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Seo CJ, Tan JWS, Farid M, Wong JSM, Soo KC, Chia CS, Ong CAJ. Radical resection and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of high risk recurrent retroperitoneal sarcoma-A pilot study in a tertiary Asian centre. PLoS One 2024; 19:e0300594. [PMID: 38574044 PMCID: PMC10994346 DOI: 10.1371/journal.pone.0300594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/23/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Peritoneal sarcomatosis (PS) is a difficult entity to treat with limited options and guarded prognosis. We aimed to determine if the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) could offer superior local recurrence-free survival in patients with retroperitoneal sarcoma at high risk of developing PS as opposed to extended resection alone. METHODS This is a single arm, phase II intervention study where all patients with recurrent localized retroperitoneal sarcoma considered at high risk of developing PS were considered for enrolment (ClinicalTrials.gov identifier: NCT03792867). Upon enrolment, patients underwent vigorous preoperative testing to ensure fitness for the procedure. During surgery, patients underwent extended resection and HIPEC with doxorubicin. Patients were followed-up every 2 weeks (± 10 days) for the first month and subsequently every three months (± 1 month) up to a year post-surgery, and were assessed for potential chemotherapy toxicity and post-treatment complications. After a year from resection and HIPEC, patients were followed-up either during routine clinic review or contacted via telephone every year (± 1 month) for 3 years. RESULTS Six patients were recruited but one patient dropped out due to adverse and unexpected intraoperative events. The remaining patients completed the procedure uneventfully. Post-HIPEC, all patients recurred with a disease-free interval ranging from six to 24 months. Three patients died due to complications from recurrent disease whereas the remaining three patients are alive as of their last visit. The overall survival at time at reporting ranged between 22 to 56 months. CONCLUSION The procedure is feasible with no major morbidity to patients. However, we are unable to recommend for it to be implemented as a routine procedure at this current stage due to lack of improved survival outcomes. Further multi-institutional studies may be conducted to yield better results.
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Affiliation(s)
- Chin Jin Seo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Joey Wee-Shan Tan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Khee Chee Soo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Chin-Ann Johnny Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore, Singapore
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Wong LCK, Li Z, Fan Q, Tan JWS, Tan QX, Wong JSM, Ong CAJ, Chia CS. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal sarcomatosis-A systematic review and meta-analysis. Eur J Surg Oncol 2021; 48:640-648. [PMID: 34716035 DOI: 10.1016/j.ejso.2021.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022] Open
Abstract
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) play an important role in the treatment of various peritoneal surface malignancies, but its efficacy in peritoneal sarcomatosis (PS) remains unknown. Hence, we performed a systematic review and meta-analysis to investigate outcomes of CRS-HIPEC in PS, in accordance with PRISMA guidelines. 16 studies with a total of 320 patients were included in the meta-analysis. Pooled mean length of hospital stay after CRS-HIPEC was 16.0 days (95% CI: 12.2-19.8) and rate of serious complications was 17.4% (95% CI: 9.8-26.3). The median DFS was 12.0 months (95% CI: 8.0-16.0) and the 5-year DFS was 21.8% (95% CI: 13.2-31.7). Overall pooled median OS was 29.3 months (95% CI: 23.8-34.8), with a 5-year OS of 35.3% (95% CI: 26.3-44.8). Subgroup analysis showed that patients with CC-0 cytoreduction had a higher median OS of 34.6 months (95% CI: 23.2-45.9). Median OS for patients with a primary tumour histology of leiomyosarcoma and liposarcoma was 33.5 months (95% CI: 15.9-51.1) and 39.1 months (95% CI: 20.8-57.5) respectively. The site of recurrence was locoregional in 57.3% (95% CI: 38.9-74.8), distant in 17.3% (95% CI: 3.9-35.6), and both in 17.4% (95% CI: 5.8-32.2). In conclusion, our results suggest that CRS-HIPEC may improve outcomes in a select group of PS patients.
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Affiliation(s)
- Louis Choon Kit Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Zhenyue Li
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Qiao Fan
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Joey Wee-Shan Tan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Qiu Xuan Tan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Chin-Ann Johnny Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore; Institute of Molecular and Cell Biology, A∗STAR Research Entities, Singapore; SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Claramae Shulyn Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore.
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Cheng T, Zhang Z, Shen H, Jian Z, Li J, Chen Y, Shen Y, Dai X. Topically applicated curcumin/gelatin-blended nanofibrous mat inhibits pancreatic adenocarcinoma by increasing ROS production and endoplasmic reticulum stress mediated apoptosis. J Nanobiotechnology 2020; 18:126. [PMID: 32891174 PMCID: PMC7487882 DOI: 10.1186/s12951-020-00687-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/30/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pancreatic adenocarcinoma (PDAC) is one of the most fatal malignancies. Surgical resection supplemented by chemotherapy remains the major therapeutic regimen, but with unavoidable resistance and systemic toxic reaction. Curcumin is a known safe natural compound that can effectively eliminate pancreatic adenocarcinoma cells in vitro, making it a promising candidate for substitution in subsequent chemotherapy. However, due to its extremely low bioavailability caused by its insolubility and circular elimination, curcumin had an unexpectedly modest therapeutic effect in clinical trials. RESULTS Here, we electrospun curcumin/gelatin-blended nanofibrous mat to largely improve curcumin's bioavailability by local controlled-release. With characterization by scanning electron microscopy, fluorescence microscopy, Fourier transform infrared spectroscopy, X-ray diffraction and high-performance liquid chromatography, it was revealed that curcumin was uniformly dispersed in the fiber of the mats with nanoscopic dimensions and could be continuously released into the surrounding medium for days. The cancer inhibitory effects of nano-curcumin and underlying mechanisms were further explored by assays using pancreatic adenocarcinoma cell and experiments using xenograft model. The results showed the released nano-curcumin could effectively inhibit pancreatic adenocarcinoma cell proliferation not only in vitro, but more importantly in vivo. This cytotoxic effect of nano-curcumin against pancreatic adenocarcinoma was achieved through provoking the production of intracellular reactive oxygen species and activating endoplasmic reticulum stress, which leads to enhanced cell apoptosis via decreased phosphorylation of signal transducer and activator of transcription 3. CONCLUSIONS Clinically, curcumin/gelatin-blended nanofibrous mat could be a promising, secure, efficient and affordable substitutional agent for the elimination of residual cancer cells after tumor resection. Moreover, our strategy to obtain curcumin released from nanofibrous mat may provide a universally applicable approach for the study of the therapeutic effects and molecular mechanisms of other potential medicines with low bioavailability.
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Affiliation(s)
- Tao Cheng
- Department of General Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210000, China
| | - Zhiheng Zhang
- Department of Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, 81675, Munich, Germany
| | - Hua Shen
- Department of Plastic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Ziying Jian
- Department of Hematology and Oncology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 21000, China
| | - Junsheng Li
- Department of General Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210000, China
| | - Yujun Chen
- Bio-ID Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yi Shen
- Bio-ID Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Xinyi Dai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200011, China.
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Dedifferentiated liposarcoma with a rare presentation of disseminated intraperitoneal sarcomatosis: A case report. Int J Surg Case Rep 2019; 60:331-335. [PMID: 31280066 PMCID: PMC6612661 DOI: 10.1016/j.ijscr.2019.06.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/20/2019] [Indexed: 11/25/2022] Open
Abstract
Dedifferentiated liposarcoma can present with disseminated intraperitoneal sarcomatosis. Fluorescence in situ hybridization for MDM2 gene amplification is diagnostically discriminative. Prognosis is poor and the benefit of chemotherapy remains uncertain. Novel targeted therapies involving MDM2 and CKD4 inhibitors may emerge as viable systemic therapy options.
Introduction Dedifferentiated liposarcoma is rare and tends to present with discrete tumors in the retroperitoneum, limbs and trunk. Majority of cases arise de-novo as primary tumors, while a minority occur as recurrences of well-differentiated liposarcomas. There has been no previous report of dedifferentiated liposarcoma presenting as disseminated intraperitoneal sarcomatosis. Presentation of case This report describes a young Asian female with disseminated intraperitoneal sarcomatosis arising from de-novo dedifferentiated liposarcoma, and discusses the diagnostic challenges faced in this highly unusual disease presentation. Initial biopsy was unconclusive, and considerations included sclerosing mesenteritis or an inflammatory myofibroblastic tumor. Fluorescence in situ hybridization was subsequently performed and showed amplification of the MDM2 gene. A diagnosis of dedifferentiated liposarcoma was then made. Discussion This was an extremely unusual presentation of advanced dedifferentiated liposarcoma that was eventually diagnosed using fluorescence in situ hybridization. Prognosis is poor and the only viable treatment options was palliative chemotherapy. Conclusion The diagnosis of dedifferentiated liposarcoma should be considered early and surgery carried out when still feasible.
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Sardi A, Muñoz‐Zuluaga CA, Sittig M, Diaz‐Montes T. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in seven patients with peritoneal sarcomatosis from uterine sarcoma. Clin Case Rep 2018; 6:1142-1152. [PMID: 29881584 PMCID: PMC5986004 DOI: 10.1002/ccr3.1491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/06/2018] [Accepted: 02/17/2018] [Indexed: 12/14/2022] Open
Abstract
Peritoneal sarcomatosis from uterine sarcoma is a rare disease with no effective treatment and poor prognosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has successful results in peritoneal carcinomatosis from gastrointestinal/gynecological origins. We show that CRS/HIPEC is safe, feasible, and may benefit selected patients with peritoneal sarcomatosis from uterine sarcoma.
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Affiliation(s)
- Armando Sardi
- The Institute for Cancer CareMercy Medical Center227 St. Paul PlaceBaltimore21202‐2001Maryland
| | - Carlos A. Muñoz‐Zuluaga
- The Institute for Cancer CareMercy Medical Center227 St. Paul PlaceBaltimore21202‐2001Maryland
| | - Michelle Sittig
- The Institute for Cancer CareMercy Medical Center227 St. Paul PlaceBaltimore21202‐2001Maryland
| | - Teresa Diaz‐Montes
- The Institute for Cancer CareMercy Medical Center227 St. Paul PlaceBaltimore21202‐2001Maryland
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6
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Karamveri C, Pallas N, Kyziridis D, Hristakis C, Kyriakopoulos V, Kalakonas A, Vaikos D, Tentes AAK. Cytoreductive Surgery in Combination with HIPEC in the Treatment of Peritoneal Sarcomatosis. Indian J Surg Oncol 2018; 10:40-45. [PMID: 30948870 DOI: 10.1007/s13193-018-0782-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/09/2018] [Indexed: 12/17/2022] Open
Abstract
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for peritoneal carcinomatosis, but it has been debated for peritoneal sarcomatosis. The purpose of the study is the presentation of perioperative and long-term results of CRS and hyperthermic intraoperative intraperitoneal chemotherapy in patients with peritoneal sarcomatosis. Retrospective study in a prospectively maintained database of 20 patients that underwent 29 CRS + HIPEC for peritoneal sarcomatosis. Clinical and histopathologic variables were correlated to survival. Complete cytoreduction was possible in 86.2% of the cases. The hospital mortality and morbidity rate were 0 and 20.7%, respectively. The median follow-up was 26 months, and recurrence was recorded in 20 cases (69%). The median and 5-year survival was 55 ± 13 (34-58) months and 43%, respectively. Prior surgical score (PSS) was the single variable related to survival (p = 0.018). The histologic subtype of the tumor was related to recurrence (p < 0.001). CRS and HIPEC in peritoneal sarcomatosis may offer a survival benefit in selected patients with low hospital mortality. The variety of histologic types of sarcomatosis has not made possible the identification of subgroups of patients that may be offered significant benefit by CRS and HIPEC. Further studies are required.
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Affiliation(s)
- Christina Karamveri
- 1Surgical Oncology, Peritoneal Surface Malignancy Program, Metropolitan Hospital, Venizelou 1, 18547 New Faliro, Greece
| | - Nicolaos Pallas
- 1Surgical Oncology, Peritoneal Surface Malignancy Program, Metropolitan Hospital, Venizelou 1, 18547 New Faliro, Greece
| | - Dimitrios Kyziridis
- 2Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica, Kyanous Stavros, Viziis 1, 54636 Thessaloniki, Greece
| | - Christos Hristakis
- 2Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica, Kyanous Stavros, Viziis 1, 54636 Thessaloniki, Greece
| | - Vasileios Kyriakopoulos
- 1Surgical Oncology, Peritoneal Surface Malignancy Program, Metropolitan Hospital, Venizelou 1, 18547 New Faliro, Greece
| | - Apostolos Kalakonas
- 2Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica, Kyanous Stavros, Viziis 1, 54636 Thessaloniki, Greece
| | - Dimitrios Vaikos
- 2Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica, Kyanous Stavros, Viziis 1, 54636 Thessaloniki, Greece
| | - Antonios-Apostolos K Tentes
- 1Surgical Oncology, Peritoneal Surface Malignancy Program, Metropolitan Hospital, Venizelou 1, 18547 New Faliro, Greece.,2Surgical Oncology, Peritoneal Surface Malignancy Program, Euromedica, Kyanous Stavros, Viziis 1, 54636 Thessaloniki, Greece
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Yee FZY, Tan GHC, Chia CS, Soo KC, Teo MCC. Uncommon indications for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Pleura Peritoneum 2017; 2:129-136. [PMID: 30911642 DOI: 10.1515/pp-2017-0017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/23/2017] [Indexed: 11/15/2022] Open
Abstract
Background Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has changed treatment for selected patients with peritoneal metastases (PM) arising from appendiceal, colorectal, epithelial ovarian, primary peritoneal and gastric cancers. However, the results of CRS with HIPEC remain unclear in PM from other tumor histologies. Methods We report a series of 10 patients who underwent CRS and HIPEC between 2006 and 2015, for PM arising from uncommon tumor origins. Results Ten patients with PM from uncommon tumor origins underwent CRS and HIPEC. Median age was 46.5 years. Two patients had ovarian Sertoli-Leydig cell tumors (SLCT) and two had small bowel adenocarcinomas. The other histologies included: ovarian transitional cell carcinoma, ovarian granulosa cell tumor, endometroid adenocarcinoma, endocervical adenocarcinoma, synovial sarcoma, and ovarian leiomyosarcoma. Median peritoneal cancer index was 9 (2-18) and complete cytoreduction was achieved for all patients. Median follow-up was 14 months (2-100), and median time to recurrence from CRS and HIPEC was 16.0 months by Kaplan-Meier estimate. Four patients remain alive and disease-free, five are alive with disease, and one had died with disease. Median survival was not reached. Conclusions Eight of ten patients with peritoneal metastases in the above rare indications survived 10 months or more after CRS and HIPEC. These encouraging results are a rationale for prospective clinical trials in these tumor histologies.
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Affiliation(s)
- Francis Zheng Yi Yee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Grace Hwei Ching Tan
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Claramae Shulyn Chia
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Khee Chee Soo
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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Tentes AA, Stamou K, Pallas N, Karamveri C, Kyziridis D, Hristakis C. The effect of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) as an adjuvant in patients with resectable pancreatic cancer. Int J Hyperthermia 2016; 32:895-899. [PMID: 27545750 DOI: 10.1080/02656736.2016.1227094] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/16/2016] [Indexed: 02/07/2023] Open
Abstract
Background - aims: The long-term survival of pancreatic cancer is poor even after potentially curative resection. The incidence of local-regional failures is high. There is evidence that hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC) is effective in controlling the local-regional failures. The purpose of the study is to identify the effect of HIPEC after surgical removal of pancreatic carcinoma. Patients - Methods: Prospective study including 33 patients with resectable pancreatic carcinomas. All patients underwent surgical resection (R0) and ΗIPEC as an adjuvant. Morbidity and hospital mortality were recorded. The patients were followed-up for 5 years. Survival was calculated. Recurrences and the sites of failure were recorded. RESULTS The mean age of the patients was 67.8 ± 11.1 years (38-86). The hospital mortality was 6.1% (2 patients) and the morbidity 24.2% (8 patients). The overall 5-year survival was 24%. The mean and median survival was 33 and 13 months, respectively. The median follow-up time was 11 months. The recurrence rate was 60.6% (20 patients). Three patients were recorded with local-regional failures (9.1%) and the others with liver metastases. CONCLUSIONS It appears that HIPEC as an adjuvant following potentially curative resection (R0) of pancreatic carcinoma may effectively control the local-regional disease. Prospective randomised studies are required.
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Affiliation(s)
- Antonios-Apostolos Tentes
- a Department of Surgical Oncology , Metropolitan Hospital, Programme of Peritoneal Surface Malignancy , Athens , Greece
| | - Konstantinos Stamou
- a Department of Surgical Oncology , Metropolitan Hospital, Programme of Peritoneal Surface Malignancy , Athens , Greece
| | - Nikolaos Pallas
- a Department of Surgical Oncology , Metropolitan Hospital, Programme of Peritoneal Surface Malignancy , Athens , Greece
| | - Christina Karamveri
- a Department of Surgical Oncology , Metropolitan Hospital, Programme of Peritoneal Surface Malignancy , Athens , Greece
| | - Dimitrios Kyziridis
- b Department of Surgical Oncology , Euromedica Kyanous Stavros , Thessaloniki , Greece
| | - Christos Hristakis
- b Department of Surgical Oncology , Euromedica Kyanous Stavros , Thessaloniki , Greece
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Uterine sarcoma Part I—Uterine leiomyosarcoma: The Topic Advisory Group systematic review. Taiwan J Obstet Gynecol 2016; 55:463-71. [DOI: 10.1016/j.tjog.2016.04.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2016] [Indexed: 12/21/2022] Open
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Macciò A, Kotsonis P, Chiappe G, Melis L, Zamboni F, Madeddu C. Long-Term Survival in a Patient With Abdominal Sarcomatosis From Uterine Leiomyosarcoma: Role of Repeated Laparoscopic Surgery in Treatment and Follow-Up. J Minim Invasive Gynecol 2016; 23:1003-8. [PMID: 27234428 DOI: 10.1016/j.jmig.2016.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 11/18/2022]
Abstract
Uterine leiomyosarcoma (LMS) in some cases may disseminate through the abdominal cavity, without extra-abdominal spreading, determining a condition of abdominal sarcomatosis, which represents a peculiar situation. Only radical surgical removal offers a chance of long-term survival in such cases of LMS. Here we describe a case of diffuse abdominal sarcomatosis from uterine LMS in a 51-year-old perimenopausal woman who underwent laparoscopic radical hysterectomy, bilateral salpingo-oophorectomy, total pelvic peritonectomy, pelvic lymphadenectomy to the mesenteric inferior artery, and omentectomy. Then, given the high probability of disease recurrence, the patient underwent a close follow-up consisting of positron emission tomography (PET)/computed tomography every 3 months and diagnostic (and if necessary operative) laparoscopy every 6 months. To date, the patient had 11 laparoscopies; 5 of them were preceded by a PET indicative of the presence of disease with high metabolic activity, which was confirmed at surgery and each time completely removed laparoscopically with no evidence of residual disease. To date, 5 years from diagnosis the patient is alive and continues her follow-up. Our report brings to light the ability of laparoscopic surgery to obtain disease control in a case of LMS with abdominal dissemination. Moreover, laparoscopic surgery, as demonstrated in our case, may have an important role in the close follow-up of the disease and allow a timely and early radical surgical approach of relapses before they become extremely large and difficult to remove radically.
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Affiliation(s)
- Antonio Macciò
- Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Italy.
| | | | - Giacomo Chiappe
- Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Italy
| | - Luca Melis
- Department of Nuclear Medicine, Azienda Ospedaliera Brotzu, Italy
| | - Fausto Zamboni
- Department of General Surgery, Azienda Ospedaliera Brotzu, Italy
| | - Clelia Madeddu
- Department of Medical Sciences M. Aresu, University of Cagliari, Italy
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Abu-Zaid A, Azzam A, Abuzaid M, Elhassan T, Albadawi N, Alkhatib L, AlOmar O, Alsuhaibani A, Amin T, Al-Badawi IA. Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy for Management of Peritoneal Sarcomatosis: A Preliminary Single-Center Experience from Saudi Arabia. Gastroenterol Res Pract 2016; 2016:6567473. [PMID: 27212941 PMCID: PMC4860243 DOI: 10.1155/2016/6567473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/08/2016] [Accepted: 04/07/2016] [Indexed: 02/05/2023] Open
Abstract
Aim. To report our preliminary single-center experience with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for management of peritoneal sarcomatosis (PS). Methods. Eleven patients were retrospectively analyzed for perioperative details. Results. Cytoreduction completeness (CC-0/1) was achieved in all patients with median peritoneal cancer index (PCI) of 14 ± 8.9 (range: 3-29). Combination cisplatin + doxorubicin HIPEC chemotherapy was used in 6 patients. Five patients received intraoperative radiation therapy (IORT). The median operative time, estimated blood loss, and hospital stay were 8 ± 1.4 hours (range: 6-10), 1000 ± 250 mL (range: 700-3850), and 11 ± 2.4 days (range: 7-15), respectively. Major postoperative Clavien-Dindo grade III/IV complications occurred in 1 patient and none developed HIPEC chemotherapy-related toxicities. The median overall survival (OS) and disease-free survival (DFS) after CRS + HIPEC were 28.3 ± 3.2 and 18.0 ± 4.0 months, respectively. The median follow-up time was 12 months (range: 6-33). Univariate analysis of several prognostic factors (age, gender, PS presentation/pathology, CC, PCI, HIPEC chemotherapy, and IORT) did not demonstrate statistically significant differences of OS and DFS. Conclusion. CRS + HIPEC appear to be feasible, safe, and offer survival oncological benefits. However, definitive conclusions cannot be deduced.
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Affiliation(s)
- Ahmed Abu-Zaid
- 1College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Ayman Azzam
- 2Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
- 3King Faisal Oncology Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Mohammed Abuzaid
- 4Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Tusneem Elhassan
- 3King Faisal Oncology Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Naryman Albadawi
- 1College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Lynn Alkhatib
- 1College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Osama AlOmar
- 5Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia
| | - Abdullah Alsuhaibani
- 3King Faisal Oncology Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Tarek Amin
- 3King Faisal Oncology Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Ismail A. Al-Badawi
- 1College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- 5Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia
- *Ismail A. Al-Badawi:
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12
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Current management of gastrointestinal stromal tumors: Surgery, current biomarkers, mutations, and therapy. Surgery 2015; 158:1149-64. [DOI: 10.1016/j.surg.2015.06.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/18/2015] [Accepted: 06/24/2015] [Indexed: 12/11/2022]
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13
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Cardi M, Sammartino P, Mingarelli V, Sibio S, Accarpio F, Biacchi D, Musio D, Sollazzo B, Di Giorgio A. Cytoreduction and HIPEC in the treatment of "unconventional" secondary peritoneal carcinomatosis. World J Surg Oncol 2015; 13:305. [PMID: 26493405 PMCID: PMC4618525 DOI: 10.1186/s12957-015-0703-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 09/22/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Peritoneal metastasis (PM) is considered a terminal and incurable disease. In the last 30 years, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) radically changed the therapeutic approach for these patients and is regarded as the standard of care for pseudomyxoma peritonei from appendiceal cancer and peritoneal mesotheliomas. Improved survival has also been reported in treating PM from ovarian, gastric, and colorectal cancers. However, PM often seriously complicates the clinical course of patients with other primary digestive and non-digestive cancers. There is increasing literature evidence that helped to identify not only the primary tumors for which CRS and HIPEC showed a survival advantage but also the patients who may benefit form this treatment modality for the potential lethal complications. Our goal is to report our experience with cytoreduction and HIPEC in patients with PM from rare or unusual primary tumors, discussing possible "unconventional" indications, outcome, and the peculiar issues related to each tumor. METHODS From a series of 253 consecutive patients with a diagnosis of peritoneal carcinomatosis and treated by CRS and HIPEC, we selected only those with secondary peritoneal carcinomatosis from rare or unusual primary tumors, excluding pseudomyxoma peritonei, peritoneal mesotheliomas, ovarian, gastric, and colorectal cancers. Complications and adverse effects were graded from 0 to 5 according to the WHO Common Toxicity Criteria for Adverse Events (CTCAE). Survival was expressed as mean and median. RESULTS We admitted and treated by CRS and HIPEC 28 patients with secondary peritoneal carcinomatosis from rare or unusual primary tumors. Morbidity and mortality rates were in line with those reported for similar procedures. Median survival for the study group was 56 months, and 5-year overall survival reached 40.3 %, with a difference between patients with no (CC0) and minimal (CC1) residual disease (52.3 vs. 25.7), not reaching statistical significance. Ten patients are alive disease-free, and eight are alive with disease. CONCLUSIONS Cytoreduction and HIPEC should not be excluded "a priori" for the treatment of peritoneal metastases from unconventional primary tumors. This combined therapeutic approach, performed in an experienced center, is safe and can provide a survival benefit over conventional palliative treatments.
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Affiliation(s)
- Maurizio Cardi
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy. .,, Via Bolzano 32, 00198, Rome, Italy.
| | - Paolo Sammartino
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
| | - Valentina Mingarelli
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
| | - Simone Sibio
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
| | - Fabio Accarpio
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
| | - Daniele Biacchi
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
| | - Daniela Musio
- Dipartimento di Scienze Radioterapiche, Oncologiche ed Anatomopatologiche, "Sapienza" Università di Roma, Rome, Italy.
| | - Bianca Sollazzo
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
| | - Angelo Di Giorgio
- UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy.
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Peritoneal sarcomatosis: site of origin for the establishment of an in vitro and in vivo cell line model to study therapeutic resistance in dedifferentiated liposarcoma. Tumour Biol 2015; 37:2341-51. [DOI: 10.1007/s13277-015-4050-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/02/2015] [Indexed: 12/31/2022] Open
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15
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Randle RW, Votanopoulos KI, Shen P, Levine EA, Stewart JH. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Colombo C, Baratti D, Kusamura S, Deraco M, Gronchi A. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) and isolated perfusion (ILP) interventions in sarcoma. J Surg Oncol 2014; 111:570-9. [PMID: 25351775 DOI: 10.1002/jso.23808] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/13/2014] [Indexed: 01/28/2023]
Abstract
Locally advanced sarcomas in the extremity and in the retroperitoneum/abdominal cavity (peritoneal sarcomatosis, PS) can be managed administering chemotherapy locally using isolated limb perfusion (ILP) and hyperthermic intraperitoneal chemotherapy (HIPEC), respectively. In this review, the authors discuss the pros and cons of the use of these locoregional therapies in locally advanced soft tissue sarcoma, with a view to establishing their role in the multidisciplinary approach to these difficult diseases.
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Affiliation(s)
- Chiara Colombo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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17
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Bryan ML, Fitzgerald NC, Levine EA, Shen P, Stewart JH, Votanopoulos KI. Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in Sarcomatosis from Gastrointestinal Stromal Tumor. Am Surg 2014. [DOI: 10.1177/000313481408000923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The role of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) procedures in the management of patients with gastrointestinal stromal tumor (GIST)-induced sarcomatosis that is refractory to tyrosine kinase inhibitors (TKI) is not well defined. A retrospective analysis of a prospective database of 1070 CRS/HIPEC procedures was performed. Demographics, Eastern Cooperative Oncology Group performance status, resection status, morbidity, mortality, perioperative use of targeted therapies, and overall survival were analyzed. Since 1992, 18 CRS/ HIPEC procedures were performed for peritoneal dissemination of GIST. Fifty per cent of these cases were performed before the introduction of TKIs. R0/1 resection was achieved in 72 per cent, whereas 63 per cent of patients were treated with neoadjuvant and/or adjuvant targeted therapy. Thirty-day morbidity and mortality were 33.3 and 5.6 per cent, respectively. Median overall survival after CRS/HIPEC was 3.33 years with 3-year survival of 56 per cent. Median survival in those who did not receive targeted therapy was 1.04 versus 7.9 years for those treated with TKI and cytoreduction. Median postsurgical survival for those treated preoperatively with progression on TKI treatment was 1.35 years versus not reached in those on TKI therapy without progression. Primary therapy for patients with disseminated GIST should be TKI therapy. However, in patients with sarcomatosis from GIST, cytoreduction should be considered before developing TKI resistance. Progression on TKI is associated with poor outcomes even after complete cytoreduction.
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Affiliation(s)
- Michelle L. Bryan
- Surgical Oncology Service in the Departments of General Surgery, Winston-Salem, North Carolina
| | - Nora C. Fitzgerald
- Department of Biostatistics, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Edward A. Levine
- Surgical Oncology Service in the Departments of General Surgery, Winston-Salem, North Carolina
| | - Perry Shen
- Surgical Oncology Service in the Departments of General Surgery, Winston-Salem, North Carolina
| | - John H. Stewart
- Surgical Oncology Service in the Departments of General Surgery, Winston-Salem, North Carolina
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Budker VG, Monahan SD, Subbotin VM. Loco-regional cancer drug therapy: present approaches and rapidly reversible hydrophobization (RRH) of therapeutic agents as the future direction. Drug Discov Today 2014; 19:1855-70. [PMID: 25173702 DOI: 10.1016/j.drudis.2014.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/10/2014] [Accepted: 08/21/2014] [Indexed: 01/01/2023]
Abstract
Insufficient drug uptake by solid tumors remains the major problem for systemic chemotherapy. Many studies have demonstrated anticancer drug effects to be dose-dependent, although dose-escalation studies have resulted in limited survival benefit with increased systemic toxicities. One solution to this has been the idea of loco-regional drug treatments, which offer dramatically higher drug concentrations in tumor tissues while minimizing systemic toxicity. Although loco-regional delivery has been most prominent in cancers of the liver, soft tissues and serosal peritoneal malignancies, survival benefits are very far from desirable. This review discusses the evolution of loco-regional treatments, the present approaches and offers rapidly reversible hydrophobization of drugs as the new future direction.
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