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Padilla-Valverde D, Bodoque-Villar R, García-Santos E, Sanchez S, Manzanares-Campillo C, Rodriguez M, González L, Ambrós A, Cano JM, Padilla-Marcote M, Redondo-Calvo J, Martin J, Serrano-Oviedo L. Safety and Effectiveness of Perioperative Hyperthermic Intraperitoneal Chemotherapy with Gemcitabine in Patients with Resected Pancreatic Ductal Adenocarcinoma: Clinical Trial EudraCT 2016-004298-41. Cancers (Basel) 2024; 16:1718. [PMID: 38730669 PMCID: PMC11083892 DOI: 10.3390/cancers16091718] [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: 03/10/2024] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Despite the improvement in therapies, pancreatic cancer represents one of the most cancer-related deaths. In our hypothesis, we propose that Hyperthermic Intraperitoneal Chemotherapy with gemcitabine after pancreatic cytoreductive surgery could reduce tumor progression by reducing residual neoplastic volume and residual pancreatic cancer stem cells. MATERIALS AND METHODS A randomized trial involving 42 patients. All patients were diagnosed with pancreatic ductal adenocarcinoma. Group I: R0 resection. Group II. R0 resection and HIPEC with gemcitabine (120 mg/m2 for 30 min). Effectiveness was measured with analysis of overall survival, disease-free survival, distant recurrence, locoregional recurrence, and measuring of pancreatic cancer stem cells (EpCAM+CXCR4+CD133+). RESULTS From 2017 to 2023, 63 patients were recruited for our clinical trial; 21 patients were included in each group, and 21 were excluded. Locoregional recurrence, p-value: 0.022, was lower in the experimental group. There were no significant differences between the two groups in hospital mortality, perioperative complications, or hospital costs. We found a significant decrease in pancreatic cancer stem cells in patients in the experimental group after treatment, p -value of 0.018. CONCLUSIONS The use of HIPEC with gemcitabine after surgery in patients with resectable pancreatic ductal adenocarcinoma reduces locoregional recurrence and may be associated with a significant decrease in pancreatic cancer stem cells.
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Affiliation(s)
- David Padilla-Valverde
- Head of the Hepatobiliary Surgery Unit and Carcinomatosis Programme, Department of Surgery, General University Hospital, Faculty of Medicine, UCLM, C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain; (E.G.-S.); (S.S.); (C.M.-C.); (M.P.-M.); (J.M.)
| | - Raquel Bodoque-Villar
- Traslational Investigation Unit, University General Hospital of Ciudad Real, SESCAM, Research Institute of Castilla-La Mancha (IDISCAM), C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain; (R.B.-V.); (J.R.-C.)
| | - Esther García-Santos
- Head of the Hepatobiliary Surgery Unit and Carcinomatosis Programme, Department of Surgery, General University Hospital, Faculty of Medicine, UCLM, C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain; (E.G.-S.); (S.S.); (C.M.-C.); (M.P.-M.); (J.M.)
| | - Susana Sanchez
- Head of the Hepatobiliary Surgery Unit and Carcinomatosis Programme, Department of Surgery, General University Hospital, Faculty of Medicine, UCLM, C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain; (E.G.-S.); (S.S.); (C.M.-C.); (M.P.-M.); (J.M.)
| | - Carmen Manzanares-Campillo
- Head of the Hepatobiliary Surgery Unit and Carcinomatosis Programme, Department of Surgery, General University Hospital, Faculty of Medicine, UCLM, C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain; (E.G.-S.); (S.S.); (C.M.-C.); (M.P.-M.); (J.M.)
| | - Marta Rodriguez
- Department of Pharmacy, General University Hospital, Ciudad Real, Faculty of Medicine, UCLM, C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain;
| | - Lucia González
- Department of Pathology, General University Hospital, Ciudad Real, Faculty of Medicine, UCLM C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain;
| | - Alfonso Ambrós
- Intensive Care Unit, General University Hospital, Ciudad Real, Faculty of Medicine, UCLM, C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain;
| | - Juana M. Cano
- Oncology Department, University General Hospital, Ciudad Real, Faculty of Medicine, UCLM, C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain;
| | - Maria Padilla-Marcote
- Head of the Hepatobiliary Surgery Unit and Carcinomatosis Programme, Department of Surgery, General University Hospital, Faculty of Medicine, UCLM, C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain; (E.G.-S.); (S.S.); (C.M.-C.); (M.P.-M.); (J.M.)
| | - Javier Redondo-Calvo
- Traslational Investigation Unit, University General Hospital of Ciudad Real, SESCAM, Research Institute of Castilla-La Mancha (IDISCAM), C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain; (R.B.-V.); (J.R.-C.)
| | - Jesus Martin
- Head of the Hepatobiliary Surgery Unit and Carcinomatosis Programme, Department of Surgery, General University Hospital, Faculty of Medicine, UCLM, C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain; (E.G.-S.); (S.S.); (C.M.-C.); (M.P.-M.); (J.M.)
| | - Leticia Serrano-Oviedo
- Traslational Investigation Unit, University General Hospital of Ciudad Real, SESCAM, Research Institute of Castilla-La Mancha (IDISCAM), C/Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain; (R.B.-V.); (J.R.-C.)
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Guo J, Deng Z, Jin L, Yin S, Xiong Z, Wang C, Chen H, Luo D, Huang D, Peng J, Chen S, Lian L. Prognostic value of hyperthermic intraperitoneal chemotherapy in gastric cancer with synchronous peritoneal metastases: a real-world retrospective study. J Cancer Res Clin Oncol 2023; 149:17881-17896. [PMID: 37947869 DOI: 10.1007/s00432-023-05481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Peritoneal metastasis in gastric cancer (GC) is a late-stage condition with a poor prognosis. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a popular treatment for peritoneal metastases. Here, we aim to investigate the real-world application and efficacy of HIPEC alone for GC patients with synchronous peritoneal metastases. METHODS We conducted a retrospective analysis on GC patients with synchronous peritoneal metastasis at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2011 and December 2022. Survival analyses and Cox regression models were performed based on overall survival (OS) and cancer-specific survival (CSS), and subgroup analysis was used to determine the prognostic value of HIPEC across different treatment. RESULTS We enrolled 250 patients, of whom 120 (48%) received HIPEC while 130 (52%) did not. HIPEC showed no survival benefit for GC patients (P = 0.220 for OS and P = 0.370 for CSS). However, subgroup analysis found that HIPEC can only improve OS and CSS when combined with primary tumor resection (P = 0.034 for OS and P = 0.036 for CSS). Moreover, survival analyses also demonstrated that HIPEC independently improved OS (HR for OS = 0.58, 95% CI 0.37-0.92, P = 0.020) and CSS (HR for CSS = 0.58, 95% CI 0.37-0.93, P = 0.024) for patients who underwent primary site resection, but not for those who did not. CONCLUSION HIPEC can improve survival in GC patients with synchronous peritoneal metastases who have primary tumor resection, but not in those without primary tumor resection.
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Affiliation(s)
- Jianping Guo
- Department of Gastrointestinal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, Guangdong, China
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zijian Deng
- Department of Gastrointestinal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, Guangdong, China
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Longyang Jin
- Department of Gastrointestinal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, Guangdong, China
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shi Yin
- Department of Gastrointestinal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, Guangdong, China
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhizhong Xiong
- Department of Gastrointestinal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, Guangdong, China
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Caiqin Wang
- Department of Gastrointestinal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, Guangdong, China
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huaxian Chen
- Department of Gastrointestinal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, Guangdong, China
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dandong Luo
- Department of Gastrointestinal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, Guangdong, China
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dayin Huang
- Department of Gastrointestinal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, Guangdong, China
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junsheng Peng
- Department of Gastrointestinal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, Guangdong, China.
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Shi Chen
- Department of Gastrointestinal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, Guangdong, China.
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Lei Lian
- Department of Gastrointestinal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd., Guangzhou, Guangdong, China.
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Cytoreductive surgery and intraperitoneal chemotherapy for peritoneal metastasis of colorectal cancer: long-term follow-up results at a single institution in Korea. Int J Colorectal Dis 2023; 38:44. [PMID: 36795220 DOI: 10.1007/s00384-023-04340-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE This study aimed to examine the 7-year follow-up results of cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for peritoneal metastasis (PM) of colorectal cancer. METHODS We performed 54 cases of CRS and IPC in 53 patients with PM of colorectal cancer from December 2011 to December 2013. We prospectively collected data and analyzed peritoneal carcinomatosis grade, completeness of cytoreduction, and long-term follow-up (median, 10 [range, 2-92] months) results. RESULTS The mean peritoneal cancer index was 15 (1 ~ 35), and complete cytoreduction was possible in 35 (64.8%) patients. Excluding the four patients who died, 11 (22.4%) out of the 49 patients were alive at the time of the last follow-up, and the overall median survival period was 10.3 months. The overall 2- and 5-year survival rates were 31% and 17%, respectively. Patients with complete cytoreduction had a median survival period of 22.6 months, which was significantly longer than that for patients without complete cytoreduction (3.5 months) (P < 0.001). The 5-year survival rate for patients with complete cytoreduction was 24%, and four patients were still alive without disease. CONCLUSIONS CRS and IPC show a 5-year survival rate of 17% in patients with PM of colorectal cancer. A possibility of long-term survival is observed in a selected group. Multidisciplinary team evaluation for careful patient selection and CRS training program to achieve complete cytoreduction are significantly important factors in improving survival rate.
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Kose S. Role of Computed Tomography in the Evaluation of Peritoneal Carcinomatosis. J Belg Soc Radiol 2023; 107:27. [PMID: 37064170 PMCID: PMC10103720 DOI: 10.5334/jbsr.2921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/23/2023] [Indexed: 04/18/2023] Open
Abstract
Peritoneal carcinomatosis (PC) refers to metastatic spread of tumor into the peritoneal cavity. Earlier, PC was thought to be associated with grave clinical outcome. However, various advances in treatment options including cytoreductive surgery and heated intraperitoneal chemotherapy or early post-operative chemotherapy can prolong survival of patients with peritoneal carcinomatosis. These treatment options are associated with high morbidity and mortality. The purpose of this article is to acquaint the radiologist about various appearances of peritoneal carcinomatosis in order to help clinicians in selecting candidates for surgery and avoid unnecessary potentially debilitating surgeries in patients with unresectable PC.
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Affiliation(s)
- Snehal Kose
- All India Institute of Medical Sciences, New Delhi, IN
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Cytoreductive Surgery (CRS) and HIPEC for Advanced Ovarian Cancer with Peritoneal Metastases: Italian PSM Oncoteam Evidence and Study Purposes. Cancers (Basel) 2022; 14:cancers14236010. [PMID: 36497490 PMCID: PMC9740463 DOI: 10.3390/cancers14236010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Ovarian cancer is the eighth most common neoplasm in women with a high mortality rate mainly due to a marked propensity for peritoneal spread directly at diagnosis, as well as tumor recurrence after radical surgical treatment. Treatments for peritoneal metastases have to be designed from a patient's perspective and focus on meaningful measures of benefit. Hyperthermic intraperitoneal chemotherapy (HIPEC), a strategy combining maximal cytoreductive surgery with regional chemotherapy, has been proposed to treat advanced ovarian cancer. Preliminary results to date have shown promising results, with improved survival outcomes and tumor regression. As knowledge about the disease process increases, practice guidelines will continue to evolve. In this review, we have reported a broad overview of advanced ovarian cancer management, and an update of the current evidence. The future perspectives of the Italian Society of Surgical Oncology (SICO) are discussed conclusively.
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Hyperthermic Intraperitoneal Chemotherapy and Recirculation with CO2: A Safe Technique. J Clin Med 2022; 11:jcm11206152. [PMID: 36294474 PMCID: PMC9605477 DOI: 10.3390/jcm11206152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) has evolved as a treatment for peritoneal carcinomatosis in various tumors after a careful and complete cytoreductive surgery, and it demonstrated much better and longer survival than more traditional therapeutic schemas. Our objective has been to examine the safety, efficacy and survival achieved with closed technique with CO2-agitation system Combat PRS® (Peritoneal Recirculation System: PRS). To achieve this, we compared the appearance of adverse events, mortality and survival with the described using classic techniques (open, closed without CO2-agitation) for the treatment of selected patients with peritoneal carcinomatosis; Materials and methods: We studied overall survival, disease-free survival and safety (morbidity and mortality) of the administration of HIPEC through a closed method technique with CO2 recirculation (Combat PRS®) in 482 patients from 11 Spanish hospitals; Results: The mortality of our technique (1.66%) was similar to other published techniques (open, closed). Morbidity exhibited a 9.96% rate of Clavien-Dindo (CD) III/IV complications in 482 patients, which was lower than in other series. Survival (overall survival (OS) and disease-free survival (DFS)) was similar to previously published results: 86% 1y-OS, 54% 3y-OS, 77% 1y-DFS and 31% 3y-DFS; Conclusion: The procedure with closed PRS with CO2 agitation is as safe as standard open and closed procedures for the administration of HIPEC after complete cytoreductive surgery, with similar and very low mortality (1.66%) and lower morbidity (9.96% CD III and IV in our series vs range of 20–40% in the majority of different series); only Kusamura had similar results, with 12% in 205 patients, using the closed technique without CO2 agitation).
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Wong KM, Haidous M, AlShanableh Z, Palaparty P, Ravakhah K. Metastatic Mucinous Adenocarcinoma of Gastrointestinal Origin: A Rare Presentation of Peritoneal Carcinomatosis in a Woman. Cureus 2022; 14:e22517. [PMID: 35371749 PMCID: PMC8950696 DOI: 10.7759/cureus.22517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Abstract
Peritoneal carcinomatosis is most commonly a rare late-stage manifestation of disseminated ovarian cancer. Women with peritoneal carcinomatosis with no obvious primary tumor are presumptively treated for ovarian cancer. However, less frequently, gastrointestinal cancer disseminates to the peritoneum, which would confer other treatment options. Herein, we present a case of a 68-year-old woman who was managed for peritoneal carcinomatosis of metastatic mucinous adenocarcinoma of lower gastrointestinal origin.
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Prophylactic hyperthermic intraperitoneal chemotherapy may benefit the long-term survival of patients after radical gastric cancer surgery. Sci Rep 2022; 12:2583. [PMID: 35173230 PMCID: PMC8850581 DOI: 10.1038/s41598-022-06417-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/27/2022] [Indexed: 12/24/2022] Open
Abstract
Hyperthermic intraperitoneal chemotherapy (HIPEC) has been proven to improve the survival rate of gastric cancer and reduce peritoneal recurrence. We aimed to evaluate the effectiveness and safety of prophylactic HIPEC after radical gastric cancer surgery in this study. Researchers searched for studies published in PubMed, Embase, Web of science, Scopus, Cochrane, Clinical key databases and Microsoft Academic databases to identify studies that examine the impact of prophylactic HIPEC on the survival, recurrence and adverse events of patients undergoing radical gastric cancer surgery. RevMan 5.3 was used to analyze the results and risk of bias. The PROSERO registration number is CRD42021262016. This meta-analysis included 22 studies with a total of 2097 patients, 12 of which are RCTs. The results showed that the 1-, 3- and 5-year overall survival rate was significantly favorable to HIPEC (OR 5.10, 2.07, 1.96 respectively). Compared with the control group, the overall recurrence rate and peritoneal recurrence rate of the HIPEC group were significantly lower (OR 0.41, 0.24 respectively). Significantly favorable to the control group in terms of renal dysfunction and pulmonary dysfunction complications (OR 2.44, 6.03 respectively). Regarding the causes of death due to postoperative recurrence: liver recurrence, lymph node and local recurrence and peritoneal recurrence, the overall effect is not significantly different (OR 0.81, 1.19, 0.37 respectively). 1-, 3- and 5-year overall survival follow-up may be incremented by the prophylactic HIPEC, and which reduce the overall recurrence rate and peritoneal recurrence rate. HIPEC may have high-risk of pulmonary dysfunction and renal dysfunction complications. No difference has been found in the deaths due to recurrence after surgery.
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Chevallay M, Wassmer CH, Iranmanesh P, Jung MK, Mönig SP. Multimodal treatment in oligometastatic gastric cancer. World J Gastrointest Oncol 2022; 14:434-449. [PMID: 35317315 PMCID: PMC8919006 DOI: 10.4251/wjgo.v14.i2.434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/02/2021] [Accepted: 12/28/2021] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is generally diagnosed at an advanced stage, especially in countries without screening programs. Previously, the metastatic stage was synonymous with palliative management, and surgical indications were only for symptomatic relief. However, this therapeutic option is associated with poor prognosis. A subgroup of patients with limited metastatic disease could benefit from intensive treatment. A combination of chemotherapy, immunotherapy, and targeted therapy could help either maintain a resectable state for oligometastatic disease or diminish the metastasis size to obtain a complete resection configuration. This latter strategy is known as conversion therapy and has growing evidence with favorable outcomes. Oncosurgical approach of metastatic disease could prolong survival in selected patients. The challenge for the surgeon and oncologist is to identify these specific patients to offer the best multimodal management. We review in this article the actual evidence for the treatment of oligometastatic gastric cancer with curative intent.
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Affiliation(s)
- Mickael Chevallay
- Division of Digestive Surgery, Geneva University Hospital and Faculty of Medicine, Geneva 1205, Genève, Switzerland
| | - Charles-Henri Wassmer
- Division of Digestive Surgery, Geneva University Hospital and Faculty of Medicine, Geneva 1205, Genève, Switzerland
| | - Pouya Iranmanesh
- Division of Digestive Surgery, Geneva University Hospital and Faculty of Medicine, Geneva 1205, Genève, Switzerland
| | - Minoa K Jung
- Division of Digestive Surgery, Geneva University Hospital and Faculty of Medicine, Geneva 1205, Genève, Switzerland
| | - Stefan P Mönig
- Division of Digestive Surgery, Geneva University Hospital and Faculty of Medicine, Geneva 1205, Genève, Switzerland
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Rhode P, Mehdorn M, Lyros O, Kahlert C, Kurth T, Venus T, Schierle K, Estrela-Lopis I, Jansen-Winkeln B, Lordick F, Gockel I, Thieme R. Characterization of Total RNA, CD44, FASN, and PTEN mRNAs from Extracellular Vesicles as Biomarkers in Gastric Cancer Patients. Cancers (Basel) 2021; 13:cancers13235975. [PMID: 34885085 PMCID: PMC8656496 DOI: 10.3390/cancers13235975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Liquid biopsy is an easily accessible and non-invasive method to gain information about tumor diseases. The purpose of our study was to determine the value of extracellular vesicle-derived mRNAs as biomarkers for the diagnosis of gastric cancer and the response to its treatment. In a cohort of 87 gastric cancer patients and a control group of 14 individuals, we analyzed the absolute RNA concentration from extracellular vesicles (EV) and the relative levels of FASN, PTEN, and CD44 mRNA, and their correlation with clinico-pathological features. These correlated with treatment, tumor grading, and the pathological subtype according to Laurén’s classification. This might reflect their potential as both diagnostic and therapeutic predictors. Abstract In-depth characterization has introduced new molecular subtypes of gastric cancer (GC). To identify these, new approaches and techniques are required. Liquid biopsies are trendsetting and provide an easy and feasible method to identify and to monitor GC patients. In a prospective cohort of 87 GC patients, extracellular vesicles (EVs) were isolated from 250 µL of plasma. The total RNA was isolated with TRIZOL. The total RNA amount and the relative mRNA levels of CD44, PTEN, and FASN were measured by qRT-PCR. The isolation of EVs and their contained mRNA was possible in all 87 samples investigated. The relative mRNA levels of PTEN were higher in patients already treated by chemotherapy than in chemo-naïve patients. In patients who had undergone neoadjuvant chemotherapy followed by gastrectomy, a decrease in the total RNA amount was observed after neoadjuvant chemotherapy and gastrectomy, while FASN and CD44 mRNA levels decreased only after gastrectomy. The amount of RNA and the relative mRNA levels of FASN and CD44 in EVs were affected more significantly by chemotherapy and gastrectomy than by chemotherapy alone. Therefore, they are a potential biomarker for monitoring treatment response. Future analyses are needed to identify GC-specific key RNAs in EVs, which could be used for the diagnosis of gastric cancer patients in order to determine their molecular subtype and to accompany the therapeutic response.
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Affiliation(s)
- Philipp Rhode
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, D-04103 Leipzig, Germany; (P.R.); (M.M.); (O.L.); (B.J.-W.); (I.G.)
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, D-04103 Leipzig, Germany; (P.R.); (M.M.); (O.L.); (B.J.-W.); (I.G.)
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, D-04103 Leipzig, Germany; (P.R.); (M.M.); (O.L.); (B.J.-W.); (I.G.)
| | - Christoph Kahlert
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, D-01307 Dresden, Germany;
| | - Thomas Kurth
- Center for Molecular and Cellular Bioengineering (CMCB), Technology Platform, Technische Universität Dresden, D-01307 Dresden, Germany;
| | - Tom Venus
- Institute of Medical Physics and Biophysics, University of Leipzig, D-0407 Leipzig, Germany; (T.V.); (I.E.-L.)
| | - Katrin Schierle
- Institute of Pathology, University Hospital Leipzig, D-04103 Leipzig, Germany;
| | - Irina Estrela-Lopis
- Institute of Medical Physics and Biophysics, University of Leipzig, D-0407 Leipzig, Germany; (T.V.); (I.E.-L.)
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, D-04103 Leipzig, Germany; (P.R.); (M.M.); (O.L.); (B.J.-W.); (I.G.)
| | - Florian Lordick
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases, University Hospital Leipzig, D-04103 Leipzig, Germany;
- University Cancer Center Leipzig (UCCL), University Hospital Leipzig, D-04103 Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, D-04103 Leipzig, Germany; (P.R.); (M.M.); (O.L.); (B.J.-W.); (I.G.)
| | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, D-04103 Leipzig, Germany; (P.R.); (M.M.); (O.L.); (B.J.-W.); (I.G.)
- Correspondence:
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11
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Panagiotopoulou PB, Courcoutsakis N, Tentes A, Prassopoulos P. CT imaging of peritoneal carcinomatosis with surgical correlation: a pictorial review. Insights Imaging 2021; 12:168. [PMID: 34767065 PMCID: PMC8589944 DOI: 10.1186/s13244-021-01110-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy has revolutionized the survival and the quality of life in selected patients with peritoneal carcinomatosis. Preoperative CT is important for the selection of patients that may benefit from cytoreductive surgery and is useful for surgical planning. There are several tasks for the radiologist during CT interpretation: to describe cancerous implants on a "site-by-site" basis in the peritoneum, ligaments, mesenteries and visceral surfaces, to analyze patterns of involvement and to estimate the disease burden. Knowledge of the correlation between the CT and the surgical findings enhances the understanding of the disease and facilitates the communication between radiologists and surgeons.
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Affiliation(s)
| | - Nikos Courcoutsakis
- Department of Radiology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Apostolos Tentes
- Department of Surgery, Euromedica "Kyanos Stavros" Hospital, Thessaloniki, Greece
| | - Panos Prassopoulos
- Department of Radiology, AHEPA UniversityHospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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12
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Sun T, Zhang G, Ning T, Chen Q, Chu Y, Luo Y, You H, Su B, Li C, Guo Q, Jiang C. A Versatile Theranostic Platform for Colorectal Cancer Peritoneal Metastases: Real-Time Tumor-Tracking and Photothermal-Enhanced Chemotherapy. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2102256. [PMID: 34398516 PMCID: PMC8529449 DOI: 10.1002/advs.202102256] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/30/2021] [Indexed: 06/13/2023]
Abstract
A versatile tumor-targeting stimuli-responsive theranostic platform for peritoneal metastases of colorectal cancer is proposed in this work for tumor tracking and photothermal-enhanced chemotherapy. A quenched photosensitizer ("off" state) is developed and escorted into a tumor-targeting oxaliplatin-embedded micelle. Once reaching the tumor cell, the micelle is clasped to release free oxaliplatin, as well as the "off" photosensitizer, which is further activated ("turned-on") in the tumor reducing microenvironment to provide optical imaging and photothermal effect. The combined results from hyperthermia-enhanced chemotherapy, deep penetration, perfused O2 , and the leveraged GSH-ROS imbalance in tumor cells are achieved for improved antitumor efficacy and reduced systematic toxicity.
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Affiliation(s)
- Tao Sun
- Key Laboratory of Smart Drug Delivery (Ministry of Education)Minhang HospitalState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceInstitutes of Brain ScienceDepartment of PharmaceuticsSchool of PharmacyFudan University826 Zhangheng RoadShanghai201203China
| | - Guangping Zhang
- Shandong Province Key Laboratory of Medical Physics and Image Processing TechnologySchool of Physics and Electronics and Institute of Materials and Clean EnergyShandong Normal University1 University RoadJinan250358P. R. China
| | - Tingting Ning
- Key Laboratory of Smart Drug Delivery (Ministry of Education)Minhang HospitalState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceInstitutes of Brain ScienceDepartment of PharmaceuticsSchool of PharmacyFudan University826 Zhangheng RoadShanghai201203China
| | - Qinjun Chen
- Key Laboratory of Smart Drug Delivery (Ministry of Education)Minhang HospitalState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceInstitutes of Brain ScienceDepartment of PharmaceuticsSchool of PharmacyFudan University826 Zhangheng RoadShanghai201203China
| | - Yongchao Chu
- Key Laboratory of Smart Drug Delivery (Ministry of Education)Minhang HospitalState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceInstitutes of Brain ScienceDepartment of PharmaceuticsSchool of PharmacyFudan University826 Zhangheng RoadShanghai201203China
| | - Yifan Luo
- Key Laboratory of Smart Drug Delivery (Ministry of Education)Minhang HospitalState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceInstitutes of Brain ScienceDepartment of PharmaceuticsSchool of PharmacyFudan University826 Zhangheng RoadShanghai201203China
| | - Haoyu You
- Key Laboratory of Smart Drug Delivery (Ministry of Education)Minhang HospitalState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceInstitutes of Brain ScienceDepartment of PharmaceuticsSchool of PharmacyFudan University826 Zhangheng RoadShanghai201203China
| | - Boyu Su
- Key Laboratory of Smart Drug Delivery (Ministry of Education)Minhang HospitalState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceInstitutes of Brain ScienceDepartment of PharmaceuticsSchool of PharmacyFudan University826 Zhangheng RoadShanghai201203China
| | - Chao Li
- Key Laboratory of Smart Drug Delivery (Ministry of Education)Minhang HospitalState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceInstitutes of Brain ScienceDepartment of PharmaceuticsSchool of PharmacyFudan University826 Zhangheng RoadShanghai201203China
| | - Qin Guo
- Key Laboratory of Smart Drug Delivery (Ministry of Education)Minhang HospitalState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceInstitutes of Brain ScienceDepartment of PharmaceuticsSchool of PharmacyFudan University826 Zhangheng RoadShanghai201203China
| | - Chen Jiang
- Key Laboratory of Smart Drug Delivery (Ministry of Education)Minhang HospitalState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceInstitutes of Brain ScienceDepartment of PharmaceuticsSchool of PharmacyFudan University826 Zhangheng RoadShanghai201203China
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13
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Padilla-Valverde D, García-Santos E, Sanchez S, Manzanares C, Rodriguez M, González L, Ambrós A, Cano JM, Serrano L, Bodoque R, Vergara T, Martin J. Safety of perioperative hyperthermic intraperitoneal chemotherapy with gemcitabine in patients with resected pancreatic adenocarcinoma: a pilot study of the clinical trial EudraCT 2016-004298-41. J Gastrointest Oncol 2021; 12:S80-S90. [PMID: 33968428 DOI: 10.21037/jgo-20-238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Hyperthermic intraperitoneal chemotherapy (HIPEC) with gemcitabine, after cytoreductive surgery, may reduce the tumor progression of pancreatic cancer through the reduction of the neoplastic volume and the subpopulation of residual pancreatic cancer stem cells, improving the survival of patients with pancreatic cancer and decreasing the recurrence of the disease. Methods A pilot study is performed with the first ten patients in the experimental group. A randomized study (phase II-III clinical trial) that requires a population of 42 patients, with 21 patients in each group. All patients have a diagnosis of ductal adenocarcinoma of the pancreas, which will be surgically resected with curative intention. (I) Group I: after an R0 resection, patients receive individualized adjuvant treatments. (II) Group II: after an R0 resection, HIPEC is performed with gemcitabine (120 mg/m2 for 30 min), and they also receive individualized adjuvant treatments. To analyze the safety of the procedure, the main variables measured were as follows: grades of complications by means of the Clavien-Dindo system: pancreas surgery complications (e.g., pancreatic fistula, perioperative hemorrhage, delayed gastric emptying, biliary fistula), operative mortality, and laboratory parameters to control system functions. Values were measured three times: preoperatively, twenty-four hours after surgery, and on the 7th postoperative day. Results From 2018 to 2019, 31 patients were recruited for our clinical trial. Fifteen patients were excluded because of intraoperative unresectability or a different intraoperative histologic diagnosis. Ten patients were included in the experimental group (resection plus HIPEC gemcitabine). The mean age was 65±7 years, and six patients were female (60%). We confirmed the histologic diagnosis of ductal pancreatic adenocarcinoma in all patients prior to HIPEC. Total pancreatectomy was performed in five patients. The surgical median time was 360 min, and the hospital stay was 11 days. Four patients showed complications classified as Clavien-Dindo type II and one showing type I. Six patients were classified as having stage III tumors. To date, no hospital mortality, locoregional recurrence, or differences between the two groups in terms of perioperative complications, biochemical and gasometric values, or Clavien-Dindo complication grades were observed. Conclusions Our clinical pilot study demonstrated a similar perioperative outcome that allows the trial until main objectives are achieved.
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Affiliation(s)
- David Padilla-Valverde
- Department of Surgery, University General Hospital, Ciudad Real, Faculty of Medicine, Ciudad Real, University of Castilla-La Mancha, Castilla La Mancha, Spain
| | - Esther García-Santos
- Department of Surgery, University General Hospital, Ciudad Real, Faculty of Medicine, Ciudad Real, University of Castilla-La Mancha, Castilla La Mancha, Spain
| | - Susana Sanchez
- Department of Surgery, University General Hospital, Ciudad Real, Faculty of Medicine, Ciudad Real, University of Castilla-La Mancha, Castilla La Mancha, Spain
| | - Carmen Manzanares
- Department of Surgery, University General Hospital, Ciudad Real, Faculty of Medicine, Ciudad Real, University of Castilla-La Mancha, Castilla La Mancha, Spain
| | - Marta Rodriguez
- Department of Pharmacy, University General Hospital, Ciudad Real, Faculty of Medicine, Ciudad Real, University of Castilla-La Mancha, Castilla La Mancha, Spain
| | - Lucia González
- Department of Pathology, University General Hospital, Ciudad Real, Faculty of Medicine, Ciudad Real, University of Castilla-La Mancha, Castilla La Mancha, Spain
| | - Alfonso Ambrós
- Intensive Care Unit, University General Hospital, Ciudad Real, Faculty of Medicine, Ciudad Real, University of Castilla-La Mancha, Castilla La Mancha, Spain
| | - Juana M Cano
- Department of Oncology, University General Hospital, Ciudad Real, Faculty of Medicine, Ciudad Real, University of Castilla-La Mancha, Castilla La Mancha, Spain
| | - Leticia Serrano
- Translational Investigation Unit, UIT, University General Hospital, Ciudad Real, Faculty of Medicine, Ciudad Real, University of Castilla-La Mancha, Castilla La Mancha, Spain
| | - Raquel Bodoque
- Translational Investigation Unit, UIT, University General Hospital, Ciudad Real, Faculty of Medicine, Ciudad Real, University of Castilla-La Mancha, Castilla La Mancha, Spain
| | - Teresa Vergara
- Department of Surgery, University General Hospital, Ciudad Real, Faculty of Medicine, Ciudad Real, University of Castilla-La Mancha, Castilla La Mancha, Spain
| | - Jesus Martin
- Department of Surgery, University General Hospital, Ciudad Real, Faculty of Medicine, Ciudad Real, University of Castilla-La Mancha, Castilla La Mancha, Spain
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14
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Feng J, Li K, Liu G, Feng Y, Shi H, Zhang X. Precision hyperthermia-induced miRNA-409-3p upregulation inhibits migration, invasion, and EMT of gastric cancer cells by targeting KLF17. Biochem Biophys Res Commun 2021; 549:113-119. [PMID: 33667708 DOI: 10.1016/j.bbrc.2021.02.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/15/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hyperthermic intraperitoneal chemotherapy (HIPEC) is widely used for clinical treatment of advanced cancers. However, the regulatory mechanism underlying precise hyperthermia treatment in advanced gastric cancer (AGC) remains unclear. MiR-409-3p is reportedly downregulated in a variety of cancers, although its role in regulating treatment of AGC by precise hyperthermia remains unclear. The underlying mechanisms of miRNA-medicated regulation have been investigated using predicted and validated miRNA-gene targets, confirming the role of miRNA in HIPEC; METHODS: We used quantitative real time PCR (qRT-PCR) to detect miR-409-3p expression in gastric cancer (GC), as well as adjacent normal tissues, following exposure to varying temperatures. We detected miR-409-3p targets using dual-luciferase assay, then performed cell apoptosis, western blotting, invasion, and migration assays to detect GC functions; RESULTS: MiR-409-3p was upregulated and downregulated in precise hyperthermia and AGC, respectively. Moreover, miR-409-3p upregulated the Krüppel-like-factor 17 (KLF17), which subsequently inhibited migration, invasiveness, and epithelial-mesenchymal transition (EMT) but promoted apoptosis in GC cells; CONCLUSIONS: Precise hyperthermia upregulated miR-409-3p and KLF17 indirectly, thereby inhibiting invasion, migration, and EMT, and promoting apoptosis of gastric cancer cells.
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Affiliation(s)
- Jinxin Feng
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Hengzhigang Road 78#, Guangzhou, 510095, Guangdong, China
| | - Kejun Li
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Hengzhigang Road 78#, Guangzhou, 510095, Guangdong, China
| | - Gaojie Liu
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Hengzhigang Road 78#, Guangzhou, 510095, Guangdong, China
| | - Yanlin Feng
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Hengzhigang Road 78#, Guangzhou, 510095, Guangdong, China
| | - Huijuan Shi
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, 510080, PR China.
| | - Xiangliang Zhang
- Department of Abdominal Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Hengzhigang Road 78#, Guangzhou, 510095, Guangdong, China.
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15
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Sabouri Z, Labbaf S, Karimzadeh F, Baharlou-Houreh A, McFarlane TV, Esfahani MHN. Fe3O4/bioactive glass nanostructure: a promising therapeutic platform for osteosarcoma treatment. Biomed Mater 2021; 16. [DOI: 10.1088/1748-605x/aba7d5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/21/2020] [Indexed: 01/28/2023]
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16
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Marrelli D, Petrioli R, Cassetti D, D'Ignazio A, Marsili S, Mazzei MA, Lazzi S, Roviello F. A novel treatment protocol with 6 cycles of neoadjuvant chemotherapy followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in stage III primary ovarian cancer. Surg Oncol 2021; 37:101523. [PMID: 33545658 DOI: 10.1016/j.suronc.2021.101523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/24/2020] [Accepted: 01/25/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Few prospective studies investigated neoadjuvant chemotherapy (NAC), interval cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced ovarian cancer. We report the results of a phase II study where 6 rather than 3 cycles of NAC, followed by CRS and HIPEC, were adopted (HIPEC_ovaio, EudraCT number 2007-005674-31). MATERIALS AND METHODS Between 2007 and 2014, 56 patients with stage III primary ovarian cancer and peritoneal carcinomatosis were assigned to 6 cycles of platinum and taxane-based NAC. Of these, two had progression, 8 underwent palliative surgery, and 46 had CRS and HIPEC. RESULTS A complete pathological response was observed in 9 patients. Of 46 patients who completed the treatment protocol, 29 had no macroscopic residual tumor. Postoperative grade III morbidity rate was 28.2%; no grade IV complications or mortality events were observed. Five-year overall survival (OS) of the entire series was 36 ± 7% (median: 36, 95% CI: 26-45 months). In 46 patients treated by CRS and HIPEC, 5-year OS was 42 ± 8% (median: 53, 95% CI: 29-76 months), and 5-year progression-free survival was 26 ± 7% (median: 23, 95% CI: 19-27 months). Completeness of cytoreduction, peritoneal cancer index and FIGO stage resulted as significant prognostic factors. CONCLUSIONS A novel protocol consisting of 6 cycles of NAC, followed by CRS and HIPEC, is associated with notable improvement in peritoneal carcinomatosis, limited postoperative morbidity risk and high survival rates in responders, and could deserve further investigations in randomized clinical trials.
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Affiliation(s)
- Daniele Marrelli
- Department of Medicine, Surgery and Neuroscience, Unit of General Surgery and Surgical Oncology, University of Siena, Italy.
| | - Roberto Petrioli
- Department of Oncology, Unit of Medical Oncology, Azienda Ospedaliera Universitaria Senese, Italy
| | - Dario Cassetti
- Department of Medicine, Surgery and Neuroscience, Unit of General Surgery and Surgical Oncology, University of Siena, Italy
| | - Alessia D'Ignazio
- Department of Medicine, Surgery and Neuroscience, Unit of General Surgery and Surgical Oncology, University of Siena, Italy
| | - Stefania Marsili
- Department of Oncology, Unit of Medical Oncology, Azienda Ospedaliera Universitaria Senese, Italy
| | - Maria Antonietta Mazzei
- Department of Medicine, Surgery and Neuroscience, Unit of Diagnostic Imaging, University of Siena, Italy
| | - Stefano Lazzi
- Department of Medical Biotechnologies, Unit of Pathology, University of Siena, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neuroscience, Unit of General Surgery and Surgical Oncology, University of Siena, Italy
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17
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Brind'Amour A, Dubé P, Tremblay JF, Soucisse ML, Mack L, Bouchard-Fortier A, McCart JA, Govindarajan A, Bischof D, Haase E, Giacomantonio C, Hebbard P, Younan R, MacNeill A, Boulanger-Gobeil C, Sidéris L. Canadian guidelines on the management of colorectal peritoneal metastases. Curr Oncol 2020; 27:e621-e631. [PMID: 33380878 PMCID: PMC7755452 DOI: 10.3747/co.27.6919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Modern management of colorectal cancer (crc) with peritoneal metastasis (pm) is based on a combination of cytoreductive surgery (crs), systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy (hipec). Although the role of hipec has recently been questioned with respect to results from the prodige 7 trial, the role and benefit of a complete crs were confirmed, as observed with a 41-month gain in median survival in that study, and 15% of patients remaining disease-free at 5 years. Still, crc with pm is associated with a poor prognosis, and good patient selection is essential. Many questions about the optimal management approach for such patients remain, but all patients with pm from crc should be referred to, or discussed with, a pm surgical oncologist, because cure is possible. The objective of the present guideline is to offer a practical approach to the management of pm from crc and to reflect on the new practice standards set by recent publications on the topic.
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Affiliation(s)
- A Brind'Amour
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, chu de Québec-Université Laval, Quebec City
| | - P Dubé
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, University of Montreal, Montreal, QC
| | - J F Tremblay
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, University of Montreal, Montreal, QC
| | - M L Soucisse
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, University of Montreal, Montreal, QC
| | - L Mack
- Department of Surgery, University of Calgary, Calgary, AB
| | | | - J A McCart
- Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON
- Department of Surgery, University of Toronto, Toronto, ON
| | - A Govindarajan
- Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON
- Department of Surgery, University of Toronto, Toronto, ON
| | - D Bischof
- Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON
- Department of Surgery, University of Toronto, Toronto, ON
| | - E Haase
- Department of Surgery, University of Alberta, Edmonton, AB
| | | | - P Hebbard
- Department of Surgery, University of Manitoba, Winnipeg, MB
| | - R Younan
- Department of Surgery, University of Montreal, Montreal, QC
- Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - A MacNeill
- Department of Surgery, University of British Columbia, Vancouver, BC
| | | | - L Sidéris
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, University of Montreal, Montreal, QC
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18
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Lindsey PT, Martin RCG, Scoggins CR, Philips P, Marshall BM, Carter TS, Egger ME. Impact of Perfusate Glucose Concentration on Perioperative Outcomes in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. J Surg Res 2020; 256:206-211. [PMID: 32711177 DOI: 10.1016/j.jss.2020.06.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a common treatment for peritoneal surface malignancies but no standard carrier solution currently exists for the procedure. This study compared a standard low-dextrose perfusate to a higher-dextrose dialysate that has previously shown favorable impact on perioperative patient outcomes in trauma settings. MATERIALS AND METHODS A single-center retrospective study identified patients undergoing CRS/HIPEC from 2008 to 2019 with recorded dextrose concentration of administered perfusate. An institutional shift to a higher-dextrose solution was made in late 2015. Comparisons of preoperative factors, intraoperative and postoperative glucose levels, and postoperative outcomes were made using the chi-square test, Fisher's exact test, Wilcoxon rank sum test, or repeated measures analysis of variance. RESULTS There were 97 patients in the study, 73 (75%) in the low-dextrose group and 24 (25%) in the high-dextrose group. There was no significant difference in peak intraoperative blood glucose levels between the 1.5% (mean 230 mg/dL) and the 2.5% group (mean 199 mg/dL, P = 0.15). Daily postoperative glucose values were also not statistically different (repeated measures analysis of variance, P = 0.18). Median length of stay was slightly lower for the high-dextrose group (10 d, interquartile range 8-15) than that for the low-dextrose group (12 d, interquartile range 9-17), but was not statistically significant (P = 0.29). Return of bowel function and resumption of diet were similar between the groups. The high-dextrose group had a lower rate of overall complications (20.8%) than the low-dextrose group (49.3%, P = 0.0143). Ninety-day mortality was equivalent between the two groups (2.7% low-dextrose, 4.2% high-dextrose, P = 1.0). CONCLUSIONS Use of 2.5% dextrose-containing perfusate appears safe for CRS/HIPEC operations, does not negatively impact intraoperative or postoperative glucose levels, and may be associated with a decreased risk of complications.
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Affiliation(s)
- Phillip T Lindsey
- The Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Robert C G Martin
- The Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Charles R Scoggins
- The Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Prejesh Philips
- The Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Bryce M Marshall
- The Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Toni S Carter
- The Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Michael E Egger
- The Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
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19
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Yang SY, Kang JH, Kim HS, Han YD, Min BS, Lee KY. Status of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer. J Gastrointest Oncol 2019; 10:1251-1265. [PMID: 31949946 DOI: 10.21037/jgo.2019.01.36] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Peritoneal carcinomatosis (PC) was previously considered an incurable disease with a poor survival outcome. As our understanding of its biology evolved, the paradigm of the management of PC from colorectal cancer (CRC) has changed, including the combination of macroscopic disease control, cytoreductive surgery (CRS), maximal regional chemotherapy to treat residual microscopic disease, and hyperthermic intraperitoneal chemotherapy (HIPEC). As with many surgical innovations, CRS with HIPEC has evolved faster than data to support it, leaving many skeptics and critics. This review highlights the recent evidence of current practice and outcome of CRS with HIPEC. Furthermore, it also summarizes the ongoing clinical trials and potential future progress of this treatment modality.
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Affiliation(s)
- Seung Yoon Yang
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Hyun Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Ho Seung Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoon Dae Han
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Soh Min
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Kang Young Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
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20
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Lin SD, Soucisse ML, Lansom J, Morris DL. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a patient with peritoneal carcinomatosis from a pancreatic cystadenocarcinoma: A case report. Int J Surg Case Rep 2019; 63:48-52. [PMID: 31563663 PMCID: PMC6796650 DOI: 10.1016/j.ijscr.2019.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/10/2019] [Accepted: 08/17/2019] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a well-established procedure commonly employed in the management of peritoneal carcinomatosis (PC) from tumors of various specific origins. However, it is not traditionally used in the management of PC of pancreatic origin due to various reasons, including the aggressive nature of pancreatic tumors. CASE PRESENTATION A 67-year-old female presented with a large amount of intractable malignant ascites. Computed tomography (CT) imaging showed a nodule in the right paracolic gutter. A diagnostic laparoscopy and omental biopsy showed a well-differentiated adenocarcinoma of pancreatic origin. She was initially not considered suitable for CRS and HIPEC due to apparent liver metastases on CT imaging and was arranged to undergo palliative chemotherapy; however, due to her large amount of refractory ascites and a suspected ruptured right krukenberg tumor, surgical intervention was offered. We performed CRS, bilateral salpingo-oophorectomy, and an omentectomy with a CC (completeness of cytoreduction) score of 1. HIPEC with mitomycin C was also administered. Notably, our patient remains clinically well at 48-months post CRS and HIPEC, with no signs or symptoms suggestive of tumor recurrence. CONCLUSION Despite the current lack of evidence supporting the use of CRS and HIPEC in the curation of PC of pancreatic origin, this case report highlights the importance of patient selection in determining suitability for CRS. In the presence of positive prognostic factors and favorable tumor histology, CRS and HIPEC is a potential curative procedure that could be offered to highly selected patients presenting with PC from a primary pancreatic malignancy.
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Affiliation(s)
- Sophia D Lin
- Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia.
| | - Mikael L Soucisse
- Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia; Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada
| | - Joshua Lansom
- Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia
| | - David L Morris
- Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia
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Lan T, Chen Y, Su Q, Ye J. Oncological Outcome of Cytoreductive Radical Prostatectomy in Prostate Cancer Patients With Bone Oligometastases. Urology 2019; 131:166-175. [PMID: 31181273 DOI: 10.1016/j.urology.2019.03.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To explore the role of cytoreductive radical prostatectomy (CRP) for locally resectable and distant oligometastatic prostate cancer (CaP). PATIENTS AND METHODS Oligometastases were defined as the presence of 5 or fewer metastatic lesions detected on 99mTc bone scan and no suspicious visceral involvement at pretreatment imaging. Clinical data on 111 consecutive patients who were diagnosed as oligometastatic CaP in our center from 2005 to 2016 was retrospectively collected. In this retrospective cohort study, 35 patients underwent CRP and androgen deprivation therapy, and 76 patients underwent androgen deprivation therapy alone. Oncological outcomes were analyzed by employing Kaplan-Meier method. RESULTS The median follow-up of both groups was 35 months. In whole cohort analyses, prostate-specific antigen (PSA) decrease velocity (P = .167), PSA half-time (P = .263), and PSA nadir (P = .196) were not significantly different between 2 groups. Meanwhile, the differences in oncological outcomes between 2 groups did not reach statistical significance with regard to PSA relapse-free survival (P = .184), clinical progression-free survival (P = .118), and cancer-specific survival (P = .773). In addition, similar results were also observed in prespecified subgroup analyses (lower PSA group [0-100 ng/mL, P = .543], lower Gleason score group [6-7, P = .266], lower clinical T stage group [2-3 stage, P = .962], lower radiological N stage group [0 stage, P = .364]). CONCLUSION In our study, significant benefit from CRP has not been detected in patients with oligometastatic CaP. Facing current trend, it demands deliberate consideration to select candidates for cytoreductive surgery, and the selection criteria should be further refined by incorporating additional prognostic factors.
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Affiliation(s)
- Tian Lan
- Department of Urology, Lanzhou General Hospital of Lanzhou Command, Lanzhou, China
| | - Ye Chen
- Department of Surgery and Anesthesiology, Lanzhou General Hospital of Lanzhou Command, Lanzhou, China.
| | - QinJun Su
- Department of Pathology, Lanzhou General Hospital of Lanzhou Command, Lanzhou, China
| | - JianJun Ye
- China Department of Medical Imaging, Lanzhou General Hospital of Lanzhou Command, Lanzhou, China
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Abdalla Ahmed S, Abou-Taleb H, Ali N, M Badary D. Accuracy of radiologic- laparoscopic peritoneal carcinomatosis categorization in the prediction of surgical outcome. Br J Radiol 2019; 92:20190163. [PMID: 31112412 DOI: 10.1259/bjr.20190163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To evaluate the agreement between multiple detector CT (MDCT) and laparoscopy in the preoperative categorization of peritoneal carcinomatosis, and to determine the impact of this categorization on the prediction of cytoreduction status. METHODS This prospective study included 80 consecutive females with primary ovarian cancer eligible for cytoreductive surgery (CRS). MDCT and diagnostic laparoscopy were performed prior to surgery for assessment of peritoneal carcinomatosis extent. Based on PCI (peritoneal cancer index) score, carcinomatosis was categorized into three groups. Categorization agreement between CT and laparoscopy was assessed and compared with the intraoperative-histopathologically proven PCI. Impact of PCI categorization on cytoreduction status was also evaluated. RESULTS The overall agreement between CT and laparoscopy in preoperative peritoneal carcinomatosis categorization was good (K =0.71-0.79) in low category group and excellent in both moderate and large group (interclass correlation coeeficient = 0.89-0.91). (p<0.01) Optimal cytoreduction was achieved in 62/80 (77.5%) patients, PCI < 20 was detected in 48/62 (77.4%), pre-operative PCI < 20 correctly predicted optimal cytoreductive surgery (OCS) in 40/48 (83.3%) cases. Suboptimal cytoreduction was performed in 18/80 (22.5%) patients. PCI > 20 was detected in (10/18) 55.6%, preoperative CT and laparoscopy PCI > 20 correctly predicted SCS in 8/10 (80%) cases. The area under receiver operating characteristic curve showed that PCI cut-off <20 was the best predictor of OCS with an accuracy 85%, sensitivity 97%, specificity 40%, negative predictive value 76%, and positive predictive value 93%. CONCLUSION Both laparoscopy and CT are equally effective in pre-operative peritoneal carcinomatosis categorization. PCI < 20 is accurate in the prediction of optimal cytoreduction. More than half of patients with suboptimal cytoreduction had PCI > 20 and interval debulking surgery can be recommended. ADVANCES IN KNOWLEDGE Both laparoscopy and CT are equally effective in pre-operative peritoneal carcinomatosis categorization. PCI < 20 is accurate in the prediction of optimal cytoreduction. More than half of patients with suboptimal cytoreduction had PCI > 20 and interval debulking surgery can be recommended.
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Affiliation(s)
- Shimaa Abdalla Ahmed
- 1 Lecturer of Radiodiagnosis, South Egypt Cancer Institute Assiut University, Asyut, Egypt
| | - Hisham Abou-Taleb
- 2 Gynecologic Oncologist Lecturer of obstetrics and gynecology. Obstetrics & Gynecology Department, Women Health Hospital, Assiut University, Assiut, Egypt
| | - Noha Ali
- 3 Lecturer of Radiotherapy, South Egypt Cancer Institute, Assiut University, Asyut, Egypt
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Variation in Clinical Application of Hyperthermic Intraperitoneal Chemotherapy: A Review. Cancers (Basel) 2019; 11:cancers11010078. [PMID: 30641919 PMCID: PMC6357036 DOI: 10.3390/cancers11010078] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 12/24/2022] Open
Abstract
Peritoneal metastasis (PM) originating from gastrointestinal and gynecological malignancies are associated with a poor prognosis and rapid disease progression. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment option with curative intent. Hyperthermia enhances the cytotoxicity of chemotherapeutic drugs, thereby killing microscopic tumors and reducing the risk of tumor recurrence. Eight parameters potentially have an impact on the efficacy of HIPEC: the type of drug, drug concentrations, carrier solution, volume of the perfusate, temperature of the perfusate, duration of the treatment, the technique of delivery, and patient selection. In this review, a literature search was performed on PubMed, and a total of 564 articles were screened of which 168 articles were included. Although HIPEC is a successful treatment, there is no standardized method for delivering HIPEC: the choice of parameters is presently largely determined by institutional preferences. We discuss the current choice of the parameters and hypothesize about improvements toward uniform standardization. Quantifying the effect of each parameter separately is necessary to determine the optimal way to perform HIPEC procedures. In vivo, in vitro, in silico, and other experimental studies should shed light on the role of each of the eight parameters.
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24
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Preoperative assessment of splenic involvement in patients with peritoneal carcinomatosis with CT and MR imaging. Eur J Radiol 2019; 110:60-65. [DOI: 10.1016/j.ejrad.2018.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 01/01/2023]
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Gockel I, Jansen-Winkeln B, Haase L, Rhode P, Mehdorn M, Niebisch S, Moulla Y, Lyros O, Lordick F, Schierle K, Wittekind C, Thieme R. Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in Gastric Cancer Patients with Peritoneal Metastasis (PM): Results of a Single-Center Experience and Register Study. J Gastric Cancer 2018; 18:379-391. [PMID: 30607301 PMCID: PMC6310762 DOI: 10.5230/jgc.2018.18.e37] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Gastric cancer (GC) patients with peritoneal metastasis (PM) have poor prognosis. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in combination with systemic chemotherapy is a novel treatment option for patients in stage IV of the disease. MATERIALS AND METHODS Between November 2015 and June 2018, prospective data collection was performed in 24 patients with GC and PM (median age, 57; range, 44-75 years). These patients underwent 46 PIPAC procedures with a median number of 2 interventions per patient (range, 1-6). A laparoscopic access was used and a combined therapy of cisplatin and doxorubicin aerosol was administered. RESULTS The median peritoneal carcinomatosis index before the 1st PIPAC was 14 (range, 2-36), and the median ascites volume in patients before the 1st PIPAC was 100 mL (range, 0-6 mL, 300 mL). Eleven patients, who received 2 or more PIPAC procedures, had decreased and stable volumes of ascites, while only 3 patients displayed increasing volume of ascites. The median overall survival was 121 days (range, 66-625 days) after the 1st PIPAC procedure, while 8 patients who received more than 3 PIPAC procedures had a median survival of 450 days (range, 206-481 days) (P=0.0376). CONCLUSIONS Our data show that PIPAC is safe and well tolerated, and that the production of ascites can be controlled by PIPAC in GC patients. Patients, who received 2 or more PIPAC procedures, reported a stable overall quality of life. Further studies are required to document the significance of PIPAC as a palliative multimodal therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03100708.
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Affiliation(s)
- Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Linda Haase
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Philipp Rhode
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Stefan Niebisch
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Florian Lordick
- University Cancer Center Leipzig, University Hospital of Leipzig, Leipzig, Germany
| | - Katrin Schierle
- Institute of Pathology, University Hospital of Leipzig, Leipzig, Germany
| | | | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
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Flanagan M, Solon J, Chang K, Deady S, Moran B, Cahill R, Shields C, Mulsow J. Peritoneal metastases from extra-abdominal cancer – A population-based study. Eur J Surg Oncol 2018; 44:1811-1817. [DOI: 10.1016/j.ejso.2018.07.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/10/2018] [Accepted: 07/02/2018] [Indexed: 01/30/2023] Open
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Garg PK, Brandl A, Rau B. Hyperthermic Intraperitoneal Chemotherapy - Fading Perspective in the Light of Modern Systemic Chemotherapy? Visc Med 2018; 34:412-416. [PMID: 30675484 DOI: 10.1159/000493493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Peritoneal metastasis (PM) in a gastrointestinal cancer is associated with a poor prognosis. Various guidelines recommend palliative chemotherapy in these patients as cure is not achievable. However, hyperthermic intraperitoneal chemotherapy (HIPEC) in combination with cytoreductive surgery (CRS) can achieve long-term survival with low morbidity in selected patients. During the last decades, CRS and HIPEC have been performed in a number of indications, aiming for long-term survival. What is more, new drugs and treatment regimens demonstrate favorable results. Methods The recently published important literature on PM in gastrointestinal cancer was analyzed. Results Resection of isolated PM in a gastrointestinal cancer should be considered, and HIPEC is feasible. However, there is a lack of well-designed randomized controlled trials (RCTs) in gastrointestinal cancer-related PM. Many RCTs are being conducted across the world whose results will be available in 1-2 years. Systemic chemotherapy alone as an adequate management plan for isolated PM in a gastrointestinal cancer is not compatible with a high standard of care. Formulating an optimal plan combining the benefits of CRS and HIPEC coupled with systemic chemotherapy is a necessary task of the multidisciplinary team. Proper selection of the patients for CRS and HIPEC is necessary to achieve maximal oncological benefit and minimal perioperative morbidity and mortality. Conclusions A multidisciplinary approach combining the benefits of both CRS and HIPEC, and systemic chemotherapy is the way forward to manage those patients with gastrointestinal cancer and PM. Further studies are warranted to identify the selection variables for CRS and HIPEC.
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Affiliation(s)
- Pankaj Kumar Garg
- Department of Surgery, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Andreas Brandl
- Department of General Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Beate Rau
- Department of General Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Medina Medina C, Gaona Morales J, Roselló-Sastre E, Delgado Barriga K, Escrig Sos J, Herráiz Roda JL, Llueca Abellá JA. [Protocol for the examination of surgical specimens from patients with peritoneal carcinomatosis originating in ovary, fallopian tube and peritoneum]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2018; 51:216-223. [PMID: 30269772 DOI: 10.1016/j.patol.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/10/2018] [Accepted: 01/13/2018] [Indexed: 06/08/2023]
Abstract
Peritoneal carcinomatosis (PC) is a malignant entity with a high rate of morbimortality. It is considered an end-stage common to several abdominal and pelvic malignant tumours, such as epithelial ovarian, fallopian tubal and peritoneal cancer. Although many of these tumors have a good response to chemotherapy, prognosis is poor due to the high rate of recurrence. Surgeons, gynecologists and oncologists are increasingly concerned with improving the survival. The surgical technique described by Sugarbaker in the eighties is a plausible option. It aims for a complete resection of macroscopic carcinomatosis (cytoreductive surgery) followed by intraoperative or perioperative intraperitoneal chemotherapy. This therapeutic option necessarily involves specific multidisciplinary units; histopathology of specimens from this surgical technique is now more frequent in our department. We describe our initial experience with PC originating from epithelial ovarian, tubal and peritoneal cancer treated with the modified Sugarbaker surgery employed in our hospital. We outline our protocol designed to achieve uniformity in procedure, and summarize the initial results.
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Affiliation(s)
- Carmen Medina Medina
- Servicio de Anatomía Patológica, Hospital General Universitario de Castellón, Castellón, España.
| | - John Gaona Morales
- Servicio de Anatomía Patológica, Hospital General Universitario de Castellón, Castellón, España
| | - Esther Roselló-Sastre
- Servicio de Anatomía Patológica, Hospital General Universitario de Castellón, Castellón, España
| | - Katty Delgado Barriga
- Servicio de Radiología, Hospital General Universitario de Castellón, Castellón, España
| | - Javier Escrig Sos
- Servicio de Cirugía, Hospital General Universitario de Castellón, Castellón, España
| | - José Luis Herráiz Roda
- Servicio de Ginecología y Obstetricia, Hospital General Universitario de Castellón, Castellón, España
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El Hajj Diab D, Clerc P, Serhan N, Fourmy D, Gigoux V. Combined Treatments of Magnetic Intra-Lysosomal Hyperthermia with Doxorubicin Promotes Synergistic Anti-Tumoral Activity. NANOMATERIALS (BASEL, SWITZERLAND) 2018; 8:E468. [PMID: 29954075 PMCID: PMC6071107 DOI: 10.3390/nano8070468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 11/25/2022]
Abstract
Doxorubicin is a cytotoxic drug used for the treatment of many cancer types. However, its significant dose-related adverse effects including cardiotoxicity may hamper its efficiency. Moreover, the multidrug resistance that appears during treatments limits anti-cancer therapies. Hyperthermia has been introduced as an adjuvant anti-cancer therapy and presents promising opportunities especially in combination with chemotherapy. However, hyperthermia methods including standard magnetic hyperthermia do not discriminate between the target and the surrounding normal tissues and can lead to side effects. In this context, a Magnetic Intra-Lysosomal Hyperthermia (MILH) approach, which occurs without perceptible temperature rise, has been developed. We previously showed that minute amounts of iron oxide magnetic nanoparticles targeting the gastrin receptor (CCK2R) are internalized by cancer cells through a CCK2R-dependent physiological process, accumulated into their lysosomes and kill cancer cells upon high frequency alternating magnetic field (AMF) application through lysosomal cell death. Here, we show that the combination of MILH with doxorubicin increases the efficiency of the eradication of endocrine tumor cells with synergism. We also demonstrate that these two treatments activate two different cell death pathways that are respectively dependent on Caspase-1 and Caspase-3 activation. These findings will result in the development of new anti-tumoral, intra-lysosomal-thermo/chemotherapy with better curative effects than chemotherapy alone and that are devoid of adverse effects linked to standard hyperthermia approaches.
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Affiliation(s)
- Darine El Hajj Diab
- INSERM ERL1226-Receptology and Therapeutic Targeting of Cancers, Laboratoire de Physique et Chimie des Nano-Objets, CNRS UMR5215-INSA, Université de Toulouse III, F-31432 Toulouse, France.
| | - Pascal Clerc
- INSERM ERL1226-Receptology and Therapeutic Targeting of Cancers, Laboratoire de Physique et Chimie des Nano-Objets, CNRS UMR5215-INSA, Université de Toulouse III, F-31432 Toulouse, France.
| | - Nizar Serhan
- INSERM ERL1226-Receptology and Therapeutic Targeting of Cancers, Laboratoire de Physique et Chimie des Nano-Objets, CNRS UMR5215-INSA, Université de Toulouse III, F-31432 Toulouse, France.
| | - Daniel Fourmy
- INSERM ERL1226-Receptology and Therapeutic Targeting of Cancers, Laboratoire de Physique et Chimie des Nano-Objets, CNRS UMR5215-INSA, Université de Toulouse III, F-31432 Toulouse, France.
| | - Véronique Gigoux
- INSERM ERL1226-Receptology and Therapeutic Targeting of Cancers, Laboratoire de Physique et Chimie des Nano-Objets, CNRS UMR5215-INSA, Université de Toulouse III, F-31432 Toulouse, France.
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30
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Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Magge D, Ramalingam L, Shuai Y, Edwards RP, Pingpank JF, Ahrendt SS, Holtzman MP, Zeh HJ, Bartlett DL, Choudry HA. Hyperthermic intraperitoneal chemoperfusion as a component of multimodality therapy for ovarian and primary peritoneal cancer. J Surg Oncol 2017. [PMID: 28628712 DOI: 10.1002/jso.24666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES The role of hyperthermic intraperitoneal chemoperfusion (HIPEC) in the multimodality treatment of ovarian peritoneal metastases (OPM) and primary peritoneal cancer (PPC) remains controversial. We hypothesized that cytoreductive surgery (CRS) and HIPEC would provide meaningful survival benefit without excessive morbidity. METHODS We reviewed clinicopathologic and perioperative data following 96 CRS-HIPEC procedures for primary or recurrent OPM and PPC. Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting oncologic outcomes. RESULTS CRS-HIPEC was mostly performed for recurrent disease (56.3%) and high-grade serous carcinoma (72.9%). Platinum-based systemic chemotherapy was administered to 89.5% of patients, with 75.5% having platinum-sensitive disease at CRS-HIPEC. Complete macroscopic resection was achieved in 70.8% of patients. Clavien-Dindo grade 3/4 morbidity occurred in 23.4% of patients; three patients died within 60-days postoperatively. Median overall survival from diagnosis of peritoneal metastases and CRS-HIPEC was 78 and 38 months, respectively. Completeness of cytoreduction, pathologic subtype, and 30-day morbidity were independent predictors of survival in multiple regression analysis. CONCLUSIONS Our study demonstrates promising survival data and supports the role of HIPEC in the multimodality treatment algorithm for primary or recurrent OPM and PPC. However definite indications and timing of HIPEC need to be clarified by prospective studies.
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Affiliation(s)
- Deepa Magge
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lekshmi Ramalingam
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yongli Shuai
- The University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, Pennsylvania
| | - Robert P Edwards
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James F Pingpank
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven S Ahrendt
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew P Holtzman
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Herbert J Zeh
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David L Bartlett
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Haroon A Choudry
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
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Kapoor S, Bassily-Marcus A, Alba Yunen R, Tabrizian P, Semoin S, Blankush J, Labow D, Oropello J, Manasia A, Kohli-Seth R. Critical care management and intensive care unit outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. World J Crit Care Med 2017; 6:116-123. [PMID: 28529913 PMCID: PMC5415851 DOI: 10.5492/wjccm.v6.i2.116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/14/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To study the early postoperative intensive care unit (ICU) management and complications in the first 2 wk of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
METHODS Our study is a retrospective, observational study performed at Icahn School of Medicine at Mount Sinai, quaternary care hospital in New York City. All adult patients who underwent CRS and HIPEC between January 1, 2007 and December 31, 2012 and admitted to ICU postoperatively were studied. Fifty-one patients came to the ICU postoperatively out of 170 who underwent CRS and HIPEC therapy during the study period. Data analysis was performed using descriptive statistics.
RESULTS Of the 170 patients who underwent CRS and HIPEC therapy, 51 (30%) came to the ICU postoperatively. Mean ICU length of stay was 4 d (range 1-60 d) and mean APACHE II score was 15 (range 7-23). Thirty-one/fifty-one (62%) patients developed postoperative complications. Aggressive intraoperative and postoperative fluid resuscitation is required in most patients. Hypovolemia was seen in all patients and median amount of fluids required in the first 48 h was 6 L (range 1-14 L). Thirteen patients (25%) developed postoperative hypotension with seven requiring vasopressor support. The major cause of sepsis was intraabdominal, with 8 (15%) developing anastomotic leaks and 5 (10%) developing intraabdominal abscess. The median survival was 14 mo with 30 d mortality of 4% (2/51) and 90 d mortality of 16% (8/51). One year survival was 56.4% (28/51). Preoperative medical co morbidities, extent of surgical debulking, intraoperative blood losses, amount of intra op blood products required and total operative time are the factors to be considered while deciding ICU vs non ICU admission.
CONCLUSION Overall, ICU outcomes of this study population are excellent. Triage of these patients should consider preoperative and intraoperative factors. Intensivists should be vigilant to aggressive postop fluid resuscitation, pain control and early detection and management of surgical complications.
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Leyh-Bannurah SR, Gazdovich S, Budäus L, Zaffuto E, Briganti A, Abdollah F, Montorsi F, Schiffmann J, Menon M, Shariat SF, Fisch M, Chun F, Steuber T, Huland H, Graefen M, Karakiewicz PI. Local Therapy Improves Survival in Metastatic Prostate Cancer. Eur Urol 2017; 72:118-124. [PMID: 28385454 DOI: 10.1016/j.eururo.2017.03.020] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/14/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Treatment of the primary, termed local therapy (LT), may improve survival in metastatic prostate cancer (mPCa) versus no local therapy (NLT). OBJECTIVE To assess cancer-specific mortality (CSM) after LT versus NLT in mPCa. DESIGN, SETTING, AND PARTICIPANTS Within the Surveillance, Epidemiology and End Results database (2004-2013), 13 692 mPCa patients were treated with LT (radical prostatectomy [RP] or radiation therapy [RT]) or NLT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable competing risk regression analyses (MVA CRR) tested CSM after propensity score matching (PSM) in two analyses, (1) NLT versus LT and (2) RP versus RT, and were complemented with interaction, sensitivity, unmeasured confounder, and landmark analyses. RESULTS AND LIMITATIONS Of 13 692 mPCa patients, 474 received LT: 313 underwent RP and 161 RT. In MVA CRR, after PSM, LT (n=474) results in lower CSM (subhazard ratio [SHR] 0.40, 95% confidence interval [CI] 0.32-0.50) versus NLT (n=1896). In MVA CRR after PSM, RP (n=161) results in lower CSM (SHR 0.59, 95% CI 0.35-0.99) versus RT (n=161). Invariably, lowest CSM rates were recorded for Gleason ≤7, ≤cT3, and M1a substage. Interaction and sensitivity analyses confirmed the robustness of results, and landmark analyses rejected the bias favouring LT. A strong unmeasured confounder (HR=5), affecting 30% of NLT patients, could obliterate LT benefit. Data were retrospective. CONCLUSIONS In mPCa, LT results in lower mortality relative to NLT. Within LT, lower mortality is recorded after RP than RT. Patients with most favourable grade, local stage, and metastatic substage derive most benefit from LT. They also derive most benefit from RP, when LT types are compared (RP vs RT). It is important to consider study limitations until ongoing clinical trials confirm the proposed benefits. PATIENT SUMMARY Individuals with prostate cancer that spreads outside of the prostate might still benefit from prostate-directed treatments, such as radiation or surgery, in addition to receiving androgen deprivation therapy.
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Affiliation(s)
- Sami-Ramzi Leyh-Bannurah
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Stéphanie Gazdovich
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada
| | - Lars Budäus
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Emanuele Zaffuto
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Firas Abdollah
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jonas Schiffmann
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Mani Menon
- Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
| | | | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Steuber
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada
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Colby AH, Oberlies NH, Pearce CJ, Herrera VLM, Colson YL, Grinstaff MW. Nanoparticle drug-delivery systems for peritoneal cancers: a case study of the design, characterization and development of the expansile nanoparticle. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2017; 9. [PMID: 28185434 DOI: 10.1002/wnan.1451] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/30/2016] [Accepted: 12/17/2016] [Indexed: 12/24/2022]
Abstract
Nanoparticle (NP)-based drug-delivery systems are frequently employed to improve the intravenous administration of chemotherapy; however, few reports explore their application as an intraperitoneal therapy. We developed a pH-responsive expansile nanoparticle (eNP) specifically designed to leverage the intraperitoneal route of administration to treat intraperitoneal malignancies, such as mesothelioma, ovarian, and pancreatic carcinomatoses. This review describes the design, evaluation, and evolution of the eNP technology and, specifically, a Materials-Based Targeting paradigm that is unique among the many active- and passive-targeting strategies currently employed by NP-delivery systems. pH-responsive eNP swelling is responsible for the extended residence at the target tumor site as well as the subsequent improvement in tumoral drug delivery and efficacy observed with paclitaxel-loaded eNPs (PTX-eNPs) compared to the standard clinical formulation of paclitaxel, Taxol®. Superior PTX-eNP efficacy is demonstrated in two different orthotopic models of peritoneal cancer-mesothelioma and ovarian cancer; in a third model-of pancreatic cancer-PTX-eNPs demonstrated comparable efficacy to Taxol with reduced toxicity. Furthermore, the unique structural and responsive characteristics of eNPs enable them to be used in three additional treatment paradigms, including: treatment of lymphatic metastases in breast cancer; use as a highly fluorescent probe to visually guide the resection of peritoneal implants; and, in a two-step delivery paradigm for concentrating separately administered NP and drug at a target site. This case study serves as an important example of using the targeted disease-state's pathophysiology to inform the NP design as well as the method of use of the delivery system. WIREs Nanomed Nanobiotechnol 2017, 9:e1451. doi: 10.1002/wnan.1451 For further resources related to this article, please visit the WIREs website.
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Affiliation(s)
- Aaron H Colby
- Departments of Biomedical Engineering and Chemistry, Boston University, Boston, MA, USA.,Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Nicholas H Oberlies
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | - Victoria L M Herrera
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Yolonda L Colson
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mark W Grinstaff
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, Boston, MA, USA
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Gold Rods Irradiated with Ultrasound for Combination of Hyperthermia and Cancer Chemotherapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 987:119-138. [PMID: 28971453 DOI: 10.1007/978-3-319-57379-3_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE The aim of this study was to analyze feasibility (in vitro and in vivo) the use of hyperthermia produced by gold rods irradiated with ultrasound and their combination with chemotherapy with doxorubicin. MATERIALS AND METHODS initially was determined the cell viability and Hsp70 levels after treatment by gold rods irradiated with ultrasound (GR+U) in cell culture. The pretreatment with GR+U combined with doxorubicin (DOX) was evaluated from IC50, caspase-3 expression and mechanisms of cell death by electron microscopy. For evaluate the in vivo effects was used solid Ehrlich carcinoma (SEC) Tumor. The animals received three treatments with the combination of GR+U+DOX over 16 days. RESULTS The cell viability was completely inhibited after 40 min of treatment with GR+U and significant increases the expression of HSP70 was only observed after 10 min of treatment. GR+U+DOX presented significant reduction of IC50 representing 50.7%, 76.5% 45.2% and 46.6% for cell lines K562, NCI-H292, Hep-2 and MCF-7 respectively. GR+U+DOX presented significant reduction of IC50 representing 50.7%, 76.5% 45.2% and 46.6% for cell lines K562, NCI-H292, Hep-2 and MCF-7 respectively. The caspase-3 level and ultraestructural analysis showed that treatment with GR+U+DOX enhances induction of apoptosis. Pretreatment with GR+U combined with doxorubicin (1 mg) showed 87% inhibition against SEC. and no showed cardiotoxic effect. CONCLUSIONS The combined treatment of GR+U and DOX exhibit synergistic characteristics observed by increasing the efficiency of doxorubicin.
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Li Z, Li Z, Jia S, Bu Z, Zhang L, Wu X, Li S, Shan F, Ji X, Ji J. Depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis. Chin J Cancer Res 2017; 29:109-117. [PMID: 28536489 PMCID: PMC5422412 DOI: 10.21147/j.issn.1000-9604.2017.02.03] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective Diagnostic laparoscopy is recommended for the pretherapeutic staging of gastric cancer to detect any unexpected or unconfirmed intra-abdominal metastasis. The aim of this study was to evaluate the role and indications of diagnostic laparoscopy in the detection of intra-abdominal metastasis. Methods Standard diagnostic laparoscopy with peritoneal cytology examination was performed prospectively on patients who were clinically diagnosed with primary local advanced gastric cancer (cT≥2M0). We calculated the rate of intra-abdominal metastases identified by diagnostic laparoscopy, and examined the relationship between peritoneal dissemination (P) and cytology results (CY). Split-sample method was applied to find clinical risk factors for intra-abdominal metastasis. Multivariate logistic regression analysis and receiver-operator characteristic (ROC) analysis were performed in training set to find out risk factors of intra-abdominal metastasis, and then validate it in testing set. Results Out of 249 cM0 patients, 51 (20.5%) patients with intra-abdominal metastasis were identified by diagnostic laparoscopy, including 20 (8.0%) P1CY1, 17 (6.8%) P0CY1 and 14 (5.6%) P1CY0 patients. In the training set, multivariate logistic regression analysis and ROC analysis showed that the depth of tumor invasion on computer tomography (CT) scan ≥21 mm and tumor-occupied ≥2 portions of stomach are predictive factors of metastasis. In the testing set, when diagnostic laparoscopy was performed on patients who had one or two of these risk factors, the sensitivity and positive predictive value for detecting intra-abdominal metastasis were 90.0% and 32.1%, respectively. Conclusions According to our results, depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis.
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Affiliation(s)
- Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhemin Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shuqin Jia
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center for Molecular Diagnostics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhaode Bu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Lianhai Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiaojiang Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shuangxi Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xin Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Jo MH, Suh JW, Yun JS, Namgung H, Park DG. Cytoreductive surgery and intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal cancer: 2-year follow-up results at a single institution in Korea. Ann Surg Treat Res 2016; 91:157-164. [PMID: 27757392 PMCID: PMC5064225 DOI: 10.4174/astr.2016.91.4.157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 07/19/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022] Open
Abstract
Purpose The purpose of this study was to examine 2-year follow-up results of cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for peritoneal carcinomatosis (PC) of colorectal cancer. Methods We performed 54 cases of CRS and IPC in 53 patients with PC of colorectal cancer from December 2011 to December 2013. We collected data prospectively and analyzed the grade of PC, morbidity and mortality, and short-term follow-up (median, 10 months; range, 2–47 months) results. Results Mean peritoneal cancer index (PCI) was 15 (range, 1–35), and complete cytoreduction was possible in 35 patients (64.8%). Complications occurred in 25 patients (46.3%) and mortality occurred in 4 patients (7.4%). Excluding the 4 mortalities, 17 patients out of 49 patients (31.5%) were alive at the time of the last follow-up and the overall median survival was 10.3 months. Patients with complete cytoreduction had a median survival of 22.6 months, which was significantly longer than the median survival of 3.5 months for patients without complete cytoreduction (P < 0.001). PCI grade, CCR grade, cell type, and postoperative chemotherapy were significant prognostic factors by univariate analysis. Positive independent prognostic factors by multivariate analysis included PCI grade and postoperative chemotherapy. Conclusion CRS and IPC increased the survival of patients with low PCI and postoperative systemic chemotherapy was mandatory. However, this combined therapeutic approach showed high rate of complications and mortality. Therefore, this aggressive treatment should be performed in only selected patients by considering the general condition of the patient and the extent of PC.
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Affiliation(s)
- Min Hyeong Jo
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jung Wook Suh
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jeong Seok Yun
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Hwan Namgung
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Dong-Guk Park
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
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Geng X, Liu H, Lin T, Hu Y, Chen H, Zhao L, Mou T, Qi X, Yu J, Li G. Survival benefit of gastrectomy for gastric cancer with peritoneal carcinomatosis: a propensity score-matched analysis. Cancer Med 2016; 5:2781-2791. [PMID: 27650694 PMCID: PMC5083731 DOI: 10.1002/cam4.877] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/21/2016] [Accepted: 07/28/2016] [Indexed: 12/23/2022] Open
Abstract
Peritoneal carcinomatosis (PC) is the most frequent pattern of metastasis in stage IV gastric cancer (GC). The study aims to investigate the efficacy of gastrectomy in GC with PC. Clinicopathological data of 518 stage IV GC patients were retrospectively collected in Nanfang Hospital. Among all cases, 312 GC patients with PC (without other site of metastasis) were eligible. Univariate and multivariate analyses were performed to identify the independent prognostic factors. Propensity score matching analysis was performed to balance the characteristics and treatment‐related factors. There was a significantly improved overall survival in gastrectomy group (148 patients) compared with nonresection group (164 patients) (P < 0.001). The 1‐year and 2‐year survival rates were 49.8% and 21.5% in gastrectomy group, whereas 28.8% and 9.7% in nonresection group, respectively. Further analysis showed that gastrectomy had also improved survival in P1 (P = 0.017) and P2 stage patients (P < 0.001), but not P3 stage (P = 0.495). The modality of gastrectomy plus chemotherapy plus hyperthermic intraperitoneal chemotherapy (HIPEC) showed an optimum survival. In addition, P3 disease, nongastrectomy, nonchemotherapy, non‐HIPEC, and age ≥ 60 years were independently associated with poor survival. The gastrectomy plus chemotherapy plus HIPEC modality showed a significant survival benefit for gastric adenocarcinoma patients, particularly in those with P1 and P2 diseases.
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Affiliation(s)
- Xiuwen Geng
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Gastrointestinal Surgery, The First People's Hospital of Yueyang, Yueyang, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tian Lin
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanfeng Hu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liying Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tingyu Mou
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaolong Qi
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Feist M, Smith J, Enkelmann S, Hommel K, Brandl A, Rau B. Intraoperative Chemotherapie. DER ONKOLOGE 2016; 22:651-658. [DOI: 10.1007/s00761-016-0061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Castro-Mesta J, González-Guerrero J, Barrios-Sánchez P, Villarreal-Cavazos G. Bases and foundations of the treatment of peritoneal carcinomatosis: Review article. MEDICINA UNIVERSITARIA 2016. [DOI: 10.1016/j.rmu.2016.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Neuwirth MG, Alexander HR, Karakousis GC. Then and now: cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), a historical perspective. J Gastrointest Oncol 2016; 7:18-28. [PMID: 26941981 DOI: 10.3978/j.issn.2078-6891.2015.106] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The management of peritoneal carcinomatosis, once considered a condition with few therapeutic options, has undergone dramatic change with the advancement of surgical techniques and systemic cancer therapy. Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) administration, in particular, has significantly impacted the prospect of improving outcomes for this debilitating presentation of malignancy in selected patients. This regional surgical therapy itself has undergone many stages of evolution through its original conception nearly a century ago. Progressive changes in this field have included refinements and ongoing standardization in technique, development of a common language to describe tumor burden and extent of resection, better selection of chemotherapeutics based on tumor histology, reduction of surgical morbidity and mortality, and an improved understanding of factors for appropriate patient selection, to list but a few examples. CRS/HIPEC continues to play an important role in the management of select patients with carcinomatosis of certain tumor histology and its role will no doubt continue to be redefined as new therapies emerge.
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Affiliation(s)
- Madalyn G Neuwirth
- 1 Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA ; 2 Department of Surgery, University of Maryland, Maryland, MD 20742, USA
| | - H Richard Alexander
- 1 Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA ; 2 Department of Surgery, University of Maryland, Maryland, MD 20742, USA
| | - Giorgos C Karakousis
- 1 Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA ; 2 Department of Surgery, University of Maryland, Maryland, MD 20742, USA
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Biau J, Devun F, Verrelle P, Dutreix M. [Dbait: An innovative concept to inhibit DNA repair and treat cancer]. Bull Cancer 2016; 103:227-35. [PMID: 26917468 DOI: 10.1016/j.bulcan.2016.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 12/22/2022]
Abstract
The ability of cancer cells to recognize damage and initiate DNA repair is an important mechanism for therapeutic resistance. The use of inhibitors of DNA damage repair or signaling pathways appears to provide a unique opportunity for targeting genetic differences between tumor and normal cells. In this review, we firstly describe the main DNA lesions induced by the different treatments and the pathways involved in their repair. Then we review the mechanism of action and applications of an innovative DNA repair inhibitor: Dbait (and its clinical form DT01). Dbait/DT01 consists of 32 bp deoxyribonucleotides forming an intramolecular DNA double helix that mimics DNA lesions. They act as a bait for DNA damage signaling enzymes, the polyadenyl-ribose polymerase (PARP), and the DNA-dependent kinase (DNA-PK), inducing a "false" DNA damage signal and ultimately inhibiting recruitment at the damage site of many proteins involved in double-strand break and single-strand break repair pathways. Preclinical studies have demonstrated the capacity of Dbait/DT01 to improve the efficiency of (i) chemotherapy in colorectal cancer or hepatocellular carcinoma models, (ii) radiofrequency ablative in colorectal cancer liver metastases models, and (iii) radiotherapy in xenografted mice with head & neck squamous cell carcinoma, glioblastoma and melanoma. Following this good preclinical results, we performed a first-in-human phase 1-2a study evaluating the safety and efficacy of the combination of DT01 with radiotherapy for the treatment of skin metastases of melanoma. Twenty-three patients were included. No dose-limiting toxicity was observed. An objective response was observed in 59% lesions, including 30% complete responses. This first promising clinical efficacy provides future potential interesting clinical development of Dbait/DT01 with various anticancer treatments.
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Affiliation(s)
- Julian Biau
- Centre de recherche, institut Curie, 91400 Orsay, France; Centre national de la recherche scientifique, UMR3347, Orsay, France; Institut national de la santé et de la recherche médicale, U1021, Orsay, France; Université Paris Sud, Orsay, France; Clermont université, université d'Auvergne, EA7283 CREaT, 63011 Clermont-Ferrand, France; Centre Jean-Perrin, département de radiothérapie, 58, rue Montalembert, 63011 Clermont-Ferrand, France.
| | - Flavien Devun
- Centre de recherche, institut Curie, 91400 Orsay, France; DNA Therapeutics, 91000 Evry, France
| | - Pierre Verrelle
- Centre de recherche, institut Curie, 91400 Orsay, France; Clermont université, université d'Auvergne, EA7283 CREaT, 63011 Clermont-Ferrand, France; Centre Jean-Perrin, département de radiothérapie, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - Marie Dutreix
- Centre de recherche, institut Curie, 91400 Orsay, France; Centre national de la recherche scientifique, UMR3347, Orsay, France; Institut national de la santé et de la recherche médicale, U1021, Orsay, France; Université Paris Sud, Orsay, France
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Zhao H, Chen W, Lin Y, Qin J, Wang L. Analysis of surgery for incurable gastric cancer. World J Surg Oncol 2015; 13:339. [PMID: 26684015 PMCID: PMC4683841 DOI: 10.1186/s12957-015-0750-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/09/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is important to evaluate the curability of and avoid unnecessary exploratory surgery for gastric cancer preoperatively. However, no related research has been reported until now. The aim of this study was to evaluate the factors influencing surgery for incurable gastric cancer. METHODS 310 cases of T3-4 gastric cancer patients were analyzed retrospectively, including 141 cases with radical surgery and 169 with surgery for incurable gastric cancer. The incurable factors were categorized as T status (unresectable T4 tumor), N status (unresectable lymph node), peritoneal metastasis, and distant metastasis. χ (2) test and logistic regression were performed to analyze the associations between curability, T status, N status, peritoneal metastasis, or distant metastasis and clinicopathological data. RESULTS Esophageal involvement and T grade were associated with curability. Cardia involvement and Borrmann type were associated with T status. Esophageal involvement and T grade were associated with N status. Gastric body involvement, esophageal involvement, and T grade were associated with peritoneal metastasis. Gastric antrum involvement was associated with distant metastasis. CONCLUSIONS The influencing factors of surgery for incurable gastric cancer should be analyzed preoperatively. Resectability should be evaluated according to these influencing factors combined with imaging analysis.
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Affiliation(s)
- Honguang Zhao
- Department of Thoracic Surgery, Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China.,Wenzhou Medical University, Wenzhou, 325035, People's Republic of China
| | - Wenhu Chen
- Department of Biochemistry, Institute of Basic Medical Science, Zhejiang Medical College, Hangzhou, 310053, People's Republic of China
| | - Yehua Lin
- Department of Medical Record, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Jiangfeng Qin
- Department of Biochemistry, Institute of Basic Medical Science, Zhejiang Medical College, Hangzhou, 310053, People's Republic of China
| | - Lifang Wang
- Department of Biochemistry, Institute of Basic Medical Science, Zhejiang Medical College, Hangzhou, 310053, People's Republic of China.
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Polom K, Marano L, Roviello G, Petrioli R, Piagnerelli R, de Franco L, Marrelli D, Roviello F. Evolution and emerging future of cytoreducxtive surgery and hyperthermic intraperitoneal chemoperfusion in gastric cancer: From treating the incurable to preventing recurrence. Int J Hyperthermia 2015; 32:173-9. [DOI: 10.3109/02656736.2015.1111432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Bertozzi S, Londero AP, Cedolini C, Uzzau A, Seriau L, Bernardi S, Bacchetti S, Pasqual EM, Risaliti A. Prevalence, risk factors, and prognosis of peritoneal metastasis from breast cancer. SPRINGERPLUS 2015; 4:688. [PMID: 26576331 PMCID: PMC4641144 DOI: 10.1186/s40064-015-1449-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 10/19/2015] [Indexed: 01/14/2023]
Abstract
Peritoneal metastasis from breast cancer is a serious and deadly condition only limited considered in the literature. Our aim was to study prevalence, risk factors, and prognosis of breast cancer peritoneal metastasis. We retrospectively analyzed 3096 women with a diagnosis of invasive breast cancer. We took into consideration presence and localization of breast cancer distant metastasis as well as the possible risk factors and survival from the diagnosis of the breast cancer metastasis. The prevalence of breast cancer peritoneal metastases was 0.7 % (22/3096), representing the 7.6 % (22/289) of women affected by distant metastases. Moreover, independent risk factors for breast cancer peritoneal metastases resulted high grading, lobular invasive histology, and advanced T and N stage at diagnosis. Overall survival after metastasis diagnosis was shorter in women affected by peritoneal metastases or brain metastases in comparison to other metastatic women. Breast cancer peritoneal metastases were uncommon but not rare events with a poor prognosis after standard treatments.
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Affiliation(s)
- Serena Bertozzi
- Clinic of Surgery, AOU "Santa Maria della Misericordia", DISM, DSMB, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, UD Italy.,Surgical Oncology Department, IRCSS CRO, Via Franco Gallini, 2, 33081 Aviano, PN Italy
| | - Ambrogio P Londero
- Unit of Obstetrics and Gynecology, S Polo Hospital, via Galvani 1, 34074 Monfalcone, GO Italy
| | - Carla Cedolini
- Clinic of Surgery, AOU "Santa Maria della Misericordia", DISM, DSMB, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, UD Italy
| | - Alessandro Uzzau
- Clinic of Surgery, AOU "Santa Maria della Misericordia", DISM, DSMB, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, UD Italy
| | - Luca Seriau
- Clinic of Surgery, AOU "Santa Maria della Misericordia", DISM, DSMB, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, UD Italy
| | - Sergio Bernardi
- Unit of Surgery, Hospital of Latisana, via Sabbionera 45, 33053 Latisana, UD Italy
| | - Stefano Bacchetti
- Clinic of Surgery, AOU "Santa Maria della Misericordia", DISM, DSMB, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, UD Italy
| | - Enrico Maria Pasqual
- Clinic of Surgery, AOU "Santa Maria della Misericordia", DISM, DSMB, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, UD Italy
| | - Andrea Risaliti
- Clinic of Surgery, AOU "Santa Maria della Misericordia", DISM, DSMB, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, UD Italy
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Verné E, Bruno M, Miola M, Maina G, Bianco C, Cochis A, Rimondini L. Composite bone cements loaded with a bioactive and ferrimagnetic glass-ceramic: Leaching, bioactivity and cytocompatibility. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 53:95-103. [PMID: 26042695 DOI: 10.1016/j.msec.2015.03.039] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/26/2014] [Accepted: 03/22/2015] [Indexed: 11/28/2022]
Abstract
In this work, composite bone cements, based on a commercial polymethylmethacrylate matrix (Palamed®) loaded with ferrimagnetic bioactive glass-ceramic particles (SC45), were produced and characterized in vitro. The ferrimagnetic bioactive glass-ceramic belongs to the system SiO2-Na2O-CaO-P2O5-FeO-Fe2O3 and contains magnetite (Fe3O4) crystals into a residual amorphous bioactive phase. Three different formulations (containing 10, 15 and 20 wt.% of glass-ceramic particles respectively) have been investigated. These materials are intended to be applied as bone fillers for the hyperthermic treatment of bone tumors. The morphological, compositional, calorimetric and mechanical properties of each formulation have been already discussed in a previous paper. The in vitro properties of the composite bone cements described in the present paper are related to iron ion leaching test (by graphite furnace atomic absorption spectrometer), bioactivity (i.e. the ability to stimulate the formation of a hydroxyapatite - HAp - layer on their surface after soaking in simulated body fluid SBF) and cytocompatibility toward human osteosarcoma cells (ATCC CRL-1427, Mg63). Morphological and chemical characterizations by scanning electron microscopy and energy dispersion spectrometry have been performed on the composite samples after each test. The iron release was negligible and all the tested samples showed the growth of HAp on their surface after 28 days of immersion in a simulated body fluid (SBF). Cells showed good viability, morphology, adhesion, density and the ability to develop bridge-like structures on all investigated samples. A synergistic effect between bioactivity and cell mineralization was also evidenced.
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Affiliation(s)
- Enrica Verné
- Institute of Materials Physics and Engineering, Applied Science and Technology Department, Politecnico di Torino, C. so Duca degli Abruzzi 24, 10129 Torino, Italy.
| | - Matteo Bruno
- Institute of Materials Physics and Engineering, Applied Science and Technology Department, Politecnico di Torino, C. so Duca degli Abruzzi 24, 10129 Torino, Italy
| | - Marta Miola
- Institute of Materials Physics and Engineering, Applied Science and Technology Department, Politecnico di Torino, C. so Duca degli Abruzzi 24, 10129 Torino, Italy; Department of Health Sciences, Università del Piemonte Orientale "Amedeo Avogadro", Via Solaroli 17, 28100 Novara, Italy
| | - Giovanni Maina
- Traumatology Orthopedics and Occupational Medicine Dept., Università di Torino, Via G. Zuretti 29, 10126 Torino, Italy
| | - Carlotta Bianco
- Traumatology Orthopedics and Occupational Medicine Dept., Università di Torino, Via G. Zuretti 29, 10126 Torino, Italy
| | - Andrea Cochis
- Department of Health Sciences, Università del Piemonte Orientale "Amedeo Avogadro", Via Solaroli 17, 28100 Novara, Italy
| | - Lia Rimondini
- Department of Health Sciences, Università del Piemonte Orientale "Amedeo Avogadro", Via Solaroli 17, 28100 Novara, Italy; Consorzio Interuniversitario Nazionale per la Scienza e Tecnologia dei Materiali, Via G. Giusti, 9, 50121 Firenze, Italy
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Long noncoding RNA aberrant expression profiles after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy of AGC ascertained by microarray analysis. Tumour Biol 2015; 36:5021-9. [PMID: 25652469 DOI: 10.1007/s13277-015-3153-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/26/2015] [Indexed: 12/28/2022] Open
Abstract
Long noncoding RNAs (lncRNAs) have been shown to be involved in the development and progression of advanced gastric cancer (AGC). However, the roles of lncRNAs in advanced gastric cancer during the process of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are not well understood. A high-throughput microarray analysis was performed to compare the expression profiles of lncRNAs and messenger RNAs (mRNAs) in AGC serum samples during the process of CRS + HIPEC. Several potentially AGC-associated lncRNAs were verified by real-time quantitative reverse transcription polymerase chain reaction (PCR) analysis. Using abundant and varied probes, we were able to assess 33,045 lncRNAs and 30,215 mRNAs in our microarray. We found that 566 lncRNAs were differentially expressed (2-fold change) in AGC serum samples, indicating the significantly up- or downregulated lncRNAs play important roles in AGC during the process of CRS + HIPEC. Quantitative PCR results further verified that eight lncRNAs were aberrantly expressed in AGC serum samples after CRS + HIEC compared with matched serum sample before CRS + HIPEC. Among them, BC031243 and RP11-356I2.2 were the most aberrantly expressed lncRNAs, as estimated by quantitative PCR in six pairs of AGC serum samples. Our study demonstrated the expression patterns of lncRNAs in AGC serums before and after CRS + HIPEC by microarray. These results revealed that lncRNAs were differentially expressed during the process of CRS + HIPEC, suggesting that they might play key roles in tumor development.
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Razenberg LGEM, van Gestel YRBM, Creemers GJ, Verwaal VJ, Lemmens VEPP, de Hingh IHJT. Trends in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of synchronous peritoneal carcinomatosis of colorectal origin in the Netherlands. Eur J Surg Oncol 2015; 41:466-71. [PMID: 25680955 DOI: 10.1016/j.ejso.2015.01.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/14/2015] [Accepted: 01/22/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Population-based data on the percentage of colorectal cancer (CRC) patients with synchronous peritoneal carcinomatosis (PC) being treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are currently lacking. The current population-based study describes trends in the use of CRS-HIPEC in the Netherlands, one of the first countries where CRS and HIPEC was introduced. METHODS All patients diagnosed with synchronous PC of CRC between 2005 and 2012 were extracted from the Netherlands Cancer Registry (n = 4623). Patients with primary appendiceal cancer were excluded resulting in a study population of 4430 patients. Trends in the use of CRS-HIPEC over time were analyzed by means of a Cochrane-Armitage trend test. Survival proportions were calculated as the time between diagnosis and date of death or last follow-up (January 2014). RESULTS Of the total 4430 patients with synchronous PC, 297 (6.4%) underwent treatment with CRS-HIPEC. The proportion of colorectal PC patients receiving CRS-HIPEC increased significantly over time from 3.6% in 2005-2006 to 9.7% in 2011-2012 (p < 0.0001). Overall median survival (MS) for patients treated with CRS-HIPEC was 32.3 months, whereas MS rates were respectively 12.6, 6.1 and 1.5 for months palliative chemotherapy with/without surgery, palliative surgery and best supportive care. CONCLUSION The proportion of patients diagnosed with synchronous PC from CRC treated with CRS-HIPEC has increased significantly over time and currently almost 10% of PC patients are treated with CRS-HIPEC. Median survival in this population based group is 32.3 months.
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Affiliation(s)
- L G E M Razenberg
- Department of Oncology, Catharina Hospital, Eindhoven, The Netherlands; Eindhoven Cancer Registry/Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands
| | - Y R B M van Gestel
- Eindhoven Cancer Registry/Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands
| | - G-J Creemers
- Department of Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - V J Verwaal
- Department of Surgical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - V E P P Lemmens
- Eindhoven Cancer Registry/Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
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Hayes-Jordan A, Green H, Lin H, Owusu-Agyemang P, Mejia R, Okhuysen-Cawley R, Cortes J, Fitzgerald NE, McAleer MF, Herzog C, Huh WW, Anderson P. Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for children, adolescents, and young adults: the first 50 cases. Ann Surg Oncol 2015; 22:1726-32. [PMID: 25564159 DOI: 10.1245/s10434-014-4289-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Extensive peritoneal metastatic disease is rare in children. Although usually manifested as carcinomatosis in adults, sarcomatosis is more common in children. The authors began a pediatric hyperthermic intraperitoneal chemotherapy (HIPEC) program, and this report describes their initial results from the first 50 pediatric, adolescent, and young adult patients. METHODS A single-institution, retrospective study investigated the first 50 cytoreductive surgeries and HIPEC by one surgeon for patients 3-21 years of age. The HIPEC was added to chemotherapy and radiotherapy treatment. Demographics, outcome, and complications were recorded. RESULTS The median follow-up period for the surviving patients was 21.9 months. The most common diagnoses were desmoplastic small round cell tumor (n = 21), rhabdomyosarcoma (n = 7), mesothelioma (n = 4), and other carcinoma (n = 17). Multivariate analysis showed that patients treated with HIPEC and an incomplete cytoreduction had a greater risk for recurrence than those who had a complete cytoreduction (p = 0.0002). The patients with a higher peritoneal cancer index (PCI) (i.e., a large tumor burden) had a median overall survival (OS) time of 19.9 months relative to the patients with a lower PCI score, who had a median OS of 34 months (p = 0.049). The patients without complete cytoreduction had a median OS of 7.1 months compared with 31.4 months for the patients with complete cytoreduction (p = 0.012). No perioperative mortalities occurred. The incidence of major complications was 28 %. CONCLUSION Cytoreductive surgery and HIPEC with a programmatic approach for patients 3-21 years of age is unique. The best outcome was experienced by patients with desmoplastic small round cell tumor and those with complete cytoreduction. Complete cytoreduction for patients without disease outside the abdominal cavity at the time of surgery affords the best outcome.
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Affiliation(s)
- Andrea Hayes-Jordan
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA,
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Dayal S, Ghosh D, Moran B. Miscellaneous conditions of the peritoneal cavity--peritoneal tumors, pseudomyxoma, mesothelioma, fibroblastic reaction, cocoon, cystic lymphatic malformations, blue-bleb, and chylous ascites. Semin Pediatr Surg 2014; 23:363-8. [PMID: 25459443 DOI: 10.1053/j.sempedsurg.2014.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The peritoneum is subject to both primary neoplasia and secondary malignancy from direct, trans-coelomic, or hematogenous spread from any cancer. The knowledge base in the pediatric age group is very limited due to the rarity of peritoneal conditions in children, and much of the information is extrapolated from adult literature. There have been few reports in the pediatric population on the diagnosis and management of peritoneal conditions including peritoneal malignancy. In this article, we aim to highlight some of these conditions and the treatments available with a special emphasis on the evolving role of cytoreduction surgery and hyperthermic intraperitoneal chemotherapy in the treatment of certain peritoneal malignancies in children.
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Affiliation(s)
- Sanjeev Dayal
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Dhruv Ghosh
- Children׳s Hospital at Westmead, Westmead, Sydney, New South Wales, Australia
| | - Brendan Moran
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
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