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Muñoz-Casares FC, Martín-Broto J, Cascales-Campos P, Torres-Melero J, López-Rojo I, Gómez-Barbadillo J, González-Bayón L, Sebio A, Serrano C, Carvalhal S, Abreu de Souza J, Souza A, Flores-Ayala G, Palacios Fuenmayor LJ, Lopes-Bras R, González-López JA, Vasques H, Asencio-Pascual JM. Ibero-American Consensus for the Management of Peritoneal Sarcomatosis: Updated Review and Clinical Recommendations. Cancers (Basel) 2024; 16:2646. [PMID: 39123374 PMCID: PMC11311413 DOI: 10.3390/cancers16152646] [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: 06/14/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Peritoneal sarcomatosis is a rare malignant disease with a poor prognosis, secondary to peritoneal dissemination of abdominopelvic soft tissue sarcomas. Its rarity, together with the characteristic histological heterogeneity and the historically poor response to systemic treatments, has prevented the establishment of widely accepted treatment criteria with curative intent. In this sense, radical cytoreductive surgery (CRS) with peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (HIPEC), widely used in peritoneal carcinomatosis with excellent results, have not had the same evolutionary development in patients with peritoneal sarcomatosis. A multidisciplinary working group of experts in sarcomas and peritoneal oncological surgery established a series of recommendations based on current scientific evidence for the management of peritoneal sarcomatosis, taking into account the different histological subgroups of abdominopelvic sarcomas that can cause it depending on their origin: retroperitoneal sarcomas, uterine sarcomas, and visceral/peritoneal sarcomas of GIST (gastrointestinal stromal tumor) and non-GIST origin. This article shows the results of sarcoma experts' voting on the recommendations presented during the I Ibero-American Consensus on the Management of Peritoneal Sarcomatosis, which took place during the recent celebration of the III Hispanic-Portuguese Meeting for Updates on the Treatment of Sarcomas.
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Affiliation(s)
| | - Javier Martín-Broto
- Medical Oncology Department, Jimenez Diaz Foundation University Hospital, 28040 Madrid, Spain
| | - Pedro Cascales-Campos
- Peritoneal and Sarcomas Oncology Surgery Unit, Virgen de la Arrixaca University Hospital, 30120 Murcia, Spain
| | - Juan Torres-Melero
- Peritoneal Oncology Surgery Unit, Torrecárdenas University Hospital, 04009 Almeria, Spain
| | - Irene López-Rojo
- Surgery Department, MD Anderson Cancer Center Madrid, 28033 Madrid, Spain
| | - José Gómez-Barbadillo
- Peritoneal Carcinomatosis and Retroperitoneal Sarcomas Unit, San Juan de Dios Hospital, 14012 Córdoba, Spain
| | - Luis González-Bayón
- Peritoneal Carcinomatosis Unit, Gregorio Marañón University Hospital, 28007 Madrid, Spain
| | - Ana Sebio
- Medical Oncology Department, Santa Creu i Sant Pau University Hospital, 08025 Barcelona, Spain
| | - César Serrano
- Medical Oncology Department, Vall D’Hebron University Hospital, 08035 Barcelona, Spain
| | - Sara Carvalhal
- Surgery Department, Portuguese Institute of Oncology of Lisbon, 1099-023 Lisbon, Portugal
| | | | - Alexandre Souza
- Surgery Department, Portuguese Institute of Oncology of Porto, 4200-072 Porto, Portugal
| | | | | | - Raquel Lopes-Bras
- Medical Oncology Department, Santa María Hospital, Lisboa North University Center, 1649-028 Lisboa, Portugal
| | | | - Hugo Vasques
- Surgery Department, Portuguese Institute of Oncology of Lisbon, 1099-023 Lisbon, Portugal
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Grillo-Marín C, Antón-Rodríguez C, Prieto L, Ortega-Pérez G, González-Moreno S. Nephrotoxicity Associated with Cytoreductive Surgery Combined with Cisplatin-Based Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Malignant Disease: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3793. [PMID: 38999359 PMCID: PMC11242517 DOI: 10.3390/jcm13133793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Cisplatin is employed in hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) for peritoneal surface malignancies (PSMs). The main concern regarding intraperitoneal cisplatin administration is nephrotoxicity. Numerous reports in this context are available. Our objective was to conduct a systematic review and meta-analysis to assess cisplatin-based HIPEC-related nephrotoxicity (CHRN). Methods: A systematic literature review on CHRN after CRS for the treatment of PSMs was performed. The literature search was carried out using Medline, Cochrane, and Embase. The last day of the search was 23 October 2023. PRISMA guidelines were used. A meta-analysis was then conducted. The main endpoint was the incidence of acute and chronic renal impairment after CHRN. Secondary endpoints included the potential impact of several clinical variables on the primary endpoint and a critical appraisal of the different renal impairment scales employed. Results: Our study included 26 articles with a total sample of 1473 patients. The incidence of acute kidney injury (AKI) was 18.6% (95% CI: 13.6-25%, range of true effects 3-59%). For chronic kidney disease, it was 7% (95% CI: 3-15.3%, range of true effects 1-53%). The variables that statistically influenced these results were the scale used to measure renal insufficiency, the use of nephroprotective agents, and the presence of pre-existing renal disease. Conclusions: The reported incidence of renal impairment following cisplatin-based HIPEC is highly variable. The incidence of renal failure obtained in this meta-analysis should be used as a reference for subsequent reports on this topic. Further prospective studies are warranted to establish optimal and standardized management.
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Affiliation(s)
- Cristián Grillo-Marín
- Department of General Surgery, Hospital Universitario Puerta de Hierro, Calle Joaquín Rodrigo 1, 28222 Majadahonda, Spain;
- Unidad de Apoyo a la Investigación, Facultad de Medicina, Universidad Francisco de Vitoria M-515, km 1, 800, 28223 Pozuelo de Alarcón, Spain; (C.A.-R.); (L.P.)
- MD Anderson Cancer Center, Madrid Spain Foundation, Calle Arturo Soria 270, 28033 Madrid, Spain
| | - Cristina Antón-Rodríguez
- Unidad de Apoyo a la Investigación, Facultad de Medicina, Universidad Francisco de Vitoria M-515, km 1, 800, 28223 Pozuelo de Alarcón, Spain; (C.A.-R.); (L.P.)
| | - Lola Prieto
- Unidad de Apoyo a la Investigación, Facultad de Medicina, Universidad Francisco de Vitoria M-515, km 1, 800, 28223 Pozuelo de Alarcón, Spain; (C.A.-R.); (L.P.)
| | - Gloria Ortega-Pérez
- Department of Surgical Oncology, Peritoneal Surface Oncology Program, MD Anderson Cancer Center, Calle Arturo Soria 270, 28033 Madrid, Spain;
| | - Santiago González-Moreno
- Department of Surgical Oncology, Peritoneal Surface Oncology Program, MD Anderson Cancer Center, Calle Arturo Soria 270, 28033 Madrid, Spain;
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Muñoz Casares FC, Padillo Ruiz FJ, González de Pedro C, Gómez Barbadillo J, Martín Broto J, Almoguera González F, Díaz Gómez D, Fernández-Hernández JÁ, González López JA, Asencio Pascual JM. Radical cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal sarcomatosis: Results from a reference center and considerations based on current evidence. Cir Esp 2024:S2173-5077(24)00150-9. [PMID: 38908514 DOI: 10.1016/j.cireng.2024.05.015] [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: 03/02/2024] [Accepted: 05/08/2024] [Indexed: 06/24/2024]
Abstract
INTRODUCTION Peritoneal sarcomatosis is a rare disease, with multiple histological origins and poor overall prognosis. The option of radical cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is controversial. The results of a surgical team experienced in these procedures are analyzed and discussed based on the available evidence. METHODS Study on a prospective database of patients with peritoneal sarcomatosis who underwent CRS and HIPEC, from 2016 to 2022, in a national reference center for sarcomas and peritoneal oncological surgery, who met the established inclusion/exclusion criteria. RESULTS 23 patients were included in the study, with a median age of 53 years (6-68). Recurrent/persistent clinical presentation predominated (78.3%). Visceral origin (including GIST and non-GIST peritoneal) accounted for 47.8% of patients, compared to 43.5% uterine and 8.7% retroperitoneal. The median PCI was 17 (3-36), with CC0 cytoreduction of 87%. Postoperative morbidity (Dindo Clavien III-IV) of 13%, with no postoperative mortality in the series. Overall survival and disease-free survival at 5 years were 64% and 34%, respectively. Histological grade was the most influential prognostic factor for survival. CONCLUSIONS The results of the series, with low morbidity, support the benefit of radical peritoneal oncological surgery in patients with peritoneal sarcomatosis after adequate selection, as long as it is performed in high-volume centers, experienced surgeons and expert multidisciplinary teams. However, the role of HIPEC remains to be demonstrated and pending future studies.
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Affiliation(s)
| | - Francisco Javier Padillo Ruiz
- Servicio de Cirugía General y del Aparato Digestivo, CSUR de Sarcomas y Tumores Músculo-Esqueléticos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carlos González de Pedro
- Servicio de Cirugía General y del Aparato Digestivo, CSUR de Sarcomas y Tumores Músculo-Esqueléticos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José Gómez Barbadillo
- Unidad Integral de Carcinomatosis Peritoneal y Sarcomas Retroperitoneales, Servicio Cirugía General y Aparato Digestivo, Hospital San Juan de Dios, Córdoba, Spain
| | - Javier Martín Broto
- Departamento Oncología Médica, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Francisco Almoguera González
- Servicio de Cirugía General y del Aparato Digestivo, CSUR de Sarcomas y Tumores Músculo-Esqueléticos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Daniel Díaz Gómez
- Servicio de Cirugía General y del Aparato Digestivo, CSUR de Sarcomas y Tumores Músculo-Esqueléticos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Juan Ángel Fernández-Hernández
- Sección Tumores Mesenquimales y Sarcomas de la Asociación Española de Cirujanos (AEC), Madrid, Spain; Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Los Arcos del Mar Menor, Pozo Aledo, Murcia, Spain
| | - José Antonio González López
- Sección Tumores Mesenquimales y Sarcomas de la Asociación Española de Cirujanos (AEC), Madrid, Spain; Servicio de Cirugía General y del Aparato Digestivo, CSUR de Sarcomas y Tumores Músculo-Esqueléticos, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Manuel Asencio Pascual
- Sección Tumores Mesenquimales y Sarcomas de la Asociación Española de Cirujanos (AEC), Madrid, Spain; Servicio de Cirugía General y del Aparato Digestivo, CSUR de Sarcomas y Tumores Músculo-Esqueléticos, Hospital Universitario Gregorio Marañón, Madrid, Spain
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Knotts CM, Osman MA, Aderonmu AA, Bahary N, Wagner PL, Bartlett DL, Allen CJ. Defining the Values and Quality of Life of Cancer Survivors Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: An International Survey Study. Ann Surg Oncol 2023; 30:7825-7832. [PMID: 37535272 DOI: 10.1245/s10434-023-14034-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Advances in treatment of peritoneal surface malignancies including cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS±HIPEC) have led to long-term survivorship, yet the subsequent quality of life (QOL) and values of these patients are unknown. PATIENTS AND METHODS Survivors were offered surveys via online support groups. Novel items assessed how patients prioritized experience, costs, longevity, and wellbeing. RESULTS Of the 453 gastrointestinal/hepatobiliary (GI/HPB) surgical patients that responded, 74 underwent CRS±HIPEC and were 54±12 years old, 87% female, and 93% white. Respondents averaged 29 months from diagnosis, with a maximum survival of 20 years. With a moderate level of agreement (W = 39%), rankings of value metrics among respondents were predictable (p < 0.001). Longevity and functional independence were ranked highest; treatment experience and cost of treatment were ranked lowest (p < 0.001). Those who underwent CRS±HIPEC or other GI/HPB surgeries reported the same rank order. QOL in CRS±HIPEC survivors, both mental (M-QOL) (44±13) and physical (P-QOL) (41±11) were lower than in the general population (50±10); p < 0.001. Impairments persisted throughout survivorship, but M-QOL improved over time (p < 0.05). When comparing CRS±HIPEC with other GI/HPB cancer surgery survivors, M-QOL (43±13 versus 43±14, p = 0.85) and P-QOL (40±11 versus 42±12, p = 0.41) were similar. CONCLUSIONS Although CRS±HIPEC survivors experience long-term mental and physical health impairments, they were similar to those experienced by survivors of other GI/HPB cancer surgeries, and their QOL improved significantly throughout survivorship. As CRS±HIPEC survivors prioritize longevity above all other metrics, survival benefit may outweigh a temporary reduction in QOL.
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Affiliation(s)
- Chelsea M Knotts
- Division of Surgical Oncology, Department of Surgery, Institute of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Mayar A Osman
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Nathan Bahary
- Institute of Medicine, Division of Medical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Patrick L Wagner
- Division of Surgical Oncology, Department of Surgery, Institute of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - David L Bartlett
- Division of Surgical Oncology, Department of Surgery, Institute of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Casey J Allen
- Division of Surgical Oncology, Department of Surgery, Institute of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
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Mendoza-Moreno F, Matías-García B, Quiroga-Valcárcel A, García-Moreno Nisa F, Díez-Corral C, Blázquez-Martín A, Vera-Mansilla C, Ovejero-Merino E, Díez-Alonso M, Diego-García L, Alvarez-Mon M, Ortega MA, Gutiérrez-Calvo A. Malignant adipocytic tumours: A 20‑year single‑centre retrospective study. Oncol Lett 2023; 25:247. [PMID: 37153046 PMCID: PMC10161324 DOI: 10.3892/ol.2023.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/22/2023] [Indexed: 05/09/2023] Open
Abstract
Adipocytic tumours are the most common soft tissue neoplasms. Among them, liposarcoma is the most frequent malignant neoplasm. However, to the best of our knowledge, no previously published study has assessed the evolution and oncological prognosis of the different subtypes of liposarcoma at the retroperitoneal level compared with at other locations. The present study is a retrospective observational study in which all patients were operated on between October 2000 and January 2020 with a histological diagnosis of liposarcoma. Variables, such as age, sex, location, histological type, recurrence, type of treatment and mortality, among others, were analysed. The patients were divided into two groups: Group A (retroperitoneal location) and group B (non-retroperitoneal location). A total of 52 patients with a diagnosis of liposarcoma (17 women and 35 men) and a mean age of 57.2±15.9 years were assessed. A total of 16 patients were classified into group A and 36 into group B. The OR of recurrence was 1.5 (P=0.02) for R1 vs. R0 resection in group A. The OR of recurrence in group B for R1 vs. R0 resection was 1.8 (P=0.77), whereas for R2 vs. R0 resection, the OR was 69 (P=0.011). In conclusion, 52 cases of malignant adipocytic tumours collected during 2000-2020 were analysed with the new World Health Organization classification (updated 2020). Although its recurrence potential and capacity for distant metastasis depended on each histological type, surgical treatment with unaffected margins was the main prognostic factor for survival. The present study identified differences in relation to the survival of each histological subtype and its location, finding greater survival in dedifferentiated liposarcoma, myxoid liposarcoma and pleomorphic liposarcoma located at the extraperitoneal level than in the retroperitoneal location. Resectability was not influenced by liposarcoma location.
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Affiliation(s)
- Fernando Mendoza-Moreno
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Alcalá de Henares, Spain
- Dr Fernando Mendoza-Moreno, Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Carretera Alcalá Meco s/n, 28805 Alcalá de Henares, Spain, E-mail:
| | - Belén Matías-García
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Alcalá de Henares, Spain
| | - Ana Quiroga-Valcárcel
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Alcalá de Henares, Spain
| | - Francisca García-Moreno Nisa
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Alcalá de Henares, Spain
| | - Cristina Díez-Corral
- Department of Pathological Anatomy, Príncipe de Asturias Teaching Hospital, 28805 Alcalá de Henares, Spain
| | - Alma Blázquez-Martín
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Alcalá de Henares, Spain
| | - Cristina Vera-Mansilla
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Alcalá de Henares, Spain
| | - Enrique Ovejero-Merino
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Alcalá de Henares, Spain
| | - Manuel Díez-Alonso
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Alcalá de Henares, Spain
| | - Lucía Diego-García
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Alcalá de Henares, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research, 28034 Madrid, Spain
- Immune System Diseases-Rheumatology and Internal Medicine Service, University Hospital Príncipe de Asturias, Liver and Digestive Diseases Networking Biomedical Research Centre, 28806 Alcalá de Henares, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research, 28034 Madrid, Spain
- Correspondence to: Dr Miguel A. Ortega, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Pl. de San Diego s/n, 28801 Alcalá de Henares, Spain, E-mail:
| | - Alberto Gutiérrez-Calvo
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Alcalá de Henares, Spain
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6
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Tseng WW, Swallow CJ, Strauss DC, Bonvalot S, Rutkowski P, Ford SJ, Gonzalez RJ, Gladdy RA, Gyorki DE, Fairweather M, Lee KW, Albertsmeier M, van Houdt WJ, Fau M, Nessim C, Grignani G, Cardona K, Quagliuolo V, Grignol V, Farma JM, Pennacchioli E, Fiore M, Hayes A, Tzanis D, Skoczylas J, Almond ML, Mullinax JE, Johnston W, Snow H, Haas RL, Callegaro D, Smith MJ, Bouhadiba T, Desai A, Voss R, Sanfilippo R, Jones RL, Baldini EH, Wagner AJ, Catton CN, Stacchiotti S, Thway K, Roland CL, Raut CP, Gronchi A. Management of Locally Recurrent Retroperitoneal Sarcoma in the Adult: An Updated Consensus Approach from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group. Ann Surg Oncol 2022; 29:7335-7348. [PMID: 35767103 DOI: 10.1245/s10434-022-11864-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgery is the mainstay of treatment for retroperitoneal sarcoma (RPS), but local recurrence is common. Biologic behavior and recurrence patterns differ significantly among histologic types of RPS, with implications for management. The Transatlantic Australasian RPS Working Group (TARPSWG) published a consensus approach to primary RPS, and to complement this, one for recurrent RPS in 2016. Since then, additional studies have been published, and collaborative discussion is ongoing to address the clinical challenges of local recurrence in RPS. METHODS An extensive literature search was performed, and the previous consensus statements for recurrent RPS were updated after review by TARPSWG members. The search included the most common RPS histologic types: liposarcoma, leiomyosarcoma, solitary fibrous tumor, undifferentiated pleomorphic sarcoma, and malignant peripheral nerve sheath tumor. RESULTS Recurrent RPS management was evaluated from diagnosis to follow-up evaluation. For appropriately selected patients, resection is safe. Nomograms currently are available to help predict outcome after resection. These and other new findings have been combined with expert recommendations to provide 36 statements, each of which is attributed a level of evidence and grade of recommendation. In this updated document, more emphasis is placed on histologic type and clarification of the intent for surgical treatment, either curative or palliative. Overall, the fundamental tenet of optimal care for patients with recurrent RPS remains individualized treatment after multidisciplinary discussion by an experienced team with expertise in RPS. CONCLUSIONS Updated consensus recommendations are provided to help guide decision-making for treatment of locally recurrent RPS and better selection of patients who would potentially benefit from surgery.
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Affiliation(s)
- William W Tseng
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
| | - Carol J Swallow
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, and Department of Surgery, University of Toronto, Toronto, Canada.
| | - Dirk C Strauss
- Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK
| | - Sylvie Bonvalot
- Department of Surgical Oncology, Institut Curie, PSL University, Paris, France
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Samuel J Ford
- Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Rebecca A Gladdy
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, and Department of Surgery, University of Toronto, Toronto, Canada
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, USA
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-Universität Munich, University Hospital, Munich, Germany
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Carolyn Nessim
- Department of Surgery, The Ottawa Hospital, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Torino, Italy
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Vittorio Quagliuolo
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Valerie Grignol
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elisabetta Pennacchioli
- Division of Melanoma, Sarcoma and Rare Tumor Surgery, European Institute of Oncology, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrew Hayes
- Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK
| | - Dimitri Tzanis
- Department of Surgical Oncology, Institut Curie, PSL University, Paris, France
| | - Jacek Skoczylas
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Max L Almond
- Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - John E Mullinax
- Sarcoma Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Wendy Johnston
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, and Department of Surgery, University of Toronto, Toronto, Canada
| | - Hayden Snow
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rick L Haas
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Myles J Smith
- Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK.,The Institute of Cancer Research, Chester Beatty Laboratories, London, UK
| | - Toufik Bouhadiba
- Department of Surgical Oncology, Institut Curie, PSL University, Paris, France
| | - Anant Desai
- Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Rachel Voss
- Sarcoma Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Roberta Sanfilippo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Robin L Jones
- The Institute of Cancer Research, Chester Beatty Laboratories, London, UK.,Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew J Wagner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Charles N Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Khin Thway
- Sarcoma Unit, Department of Pathology, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, USA
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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7
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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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8
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Multidisciplinary Management of Retroperitoneal Sarcoma: Diagnosis, Prognostic Factors and Treatment. Cancers (Basel) 2021; 13:cancers13164016. [PMID: 34439171 PMCID: PMC8392612 DOI: 10.3390/cancers13164016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/06/2021] [Indexed: 01/07/2023] Open
Abstract
Simple Summary The management of retroperitoneal sarcomas can be challenging due to the variety of their presentation, histopathological types, and behaviours. This literature review provides a comprehensive and practical overview of the management of retroperitoneal sarcomas, focusing on diagnostic challenges, prognostic factors, multidisciplinary aspects of treatment and new research perspectives. Abstract Retroperitoneal sarcomas (RPS) are rare cancers whose management can be challenging due to various presentation patterns, multiple organ involvement, and a high local and distant recurrence rate. Histopathology and prognostic factors analysis are essential to predict the behaviour of the disease and plan the best therapeutic strategy. To date, surgery is still the main therapeutic option that guarantees a chance of cure from the primary disease. While chemotherapy and radiotherapy seem to be good options for controlling metastatic and recurrent irresectable disease, their role in the treatment of primary RPS remains unclear. This literature review aims to provide a comprehensive overview of the multidisciplinary aspects of RPS management in high-volume centres, summarising the diagnostic path, the prognostic factors, and the most suitable therapeutic options.
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9
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Multimodal Therapy Including Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Can Result in Long-term Disease-free Survival in Pediatric Desmoplastic Small Round Cell Tumor With Extraperitoneal Disease. J Pediatr Hematol Oncol 2021; 43:228-231. [PMID: 32555030 DOI: 10.1097/mph.0000000000001861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
Desmoplastic small round cell tumor is a rare sarcoma with 5-year overall survival of 15%. An 8-year-old female presented with diffuse abdominal/pelvic desmoplastic small round cell tumor including numerous liver metastasis. She underwent neoadjuvant chemotherapy followed by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Residual disease was found shortly after CRS/HIPEC which was resected, followed by whole abdomen/pelvic radiation and autologous hematopoietic cell transplant. Previous papers have reported dismal survival in patients with liver metastasis and residual disease arguing against CRS/HIPEC. Our patient remains disease-free over 6 years after completing therapy indicating long-term survival is achievable with aggressive multimodal therapy.
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10
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Randle RW, Swett KR, Shen P, Stewart JH, Levine EA, Votanopoulos KI. Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in Peritoneal Sarcomatosis. Am Surg 2020. [DOI: 10.1177/000313481307900624] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the treatment most likely to achieve prolonged survival for peritoneal surface disease from various primaries, yet management of peritoneal sarcomatosis is controversial as a result of the propensity of sarcomas for hematogenous spread and the paucity of effective chemotherapy. Therefore, we reviewed our experience in patients with sarcomatosis. A retrospective analysis of a prospective database of 990 procedures was performed. Eastern Cooperative Oncology Group, age, type of primary, resection status, morbidity, mortality, and outcomes were reviewed. Over 20 years, 17 cytoreductions for sarcomatosis were performed. After excluding patients with gastrointestinal stromal tumor or uterine leiomyosarcoma, 10 procedures performed in seven patients remained. Median follow-up was 84.8 months. R0/1 resection was achieved in 60 per cent. The 30-day morbidity was 50 per cent; no operative mortality rate was observed. R2 resection had no long-term survivors. The reason for death was peritoneal recurrence in 57 per cent. Median survival was 21.6 months and five-year survival was 43 per cent. Median survival for patients with peritoneal sarcomatosis treated with CRS-HIPEC is similar with the historical reported survival before introducing chemoperfusion. Although a complete cytoreduction is related to improved survival, the role of HIPEC in these patients is unknown. A multi-institutional review will help define the role of CRS-HIPEC in this population.
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Affiliation(s)
- Reese W. Randle
- Surgical Oncology Service in the Departments of General Surgery and the
| | - Katrina R. Swett
- Department of Biostatistics, Wake Forest University, Winston-Salem, North Carolina
| | - Perry Shen
- Surgical Oncology Service in the Departments of General Surgery and the
| | - John H. Stewart
- Surgical Oncology Service in the Departments of General Surgery and the
| | - Edward A. Levine
- Surgical Oncology Service in the Departments of General Surgery and the
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11
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Fields AC, Lu PW, Li GZ, Welten V, Jolissaint JS, Vierra BM, Saadat LV, Larson AC, Atkinson RB, Melnitchouk N. Current practices and future steps for hyperthermic intraperitoneal chemotherapy. Curr Probl Surg 2020; 57:100727. [PMID: 32151327 DOI: 10.1016/j.cpsurg.2019.100727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/23/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Adam C Fields
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Pamela W Lu
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - George Z Li
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Vanessa Welten
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joshua S Jolissaint
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Lily V Saadat
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Abby C Larson
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rachel B Atkinson
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nelya Melnitchouk
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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12
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Sugarbaker PH. Long-term survival is possible using cytoreductive surgery plus HIPEC for sarcomatosis-Case report of 2 patients. Int J Surg Case Rep 2019; 64:10-14. [PMID: 31590134 PMCID: PMC6796721 DOI: 10.1016/j.ijscr.2019.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Sarcomatosis results from the dissemination of cells from an abdominal or pelvic primary sarcoma to the peritoneal surfaces. In most patients this is a lethal condition. METHODS The clinical and radiologic features of two patients with sarcomatosis were reviewed. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) were used for treatment. Current status of these two patients was available. RESULTS These two patients had a large extent of disease. In one, a myxoid sarcoma filled the pelvis. In another, all quadrants of the abdomen and pelvis were involved by peritoneal metastases from a uterine leiomyosarcoma. The grade of these two tumors was moderate and low. Surgical resection of all sarcomatosis was performed and this was followed by HIPEC. Clinical and radiologic follow-up at 37 and 58 months after complete cytoreduction show no evidence of disease. CONCLUSION An effort to identify patients with sarcomatosis who are predicted to have a complete cytoreduction should occur when these patients are evaluated. Patients with a complete resection and a sarcoma-specific HIPEC may have prolonged disease-free survival. No other treatments for these patients have been described.
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Affiliation(s)
- Paul H Sugarbaker
- Program in Peritoneal Surface Malignancies, MedStar Washington Hospital Center, 106 Irving St., NW, Suite 3900, Washington, DC, 20010, USA.
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13
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Naffouje SA, Tulla KA, Salti GI. A Simplified Peritoneal Sarcomatosis Score for patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Gastrointest Oncol 2019; 9:1138-1143. [PMID: 30603133 DOI: 10.21037/jgo.2018.08.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background With the introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), long-term survival can be achieved in selected patients with peritoneal surface malignancy. In patients with peritoneal sarcomatosis (PS), CRS/HIPEC remains a topic of debate. It is important that patient selection and outcome be improved with a tool that better predicts survival in such patients. To this end, we devised a Simplified Peritoneal Sarcomatosis Score (SPSS) adopted from the previously-described peritoneal surface disease severity score (PSDSS). Methods Patients were included if they were diagnosed with PS and underwent CRS/HIPEC with intended complete cytoreduction between 2007 and 2017. To calculate SPSS, we recorded symptoms (none =0, present =1), peritoneal carcinomatosis index (PCI) (≤10=0, >10=1), and grade of tumor (low =0, high =1). Thus, SPSS ranged from 0 to 3. SPSS-L (low) included patients with score of 0-1; SPSS-H (high) included patients with scores 2-3. Survival curves were generated using Kaplan-Meier method according to the two tiers of SPSS. Results Twenty-five patients were included. Mean age was 51.84±10.75 years. Median follow-up was 18 months. Compared to SPSS-H, SPSS-L patients had a longer median overall survival (OS) (36±16 vs. 16±6 months, respectively; P=0.021) and a longer median disease-free survival (DFS) (36±16 vs. 16±6 months, respectively; P<0.001). On multivariate analysis, advanced disease (SPSS-H) was an independent predictor of OS (P=0.020) and DFS (P=0.018). Conclusions SPSS can be used as a tool for patient selection for surgery, prognosis prediction, and stratification into clinical trials of PS patients.
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Affiliation(s)
- Samer A Naffouje
- Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Kiara A Tulla
- Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - George I Salti
- Division of Surgical Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.,Department of Surgical Oncology, Edward Cancer Center, Naperville, IL, USA
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14
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Zmora O, Hayes-Jordan A, Nissan A, Kventsel I, Newmann Y, Itskovsky K, Ash S, Levy-Mendelovich S, Shinhar D, Ben-Yaakov A, Toren A, Bilik R. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for disseminated intra-abdominal malignancies in children-a single-institution experience. J Pediatr Surg 2018; 53:1381-1386. [PMID: 29070431 DOI: 10.1016/j.jpedsurg.2017.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/03/2017] [Accepted: 09/02/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE Our purpose was to present our institutional experience with performing complete cytoreduction surgery and heated intraoperative chemotherapy (CRS-HIPEC) for children with disseminated intraabdominal malignancies, guided by a leading international center performing CRS-HIPEC in children. METHODS Retrospective chart review of all cases of CRS-HIPEC in children in our institution, examining diagnosis, preoperative management, operative management, postoperative treatment, short term outcome including length of stay and complications, and long term outcome including survival and recurrence of disease. RESULTS 9 children underwent CRS-HIPEC over 48months. The mean age of the patients was 8years. Tumors were: rhabdomyosarcoma (RMS), mesothelioma, Sertoli-Leydig, desmoplastic small round cell tumor, colon carcinoma and Wilms' tumor. Most patients received intraperitoneal cisplatin. Short term outcome was very good with median length of hospital stay of 13days and low rate of complications. Seven patients were alive at last follow up. Five patients developed a recurrent disease. Recurrence was intraabdominal in two of these patients. CONCLUSIONS CRS-HIPEC for children with disseminated intraabdominal malignancies performed in a dedicated institution and with guidance by a leading international center can be performed safely. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Osnat Zmora
- Department of Pediatric Surgery, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Andrea Hayes-Jordan
- Departmentof Pediatric Surgery, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Aviram Nissan
- Department of General and Oncological Surgery, Chaim Sheba Medical Center, Tel- Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Kventsel
- Department of Pediatric Hematology-Oncology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoram Newmann
- Department of Pediatric Hematology-Oncology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kira Itskovsky
- Department of Anesthesiology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shifra Ash
- Department of Pediatric Hematology-Oncology, Schneider Children's Hospital, 14 Kaplan St, Petah Tikva 20494, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarina Levy-Mendelovich
- Department of Pediatric Hematology-Oncology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Shinhar
- Department of Pediatric Surgery, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Almog Ben-Yaakov
- Department of General and Oncological Surgery, Chaim Sheba Medical Center, Tel- Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Toren
- Department of Pediatric Hematology-Oncology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Bilik
- Department of Pediatric Surgery, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Subbiah V, Lamhamedi-Cherradi SE, Cuglievan B, Menegaz BA, Camacho P, Huh W, Ramamoorthy V, Anderson PM, Pollock RE, Lev DC, Qiao W, McAleer MF, Benjamin RS, Patel S, Herzog CE, Daw NC, Feig BW, Lazar AJ, Hayes-Jordan A, Ludwig JA. Multimodality Treatment of Desmoplastic Small Round Cell Tumor: Chemotherapy and Complete Cytoreductive Surgery Improve Patient Survival. Clin Cancer Res 2018; 24:4865-4873. [PMID: 29871905 DOI: 10.1158/1078-0432.ccr-18-0202] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/07/2018] [Accepted: 06/01/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Desmoplastic small round cell tumor (DSRCT), which harbors EWSR1-WT1 t(11;22)(p13:q12) chromosomal translocation, is an aggressive malignancy that typically presents as intra-abdominal sarcomatosis in young males. Given its rarity, optimal treatment has not been defined.Experimental Design: We conducted a retrospective study of 187 patients with DSRCT treated at MD Anderson Cancer Center over 2 decades. Univariate and multivariate regression analyses were performed. We determined whether chemotherapy, complete cytoreductive surgery (CCS), hyperthermic intraperitoneal cisplatin (HIPEC), and/or whole abdominal radiation (WART) improve overall survival (OS) in patients with DSRCT. Critically, because our institutional practice limits HIPEC and WART to patients with less extensive, potentially resectable disease that had benefited from neoadjuvant chemotherapy, a time-variant analysis was performed to evaluate those adjunct treatment modalities.Results: The pre-2003 5-year OS rate of 5% has substantially improved to 25% with the advent of newer chemotherapies and better surgical and radiotherapy techniques (HR, 0.47; 95% CI, 0.29-0.75). Chemotherapy response (log rank P = 0.004) and CCS (log rank P < 0.0001) were associated with improved survival. Although WART and HIPEC lacked statistical significance, our study was not powered to detect their potential impact upon OS.Conclusions: Improved 3- and 5-year OS were observed following multidisciplinary treatment that includes Ewing sarcoma (ES)-based chemotherapy and complete tumor cytoreductive surgery, but few if any patients are cured. Prospective randomized studies will be required to prove whether HIPEC or WART are important. In the meantime, chemotherapy and CCS remain the cornerstone of treatment and provide a solid foundation to evaluate new biologically targeted therapies. Clin Cancer Res; 24(19); 4865-73. ©2018 AACR.
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Affiliation(s)
- Vivek Subbiah
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | | | - Branko Cuglievan
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian A Menegaz
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela Camacho
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Winston Huh
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vandhana Ramamoorthy
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pete M Anderson
- Department of Pediatric Hematology/Oncology/BMT, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Raphael E Pollock
- Division of Surgical Oncology, Ohio State University, Columbus, Ohio
| | - Dina C Lev
- Division of Surgical Oncology, Ohio State University, Columbus, Ohio
| | - Wei Qiao
- Division of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary Frances McAleer
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert S Benjamin
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shreyaskumar Patel
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cynthia E Herzog
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Najat C Daw
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Barry W Feig
- Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexander J Lazar
- Division of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrea Hayes-Jordan
- Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph A Ludwig
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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16
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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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17
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Hayes-Jordan AA, Coakley BA, Green HL, Xiao L, Fournier KF, Herzog CE, Ludwig JA, McAleer MF, Anderson PM, Huh WW. Desmoplastic Small Round Cell Tumor Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Results of a Phase 2 Trial. Ann Surg Oncol 2018; 25:872-877. [PMID: 29383611 DOI: 10.1245/s10434-018-6333-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Desmoplastic small round cell tumor (DSRCT) is a rare sarcoma that primarily affects adolescents and young adults. Patients can present with many peritoneal implants. We conducted a phase 2 clinical trial utilizing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) with cisplatin for DSRCT and pediatric-type abdominal sarcomas. PATIENTS AND METHODS A prospective cohort study was performed on 20 patients, who underwent CRS-HIPEC procedures, with cisplatin from 2012 to 2013. All patients were enrolled in the phase 2 clinical trial. Patients with extraabdominal disease and in whom complete cytoreduction (CCR0-1) could not be achieved were excluded. All outcomes were recorded. RESULTS Fourteen patients had DSRCT, while five patients had other sarcomas. One patient had repeat HIPEC. Patients with DSRCT had significantly longer median overall survival after surgery than patients with other tumors (44.3 vs. 12.5 months, p = 0.0013). The 3-year overall survival from time of diagnosis for DSRCT patients was 79 %. Estimated median recurrence-free survival (RFS) was 14.0 months. However, RFS for patients with DSRCT was significantly longer than for non-DSRCT patients (14.9 vs. 4.5 months, p = 0.0012). Among DSRCT patients, those without hepatic or portal metastases had longer median RFS than those with tumors at these sites (37.9 vs. 14.3 months, p = 0.02). In 100 % of patients without hepatic or portal metastasis, there was no peritoneal disease recurrence after CRS-HIPEC. CONCLUSIONS Complete CRS-HIPEC with cisplatin is effective in select DSRCT patients. DSRCT patients with hepatic or portal metastasis have poorer outcomes.
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Affiliation(s)
- Andrea A Hayes-Jordan
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Brian A Coakley
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Holly L Green
- Department of Pediatric Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - LianChun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keith F Fournier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cynthia E Herzog
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph A Ludwig
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary F McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Peter M Anderson
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Winston W Huh
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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18
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Stearns AT, Malcomson L, Punnett G, Abudeeb H, Aziz O, Selvasekar CR, Fulford PE, Wilson MS, Renehan AG, O’Dwyer ST. Long-term Quality of Life After Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei: A Prospective Longitudinal Study. Ann Surg Oncol 2018; 25:965-973. [DOI: 10.1245/s10434-017-6326-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Indexed: 12/16/2022]
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19
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Bagaria SP, Gabriel E, Mann GN. Multiply recurrent retroperitoneal liposarcoma. J Surg Oncol 2017; 117:62-68. [DOI: 10.1002/jso.24929] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/31/2017] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Gary N. Mann
- Arnot Health; Department of General and Oncologic Surgery; Elmira NY
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20
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Hinkle NM, Botta V, Sharpe JP, Dickson P, Deneve J, Munene G. The Impact of Early Recurrence on Quality of Life after Cytoreduction with HIPEC. Am Surg 2017. [DOI: 10.1177/000313481708300630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Improved oncological outcomes after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in highly selected patients have been well documented. The extensive nature of the procedure adversely affects quality of life (QoL). The aim of this study is to longitudinally evaluate QoL following CRS/HIPEC. This is a retrospective review of a prospectively maintained database of patients with peritoneal malignancies undergoing CRS/HIPEC. Clinicopathological data, oncologic outcomes, and QoL were analyzed preoperatively and post-operatively at 2 weeks, and 1, 3, 6, and 12 months. The Functional Assessment of Cancer Therapy-Colorectal instrument was used to determine changes in QoL after CRS/HIPEC and the impact of early recurrence (<12 months) on QoL. Thirty-six patients underwent CRS/HIPEC over 36 months. The median peritoneal cancer index score was 18 and the completeness of cytoreduction-0/1 rate was 97.2 per cent. Postoperative major morbidity was 16.7 per cent with one perioperative death. Disease-free survival was 12.6 months in patients with high-grade tumors versus 31.0 months in those with low-grade tumors (P = 0.03). QoL decreased postoperatively and improved to baseline in six months. Patients with early recurrence had a decrease in global QoL compared with preoperative QoL at 6 (P < 0.03) and 12 months (P < 0.05). This correlation was not found in patients who had not recurred. Patients who undergo CRS/HIPEC have a decrease in QoL that plateaus in 3 to 6 months. Early recurrence adversely impacts QoL at 6 and 12 months. This study emphasizes the importance of patient selection for CRS/HIPEC. The expected QoL trajectory in patients at risk for early recurrence must be carefully weighed against the potential oncological benefit of CRS/HIPEC.
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Affiliation(s)
- Nathan M. Hinkle
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Vandana Botta
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; and
| | - John P. Sharpe
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Paxton Dickson
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jeremiah Deneve
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gitonga Munene
- Western Michigan University Homer Stryker School of Medicine/West Michigan Cancer Center, Kalamazoo, Michigan
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21
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Hinkle NM, MacDonald J, Sharpe JP, Dickson P, Deneve J, Munene G. Cytoreduction with hyperthermic intraperitoneal chemotherapy: an appraisal of outcomes and cost at a newly established peritoneal malignancy program. Am J Surg 2016; 212:413-8. [DOI: 10.1016/j.amjsurg.2016.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 01/28/2023]
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22
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Feingold PL, Kwong MLM, Sabesan A, Sorber R, Rudloff U. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for gastric cancer and other less common disease histologies: is it time? J Gastrointest Oncol 2016; 7:87-98. [PMID: 26941987 DOI: 10.3978/j.issn.2078-6891.2015.098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is the fourth most commonly diagnosed cancer worldwide, and once spread to the peritoneum, has a 5-year survival of less than 5%. Recent years have demonstrated advances in the use of cytoreductive surgery (CRS) in combination with heated intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis due to various malignancies. The frequent desmoplastic stroma and poor vascularization impeding drug delivery particularly in the diffuse form of gastric cancer is thought to provide a sound rationale for a regionalized treatment approach in this disease. Here, we seek to review the available data to define the role of CRS and HIPEC in gastric cancer metastatic to the peritoneal surface, and furthermore, analyze the use of CRS and HIPEC in malignancies less commonly treated with the regionalized perfusion approach.
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Affiliation(s)
- Paul L Feingold
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mei Li M Kwong
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arvind Sabesan
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca Sorber
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Udo Rudloff
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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23
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Lambert LA, Harris A. Palliative cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion: current clinical practice or misnomer? J Gastrointest Oncol 2016; 7:112-21. [PMID: 26941989 DOI: 10.3978/j.issn.2078-6891.2015.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) is being used more and more frequently for the management of peritoneal carcinomatosis. Despite significant improvements in oncologic outcomes and the risk of complications and mortality, CRS/HIPEC remains one of the most morbid treatments offered for advanced cancers. Consequently CRS/HIPEC is still considered controversial by many, even in the setting of cancers that are potentially curable. However, as high volume surgical oncologists become more experienced with CRS/HIPEC, the potential role of "palliative CRS/HIPEC" in the management of peritoneal carcinomatosis is being raised. Given the often limited survival benefit expected after CRS/HIPEC, understanding the impact of the treatment on quality of life (QOL) needs to be an essential part of the decision to proceed and is critical to optimizing recovery afterwards. This article reviews the potential definitions of "palliative CRS/HIPEC" in various clinical contexts and describes the current state of the QOL experience after CRS/HIPEC.
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Affiliation(s)
- Laura A Lambert
- Divisions of Surgical Oncology and Palliative Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Ariana Harris
- Divisions of Surgical Oncology and Palliative Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
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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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25
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Sugarbaker P, Ihemelandu C, Bijelic L. Cytoreductive Surgery and HIPEC as a Treatment Option for Laparoscopic Resection of Uterine Leiomyosarcoma with Morcellation: Early Results. Ann Surg Oncol 2015; 23:1501-7. [PMID: 26545375 DOI: 10.1245/s10434-015-4960-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND A new and frequently utilized treatment option for symptomatic uterine leiomyoma is laparoscopic resection with morcellation so the specimen can be extracted through a small abdominal incision or through the vagina. Some of these tumors (approximately 0.2 %) have malignant foci of uterine leiomyosarcoma (ULMS) that is widely disseminated in the process of resection. These patients are in need of effective additional treatments. METHODS Patients with ULMS were treated with a standardized cytoreductive surgery (CRS), hyperthermic perioperative chemotherapy (HIPEC), and early postoperative intraperitoneal chemotherapy (EPIC) specifically designed for sarcomatosis. Distribution of disease by Peritoneal Cancer Index was recorded by preoperative computed tomography or magnetic resonance imaging and at the time of CRS. Completeness of cytoreduction score was determined after completion of CRS. Morbidity and mortality, as well as interval to start systemic chemotherapy, were prospectively recorded. RESULTS Six patients with disseminated ULMS after morcellation or slicing underwent CRS and HIPEC plus EPIC. All six patients had complete visible clearing of sarcoma prior to perioperative chemotherapy. Early intervention after morcellation was associated with a lesser extent of disease. No serious morbidity or mortality was observed in early referral patients, and patients eligible for systemic chemotherapy were treated with perioperative chemotherapy within 6 weeks of the CRS. CONCLUSIONS The future use of laparoscopic resection of ULMS with morcellation is currently under debate. However, patients after laparoscopic resection and morcellation have CRS and HIPEC plus EPIC as a treatment option. Results regarding short-term benefit are suggested by these early data, especially with early referral.
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Affiliation(s)
- Paul Sugarbaker
- Center for Gastrointestinal Malignancies, MedStar Washington Cancer Institute, Washington, DC, USA.
| | - Chukwuemeka Ihemelandu
- Center for Gastrointestinal Malignancies, MedStar Washington Cancer Institute, Washington, DC, USA
| | - Lana Bijelic
- Surgical Oncology, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
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26
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Inoue D, Yamamoto M, Sugita G, Kurokawa T, Yoshida Y. Debulking surgery and hyperthermic intraperitoneal chemotherapy in the management of a recurrent aggressive uterine myxoid leiomyosarcoma with peritoneal dissemination. Gynecol Oncol Rep 2015; 13:60-3. [PMID: 26425725 PMCID: PMC4563799 DOI: 10.1016/j.gore.2015.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/26/2015] [Accepted: 06/30/2015] [Indexed: 12/02/2022] Open
Abstract
A rare case of recurrent peritoneal sarcomatosis (PS) arising from aggressive uterine myxoid leiomyosarcoma was described. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) has the potential to improve outcomes in PS from uterine sarcoma. Careful patient selection for cytoreductive surgery with HIPEC is important to achieve better outcomes in PS.
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Affiliation(s)
- Daisuke Inoue
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Makoto Yamamoto
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Genki Sugita
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tetsuji Kurokawa
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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27
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Olimpiadi Y, Song S, Hu JS, Matcuk GR, Chopra S, Eisenberg BL, Sener SF, Tseng WW. Contemporary Management of Retroperitoneal Soft Tissue Sarcomas. Curr Oncol Rep 2015; 17:39. [DOI: 10.1007/s11912-015-0462-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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28
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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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29
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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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30
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Rettenmaier MA, Mendivil AA, Abaid LN, Brown JV, Micha JP, Wilcox AM, Goldstein BH. The feasibility of administering varying high-dose consolidation hyperthermic intraperitoneal chemotherapy with carboplatin in the treatment of ovarian carcinoma. Arch Gynecol Obstet 2014; 291:1381-6. [PMID: 25516177 DOI: 10.1007/s00404-014-3590-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 12/09/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Hyperthermic intraperitoneal chemotherapy (HIPEC) is an intriguing method of delivery wherein the cytotoxic agent is continuously heated and circulated throughout the peritoneum in an attempt to bolster drug efficacy. Despite HIPEC's potential, ascertaining the optimal dose without compromising patient tolerability remains indeterminate. METHODS We retrospectively evaluated 52 advanced stage ovarian cancer patients who were treated with consolidation HIPEC with carboplatin at varying doses (e.g., AUC 6, 8 or 10) subsequent to optimal debulking surgery and the attainment of a clinical complete response to their primary chemotherapy regimen. The following patient and operative characteristics were abstracted: demographics, surgery and pathology data, chemotherapy regimen, intraoperative results, toxicity, postoperative complications, length of hospital stay and survival data. RESULTS Twelve patients received HIPEC carboplatin at an AUC 6, 15 subjects were treated with carboplatin at an AUC 8 and 25 underwent carboplatin at an AUC 10. There were no intraoperative complications during the administration of HIPEC; mean estimated blood loss was 50 mL and length of hospital stay was 1.65 days. In the overall study population, 5 patients developed grade 3/4 anemia and 33 subjects exhibited grade ≤2 thrombocytopenia and neutropenia. Thirteen patients also developed grade ≤2 nausea on postoperative day 1, which was successfully addressed with anti-emetic therapy; there were no hospital readmissions. CONCLUSIONS The results from the current evaluation suggest that consolidation hyperthermic intraperitoneal chemotherapy with carboplatin is both feasible and reasonably tolerated, even at an AUC of 10. However, additional, randomized study of this procedure incorporating chemotherapy dose escalation with a more extensive patient population is warranted.
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Affiliation(s)
- Mark A Rettenmaier
- Gynecologic Oncology Associates, 351 Hospital Road, Suite 507, Newport Beach, CA, 92663, USA
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31
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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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32
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Shan LL, Saxena A, Shan BL, Morris DL. Quality of life after cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy for peritoneal carcinomatosis: A systematic review and meta-analysis. Surg Oncol 2014; 23:199-210. [PMID: 25466850 DOI: 10.1016/j.suronc.2014.10.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 08/19/2014] [Accepted: 10/17/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To review the effect of cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC) on health-related quality of life (HRQOL) in patients with peritoneal carcinomatosis. BACKGROUND CRS and HIPEC is increasingly performed with curative intent for peritoneal carcinomatosis. Significant morbidity rates are reported in the context of limited life-expectancy, necessitating accurate post-operative HRQOL outcome data. METHODS A systematic review of clinical studies published after January 2000 was performed using strict eligibility criteria. Key outcomes measures were post-operative HRQOL compared to pre-operative levels and reference populations. Quality appraisal and data tabulation were performed using pre-determined forms. Data were synthesised by narrative review and random-effects meta-analysis. Tau2 and I2 values and Funnel plots were analysed for consistency and bias. RESULTS 15 studies (1583 patients) were included. HRQOL declines at the 3-4 month time-point before becoming similar or better compared to pre-operative levels at 1 year. The pooled-effects of combined post-operative functional assessment of cancer therapy and European organisation for research and treatment quality of life questionnaire scores were significantly improved from baseline on overall health status (p=0.001) and emotional health (p=0.001). Physical health (p=0.83), social health (p=0.48) and functional health (p=0.24) remain similar. HRQOL after 1 year is less clear, but benefits may persist up to 5 years especially on overall and physical health domains. Evidence is conflicted and inconclusive on HRQOL compared to reference populations. Levels of consistency and bias were acceptable. CONCLUSIONS CRS and HIPEC for peritoneal carcinomatosis can confer small to medium benefits for HRQOL. These results should be interpreted with in caution due to the small studies and absence of more randomised controlled trials.
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Affiliation(s)
- Leonard L Shan
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Akshat Saxena
- UNSW Department of Surgery, St George Hospital, Gray Street, Kogarah, New South Wales, Australia.
| | - Bernard L Shan
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - David L Morris
- UNSW Department of Surgery, St George Hospital, Gray Street, Kogarah, New South Wales, Australia
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Honoré C, Amroun K, Vilcot L, Mir O, Domont J, Terrier P, Le Cesne A, Le Péchoux C, Bonvalot S. Abdominal Desmoplastic Small Round Cell Tumor: Multimodal Treatment Combining Chemotherapy, Surgery, and Radiotherapy is the Best Option. Ann Surg Oncol 2014; 22:1073-9. [DOI: 10.1245/s10434-014-4123-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Indexed: 01/01/2023]
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Quality of life after cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies: a systematic review. Eur J Surg Oncol 2014; 40:1605-13. [PMID: 25242382 DOI: 10.1016/j.ejso.2014.08.477] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/24/2014] [Accepted: 08/13/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cytoreductive Surgery (CRS) accompanied by Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a promising technique in the treatment of peritoneal metastatic disease. The complexity and the potential adverse effects of the procedure can significantly affect patients' Quality of Life (QoL). Few studies have assessed the impact of CRS + HIPEC in patients' QoL using structured and validated tools. This is a systematic review of the currently available published data, investigating the QoL after performing CRS + HIPEC for tumours of varying primary origin. METHODS We performed a systematic review of the studies indexed in PubMed database until July 2014, using as key phrase "quality of life" and "intraperitoneal chemotherapy", including studies using only validated questionnaires for assessing quality of life parameters. RESULTS 20 studies were identified that matched the criteria set. The results of these studies, although of significant heterogeneity, clearly demonstrate that although overall QoL scores drop in the immediate postoperative period, at an average of 3 months post procedure they recover to 80%-100% or even exceed baseline values. Furthermore, between 6 and 12 months postoperatively, overall QoL is improved in survivors compared to pre-operative status. CONCLUSIONS CRS and HIPEC is feasible as a treatment modality in selected patients with peritoneal metastatic disease and can preserve or even improve patients' overall quality of life.
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Jimenez WA, Sardi A, Nieroda C, Gushchin V. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of recurrent high-grade uterine sarcoma with peritoneal dissemination. Am J Obstet Gynecol 2014; 210:259.e1-8. [PMID: 24211479 DOI: 10.1016/j.ajog.2013.11.002] [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: 07/29/2013] [Revised: 09/26/2013] [Accepted: 11/04/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Peritoneal sarcomatosis from primary uterine sarcoma (US) is a rare condition. Conventional therapeutic modalities have failed to improve survival and outcomes among patients with high-grade US with extrapelvic spread. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown improved outcomes for peritoneal carcinomatosis from other epithelial primaries with similar clinical presentation. We report our experience applying this treatment in 3 patients with recurrent high-grade US with peritoneal dissemination. STUDY DESIGN This retrospective review of a prospective database of 378 patients with peritoneal dissemination of cancer treated with CRS/HIPEC identified 3 patients with recurrent high-grade US. Follow-up for disease progression was carried out by physical examination and computed tomography scan of the chest, abdomen, and pelvis. RESULTS Two leiomyosarcomas and 1 adenosarcoma with sarcomatous overgrowth were identified. Two of the 3 had failed standard treatment with surgery and systemic chemotherapy before CRS/HIPEC was performed. Follow-up ranged from 34 to 140 months. All 3 patients are alive, 2 with no evidence of disease (NED), and 1 alive with disease. Adramycin/cisplatin was used for HIPEC in 1 case (140 months with NED), whereas melphalan was used in the other 2 cases (53 months alive with disease, 34 months with NED). Two patients underwent 1 CRS/HIPEC, whereas 1 required 3 CRS/HIPEC due to disease recurrence. CONCLUSION CRS/HIPEC shows promise as a treatment modality for the management of selected patients with recurrent high-grade US with peritoneal dissemination. Further studies are warranted.
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Pennacchioli E, Fiore M, Gronchi A. Hyperthermia as an adjunctive treatment for soft-tissue sarcoma. Expert Rev Anticancer Ther 2014; 9:199-210. [DOI: 10.1586/14737140.9.2.199] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Hayes-Jordan A, Green HL, Lin H, Owusu-Agyemang P, Fitzgerald N, Arunkumar R, Mejia R, Okhuysen-Cawley R, Mauricio R, Fournier K, Ludwig J, Anderson P. Complete cytoreduction and HIPEC improves survival in desmoplastic small round cell tumor. Ann Surg Oncol 2014; 21:220-4. [PMID: 24046124 DOI: 10.1245/s10434-013-3269-y] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Desmoplastic small round cell tumor (DSRCT) is a rare tumor of adolescents and young adults. Less than 100 cases per year are reported in North America. Extensive peritoneal metastases are characteristic of this disease. We performed cytoreductive surgery and hyperthermic peritoneal perfusion with chemotherapy (HIPEC) using cisplatin (CDDP) for DSRCT. METHODS A retrospective cohort study was performed on 26 pediatric and adult patients who underwent cytoreduction/HIPEC using CDDP for DSRCT at a single cancer center. Neoadjuvant chemotherapy, adjuvant chemotherapy, and postoperative enteral nutrition were given to all patients. Postoperative radiation therapy was given to most patients. Follow-up was from 6 months to 6 years. Outcome variables were evaluated for disease-free and overall survival (OS). RESULTS Five patients (19 %) were less than 12 years of age at surgery. Patients who had disease outside the abdomen at surgery had a larger risk of recurrence or death than those who did not (p = 0.0158, p = 0.0393 time from surgery to death respectively). Age, liver metastasis, and peritoneal cancer index level did not significantly predict disease-free or OS. Patients who had CR0 or CR1 and HIPEC had significantly longer median survival compared with patients who had HIPEC and CR2 cytoreduction (63.4 vs. 26.7 months). CONCLUSIONS HIPEC may be an effective therapy for children and young adults with DSRCT. Patients with DSRCT require complete cytoreduction before HIPEC to optimize outcome. Patients with DSRCT and disease outside the abdomen at the time of surgery do not benefit from HIPEC.
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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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Baumgartner JM, Ahrendt SA, Pingpank JF, Holtzman MP, Ramalingam L, Jones HL, Zureikat AH, Zeh HJ, Bartlett DL, Choudry HA. Aggressive locoregional management of recurrent peritoneal sarcomatosis. J Surg Oncol 2013; 107:329-34. [DOI: 10.1002/jso.23232] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/10/2012] [Indexed: 11/07/2022]
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Huh WW, Fitzgerald NE, Mahajan A, Hayes-Jordan A. Peritoneal sarcomatosis in pediatric malignancies. Pediatr Blood Cancer 2013; 60:12-7. [PMID: 23002005 DOI: 10.1002/pbc.24293] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 07/25/2012] [Indexed: 01/02/2023]
Abstract
Peritoneal sarcomatosis (PSC) is defined as peritoneal involvement of multiple sarcomatous tumors. Desmoplastic small round cell tumors (DSRCT) and rhabdomyosarcomas are the most common pediatric PSC cases. PSC has been treated with chemotherapy and mainly palliative surgery, but long-term outcome has been poor. New imaging technologies have improved the evaluation of disease extent and patterns of peritoneal dissemination, and cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is being evaluated as a treatment option to prolong remission in pediatric patients. We will review the clinical characteristics, potential biologic mechanisms, radiographic characteristics, and potential therapies for pediatric PSC patients.
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Affiliation(s)
- Winston W Huh
- Division of Pediatrics, Children's Cancer Hospital of The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lee S, Kim J, Shim G, Kim S, Han SE, Kim K, Kwon IC, Choi Y, Kim YB, Kim CW, Oh YK. Tetraiodothyroacetic acid-tagged liposomes for enhanced delivery of anticancer drug to tumor tissue via integrin receptor. J Control Release 2012; 164:213-20. [DOI: 10.1016/j.jconrel.2012.05.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 05/19/2012] [Accepted: 05/26/2012] [Indexed: 11/27/2022]
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Hayes-Jordan A, Green H, Ludwig J, Anderson P. Toxicity of hyperthermic intraperitoneal chemotherapy (HIPEC) in pediatric patients with sarcomatosis/carcinomatosis: early experience and phase 1 results. Pediatr Blood Cancer 2012; 59:395-7. [PMID: 22492588 DOI: 10.1002/pbc.24160] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 03/13/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Intra-abdominal metastasis is a rare form of tumor dissemination in children. Complete surgical resection is usually deemed impossible. Children are frequently offered palliative care only. We adopted an aggressive approach for these cases which includes removal of dozens to hundreds of tumor nodules followed by perfusion of the abdominal cavity with hyperthermic chemotherapy (HIPEC) with a curative intent. METHODS We evaluated toxicity in 23 children and young adults undergoing 27 HIPEC procedures using cisplatin. Disease diagnoses included rhabdomyosarcoma (RMS), non-RMS soft tissue sarcoma, (NRSTS), desmoplastic small round cell tumor, (DSRCT), mesothelioma, Wilms tumor, melanomatosis, and adenocarcinoma. Patients underwent cytoreductive surgery followed by cisplatin at 40.5-41 °C, for 90 minutes. A subset of these patients was enrolled on our phase 1 study and as part of dose escalation cohort received 150 mg/m(2) of cisplatin. All toxicities were recorded. RESULTS Maximum tolerated dose was 100 mg/m(2). Dose limiting toxicity was grade 3 renal failure. In five of 27, 18% had grade 3 or higher renal failure. One patient developed a subclinical decrease in hearing and there were 2 grade 3 hematologic toxicities, 2 grade 3 hepatic toxicities, and one grade 3 ileus. One patient suffered grade3 cardiotoxicity. There were no operative/perioperative mortalities. Surgical complications occurred in 5/27 (18%) of patients. With a follow-up of 6-60 months, seven patients (26%) had no recurrence. CONCLUSIONS HIPEC is reasonably tolerated in pediatric patients with extensive abdominal metastasis. More study is needed to determine for which histologies HIPEC is most efficacious.
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Affiliation(s)
- A Hayes-Jordan
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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Salti GI, Ailabouni L, Undevia S. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for the Treatment of Peritoneal Sarcomatosis. Ann Surg Oncol 2012; 19:1410-5. [DOI: 10.1245/s10434-012-2240-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Indexed: 12/17/2022]
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Mullinax JE, Zager JS, Gonzalez RJ. Current diagnosis and management of retroperitoneal sarcoma. Cancer Control 2011; 18:177-87. [PMID: 21666580 DOI: 10.1177/107327481101800305] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Retroperitoneal sarcomas are rare neoplasms that often present with multivisceral involvement. Treatment for these tumors requires careful decision making requiring a combination of surgery, chemotherapy, and radiation therapy. METHODS We reviewed the scientific literature pertaining to the diagnosis and management of retroperitoneal sarcomas. We also identify recent developments in treatment and discuss future trends in the care of patients with this disease. RESULTS Retroperitoneal tumors often present as large, locally advanced lesions. Evaluation of these tumors requires careful consideration of a multimodality approach. Retrospective data and historical prospective series have demonstrated the survival benefit of radical resection for these tumors with en bloc resection of involved structures. Compartmental resections in the retroperitoneum along with debulking of high-grade disease and regional therapy are controversial approaches with significant morbidity that can lead to long-term survival. The application of neoadjuvant and adjuvant therapies in select tumor histologies may improve local control and survival. CONCLUSIONS The management of retroperitoneal sarcomas requires a multidisciplinary approach and is best accomplished at high-volume centers specializing in the care of patients with these complex malignancies. Current data suggest that radical resection remains the only chance for cure and that chemotherapy and radiation therapy may confer a survival benefit.
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Affiliation(s)
- John E Mullinax
- Department of Surgery at The University of South Florida College of Medicine, Tampa, Florida, USA
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Liu R, Wolinsky JB, Catalano PJ, Chirieac LR, Wagner AJ, Grinstaff MW, Colson YL, Raut CP. Paclitaxel-eluting polymer film reduces locoregional recurrence and improves survival in a recurrent sarcoma model: a novel investigational therapy. Ann Surg Oncol 2011; 19:199-206. [PMID: 21769471 DOI: 10.1245/s10434-011-1871-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Locoregional recurrences occur in up to 50% of patients after macroscopically complete (R0/R1) resections of abdominal, pelvic, and retroperitoneal sarcomas. Efficacy of a drug-eluting polymer film in reducing locoregional recurrence rates was assessed in a murine recurrent sarcoma model. METHODS Poly(glycerol monostearate-co-caprolactone) polymer films were synthesized with and without 300 μg paclitaxel (Pax-film and unloaded film). Cytotoxicity was assessed against CS-1 (human chondrosarcoma) cells in vitro and in vivo in nude mice. Following R0/R1 resection of primary subcutaneous tumors, mice were blindly randomized to: (1) Pax-film implant, (2) unloaded film implant, (3) paclitaxel 300 μg IV (Pax IV), or (4) no other therapy ("untreated"). Locoregional recurrence, overall survival (OS), and tumor mitotic index were evaluated. RESULTS Pax-films, but not unloaded films, reduced CS-1 viability in vitro for >50 days (P < 0.001). In vivo, locoregional recurrence was observed in 2 of 12 Pax-film mice (17%), 9 of 13 unloaded film mice (69%), 8 of 9 Pax IV mice (89%), and 7 of 8 untreated mice (88%) (P < 0.01). Median OS was 81, 64, 48, and 56 days, respectively. Paclitaxel levels in local tissues were 50- to 300-fold greater in Pax-film mice compared with Pax IV mice. Tumor mitotic index adjacent to Pax-films was significantly lower than adjacent to unloaded films. CONCLUSIONS Tumor bed implantation of Pax-films after R0/R1 resection is superior to Pax IV as evidenced by reduced locoregional recurrence and improved OS in a murine recurrent sarcoma model. Continuous local drug exposure via polymer films represents a potentially novel approach for treatment of locally aggressive sarcomas.
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Affiliation(s)
- Rong Liu
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Reduced dose-limiting toxicity of intraperitoneal mitoxantrone chemotherapy using cardiolipin-based anionic liposomes. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2010; 6:769-76. [DOI: 10.1016/j.nano.2010.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 04/21/2010] [Accepted: 05/12/2010] [Indexed: 11/21/2022]
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Munene G, Mack LA, Temple WJ. Systematic Review on the Efficacy of Multimodal Treatment of Sarcomatosis with Cytoreduction and Intraperitoneal Chemotherapy. Ann Surg Oncol 2010; 18:207-13. [DOI: 10.1245/s10434-010-1229-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Indexed: 01/31/2023]
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Mauricio RV, Green H, Hayes-Jordan A. Care of Pediatric Oncology Patients After Continuous Hyperthermic Peritoneal Perfusion. Crit Care Nurse 2010; 30:58-70; quiz 71. [DOI: 10.4037/ccn2010252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Riza V. Mauricio
- Riza V. Mauricio is a nurse practitioner in the pediatric intensive care unit at the Children’s Cancer Hospital of the University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Holly Green
- Holly Green is a surgical physician assistant at the Children’s Cancer Hospital of the University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Andrea Hayes-Jordan
- Andrea Hayes-Jordan is a pediatric surgeon and director of pediatric surgical oncology at the Children’s Cancer Hospital of the University of Texas M.D. Anderson Cancer Center, Houston, Texas
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Baratti D, Pennacchioli E, Kusamura S, Fiore M, Balestra MR, Colombo C, Mingrone E, Alessanrdro G, Deraco M. Peritoneal Sarcomatosis: Is There a Subset of Patients Who May Benefit from Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy? Ann Surg Oncol 2010; 17:3220-8. [DOI: 10.1245/s10434-010-1178-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Indexed: 12/12/2022]
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Stewart JH, Shen P, Levine EA. Intraperitoneal hyperthermic chemotherapy: an evolving paradigm for the treatment of peritoneal surface malignancies. Expert Rev Anticancer Ther 2009; 8:1809-18. [PMID: 18983241 DOI: 10.1586/14737140.8.11.1809] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Unfortunately, advanced colorectal cancer is often present at the time the disease is diagnosed. Many intra-abdominal malignancies spread throughout the peritoneal cavity, which is known as carcinomatosis. Peritoneal carcinomatosis is uniformly a terminal disease with a median survival of 6 months. Systemic chemotherapy is palliative and generally provides limited improvement in survival. Conventional surgery has typically been limited to ileostomy, colostomy or intestinal bypass procedures. Cytoreductive surgery alone has long been used to treat macroscopic disease, with limited success. However, cytoreductive surgery combined with intraperitoneal hyperthermic chemotherapy (IPHC) has evolved into a novel approach for peritoneal surface malignancy. IPHC was initially described in a canine model by Spratt. Although the first clinical series of peritoneal perfusion were small, Japanese trials, which utilized IPHC for prophylaxis in patients with gastric adenocarcinoma, Fujimoto was the first to report an improvement in survival for established gastric cracinomatosis. This early work provided the proof-of-principle for what has evolved into current management with aggressive cytoreduction and IPHC. The present review will outline the rationale, current practice and future directions of IPHC in the management of peritoneal surface malignancies.
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Affiliation(s)
- John H Stewart
- Surgical Oncology Service, Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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