08844-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/27/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The completeness of cytoreduction (CC) score, which quantifies residual tumor, is a major prognostic factor when treating appendiceal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Both CC-0 and CC-1 are considered complete cytoreductions (CC-0/1) and associated with the best outcomes. We analyzed if the CC-0/1 definition is reliable across appendiceal histopathologic subtypes. METHODS A prospective database of CRS/HIPEC patients with appendiceal carcinomatosis from 1998 to 2019 was reviewed to identify patients with CC-0/1. Kaplan-Meier overall survival (OS) and progression-free survival (PFS) by CC-score for each histopathology were calculated. RESULTS Overall, 297 patients had CC-0/1. Mean age was 54 ± 12 years with 67% females. Histopathologic subtypes were 45% low-grade mucinous carcinoma peritonei (LGMCP), 27% high-grade MCP (HGMCP), 20% HGMCP with signet ring cells (HGMCP-S), and 8% goblet cell adenocarcinoma (GCAC). CC-0 and CC-1 occurred in 57% and 43% of LGMCP, 65% and 35% of HGMCP, 68% and 32% of HGMCP-S, and 79% and 21% of GCAC, respectively. OS and PFS were statistically longer for CC-0 versus CC-1 in HGMCP-S (p = 0.001 and p = 0.005, respectively) and GCAC (p < 0.001 and p < 0.001), but not in LGMCP (p = 0.098 and p = 0.398) or HGMCP (p = 0.167 and p = 0.356). CONCLUSIONS Survival outcomes for CC-0 and CC-1 after CRS/HIPEC are different for HGMCP-S and GCAC but not for LGMCP and HGMCP. In HGCMP-S and GCAC, only CC-0 should be considered a complete cytoreduction and analyzed separately from CC-1. This distinction is key to understand disease behavior, accurately address patient prognosis, and explore new treatment strategies.
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Affiliation(s)
| | - Mary C King
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | | | - Kimberley Studeman
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.,Department of Pathology, Mercy Medical Center, Baltimore, MD, USA
| | - Michelle Sittig
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Ryan MacDonald
- Department of Pathology, Mercy Medical Center, Baltimore, MD, USA
| | - Carol Nieroda
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | | | - Vadim Gushchin
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Armando Sardi
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
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Papageorgiou D, Manatakis DK, Papakonstantinou K, Kyriazanos ID. A comprehensive review of childbearing after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Arch Gynecol Obstet 2020; 302:793-799. [PMID: 32653946 DOI: 10.1007/s00404-020-05687-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/04/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Our aim is to present a review on childbearing following CRS and HIPEC for peritoneal malignancy. METHODS A review of the English literature, up to December 2019, was conducted, using PubMed/MEDLINE, EmBase and Google Scholar bibliographic databases, following the MOOSE guidelines. The terms "Cytoreductive Surgery", "Hyperthermic Intraperitoneal Chemotherapy", "Peritoneal Carcinomatosis", "Pregnancy", "Fertility Preservation", "Conception" were used. All study designs were eligible for inclusion in the final analysis. RESULTS In total, 7 studies (5 case reports and 2 case series) were included in the final analysis, reporting on 14 successful pregnancies after CRS and HIPEC. The mean age of patients at the time of CRS/HIPEC was 28.8 ± 5.9 years (range 18-36), while the mean interval between CRS/HIPEC and pregnancy was 29.6 ± 20.3 months (range 9-80 months). Nine patients were treated for pseudomyxoma peritonei, four for primary peritoneal mesothelioma and one for endocrine carcinoma. Mean Peritoneal Carcinomatosis Index was 9.8 ± 7.8 (range 1-26). All patients underwent fertility-sparing CRS (preservation of at least one ovary and the uterus). In 12 cases, conception was spontaneous, whereas two pregnancies were achieved through in-vitro fertilization. One patient developed gestational hypertension, while two labors were preterm. Mean disease-free survival was 64.1 months (range 24-106 months). CONCLUSION A successful pregnancy is feasible in selected patients, after CRS and HIPEC. Assisted reproduction techniques (IVF using frozen oocytes or frozen embryos, ovarian tissue cryopreservation, preoperative treatment with GnRH analogs) should be discussed pre-operatively with the patient, without, however, compromising overall survival or risking locoregional recurrence.
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Affiliation(s)
- Dimitrios Papageorgiou
- Department of Gynecology, Athens Naval and Veterans Hospital, 70, Deinokratous str, 11521, Athens, Greece.
| | | | - Katerina Papakonstantinou
- Department of Gynecology, Athens Naval and Veterans Hospital, 70, Deinokratous str, 11521, Athens, Greece
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Elekonawo FMK, van Eden WJ, van der Plas WY, Ewalds RSG, de Jong LAW, Bremers AJA, Hemmer PHJ, Kok NFM, Kruijff S, Aalbers AGJ, de Reuver PR. Effect of intraperitoneal chemotherapy concentration on morbidity and survival. BJS Open 2020; 4:293-300. [PMID: 31950702 PMCID: PMC7093784 DOI: 10.1002/bjs5.50250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/25/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Selected patients with colorectal peritoneal metastases are treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The concentration of intraperitoneal chemotherapy reflects the administered dose and perfusate volume. The aim of this study was to calculate intraperitoneal chemotherapy concentration during HIPEC and see whether this was related to clinical outcomes. METHODS An observational multicentre study included consecutive patients with colorectal peritoneal metastases who were treated with CRS-HIPEC between 2010 and 2018 at three Dutch centres. Data were retrieved from prospectively developed databases. Chemotherapy dose and total circulating volumes of carrier solution were used to calculate chemotherapy concentrations. Postoperative complications, disease-free and overall survival were correlated with intraoperative chemotherapy concentrations. Univariable and multivariable logistic regression, Cox regression and survival analyses were performed. RESULTS Of 320 patients, 220 received intraperitoneal mitomycin C (MMC) and 100 received oxaliplatin. Median perfusate volume for HIPEC was 5·0 (range 0·7-10·0) litres. Median intraperitoneal chemotherapy concentration was 13·3 (range 7·0-76·0) mg/l for MMC and 156·0 (91·9-377·6) mg/l in patients treated with oxaliplatin. Grade III or higher complications occurred in 75 patients (23·4 per cent). Median overall survival was 36·9 (i.q.r. 19·5-62·9) months. Intraperitoneal chemotherapy concentrations were not associated with postoperative complications or survival. CONCLUSION CRS-HIPEC was performed with a wide variation in intraperitoneal chemotherapy concentrations that were not associated with complications or survival.
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Affiliation(s)
- F M K Elekonawo
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - W J van Eden
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, Netherlands
| | - W Y van der Plas
- Department of Surgery, University Medical Centre Groningen, Groningen, Netherlands
| | - R S G Ewalds
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - L A W de Jong
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, Netherlands
| | - A J A Bremers
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - P H J Hemmer
- Department of Surgery, University Medical Centre Groningen, Groningen, Netherlands
| | - N F M Kok
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, Netherlands
| | - S Kruijff
- Department of Surgery, University Medical Centre Groningen, Groningen, Netherlands
| | - A G J Aalbers
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, Netherlands
| | - P R de Reuver
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
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Blontzos N, Vafias E, Vorgias G, Kalinoglou N, Iavazzo C. Primary peritoneal serous papillary carcinoma: a case series. Arch Gynecol Obstet 2019; 300:1023-1028. [PMID: 31486887 DOI: 10.1007/s00404-019-05280-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/22/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To present the clinical and laboratory characteristics, as well as the management, of patients with primary peritoneal serous papillary carcinoma (PPSPC). METHODS This is a retrospective study of 19 patients with PPSPC who underwent debulking surgery followed by first line chemotherapy and were managed in Metaxa Memorial Cancer Hospital between January 2002 and December 2017. RESULTS The median age of the patients was found to be 66 years (range 44-76 years). Clinical presentation of PPSPC included abdominal distention and pain, constipation, as well as loss of appetite and weight gain. Two of the patients did not mention any symptomatology and the disease was suspected by an abnormal cervical smear and elevated CA125 levels respectively. Biomarkers measurement during the initial management of the patients revealed abnormal values of CA125 for all the participants (median value 565 U/ml). Human epididymis secretory protein 4 (HE4) and ratios of blood count were also measured. Perioperative Peritoneal Cancer Index ranged from 6 to 20. Optimal debulking was achieved in 5 cases. All patients were staged as IIIC and IVA PPSPC and received standard chemotherapy with paclitaxel and carboplatin, whereas bevacizumab was added in the 5 most recent cases. Median overall survival was 29 months. CONCLUSION PPSPC is a rare malignancy, the management of which should take place in tertiary oncology centers.
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Affiliation(s)
- Nikolaos Blontzos
- Department of Gynecology, Metaxa Memorial Cancer Hospital, Mpotasi 1, 17674, Piraeus, Athens, Greece.
| | - Evangelos Vafias
- Department of Gynecology, Metaxa Memorial Cancer Hospital, Mpotasi 1, 17674, Piraeus, Athens, Greece
| | - George Vorgias
- Department of Gynecology, Metaxa Memorial Cancer Hospital, Mpotasi 1, 17674, Piraeus, Athens, Greece
| | - Nikolaos Kalinoglou
- Department of Gynecology, Metaxa Memorial Cancer Hospital, Mpotasi 1, 17674, Piraeus, Athens, Greece
| | - Christos Iavazzo
- Department of Gynecology, Metaxa Memorial Cancer Hospital, Mpotasi 1, 17674, Piraeus, Athens, Greece
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Manzanedo I, Pereira F, Rihuete Caro C, Pérez-Viejo E, Serrano Á, Gutiérrez Calvo A, Regueira FM, Casado-Adam Á, Cascales-Campos PA, Arteaga X, García-Fadrique A, Gómez Sanz R, López García A, Zozaya G, Arjona Á, Gil Martínez J. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Gastric Cancer with Peritoneal Carcinomatosis: Multicenter Study of Spanish Group of Peritoneal Oncologic Surgery (GECOP). Ann Surg Oncol 2019; 26:2615-2621. [DOI: 10.1245/s10434-019-07450-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Indexed: 12/16/2022]
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Gremonprez F, Gossye H, Ceelen W. Use of hyperthermia versus normothermia during intraperitoneal chemoperfusion with oxaliplatin for colorectal peritoneal carcinomatosis: A propensity score matched analysis. Eur J Surg Oncol 2019; 45:366-370. [DOI: 10.1016/j.ejso.2018.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/25/2018] [Accepted: 08/17/2018] [Indexed: 12/20/2022] Open
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The use of cisplatin plus doxorubicin or paclitaxel in hyperthermic intraperitoneal chemotherapy (HIPEC) for stage IIIC or IV epithelial ovarian cancer: a comparative study. Clin Transl Oncol 2019; 21:1357-1363. [PMID: 30788835 DOI: 10.1007/s12094-019-02065-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Our main aim is to analyze the survival results in women operated on for advanced ovarian cancer with two different HIPEC regimens (cisplatin plus doxorubicin versus paclitaxel). PATIENTS AND METHODS A prospective cohort of patients with stage IIIC or IV epithelial ovarian cancer operated on with cytoreductive surgery and HIPEC, from October-2008 to February-2016, was retrospectively analyzed. The two drugs used, cisplatin/doxorubicin (Group A) and paclitaxel (Group B), were compared. RESULTS Forty-one patients were treated with cytoreductive surgery and HIPEC; 19 patients (46%) were in Group A and 22 (54%) were in Group B. The extent of peritoneal disease was comparable between groups (Peritoneal Cancer Index of 10 in Group A versus PCI of 12.5 in Group B). There were no differences in morbidity between groups, with a severe morbidity (Dindo-Clavien III or IV) of 36.8% versus 27.3%, respectively. There was no postoperative mortality. Median follow-up was 39 months. Median overall survival was 79 months. Overall survival at 3 years in Group A was 66% versus 82.9% in Group B (p = 0.248). Incomplete cytoreduction (macroscopic residual tumour after surgery) was identified as the only independent factor that influenced overall survival (HR 12.30, 95% CI 1.28-118.33, p = 0.03). The cytostatic used in HIPEC had no influence in overall survival. CONCLUSION The cytostatic used in HIPEC did not have a negative effect in the prognosis of patients with advanced ovarian cancer.
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First case report of malignant peritoneal mesothelioma and oral verrucous carcinoma in a patient with a germline PTEN mutation: a combination of extremely rare diseases with probable further implications. BMC MEDICAL GENETICS 2018; 19:144. [PMID: 30111295 PMCID: PMC6094911 DOI: 10.1186/s12881-018-0651-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/23/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The PTEN-hamartoma-tumor-syndrome (PHTS) is caused by germline mutations in Phosphatase and Tensin homolog (PTEN) and predisposes to the development of several typical malignancies. Whereas PTEN mutations have been implicated in the occurrence of malignant mesotheliomas, the genetic landscape of verrucous carcinomas (VC) is largely uncharted. Both VC and malignant peritoneal mesotheliomas (MPM) are exceedingly rare and a potential link between these malignancies and PHTS has never been reported. CASE PRESENTATION We here describe the clinical course of a PHTS patient who, in addition to a typical thyroid carcinoma at the age of 36 years, developed a highly-differentiated oral VC and an epithelioid MPM six years later. The patient with a history of occupational asbestos exposure underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for MPM. The clinical diagnosis of PHTS was consequently corroborated by a germline PTEN deletion. Sequencing of tumor tissue revealed a second hit in PTEN in the thyroid carcinoma and VC, confirmed by a PTEN loss and activation of the PI3K/AKT pathway in immunohistochemistry. Furthermore, additional somatic mutations in the thyroid carcinoma as well as in the VC were detected, whereas the genetics of MPM remained unrevealing. DISCUSSION AND CONCLUSIONS We here report the very unusual clinical course of a patient with rare tumors that have a germline mutation first hit in PTEN in common. Since this patient was exposed to asbestos and current evidence suggests molecular mechanisms that might render PHTS patients particularly susceptible to mesothelioma, we strongly recommend PHTS patients to avoid even minimal exposure.
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Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with gastric cancer and peritoneal carcinomatosis. Eur J Surg Oncol 2018; 44:1805-1810. [PMID: 30087071 DOI: 10.1016/j.ejso.2018.06.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/23/2018] [Accepted: 06/27/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Gastric Cancer (GC) with Peritoneal Carcinomatosis (PC) has long been regarded as a terminal disease. Over the past two decades, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has changed the traditional concept of peritoneal metastases from being a systemic disease, to being considered a locoregional dissemination. PATIENTS AND METHODS A prospective study was performed at a high-volume Carcinomatosis Center to evaluate survival, morbi-mortality and prognostic factors for survival in a cohort of patients with GC and PC treated with CRS + HIPEC between June 2006 and December 2016. RESULTS Thirty-five patients were included in the study. Median follow-up was 54 months. Postoperative major complications (>grade IIIa) occurred in 25.7% of patients, including 2 deaths (mortality 5.7%). The median overall survival (OS) was 16 months and the 1-, 3- and 5-year OS rates were 70.8%, 21.3% and 21.3% %, respectively. The median OS for patients with PCI ≤6 was 19 months, in contrast to 12 months for the 19 patients with PCI >6. Three patients were included with only a positive cytology and their median OS was not reached. Perineural invasion was the only factor that had a negative influence in prognosis (HR 18.8) in multivariate analysis. CONCLUSION Although GC with PC still has a poor prognosis, survival has improved in selected patients with CRS + HIPEC and perioperative systemic chemotherapy. Patients with isolated positive cytology or peritoneal carcinomatosis with PCI less than 6 had encouraging survival rates.
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Batista TP, Sarmento BJQ, Loureiro JF, Petruzziello A, Lopes A, Santos CC, Quadros CDA, Akaishi EH, Cordeiro EZ, Coimbra FJF, Laporte GA, Castro LS, Batista RMSS, Aguiar S, Costa WL, Ferreira FO. A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma. ACTA ACUST UNITED AC 2018; 44:530-544. [PMID: 29019584 DOI: 10.1590/0100-69912017005016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 06/08/2017] [Indexed: 12/13/2022]
Abstract
Cytoreductive surgery plus hypertermic intraperitoneal chemotherapy has emerged as a major comprehensive treatment of peritoneal malignancies and is currently the standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome as well as malignant peritoneal mesothelioma. Unfortunately, there are some worldwide variations of the cytoreductive surgery and hypertermic intraperitoneal chemotherapy techniques since no single technique has so far demonstrated its superiority over the others. Therefore, standardization of practices might enhance better comparisons between outcomes. In these settings, the Brazilian Society of Surgical Oncology considered it important to present a proposal for standardizing cytoreductive surgery plus hypertermic intraperitoneal chemotherapy procedures in Brazil, with a special focus on producing homogeneous data for the developing Brazilian register for peritoneal surface malignancies.
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Affiliation(s)
- Thales Paulo Batista
- - Medicina Integral Professor Fernando Figueira Institute, Department of Surgery / Oncology, Recife, PE, Brazil.,- University of Pernambuco, Department of Surgery, Recife, PE, Brazil
| | | | | | - Andrea Petruzziello
- - Marcelino Champagnat Hospital, Department of Surgical Oncology, Curitiba, PR, Brazil.,- AC Camargo Cancer Center, Department of Abdominal Surgery, São Paulo, SP, Brazil
| | - Ademar Lopes
- - AC Camargo Cancer Center, Department of Pelvic Surgery, São Paulo, SP, Brazil
| | | | | | - Eduardo Hiroshi Akaishi
- - Hospital das Clínicas, University of São Paulo, Department of Surgical Oncology, São Paulo, SP, Brazil
| | | | | | - Gustavo Andreazza Laporte
- - Santa Casa de Misericórdia de Porto Alegre, Department of Surgical Oncology, Porto Alegre, RS, Brazil
| | - Leonaldson Santos Castro
- - Complexo Hospitalar de Niterói, Service of Surgical Oncology, Niterói, RJ, Brazil.,- Nacional Cancer Institute, Service of Abdomino-Pelvic Surgery, Rio de Janeiro, RJ, Brazil
| | | | - Samuel Aguiar
- - AC Camargo Cancer Center, Department of Pelvic Surgery, São Paulo, SP, Brazil
| | - Wilson Luiz Costa
- - AC Camargo Cancer Center, Department of Abdominal Surgery, São Paulo, SP, Brazil
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26
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Mery E, Golzio M, Guillermet S, Lanore D, Le Naour A, Thibault B, Tilkin-Mariamé AF, Bellard E, Delord JP, Querleu D, Ferron G, Couderc B. Fluorescence-guided surgery for cancer patients: a proof of concept study on human xenografts in mice and spontaneous tumors in pets. Oncotarget 2017; 8:109559-109574. [PMID: 29312629 PMCID: PMC5752542 DOI: 10.18632/oncotarget.22728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/28/2017] [Indexed: 12/11/2022] Open
Abstract
Surgery is often the first treatment option for patients with cancer. Patient survival essentially depends on the completeness of tumor resection. This is a major challenge, particularly in cases of peritoneal carcinomatosis, where tumors are widely disseminated in the large peritoneal cavity. Any development to help surgeons visualize these residual cells would improve the completeness of the surgery. For non-disseminated tumors, imaging could be used to ensure that the tumor margins and the draining lymph nodes are free of tumor deposits. Near-infrared fluorescence imaging has been shown to be one of the most convenient imaging modalities. Our aim was to evaluate the efficacy of a near-infrared fluorescent probe targeting the αvβ3 integrins (Angiostamp™) for intraoperative detection of tumors using the Fluobeam® device. We determined whether different human tumor nodules from various origins could be detected in xenograft mouse models using both cancer cell lines and patient-derived tumor cells. We found that xenografts could be imaged by fluorescent staining irrespective of their integrin expression levels. This suggests imaging of the associated angiogenesis of the tumor and a broader potential utilization of Angiostamp™. We therefore performed a veterinary clinical trial in cats and dogs with local tumors or with spontaneous disseminated peritoneal carcinomatosis. Our results demonstrate that the probe can specifically visualize both breast and ovarian nodules, and suggest that Angiostamp™ is a powerful fluorescent contrast agent that could be used in both human and veterinary clinical trials for intraoperative detection of tumors.
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Affiliation(s)
- Eliane Mery
- Institut Claudius Regaud -IUCT Oncopole, University Toulouse III, Toulouse, France
| | - Muriel Golzio
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, Toulouse, France
| | | | | | - Augustin Le Naour
- Institut Claudius Regaud -IUCT Oncopole, University Toulouse III, Toulouse, France
| | - Benoît Thibault
- Institut Claudius Regaud -IUCT Oncopole, University Toulouse III, Toulouse, France
| | | | - Elizabeth Bellard
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, Toulouse, France
| | - Jean Pierre Delord
- Institut Claudius Regaud -IUCT Oncopole, University Toulouse III, Toulouse, France
| | - Denis Querleu
- Institut Claudius Regaud -IUCT Oncopole, University Toulouse III, Toulouse, France
| | - Gwenael Ferron
- Institut Claudius Regaud -IUCT Oncopole, University Toulouse III, Toulouse, France
| | - Bettina Couderc
- Institut Claudius Regaud -IUCT Oncopole, University Toulouse III, Toulouse, France
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McGee J, Bookman M, Harter P, Marth C, McNeish I, Moore K, Poveda A, Hilpert F, Hasegawa K, Bacon M, Gatsonis C, Brand A, Kridelka F, Berek J, Ottevanger N, Levy T, Silverberg S, Kim BG, Hirte H, Okamoto A, Stuart G, Ochiai K. Fifth Ovarian Cancer Consensus Conference: individualized therapy and patient factors. Ann Oncol 2017; 28:702-710. [DOI: 10.1093/annonc/mdx010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Indexed: 12/13/2022] Open
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28
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Sammartino P, Biacchi D, Cornali T, Accarpio F, Sibio S, Luraschi B, Impagnatiello A, Di Giorgio A. Computerized System for Staging Peritoneal Surface Malignancies. Ann Surg Oncol 2015; 23:1454-60. [PMID: 26564242 PMCID: PMC4819745 DOI: 10.1245/s10434-015-4966-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Indexed: 11/22/2022]
Abstract
Background Peritoneal surface malignancies (PSMs) are usually staged using Sugarbaker’s Peritoneal Cancer Index (PCI) and completeness of cytoreduction score (CC-s). Although these staging tools are essential for selecting patients and evaluating outcome after cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC), both scoring models lack some anatomic information, thus making staging laborious and unreliable. Maintaining Sugarbaker’s original concepts, we therefore developed a computerized digital tool, including a new anatomic scheme for calculating PCI and CC-s corresponding closely to patients’ real anatomy. Our new anatomic model belongs in a web-based application known as the PSM Staging System, which contains essential clinical and pathological data for the various PSMs currently treated. Methods The new digital tool for staging PSM runs on a personal computer or tablet and comprises male and female colored anatomic models for the 13 endoabdominal regions, with borders defined according to real anatomic landmarks. A drag-and-drop tool allows users to compute the PCI and CC-s, making it easier to localize and quantify disease at diagnosis and throughout treatment, and residual disease after CRS. Conclusions Once tested online by registered users, our computerized application should provide a modern, shareable, comprehensive, user-friendly PSM staging system. Its anatomic features, along with the drag-and-drop tool, promise to make it easier to compare preoperative and postoperative PCIs, thus improving the criteria for selecting patients to undergo CRS plus HIPEC. By specifying the size, site, and number of residual lesions after CRS plus HIPEC, our digital tool should help stratify patients into outcome classes. Electronic supplementary material The online version of this article (doi:10.1245/s10434-015-4966-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paolo Sammartino
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy.
| | - Daniele Biacchi
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | - Tommaso Cornali
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | - Fabio Accarpio
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | - Simone Sibio
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | - Bernard Luraschi
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
| | | | - Angelo Di Giorgio
- Dipartimento di Chirurgia P. Valdoni, Università di Roma Sapienza, Rome, Italy
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Heudel PE, Selle F, Morice P, Rouzier R, Taieb S, Devouassoux-Shisheboran M, Genestie C, Balleyguier C, Ray-Coquard I. [Initial management of advanced ovarian cancer: What radiological, pathological and surgical information are important for optimal therapeutic strategy?]. Bull Cancer 2015; 102:772-9. [PMID: 26028492 DOI: 10.1016/j.bulcan.2015.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 11/18/2022]
Abstract
Because the majority of patients present advanced disease at diagnosis, the management of epithelial ovarian cancer needs specialist multidisciplinary teamwork. Expertise in surgery, chemotherapy, imaging and histopathology is essential to achieve optimum outcomes. Computed tomography scans are routinely used to determine the extent of disease and to aid in surgical planning. The histologic classification is crucial to plan the best therapeutic strategy and to define the prognosis of disease. Pathological prognostic factors, such as degree of differentiation, FIGO-stage, and histological type have to be described. This report is fundamental to assessing prognosis and selection of appropriate treatment strategy. An adequate staging procedure is an extensive staging by an experienced gynecological oncologist, exploring the entire upper abdomen, and the pelvic and para-aortic lymph node regions to define the Peritoneal Cancer Index (PCI). The final assessment is the completeness of cytoreduction (CC) score, which is an assessment of residual disease after a maximal surgical effort. Initial management of advanced ovarian cancer is best provided by a specialist multidisciplinary team, including a radiologist, a pathologist, a gynecologic oncologist and a medical oncologist.
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Affiliation(s)
| | - Frédéric Selle
- Hôpital Tenon, service d'oncologie médicale, 75020 Paris, France
| | - Philippe Morice
- Institut Gustave-Roussy, département de chirurgie, 94800 Villejuif, France
| | - Roman Rouzier
- Institut Curie, département de chirurgie, 75005 Paris, France
| | - Sophie Taieb
- Centre Oscar-Lambret, département d'imagerie médicale, 59000 Lille, France
| | | | - Catherine Genestie
- Institut Gustave-Roussy, service d'anatomo-pathologie, 94800 Villejuif, France
| | - Corinne Balleyguier
- Institut Gustave-Roussy, département d'imagerie médicale, 94800 Villejuif, France
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30
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Delotte J, Arias T, Guerin O, Boulahssass R, Bereder I, Bongain A, Benchimol D, Bereder JM. Hyperthermic intraperitoneal chemotherapy for the treatment of recurrent ovarian cancer in elderly women. Acta Obstet Gynecol Scand 2015; 94:435-9. [DOI: 10.1111/aogs.12577] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 12/29/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Jérôme Delotte
- Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine; University Hospital Center of Archet II; University of Nice-Sophia Antipolis; Nice France
| | - Tatiana Arias
- Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine; University Hospital Center of Archet II; University of Nice-Sophia Antipolis; Nice France
| | - Olivier Guerin
- Department of Geriatrics; UCOG Paca-Est; University Hospital Center of Cimiez; University of Nice-Sophia Antipolis; Nice France
| | - Rabia Boulahssass
- Department of Geriatrics; UCOG Paca-Est; University Hospital Center of Cimiez; University of Nice-Sophia Antipolis; Nice France
| | - Isabelle Bereder
- Department of Geriatrics; UCOG Paca-Est; University Hospital Center of Cimiez; University of Nice-Sophia Antipolis; Nice France
| | - André Bongain
- Department of Obstetrics and Gynecology, Reproduction and Fetal Medicine; University Hospital Center of Archet II; University of Nice-Sophia Antipolis; Nice France
| | - Daniel Benchimol
- Department of General Surgery and Digestive Oncology; University Hospital Center of Archet II; University of Nice-Sophia Antipolis; Nice France
| | - Jean Marc Bereder
- Department of General Surgery and Digestive Oncology; University Hospital Center of Archet II; University of Nice-Sophia Antipolis; Nice France
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Pharmacokinetics of concomitant cisplatin and paclitaxel administered by hyperthermic intraperitoneal chemotherapy to patients with peritoneal carcinomatosis from epithelial ovarian cancer. Br J Cancer 2014; 112:306-12. [PMID: 25461804 PMCID: PMC4453456 DOI: 10.1038/bjc.2014.602] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/24/2014] [Accepted: 11/01/2014] [Indexed: 12/20/2022] Open
Abstract
Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) is advised as a treatment option for epithelial ovarian cancer (EOC) with peritoneal carcinomatosis. This study was designed to define the pharmacokinetics of cisplatin (CDDP) and paclitaxel (PTX) administered together during HIPEC. Methods: Thirteen women with EOC underwent cytoreductive surgery (CRS) and HIPEC, with CDDP and PTX. Blood, peritoneal perfusate and tissue samples were harvested to determine drug exposure by high-performance liquid chromatography and matrix-assisted laser desorption ionization imaging mass spectrometry (IMS). Results: The mean maximum concentrations of CDDP and PTX in perfusate were, respectively, 24.8±10.4 μg ml−1 and 69.8±14.3 μg ml−1; in plasma were 1.87±0.4 μg ml−1 and 0.055±0.009 μg ml−1. The mean concentrations of CDDP and PTX in peritoneum at the end of HIPEC were 23.3±8.0 μg g−1 and 30.1±18.3 μg−1g−1, respectively. The penetration of PTX into the peritoneal wall, determined by IMS, was about 0.5 mm. Grade 3–4 surgical complications were recorded in four patients, five patients presented grade 3 and two patients presented grade 4 hematological complications. Conclusions: HIPEC with CDDP and PTX after CRS is feasible with acceptable morbidity and has a favorable pharmacokinetic profile: high drug concentrations are achieved in peritoneal tissue with low systemic exposure. Larger studies are needed to demonstrate its efficacy in patients with microscopic postsurgical residual tumours in the peritoneal cavity.
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Pelissier A, Bonneau C, Chéreau E, de La Motte Rouge T, Fourchotte V, Daraï E, Rouzier R. CA125 kinetic parameters predict optimal cytoreduction in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy. Gynecol Oncol 2014; 135:542-6. [PMID: 25223808 DOI: 10.1016/j.ygyno.2014.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/30/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the different kinetic parameters of serum CA125 during neoadjuvant chemotherapy (NAC) to predict optimal interval debulking surgery (IDS). METHODS The present retrospective multicenter study included patients with advanced ovarian cancer treated with neoadjuvant platinum-based chemotherapy followed by IDS between 2002 and 2009. Demographic data, CA125 levels, radiographic data, chemotherapy and surgical-pathologic information were obtained. Univariate and multivariate analyses were performed to evaluate variables associated with complete IDS. ROC analysis was used to determine potential cut-off values to predict the likelihood of complete cytoreduction via IDS. RESULTS One hundred and forty-eight patients met the study criteria. Ninety-three patients (62.8%) had optimal cytoreduction with no residual macroscopic disease (CC-0) after IDS. In multivariate analyses, the CA125 level after the 3rd NAC was an independent predictor for optimal cytoreduction (odds ratio: 0.98 [0.97-0.99], p=0.04). The area under the ROC curve was 0.73. A threshold of 75 UI/ml displayed the most predictive power. The odds ratio to predict complete cytoreduction was 3.29 [1.56-7.10] (p=0.0008). CONCLUSION Our data indicate that for advanced ovarian cancer, a CA125 level less than 75 UI/ml after the 3rd NAC was an independent predictor factor for complete IDS.
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Affiliation(s)
- Aurélie Pelissier
- Department of breast and gynecological surgery, Institut Curie, 26 rue d'Ulm, 75248 Paris cedex, France; Department of gynecology-obstetrics, University Reims Hospital, 45 rue Cognacq Jay, 51092 Reims cedex, France
| | - Claire Bonneau
- Department of breast and gynecological surgery, Institut Curie, 26 rue d'Ulm, 75248 Paris cedex, France; Department of gynecological surgery, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Elisabeth Chéreau
- Department of surgical oncology, Institut Paoli-Calmettes, 232 bd Sainte Marguerite, 13009 Marseille, France
| | | | - Virginie Fourchotte
- Department of breast and gynecological surgery, Institut Curie, 26 rue d'Ulm, 75248 Paris cedex, France
| | - Emile Daraï
- Department of gynecological surgery, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
| | - Roman Rouzier
- Department of breast and gynecological surgery, Institut Curie, 26 rue d'Ulm, 75248 Paris cedex, France; Versailles-St-Quentin-en-Yvelines University, EA 7285: Risques cliniques et sécurité en santé des femmes et en santé périnatale, France
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Ba M, Long H, Zhang X, Tang Y, Wu Y, Yu F, Wang S, Cui S. Different sequential approaches of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in treating ovarian cancer with malignant ascites. J Cancer Res Clin Oncol 2014; 140:1497-506. [PMID: 24849730 DOI: 10.1007/s00432-014-1692-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/19/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Treatment for malignant ascites in advanced ovarian cancer (OC) patients remains controversial. The objective of this study was to investigate the efficacy of combined continuous circulatory hyperthermic intraperitoneal chemotherapy (HIPEC) preceded or followed by cytoreductive surgery (CRS) for malignant ascites in OC patients. METHODS Female OC patients (n = 32) with malignant ascites were divided based on stable (n = 17) or unstable (n = 15) vital signs. Stable patients were treated with CRS immediately followed by HIPEC (CRS + HIPEC). Unstable patients were treated using B-mode ultrasound-guided HIPEC followed by delayed CRS upon vital sign stability (HIPEC + dCRS). All patients were followed up until death or until December 2012. RESULTS Median follow-up was 29 months. All patients showed ascite regression [objective remission rates (ORR) = 100 %]. Among stable patients, CRS + HIPEC was successful in 14/17 (83.4 %). Among unstable patients, HIPEC + dCRS was successful in 13/15 (86.7 %). Median survival times were 19 and 17 months in the stable and unstable groups, respectively. No significant differences in CRS rates, ascites ORR, Karnofsky performance status scores, or survival rates were observed between groups (P > 0.05). CONCLUSION Cytoreductive surgery with immediate HIPEC and HIPEC with dCRS, determined by vital sign stability, may lead to similar outcomes in OC patients with malignant ascites.
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Affiliation(s)
- Mingchen Ba
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital of Guangzhou Medical College, Guangzhou, 510095, China,
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Delotte J, Desantis M, Frigenza M, Quaranta D, Bongain A, Benchimol D, Bereder JM. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of endometrial cancer with peritoneal carcinomatosis. Eur J Obstet Gynecol Reprod Biol 2013; 172:111-4. [PMID: 24300558 DOI: 10.1016/j.ejogrb.2013.10.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 10/06/2013] [Accepted: 10/26/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the benefit of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of endometrial peritoneal carcinomatosis. STUDY DESIGN Preoperative, intraoperative and postoperative data were collected prospectively for 13 patients treated in our University hospital. RESULTS Of the thirteen patients treated, one patient was lost to follow up. Three patients died within the first twelve months of treatment, and two patients died at respectively 12.4 and 19.4 months after the HIPEC procedure. Seven patients are alive, four of them without recurrence, between 1.5 and 124.8 months after surgery. The Peritoneal Cancer Index (PCI) and the Completeness of Cytoreduction-Score (CC-S) are prognostic factors for survival after HIPEC treatment for peritoneal carcinomatosis of endometrial origin. CONCLUSIONS The significant survival time in selected patients should lead to a study of the management of peritoneal carcinomatosis of endometrial origin in a larger number of cases, and justifies a clinical trial on a larger scale.
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Affiliation(s)
- Jérôme Delotte
- Service de gynécologie-obstétrique, reproduction et de médecine foetale, Centre hospitalier universitaire de l'Archet II, Université de Nice-Sophia Antipolis, 151, route St Antoine de Ginestière, 06200 Nice, France
| | - Mariangela Desantis
- Service de chirurgie générale et cancérologie digestive, Centre hospitalier universitaire de l'Archet II, Université de Nice-Sophia Antipolis, 151, route St Antoine de Ginestière, 06200 Nice, France
| | - Mélanie Frigenza
- Service de gynécologie-obstétrique, reproduction et de médecine foetale, Centre hospitalier universitaire de l'Archet II, Université de Nice-Sophia Antipolis, 151, route St Antoine de Ginestière, 06200 Nice, France
| | - Delphine Quaranta
- Service de gynécologie-obstétrique, reproduction et de médecine foetale, Centre hospitalier universitaire de l'Archet II, Université de Nice-Sophia Antipolis, 151, route St Antoine de Ginestière, 06200 Nice, France
| | - André Bongain
- Service de gynécologie-obstétrique, reproduction et de médecine foetale, Centre hospitalier universitaire de l'Archet II, Université de Nice-Sophia Antipolis, 151, route St Antoine de Ginestière, 06200 Nice, France
| | - Daniel Benchimol
- Service de chirurgie générale et cancérologie digestive, Centre hospitalier universitaire de l'Archet II, Université de Nice-Sophia Antipolis, 151, route St Antoine de Ginestière, 06200 Nice, France
| | - Jean Marc Bereder
- Service de chirurgie générale et cancérologie digestive, Centre hospitalier universitaire de l'Archet II, Université de Nice-Sophia Antipolis, 151, route St Antoine de Ginestière, 06200 Nice, France.
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Gonzalez Bayon L, Steiner M, Vasquez Jimenez W, Asencio J, Alvarez de Sierra P, Atahualpa Arenas F, Rodriguez del Campo J, Garcia Sabrido J. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of advanced epithelial ovarian carcinoma: Upfront therapy, at first recurrence, or later? Eur J Surg Oncol 2013; 39:1109-15. [DOI: 10.1016/j.ejso.2013.06.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/13/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022] Open
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Querleu D, Ray-Coquard I, Classe JM, Aucouturier JS, Bonnet F, Bonnier P, Darai E, Devouassoux M, Gladieff L, Glehen O, Haie-Meder C, Joly F, Lécuru F, Lefranc JP, Lhommé C, Morice P, Salengro A, Stoeckle E, Taieb S, Zeng ZX, Leblanc E. Quality indicators in ovarian cancer surgery: report from the French Society of Gynecologic Oncology (Societe Francaise d'Oncologie Gynecologique, SFOG). Ann Oncol 2013; 24:2732-9. [PMID: 23857961 DOI: 10.1093/annonc/mdt237] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Based on registries, the European experience has been that <50% of patients are treated according to protocols and/or benefit from the minimum required surgery for ovarian cancer. The French Cancer Plan 2009-2013 considers the definition of qualitative indicators in ovarian cancer surgery in France. This endeavour was undertaken by the French Society of Gynaecologic Oncology (SFOG) in partnership with the French National College of Obstetricians and Gynecologists and all concerned learned societies in a multidisciplinary mindset. METHODS The quality indicators for the initial management of patients with ovarian cancer were based on the standards of practice determined from scientific evidence or expert consensus. RESULTS The indicators were divided into structural indicators, including material (equipment), human (number and qualification of staff), and organizational resources, process indicators, and outcome indicators. CONCLUSIONS The enforcement of a quality assurance programme in any country would undoubtedly promote improvement in the quality of care for ovarian cancer patients and would result in a dramatic positive impact on their survival. Such a policy is not only beneficial to the patient, but is also profitable for the healthcare system.
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Affiliation(s)
- D Querleu
- Department of Surgery, Institut Claudius Regaud, Toulouse, France
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Weber T, Roitman M, Link KH. [Peritoneal carcinomatosis of colorectal origin: results of cytoreductive surgery with peritonectomy and hyperthermic intraoperative chemotherapy]. Chirurg 2012; 84:130, 132-9. [PMID: 23247560 DOI: 10.1007/s00104-012-2419-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Until recently peritoneal carcinomatosis (PC) arising from colorectal cancer (CRC) was considered to be a terminal disease manifestation. Despite palliative systemic chemotherapy (CHT) the majority of patients died within a few months. Nowadays cytoreductive surgery (CRS) of the peritoneal cavity in combination with hyperthermic intraperitoneal CHT and perioperative systemic CHT may offer a chance for long-term survival in selected groups of patients. In this study we report the results obtained with this treatment strategy in 30 consecutive patients. Data were assessed prospectively. After a median follow-up of 16.9 months the median survival time in all 30 patients reached 24.3 months. Favorable prognostic factors are a low extent of intraperitoneal metastases as characterized by a low peritoneal cancer index (median survival PCI ≤ 10: 33.2 months vs. PCI 11-19: 12.1 months) and a complete or nearly complete CRS (median survival CCR 0/1: 33.1 months vs. CCR2/3: 12.1 months). The 2-year overall survival was 89% for patients with a PCI ≤ 10 and 65% for those with surgical CCR 0/1 cytoreduction. As not every patient with CRC and PC may profit from this relatively aggressive therapy an interdisciplinary patient selection (tumor board) and treatment in experienced surgical oncology centers is recommended.
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Affiliation(s)
- T Weber
- Chirurgisches Zentrum und Asklepios Tumorzentrum, Asklepios Paulinenklinik, Geisenheimer Str. 10, 65197, Wiesbaden, Deutschland.
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Bakrin N, Cotte E, Golfier F, Gilly FN, Freyer G, Helm W, Glehen O, Bereder JM. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for persistent and recurrent advanced ovarian carcinoma: a multicenter, prospective study of 246 patients. Ann Surg Oncol 2012; 19:4052-8. [PMID: 22825772 DOI: 10.1245/s10434-012-2510-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Epithelial ovarian carcinoma is the main cause of death from gynaecological cancers in the western world. The initial response rate to the frontline therapy is high. However, the prognosis of persistent and recurrent disease remains poor. During the two past decades, a new therapeutic approach to peritoneal carcinomatosis has been developed, combining maximal cytoreductive effort with hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS A retrospective, multicentric study of 246 patients with recurrent or persistent ovarian cancer, treated by cytoreductive surgery and HIPEC in two French centers between 1991 and 2008, was performed. RESULTS An optimal cytoreductive surgery was possible in 92.2 % of patients. Mortality and morbidity rates were 0.37 % and 11.6 %, respectively. The overall median survival was 48.9 months. There was no significant difference in overall survival in patients with persistent or recurrent disease. In multivariate analysis, performance status was a significant prognostic factor in patients with extensive peritoneal carcinomatosis (peritoneal cancer index >10). CONCLUSIONS Salvage therapy combining optimal cytoreductive surgery and HIPEC is feasible and may achieve long-term survival in highly selected patients with recurrent ovarian carcinoma, including those with platinum resistant disease, with acceptable morbidity.
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Affiliation(s)
- N Bakrin
- Department of Oncologic Surgery, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
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Sommariva A, Zagonel V, Rossi CR. The role of laparoscopy in peritoneal surface malignancies selected for hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol 2012; 19:3737-44. [PMID: 22805859 DOI: 10.1245/s10434-012-2465-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cytoreductive surgery (CS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) was developed as locoregional treatment for primary or secondary peritoneal tumors. The role of laparoscopy over several stages of diagnosis and the treatment of the patients affected by peritoneal carcinomatosis and selected for CS + HIPEC shows some peculiarities, and their potential application in this field is not fully known. Our aim was to review and summarize the applications, the results, and the future directions of laparoscopy in the management of the patients affected by carcinomatosis and scheduled for CS + HIPEC. METHODS Appropriate keywords were adopted to identify the relevant studies on this topic in PubMed/Medline electronic databases. RESULTS The role of laparoscopy in diagnosis and staging of patients selected for CS + HIPEC seems to have a great but probably underestimated potential. Laparoscopic CS + HIPEC is technically feasible with an acceptable morbidity profile, especially in patients with low tumor load. In selected patients with malignant ascites, laparoscopic HIPEC achieves a good palliative effect, with a low morbidity profile. CONCLUSIONS Laparoscopy plays a partially explored role in diagnosis and staging of patients selected for CS + HIPEC. The use of laparoscopic HIPEC with an adjuvant, curative, or palliative intent seems feasible, but further studies are required in order to explore and validate all potential indications. For all these reasons, it would be advisable to provide every HIPEC center with specific laparoscopic skills.
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Affiliation(s)
- Antonio Sommariva
- Melanoma and Sarcoma Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
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Sangisetty SL, Miner TJ. Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures. World J Gastrointest Surg 2012; 4:87-95. [PMID: 22590662 PMCID: PMC3351493 DOI: 10.4240/wjgs.v4.i4.87] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 12/31/2011] [Accepted: 01/10/2012] [Indexed: 02/06/2023] Open
Abstract
Malignant ascites indicates the presence of malignant cells in the peritoneal cavity and is a grave prognostic sign. While survival in this patient population is poor, averaging about 20 wk from time of diagnosis, quality of life can be improved through palliative procedures. Selecting the appropriate treatment modality remains a careful process, which should take into account potential risks and benefits and the life expectancy of the patient. Traditional therapies, including paracentesis, peritoneovenous shunt placement and diuretics, are successful and effective in varying degrees. After careful review of the patient’s primary tumor origin, tumor biology, tumor stage, patient performance status and comorbidities, surgical debulking and intraperitoneal chemotherapy should be considered if the benefit of therapy outweighs the risk of operation because survival curves can be extended and palliation of symptomatic malignant ascites can be achieved in select patients. In patients with peritoneal carcinomatosis who do not qualify for surgical cytoreduction but suffer from the effects of malignant ascites, intraperitoneal chemotherapy can be safely and effectively administered via laparoscopic techniques. Short operative times, short hospital stays, low complication rates and ultimately symptomatic relief are the advantages of laparoscopically administering heated intraperitoneal chemotherapy, making it not only a valuable treatment modality but also the most successful treatment modality for achieving palliative cure of malignant ascites.
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Affiliation(s)
- Suma L Sangisetty
- Suma L Sangisetty, Thomas J Miner, Department of Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, United States
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Brücher BLDM, Piso P, Verwaal V, Esquivel J, Derraco M, Yonemura Y, Gonzalez-Moreno S, Pelz J, Königsrainer A, Ströhlein M, Levine EA, Morris D, Bartlett D, Glehen O, Garofalo A, Nissan A. Peritoneal carcinomatosis: cytoreductive surgery and HIPEC--overview and basics. Cancer Invest 2012; 30:209-24. [PMID: 22360361 DOI: 10.3109/07357907.2012.654871] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tumor involvement of the peritoneum-peritoneal carcinomatosis-is a heterogeneous form of cancer that had been generally regarded as a sign of systemic tumor disease and as a terminal condition. The multimodal treatment approach for patients with peritoneal carcinomatosis, which had been conceived and developed, consists of what is known as cytoreductive surgery, followed by hyperthermic intraperitoneal chemotherapy (HIPEC). Depending on the tumor mass as assessed intraoperatively and the histopathological differentiation, patients who undergo cytoreductive surgery and HIPEC have a significant survival benefit. Mean increases in the survival period ranging from six months to up to four years have now been reported. In view of the substantial logistic effort and the extent of the surgery involved, this treatment approach represents a major challenge both for patients and for surgical oncologists, as well as for the members of the overall interdisciplinary structure required, which includes oncology, anesthesiology and intensive care, psycho-oncology, and patient management. The surgical procedures alone may take 8-14 hr. The present paper provides an overview of the basis for the approach and the use of specialized classifications and quantitative prognostic indicators.
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Affiliation(s)
- Björn L D M Brücher
- Surgical Oncology, Department of Surgery, Tübingen Comprehensive Cancer Center, University of Tübingen, Germany.
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Cyto-reductive Surgery combined with Hyperthermic Intra-peritoneal Chemotherapy for Peritoneal Surface Malignancies: current treatment and results. Cancer Treat Rev 2011; 38:258-68. [PMID: 21807464 DOI: 10.1016/j.ctrv.2011.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 07/03/2011] [Accepted: 07/06/2011] [Indexed: 02/06/2023]
Abstract
Cyto-reductive Surgery (CS) combined with Hyperthermic Intra-peritoneal Chemotherapy (HIPEC) as loco-regional treatment of Peritoneal Surface Malignancies (PSM) has increasingly gained acceptance in clinical practice. This review summarizes the more relevant studies on this topic. Indications, pre-operative work-up, technical aspects, outcome and future directions of this combined approach in the treatment of Peritoneal Surface Malignancies are discussed here and proposed in an informative and didactic manner.
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Ortega-Deballon P, Glehen O, Levine E, Piso P, Sugarbaker PH, Hayes-Jordan A, Facy A, Bakrin N, Rat P. Childbearing after hyperthermic intraperitoneal chemotherapy: results from an international survey. Ann Surg Oncol 2011; 18:2297-301. [PMID: 21311981 DOI: 10.1245/s10434-011-1595-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) can improve survival in selected patients with primary or secondary peritoneal malignancies. With the opportunity for long-term survival, questions about the impact of those procedures in fertility in women of childbearing age can be raised. MATERIALS AND METHODS An international survey was performed among all teams participating in the International Peritoneal Surface Malignancy Group in order to collect data about pregnancies and their outcome in women having undergone previous CRS with adjuvant HIPEC. RESULTS There were 7 pregnancies reported after CRS and HIPEC in women treated for peritoneal malignancies. All these women conceived spontaneously, most of them within 2 years after the procedure. They delivered most often by vaginal way after an uneventful pregnancy. Their newborns were healthy, except 1 case of congenital diaphragmatic hernia requiring emergent surgery. There were 2 additional uneventful pregnancies reported after the diagnosis of pseudomyxoma peritonei and before CRS and HIPEC, with the support of the medical team. Another woman having undergone oocytes retrieval and embryo cryopreservation prior to the surgery was mother of twins after the procedure via a surrogate mother. CONCLUSION Childbearing after cytoreductive surgery and heated intraperitoneal chemotherapy is possible in women conserving their genital organs after the procedure. The question of fertility should be considered and discussed in women in reproductive age prior to cytoreductive surgery and heated intraperitoneal chemotherapy. Different options could be offered in this setting. Multidisciplinary decision making involving surgical oncologists and fertility specialists is important.
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[The role of interval surgery in the treatment's strategy of advanced ovarian cancer]. Bull Cancer 2011; 98:37-42. [PMID: 21282089 DOI: 10.1684/bdc.2010.1290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The extent of cytoreductive surgery and the amount of residual disease are among the most important factors impacting the survival of women with advanced ovarian cancer. Chronology of treatment is still debating. In the French standard treatment, primary surgery remains the cornerstone and interval surgery is an option. Neoadjuvant chemotherapy followed by surgery may reduce morbidity and mortality. Nevertheless the impact of this strategy on survival is still controversial.
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Kluger MD, Taub RN, Hesdorffer M, Jin Z, Chabot JA. Two-stage operative cytoreduction and intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma: Operative morbidity and mortality in phase I and II trials. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2010; 36:997-1003. [PMID: 20674253 DOI: 10.1016/j.ejso.2010.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 06/28/2010] [Accepted: 07/01/2010] [Indexed: 01/25/2023]
Abstract
AIMS The standard of care for diffuse malignant peritoneal mesothelioma involves operative cytoreduction and intraperitoneal chemotherapy. Most centers favor aggressive operative cytoreduction, accepting high morbidity and mortality. In our trials, patients underwent less extensive cytoreduction followed by prolonged intraperitoneal chemotherapy. Patients underwent a second cytoreduction with heated intraperitoneal chemotherapy. We hypothesized this would result in lower operative morbidity and mortality with similar survival. METHODS Hospital records, discharge summaries, microbiology, radiography, and office records were retrospectively reviewed to supplement a prospective database. 30-day morbidity and mortality were categorized, and classified according to the Clavien methodology. RESULTS 47 first and 39 second operations were performed with 13% and 26% morbidity, respectively. Mortality was 2%. Infections comprised 59% of the morbidity. Inclusive of both operations, formal peritonectomy was performed in 16% of patients, resection of isolated lesions in less than half, and only 19% had a visceral organs other than the spleen resected. At the completion of the protocol, only 3% of patients had visible intraperitoneal disease. The mean total length of stay for both operations combined was 16 ± 23 days. Overall median survival was 54.9 months, and median survival for the epithelioid subtype was 70.2 months. CONCLUSIONS A two-stage cytoreduction with intraperitoneal chemotherapy offers median survival comparable to one-stage protocols, with relatively low morbidity, mortality, visceral resections and length of stay despite two operations. This series supports that our protocol is a feasible and safe approach.
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Affiliation(s)
- M D Kluger
- Department of Surgery, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, New York 10032, USA
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Hyperthermic intraperitoneal chemotherapy with oxaliplatin and without adjuvant chemotherapy in stage IIIC ovarian cancer. Bull Cancer 2010; 97:E23-32. [PMID: 20202920 DOI: 10.1684/bdc.2010.1063] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the feasibility and efficacy of cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) without adjuvant chemotherapy for relapsed or persistent advanced ovarian cancer. METHODS This observational study included stage IIIC ovarian cancer patients due to undergo CRS (interval debulking or recurrent surgery) followed by HIPEC with oxaliplatin (460 mg/m2) for 30 min. RESULTS Twenty-two patients (12 interval debulking procedures and 10 recurrence procedures) were enrolled between September 2003 and September 2007. HIPEC was not performed in four patients because of operative findings. No patient received adjuvant chemotherapy after HIPEC. Patients were followed up routinely until recurrence or death. Median peritoneal cancer index at surgery was 6 (range: 1-18). Before HIPEC, all patients had completeness of cytoreduction scores of 0 or 1. Median length of hospital stay was 21 days (range 13-65). Ten patients (55.6%) had CTCAE grade 3-4 toxicity, including three patients (16.7%) requiring reoperation. No postoperative mortality was observed. With a median follow-up of 38 months (CI 95% 23.8-39.2), median overall survival was not reached. The 3-year overall survival rate was 83% (CI 95% 54-95). Median disease-free survival was, respectively, 16.9 months (CI 95% 10.2-23.2) and 10 months (CI 95% 4.5-11.3) for patients undergoing interval debulking or recurrence surgery. CONCLUSION HIPEC without adjuvant chemotherapy is both feasible and safe, but with a high rate of grade 3-5 toxicity. Survival results are encouraging but should be confirmed in a randomized trial.
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Nissan A, Stojadinovic A, Garofalo A, Esquivel J, Piso P. Evidence-based medicine in the treatment of peritoneal carcinomatosis: Past, present, and future. J Surg Oncol 2009; 100:335-44. [PMID: 19697442 DOI: 10.1002/jso.21323] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The current treatment of peritoneal surface malignancies (PSMs) is moving from a nihilistic approach, into a combined modality approach offering selected patients long-term survival. As primary PSM are rare, extrapolation of data from clinical trials of related disease is necessary to develop treatment guidelines. Secondary PSM are more common, and therefore, treatment guidelines should be developed based on prospective clinical trials. We reviewed the published and ongoing clinical trials studying the treatment of PSM.
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Affiliation(s)
- Aviram Nissan
- Department of Surgery, Hadassah-Hebrew University Medical Center Mount Scopus, Jerusalem, Israel.
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González-Moreno S, Ortega-Pérez G, González-Bayón L. Indications and patient selection for cytoreductive surgery and perioperative intraperitoneal chemotherapy. J Surg Oncol 2009; 100:287-92. [DOI: 10.1002/jso.21325] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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