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Arjona-Sánchez A, Espinosa-Redondo E, Gutiérrez-Calvo A, Segura-Sampedro JJ, Pérez-Viejo E, Concepción-Martín V, Sánchez-García S, García-Fadrique A, Prieto-Nieto I, Barrios-Sanchez P, Torres-Melero J, Ramírez Faraco M, Prada-Villaverde A, Carrasco-Campos J, Artiles-Armas M, Villarejo-Campos P, Ortega-Pérez G, Boldo-Roda E, Sánchez-Hidalgo JM, Casado-Adam A, Rodríguez-Ortiz L, Aranda E, Cano-Osuna MT, Díaz-López C, Romero-Ruiz A, Briceño-Delgado J, Rufián-Peña S. Efficacy and Safety of Intraoperative Hyperthermic Intraperitoneal Chemotherapy for Locally Advanced Colon Cancer: A Phase 3 Randomized Clinical Trial. JAMA Surg 2023; 158:683-691. [PMID: 37099280 PMCID: PMC10134040 DOI: 10.1001/jamasurg.2023.0662] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/23/2022] [Indexed: 04/27/2023]
Abstract
Importance Peritoneal metastasis in patients with locally advanced colon cancer (T4 stage) is estimated to recur at a rate of approximately 25% at 3 years from surgical resection and is associated with poor prognosis. There is controversy regarding the clinical benefit of prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) in these patients. Objective To assess the efficacy and safety of intraoperative HIPEC in patients with locally advanced colon cancer. Design, Setting, and Participants This open-label, phase 3 randomized clinical trial was conducted in 17 Spanish centers from November 15, 2015, to March 9, 2021. Enrolled patients were aged 18 to 75 years with locally advanced primary colon cancer diagnosed preoperatively (cT4N02M0). Interventions Patients were randomly assigned 1:1 to receive cytoreduction plus HIPEC with mitomycin C (30 mg/m2 over 60 minutes; investigational group) or cytoreduction alone (comparator group), both followed by systemic adjuvant chemotherapy. Randomization of the intention-to-treat population was done via a web-based system, with stratification by treatment center and sex. Main Outcomes and Measures The primary outcome was 3-year locoregional control (LC) rate, defined as the proportion of patients without peritoneal disease recurrence analyzed by intention to treat. Secondary end points were disease-free survival, overall survival, morbidity, and rate of toxic effects. Results A total of 184 patients were recruited and randomized (investigational group, n = 89; comparator group, n = 95). The mean (SD) age was 61.5 (9.2) years, and 111 (60.3%) were male. Median duration of follow-up was 36 months (IQR, 27-36 months). Demographic and clinical characteristics were similar between groups. The 3-year LC rate was higher in the investigational group (97.6%) than in the comparator group (87.6%) (log-rank P = .03; hazard ratio [HR], 0.21; 95% CI, 0.05-0.95). No differences were observed in disease-free survival (investigational, 81.2%; comparator, 78.0%; log-rank P = .22; HR, 0.71; 95% CI, 0.41-1.22) or overall survival (investigational, 91.7%; comparator, 92.9%; log-rank P = .68; HR, 0.79; 95% CI, 0.26-2.37). The definitive subgroup with pT4 disease showed a pronounced benefit in 3-year LC rate after investigational treatment (investigational: 98.3%; comparator: 82.1%; log-rank P = .003; HR, 0.09; 95% CI, 0.01-0.70). No differences in morbidity or toxic effects between groups were observed. Conclusions and Relevance In this randomized clinical trial, the addition of HIPEC to complete surgical resection for locally advanced colon cancer improved the 3-year LC rate compared with surgery alone. This approach should be considered for patients with locally advanced colorectal cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02614534.
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Affiliation(s)
- Alvaro Arjona-Sánchez
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofia, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
| | - Esther Espinosa-Redondo
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofia, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
| | - Alberto Gutiérrez-Calvo
- Unit of Peritoneal Oncologic Surgery, Surgery Department, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | | | - Vanessa Concepción-Martín
- Unit of Peritoneal Oncologic Surgery and Colorectal Surgery, Hospital University Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | | | | | - Pedro Barrios-Sanchez
- Unit of Surgery, Consorci Sanitari Integral, Hospital de Sant Joan Despí Moises Broggi, Barcelona, Spain
| | | | - Maria Ramírez Faraco
- Unit of Oncologic Surgery, University General Hospital Reina Sofia, Murcia, Spain
| | | | | | - Manuel Artiles-Armas
- Department of General and Digestive Surgery, University Hospital of Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | | | | | | | - Juan-Manuel Sánchez-Hidalgo
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofia, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
| | - Angela Casado-Adam
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofia, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
| | - Lidia Rodríguez-Ortiz
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofia, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
| | - Enrique Aranda
- Maimónides Biomedical Research Institute of Córdoba, University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
- Unit of Medical Oncology, University Hospital Reina Sofia, Córdoba, Spain
| | - Maria Teresa Cano-Osuna
- Maimónides Biomedical Research Institute of Córdoba, University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
- Unit of Medical Oncology, University Hospital Reina Sofia, Córdoba, Spain
| | - Cesar Díaz-López
- Maimónides Biomedical Research Institute of Córdoba, University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
| | - Antonio Romero-Ruiz
- Maimónides Biomedical Research Institute of Córdoba, University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
| | - Javier Briceño-Delgado
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofia, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
| | - Sebastian Rufián-Peña
- Unit of Oncologic and Pancreatic Surgery, University Hospital Reina Sofia, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain
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Bacalbasa N, Balescu I, Cretoiu D, Halmaciu I, Dimitriu M, Socea B, Diaconu C, Iliescu L, Savu C, Savu C, Filipescu A, Stoica C, Stiru O. Determination of whether HIPEC is beneficial in patients with synchronous peritoneal and liver metastases from colorectal cancer (Review). Exp Ther Med 2021; 22:1267. [PMID: 34594404 DOI: 10.3892/etm.2021.10702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/19/2021] [Indexed: 12/11/2022] Open
Abstract
Peritoneal carcinomatosis, as well as the presence of liver metastases from colorectal cancer, has been long considered as the sign of a systemic disease, transforming the patient into a candidate for palliation and best supportive care. However, in recent decades, progress in the field of medical and surgical oncology has allowed scientists worldwide to produce curative therapeutic strategies for these cases such as hyperthermic intraperitoneal chemotherapy (HIPEC) or extended liver resection. In addition, the association of these two therapies has also been performed with encouraging results. The aim of the current study was to review articles published thus far in regard to the association of these two therapeutic strategies, in order to identify which cases can benefit the most, which is the most efficient agent or combination of agents, and whether these types of therapy should be performed as monotherapy or as a two-stage procedure.
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Affiliation(s)
- Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'I. Cantacuzino' Clinical Hospital, 030167 Bucharest, Romania
| | - Irina Balescu
- Department of Visceral Surgery, 'Ponderas' Academic Hospital, 021188 Bucharest, Romania
| | - Dragos Cretoiu
- Department of Cellular, Molecular and Histology Biology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Cellular and Molecular Biology and Histology Scientific Researcher, 'Alessandrescu-Rusescu' National Institute of Mother and Child Health, Fetal Medicine Excellence Research Center, 020395 Bucharest, Romania
| | - Ioana Halmaciu
- Department of Anatomy, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540142 Târgu Mureș, Romania
| | - Mihai Dimitriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Bogdan Socea
- Department of Surgery, 'Sf. Pantelimon' Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Laura Iliescu
- Department of Internal Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Cornel Savu
- Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Thoracic Surgery, 'Marius Nasta' Institute of Pneumonology, 050159 Bucharest, Romania
| | - Carmen Savu
- Department of Anesthesiology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Alexandru Filipescu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Elias' Emergency Hospital, 125100 Bucharest, Romania
| | - Claudia Stoica
- Department of Visceral Surgery, County Emergency Hospital Ilfov, 022104 Bucharest, Romania
| | - Ovidiu Stiru
- Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Cardiovascular Surgery, 'Prof. Dr. C. C. Iliescu' Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
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3
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Shelygin YA, Sushkov OI, Sukhina MA, Saifutdinova KR, Muratov II, Shakhmatov DG, Achkasov SI. [Effectiveness of intraperitoneal chemotherapy for t4 colon cancer]. Khirurgiia (Mosk) 2020:36-43. [PMID: 33047584 DOI: 10.17116/hirurgia202010136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the effect of intraperitoneal chemotherapy (IPC) with mitomycin C on expression of intraperitoneal cancer cells markers in patients with T4 colon cancer. MATERIAL AND METHODS For the period from January 2019 to April 2020, 65 patients with T4 colon cancer were included in prospective comparative study. There were 46 patients in the main group and 19 patients in the control group. In the main group, surgical procedure was followed by IPC with mitomycin C. No IPC was performed in the control group. An effectiveness of IPC was evaluated using CD133, CD24, CD26, CD44, CD184 markers expression in peritoneal lavages. RESULTS Significant between-group differences were observed for CD133 (p=0.0168), CD24 (p=0.0455) and CD44 (p=0.0012). There was a tendency to decrease in the level of CD184 expression in both groups in the second lavage (p=0.0605). CONCLUSION IPC in patients with T4 colon cancer can reduce the expression and proliferative potential of free cancer cells.
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Affiliation(s)
- Yu A Shelygin
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - O I Sushkov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - M A Sukhina
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - K R Saifutdinova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - I I Muratov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - D G Shakhmatov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - S I Achkasov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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4
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Baaten ICPA, West NP, Quyn AJ, Seymour MT, Seligmann JF. Colorectal cancer peritoneal metastases: Biology, treatment and next steps. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:675-683. [PMID: 31806517 DOI: 10.1016/j.ejso.2019.10.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/18/2019] [Accepted: 10/28/2019] [Indexed: 01/22/2023]
Abstract
The presence of peritoneal metastases in patients with advanced colorectal cancer is associated with poor prognosis but the mechanisms for this are unclear. This review summarises the current knowledge of the pathophysiology, clinical features, prevalence, prognosis, and molecular biology of peritoneal metastases and the risk factors for the development of peritoneal metastases following resection of a primary colorectal tumour. Furthermore, the evidence for treatment strategies are described including cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, early post-operative intraperitoneal chemotherapy, sequential post-operative intraperitoneal chemotherapy and emerging novel strategies. Active areas of research should include the identification of individuals at high risk of peritoneal metastases after curative resection of primary tumour, development of a surveillance program for high-risk patients, optimisation of systematic therapies and further investigation of the use of intraperitoneal chemotherapy.
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Affiliation(s)
- Ilona C P A Baaten
- Leeds Institute of Clinical Trial Research, University of Leeds, Leeds, United Kingdom.
| | - Nicholas P West
- Leeds Institute of Medical Research at St. James's, University of Leeds, St James's University Hospital, Beckett Street, Leeds, United Kingdom.
| | - Aaron J Quyn
- Leeds Institute of Medical Research at St. James's, University of Leeds, St James's University Hospital, Beckett Street, Leeds, United Kingdom.
| | - Matthew T Seymour
- Leeds Institute of Medical Research at St. James's, University of Leeds, St James's University Hospital, Beckett Street, Leeds, United Kingdom.
| | - Jenny F Seligmann
- Leeds Institute of Medical Research at St. James's, University of Leeds, St James's University Hospital, Beckett Street, Leeds, United Kingdom.
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5
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Saifutdinova KR, Sushkov OI, Achkasov SI. [Prevention of carcinomatosis in colon cancer]. Khirurgiia (Mosk) 2019:88-92. [PMID: 31714536 DOI: 10.17116/hirurgia201911188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Colorectal cancer (CRC) is one of the leading forms of cancer. In 2017, over 72,000 of Russian citizens have been diagnosed with CRC. Cancer stage IV was diagnosed in 18 149 of them. Peritoneal carcinomatosis (PC) is one of the forms of metastatic dissemination throughout the peritoneum. There no any unified and standardized approaches to the treatment or prevention of PC associated with CRC. Therefore, it is advisable to identify PC predictors in patients with colon cancer and prevention measures.
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Affiliation(s)
- K R Saifutdinova
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - O I Sushkov
- State Scientific Centre of Coloproctology, Moscow, Russia
| | - S I Achkasov
- State Scientific Centre of Coloproctology, Moscow, Russia
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Morris MC, Dhar VK, Stevenson MA, Winer LK, Lee TC, Wang J, Ahmad SA, Patel SH, Sussman JJ, Abbott DE. Adjuvant Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for patients at High-Risk of Peritoneal Metastases. Surg Oncol 2019; 31:33-37. [PMID: 31518971 DOI: 10.1016/j.suronc.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 08/01/2019] [Accepted: 09/04/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Selection of patients for hyperthermic intraperitoneal chemotherapy (HIPEC) continues to evolve. We hypothesized that adjuvant HIPEC for patients at high-risk of peritoneal progression is safe and associated with favorable outcomes. METHODS The institutional database of a high-volume center was queried for patients with high-risk disease undergoing HIPEC with a peritoneal carcinomatosis index (PCI) of 0. High-risk patients were defined as those with ruptured primary tumors or locally advanced (T4) disease. RESULTS 37 patients underwent adjuvant HIPEC, with a median follow-up of 5.2 years. 54% had low-grade (LG) tumors while 46% had high-grade (HG) tumors. No patients underwent neoadjuvant chemotherapy, while eleven patients (32.4%) received adjuvant chemotherapy. There were no perioperative mortalities, and the overall complication rate was 43%. For the entire cohort, five year recurrence-free survival (RFS) and overall survival (OS) were 77% and 100%, respectively. Five year RFS and OS were 75% and 100% for LG patients and 81% and 100% for HG patients, respectively. CONCLUSIONS Adjuvant HIPEC for patients at high-risk of peritoneal progression, with PCI 0, is safe and associated with favorable long-term survival. Additional prospective investigation is needed to identify patient populations who may benefit most from HIPEC.
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Affiliation(s)
- Mackenzie C Morris
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vikrom K Dhar
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Megan A Stevenson
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Leah K Winer
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tiffany C Lee
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jiang Wang
- Department of Pathology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Syed A Ahmad
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sameer H Patel
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey J Sussman
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel E Abbott
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Steffen T, Putora PM, Hübner M, Gloor B, Lehmann K, Kettelhack C, Adamina M, Peterli R, Schmidt J, Ris F, Glatzer M. Diagnostic Nodes of Patient Selection for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Among Colorectal Cancer Patients: A Swiss National Multicenter Survey. Clin Colorectal Cancer 2019; 18:e335-e342. [PMID: 31371166 DOI: 10.1016/j.clcc.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The management of patients with colorectal cancer (CRC) with peritoneal metastases is challenging, and the roles of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are unclear and debated among experts. MATERIALS AND METHODS The experts of the Swiss Peritoneal Cancer Group were contacted and agreed to participate in this analysis. Experts from 9 centers in Switzerland provided their decision algorithms for CRS/HIPEC for patients with or at high risk for peritoneal metastases from CRC. Their responses were converted into decision trees on the basis of objective consensus methodology. The decision trees were used as a basis to identify consensus and discrepancies. RESULTS The final treatment algorithms included a total of 5 decision criteria (age, Peritoneal Cancer Index [PCI], extraperitoneal metastases, Peritoneal Surface Disease Severity Score, and various risk factors [RF]) and 2 treatment options (HIPEC, yes or no). HIPEC was never recommended for patients without peritoneal metastases in the absence of RF for peritoneal metastases. For patients with a PCI ≤15 without organ metastases, all centers recommended CRS/HIPEC. There was also a consensus not to perform CRS/HIPEC in elderly patients (80 years and older), those with a PCI >20, and those with unresectable metastases. For patients with a PCI = 16 to 20, there was no consensus. CONCLUSION Multiple decision criteria relevant to all participating centers were identified. Because patient selection for CRS/HIPEC remains difficult, uniform criteria for the term "high risk" for peritoneal metastases and systemic metastases are helpful. Future trials and guidelines should take these criteria into account.
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Affiliation(s)
- Thomas Steffen
- Department of Surgery, Kantonsspital St Gallen, St Gallen, Switzerland.
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Bern, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Beat Gloor
- Department of Surgery, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Kuno Lehmann
- Department of Surgery and Transplantation, University Hospital of Zürich, Zürich, Switzerland
| | | | - Michel Adamina
- Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Ralph Peterli
- Department of Surgery, St Claraspital, Basel, Switzerland
| | - Jan Schmidt
- Department of Surgery, Klinik Hirslanden, Zürich, Switzerland
| | - Frédéric Ris
- Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Markus Glatzer
- Department of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
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8
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Sugarbaker PH. Prevention and Treatment of Peritoneal Metastases: a Comprehensive Review. Indian J Surg Oncol 2019; 10:3-23. [PMID: 30948866 PMCID: PMC6414583 DOI: 10.1007/s13193-018-0856-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/04/2018] [Indexed: 02/06/2023] Open
Abstract
Peritoneal metastases may occur from a majority of cancers that occur within the abdomen or pelvis. When cancer spread to the peritoneal surfaces is documented, a decision regarding palliation versus an aggressive approach using cytoreductive surgery (CRS) and hyperthermic perioperative intraperitoneal chemotherapy (HIPEC) must be made. This decision is dependent on a well-defined group of prognostic indicators. In addition to treatment, prevention of peritoneal metastases may be an option. The clinical and pathologic features of a primary cancer can be used to select perioperative treatments that may prevent cancer cells within the abdomen and pelvis from progressing to established peritoneal metastases. In some clinical situations with appendiceal and colorectal cancers, the clinical or histopathologic features may indicate that second-look surgery plus perioperative chemotherapy should occur. Peritoneal metastases should always be considered by the multidisciplinary team for treatment or prevention.
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Affiliation(s)
- Paul H. Sugarbaker
- Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, 106 Irving St., NW, Suite 3900, Washington, DC 20010 USA
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9
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Goéré D, Sourrouille I, Gelli M, Benhaim L, Faron M, Honoré C. Peritoneal Metastases from Colorectal Cancer. Surg Oncol Clin N Am 2018; 27:563-583. [DOI: 10.1016/j.soc.2018.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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10
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Abstract
PURPOSE OF REVIEW Peritoneal metastases may occur from a majority of cancers that occur within the abdomen or pelvis. When cancer spread to the peritoneal surfaces is documented, a decision regarding palliation vs. an aggressive approach using cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy must be made. The perioperative chemotherapy may be hyperthermic intraperitoneal chemotherapy (HIPEC) administered in the operating room or early postoperative intraperitoneal chemotherapy (EPIC) administered in the first 4 or 5 postoperative days. RECENT FINDINGS This decision is dependent on a well-defined group of prognostic indicators. In addition to treatment, the clinical and pathologic features of a primary cancer can be used to select perioperative treatments that may prevent cancer cells within the abdomen and pelvis from progressing to established peritoneal metastases. In some clinical situations with appendiceal and colorectal cancers, the clinical or histopathologic features may indicate that second-look surgery plus perioperative chemotherapy should occur. Peritoneal metastases should always be considered for treatment or prevention.
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11
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Arjona-Sánchez A, Barrios P, Boldo-Roda E, Camps B, Carrasco-Campos J, Concepción Martín V, García-Fadrique A, Gutiérrez-Calvo A, Morales R, Ortega-Pérez G, Pérez-Viejo E, Prada-Villaverde A, Torres-Melero J, Vicente E, Villarejo-Campos P, Sánchez-Hidalgo JM, Casado-Adam A, García-Martin R, Medina M, Caro T, Villar C, Aranda E, Cano-Osuna MT, Díaz-López C, Torres-Tordera E, Briceño-Delgado FJ, Rufián-Peña S. HIPECT4: multicentre, randomized clinical trial to evaluate safety and efficacy of Hyperthermic intra-peritoneal chemotherapy (HIPEC) with Mitomycin C used during surgery for treatment of locally advanced colorectal carcinoma. BMC Cancer 2018; 18:183. [PMID: 29439668 PMCID: PMC5812226 DOI: 10.1186/s12885-018-4096-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 02/05/2018] [Indexed: 12/13/2022] Open
Abstract
Background Local relapse and peritoneal carcinomatosis (PC) for pT4 colon cancer is estimated in 15,6% and 36,7% for 12 months and 36 months from surgical resection respectively, achieving a 5 years overall survival of 6%. There are promising results using prophylactic HIPEC in this group of patients, and it is estimated that up to 26% of all T4 colon cancer could benefit from this treatment with a minimal morbidity. Adjuvant HIPEC is effective to avoid the possibility of peritoneal seeding after surgical resection. Taking into account these results and the cumulative experience in HIPEC use, we will lead a randomized controlled trial to determine the effectiveness and safety of adjuvant treatment with HIPEC vs. standard treatment in patients with colon cancer at high risk of peritoneal recurrence (pT4). Methods/Design The aim of this study is to determine the effectiveness and safety of adjuvant HIPEC in preventing the development of PC in patients with colon cancer with a high risk of peritoneal recurrence (cT4). This study will be carried out in 15 Spanish HIPEC centres. Eligible for inclusion are patients who underwent curative resection for cT4NxM0 stage colon cancer. After resection of the primary tumour, 200 patients will be randomized to adjuvant HIPEC followed by routine adjuvant systemic chemotherapy in the experimental arm, or to systemic chemotherapy only in the control arm. Adjuvant HIPEC will be performed simultaneously after the primary resection. Mitomycin C will be used as chemotherapeutic agent, for 60 min at 42–43 °C. Primary endpoint is loco-regional control (LC) in months and the rate of loco-regional control (%LC) at 12 months and 36 months after resection. Discussion We assumed that adjuvant HIPEC will reduce the expected absolute risk of peritoneal recurrence from 36% to 18% at 36 months for T4 colon-rectal carcinoma. Trial registration NCT02614534 (clinicaltrial.gov) Nov-2015.
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Affiliation(s)
- A Arjona-Sánchez
- Unit of Oncologic and Pancreatic Surgery, Hospital University Reina Sofía, Menendez Pidal Av, 14004, Córdoba, Spain. .,CIBERehd, IMIBIC, Hospital University Reina Sofía, Cordoba, Spain.
| | - P Barrios
- Unit of Surgery, Consorci Sanitari Integral, Hospital de Sant Joan Despí Moises Broggi, Barcelona, Spain
| | - E Boldo-Roda
- Unit of Surgery, Hospital Provincial Castellón, Castellón, Spain
| | - B Camps
- Unit of Oncologic Surgery, Hospital Clinico Universitary Valencia, Valencia, Spain
| | - J Carrasco-Campos
- Unit of Surgery, Hospital Regional University of Malaga, Malaga, Spain
| | - V Concepción Martín
- Unit of Peritoneal Oncologic Surgery and Colorectal Surgery, Hospital University Nuestra Señora de la Candelaria, Tenerife, Spain
| | - A García-Fadrique
- Department of Surgery, Instituto Valenciano de Oncología, Valencia, Spain
| | - A Gutiérrez-Calvo
- Surgery Department, Unit of Peritoneal Oncologic Surgery, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - R Morales
- Unit of Oncologic and Pancreatic Surgery, Hospital Son Spaces, Palma de Mallorca, Spain
| | | | - E Pérez-Viejo
- Unit of Oncologic Surgery, Hospital University Fuenlabrada, Madrid, Spain
| | | | | | - E Vicente
- Department of Surgery, Sanchinarro University Hospital. "Clara Campal" Oncological Center. San Pablo University. CEU, Madrid, Spain
| | | | - J M Sánchez-Hidalgo
- Unit of Oncologic and Pancreatic Surgery, Hospital University Reina Sofía, Menendez Pidal Av, 14004, Córdoba, Spain.,CIBERehd, IMIBIC, Hospital University Reina Sofía, Cordoba, Spain
| | - A Casado-Adam
- Unit of Oncologic and Pancreatic Surgery, Hospital University Reina Sofía, Menendez Pidal Av, 14004, Córdoba, Spain.,CIBERehd, IMIBIC, Hospital University Reina Sofía, Cordoba, Spain
| | - Ruben García-Martin
- Unit of Oncologic and Pancreatic Surgery, Hospital University Reina Sofía, Menendez Pidal Av, 14004, Córdoba, Spain
| | - Manuel Medina
- CIBERehd, IMIBIC, Hospital University Reina Sofía, Cordoba, Spain.,Unit of Pathology. Hospital University Reina Sofia, Cordoba, Spain
| | - T Caro
- CIBERehd, IMIBIC, Hospital University Reina Sofía, Cordoba, Spain.,Unit of Pathology. Hospital University Reina Sofia, Cordoba, Spain
| | - C Villar
- CIBERehd, IMIBIC, Hospital University Reina Sofía, Cordoba, Spain.,Unit of Pathology. Hospital University Reina Sofia, Cordoba, Spain
| | - Enrique Aranda
- CIBERehd, IMIBIC, Hospital University Reina Sofía, Cordoba, Spain.,Unit of Oncology, Hospital University Reina Sofia, Cordoba, Spain
| | - M T Cano-Osuna
- CIBERehd, IMIBIC, Hospital University Reina Sofía, Cordoba, Spain.,Unit of Oncology, Hospital University Reina Sofia, Cordoba, Spain
| | - C Díaz-López
- CIBERehd, IMIBIC, Hospital University Reina Sofía, Cordoba, Spain.,Unit of Colorectal Surgery, Hospital University Reina Sofia, Cordoba, Spain
| | - E Torres-Tordera
- Unit of Colorectal Surgery, Hospital University Reina Sofia, Cordoba, Spain
| | - F J Briceño-Delgado
- Unit of Oncologic and Pancreatic Surgery, Hospital University Reina Sofía, Menendez Pidal Av, 14004, Córdoba, Spain.,CIBERehd, IMIBIC, Hospital University Reina Sofía, Cordoba, Spain
| | - S Rufián-Peña
- Unit of Oncologic and Pancreatic Surgery, Hospital University Reina Sofía, Menendez Pidal Av, 14004, Córdoba, Spain.,CIBERehd, IMIBIC, Hospital University Reina Sofía, Cordoba, Spain
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12
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Virzì S, Iusco D, Baratti D, Bonomi S, Grassi A, Kusamura S, Deraco M. Pilot study of adjuvant hyperthermic intraperitoneal chemotherapy in patients with colorectal cancer at high risk for the development of peritoneal metastases. TUMORI JOURNAL 2018; 99:589-95. [DOI: 10.1177/030089161309900505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Aims and background The prognosis of peritoneal metastases from colorectal cancer has recently improved with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Although outcomes are further improved when early stage peritoneal metastases are treated, adjuvant hyperthermic intraperitoneal chemotherapy has never been thoroughly addressed. This prospective pilot study assessed feasibility, safety and efficacy of hyperthermic intraperitoneal chemotherapy combined with primary curative surgery in colorectal cancer at high risk for peritoneal metastases. Methods Twelve patients were prospectively selected according to predetermined risk factors for the development of peritoneal metastases. Patients underwent conventional colon surgery, closed-abdomen mitomycin-C plus cisplatin-based hyperthermic intraperitoneal chemotherapy, and cytoreductive surgical procedures, as needed. Results Preoperative tumor-related risk factors were confirmed by intraoperative findings and pathological examination in all patients: minimal synchronous peritoneal metastases (n = 2), synchronous ovarian metastases (n = 1), positive peritoneal washing cytology (n = 2), primary tumor directly invading other organs (n = 6), or penetrating visceral peritoneum (n = 1). Major morbidity occurred in 2 patients and operative death in none. Median follow-up was 49 months (range, 22–72). Peritoneal metastases occurred in 1 patient and distant metastases in 2. Five-year overall survival was 83.3%. Conclusions Preoperative/early intraoperative assessment can reliably identify colorectal cancer patients at high risk for peritoneal metastases. Adjuvant hyperthermic intraperitoneal chemotherapy is well tolerated and safe. These preliminary results would support the design of future phase-III trials of adjuvant hyperthermic intraperitoneal chemotherapy.
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Affiliation(s)
- Salvatore Virzì
- General Surgery Unit, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO)
| | - Domenico Iusco
- General Surgery Unit, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO)
| | - Dario Baratti
- Peritoneal Surface Malignancy Program, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Serena Bonomi
- General Surgery Unit, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO)
| | - Antonio Grassi
- General Surgery Unit, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO)
| | - Shigeki Kusamura
- Peritoneal Surface Malignancy Program, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marcello Deraco
- Peritoneal Surface Malignancy Program, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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13
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Feingold PL, Klemen ND, Kwong MLM, Hashimoto B, Rudloff U. Adjuvant intraperitoneal chemotherapy for the treatment of colorectal cancer at risk for peritoneal carcinomatosis: a systematic review. Int J Hyperthermia 2017; 34:501-511. [PMID: 29214884 DOI: 10.1080/02656736.2017.1401742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The peritoneal surface is the second most common site of disease recurrence, after the liver, following definitive surgery for colorectal cancer. Adjuvant intraperitoneal (IP) chemotherapy delivered at time of surgical resection has the potential to delay or prevent future spread to the peritoneal surface and improve clinical outcome. The exact role of adjuvant IP chemotherapy in colorectal cancer, including its associated morbidity and mortality, is not well defined. STUDY DESIGN Systematic review and pooled random effect analysis of comparative trials examining the addition of adjuvant IP chemotherapy compared to surgery alone in colorectal cancer. The primary outcome was overall survival, and the secondary outcomes were of post-operative morbidity and mortality. RESULTS In nine colorectal cancer studies identified, seven were two-arm trials comparing adjuvant IP chemotherapy to surgery alone. Of these, four trials had outcome reporting and met criteria that allowed inclusion into a random effects model. Heterogeneity was measured by Cochran's Q-test (Q = 13.9; p = 0.01) and random effect models were utilised. Pooling eligible trials together revealed a 0.55 odds ratio of death associated with the administration of IP chemotherapy compared to surgery alone (CI = 0.31, 0.98; p = 0.04). Trials selecting patients at elevated risk for the development of peritoneal carcinomatosis by clinicopathological biomarkers for administration of adjuvant IP chemotherapy reported more favourable overall outcomes. There was no increase in mortalities or IP chemotherapy-related abdominal complication rates among patients undergoing IP chemotherapy (OR = 1.4; CI = 0.52, 3.8; p = 0.5). CONCLUSIONS This systematic review supports the use of adjuvant IP chemotherapy in resectable colorectal cancer at risk for peritoneal spread. Future trials should seek to standardise inclusion criteria and IP chemotherapy modalities to better define the role of this treatment in patients with resectable colorectal cancer.
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Affiliation(s)
- Paul L Feingold
- a Thoracic and Gastrointestinal Oncology Branch , National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Nicholas D Klemen
- a Thoracic and Gastrointestinal Oncology Branch , National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Mei Li M Kwong
- a Thoracic and Gastrointestinal Oncology Branch , National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Barry Hashimoto
- b Department of International Studies , American University of Sharjah, Sharjah, UAE
| | - Udo Rudloff
- a Thoracic and Gastrointestinal Oncology Branch , National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
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14
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Sugimura K, Miyata H, Motoori M, Omori T, Fujiwara Y, Yano M. The Significance of SCC and CEA mRNA in the Pleural Cavity After Lymphadenectomy in Esophageal Cancer Patients who Underwent Preoperative Treatment. World J Surg 2017; 42:749-757. [DOI: 10.1007/s00268-017-4203-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Daryaei I, Jones KM, Pagel MD. Detection of DT-diaphorase Enzyme with a ParaCEST MRI Contrast Agent. Chemistry 2017; 23:6514-6517. [PMID: 28370655 DOI: 10.1002/chem.201700721] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Indexed: 12/26/2022]
Abstract
A responsive magnetic resonance (MRI) contrast agent has been developed that can detect the enzyme activity of DT-diaphorase. The agent produced different chemical exchange saturation transfer (CEST) MRI signals before and after incubation with the enzyme, NADH, and GSH at different pH values whereas it showed good stability in a reducing environment without enzyme.
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Affiliation(s)
- Iman Daryaei
- Department of Chemistry and Biochemistry, University of Arizona, 1306 E. University Blvd., Room 221, Tucson, Arizona, 85721-0041, USA
| | - Kyle M Jones
- Department of Biomedical Engineering, University of Arizona, 1127 E James E. Rogers Way P.O. Box 210020, Tucson, AZ, 85721-0020, USA
| | - Mark D Pagel
- Department of Medical Imaging, University of Arizona, 1501 N. Campbell, P.O. Box 245067, Tucson, Arizona, 85724, USA
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16
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Gelli M, Huguenin JF, Cerebelli C, Benhaim L, Honoré C, Elias D, Goéré D. Strategies to prevent peritoneal carcinomatosis arising from colorectal cancer. Future Oncol 2017; 13:907-918. [PMID: 28052691 DOI: 10.2217/fon-2016-0389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In the last decades, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy became a curative option for peritoneal metastases in selected patients, otherwise considered for palliative therapy alone. Better knowledge of physiopathology of peritoneal spread and identification of predictive factors for peritoneal relapse prompted specialized centers to investigate the role of a 'proactive approach' in order to early detect peritoneal metastasis. These encouraging data could justify an active attitude in selected patients at high risk of peritoneal recurrence after curative resection of primary tumor. Selection criteria and the timing of complementary hyperthermic intraperitoneal chemotherapy remain important points of discussion. In this article, we will discuss treatment principles and future perspectives to early treat and, if possible, to prevent peritoneal dissemination after curative treatment of colorectal cancer.
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Affiliation(s)
- Maximiliano Gelli
- Department of Surgical Oncology, Gustave Roussy, Université Paris-Saclay, F-94805 Villejuif, France
| | - Janina Fl Huguenin
- Department of Surgical Oncology, Gustave Roussy, Université Paris-Saclay, F-94805 Villejuif, France
| | - Cecilia Cerebelli
- Department of Surgical Oncology, Gustave Roussy, Université Paris-Saclay, F-94805 Villejuif, France
| | - Léonor Benhaim
- Department of Surgical Oncology, Gustave Roussy, Université Paris-Saclay, F-94805 Villejuif, France
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy, Université Paris-Saclay, F-94805 Villejuif, France
| | - Dominique Elias
- Department of Surgical Oncology, Gustave Roussy, Université Paris-Saclay, F-94805 Villejuif, France
| | - Diane Goéré
- Department of Surgical Oncology, Gustave Roussy, Université Paris-Saclay, F-94805 Villejuif, France
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17
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Sugarbaker PH. Improving oncologic outcomes for colorectal cancer at high risk for local-regional recurrence with novel surgical techniques. Expert Rev Gastroenterol Hepatol 2016; 10:205-13. [PMID: 26643935 DOI: 10.1586/17474124.2016.1110019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite innovation in surgical technology, colorectal adenocarcinoma is a disease process with a risk of local and regional progression of disease. This article seeks to identify patients with primary disease who are at high risk for minimal residual disease from cancer spread after resection. These are the patients who will profit from novel perioperative surgical treatments that will improve the clearance and containment of cancer cells disseminated prior to or at the time of the adenocarcinoma resection. Clinical factors that identify these patients at high risk for local recurrence and peritoneal metastases are presented. Data regarding novel surgical techniques that include perioperative cancer chemotherapy to provide more optimal treatment are described. The perioperative timing of the revised surgical options is emphasized.
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Affiliation(s)
- Paul H Sugarbaker
- a Center for Gastrointestinal Malignancies , MedStar Washington Hospital Center , Washington , DC , USA
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18
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Baratti D, Kusamura S, Iusco D, Gimondi S, Pietrantonio F, Milione M, Guaglio M, Bonomi S, Grassi A, Virzì S, Leo E, Deraco M. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) at the Time of Primary Curative Surgery in Patients with Colorectal Cancer at High Risk for Metachronous Peritoneal Metastases. Ann Surg Oncol 2016; 24:167-175. [PMID: 27519353 DOI: 10.1245/s10434-016-5488-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are maximally effective in early-stage colorectal cancer peritoneal metastases (CRC-PM); however, the use of HIPEC to treat subclinical-stage PM remains controversial. This prospective two-center study assessed adjuvant HIPEC in CRC patients at high risk for metachronous PM ( www.clinicaltrials.gov NCT02575859). METHODS During 2006-2012, a total of 22 patients without systemic metastases were prospectively enrolled to receive HIPEC simultaneously with curative surgery, plus adjuvant systemic chemotherapy (oxaliplatin/irinotecan-containing ± biologics), based on primary tumor-associated criteria: resected synchronous ovarian (n = 2) or minimal peritoneal (n = 6) metastases, primaries directly invading other organs (n = 4) or penetrating the visceral peritoneum (n = 10). A control group retrospectively included 44 matched (1:2) patients undergoing standard treatments and no HIPEC during the same period. The cumulative PM incidence was calculated in a competing-risks framework. RESULTS Patient characteristics were comparable for all groups. Median follow-up was 65.2 months [95 % confidence interval (CI) 50.9-79.5] in the HIPEC group and 34.5 months (95 % CI 21.1-47.9) in the control group. The 5-year cumulative PM incidence was 9.3 % in the HIPEC group and 42.5 % in the control group (p = 0.004). Kaplan-Meier estimated 5-year overall survival (OS) was 81.3 % in the HIPEC group versus 70.0 % in the control group (p = 0.047). No operative death occurred. Grade 3-4 [National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 4] morbidity rates were 18.2 % in the HIPEC group and 25 % in controls (p = 0.75). At multivariate analysis, HIPEC correlated to lower PM cumulative incidence [hazard ratio (HR) 0.04, 95 % CI 0.01-0.31; p = 0.002], and better OS (HR 0.25, 95 % CI 0.07-0.89; p = 0.039) and progression-free survival (HR 0.31, 95 % CI 0.11-0.85; p = 0.028). CONCLUSION Adjuvant HIPEC may benefit CRC patients at high-risk for peritoneal failure. These results warrant confirmation in phase III trials.
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Affiliation(s)
- Dario Baratti
- Peritoneal Malignancy Program, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Shigeki Kusamura
- Peritoneal Malignancy Program, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Domenico Iusco
- General Surgery Unit, Bentivoglio Hospital, AUSL Bologna, Bentivoglio, Bologna, Italy
| | - Silvia Gimondi
- Department of Haematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Filippo Pietrantonio
- Department of Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Massimo Milione
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marcello Guaglio
- Colorectal Cancer Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Serena Bonomi
- General Surgery Unit, Bentivoglio Hospital, AUSL Bologna, Bentivoglio, Bologna, Italy
| | - Antonio Grassi
- General Surgery Unit, Bentivoglio Hospital, AUSL Bologna, Bentivoglio, Bologna, Italy
| | - Salvatore Virzì
- General Surgery Unit, Bentivoglio Hospital, AUSL Bologna, Bentivoglio, Bologna, Italy
| | - Ermanno Leo
- Colorectal Cancer Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marcello Deraco
- Peritoneal Malignancy Program, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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19
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Sammartino P, Biacchi D, Cornali T, Cardi M, Accarpio F, Impagnatiello A, Sollazzo BM, Di Giorgio A. Proactive Management for Gastric, Colorectal and Appendiceal Malignancies: Preventing Peritoneal Metastases with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Indian J Surg Oncol 2016; 7:215-24. [PMID: 27065712 DOI: 10.1007/s13193-016-0497-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/20/2016] [Indexed: 12/20/2022] Open
Abstract
An integrated treatment strategy using peritonectomy procedures plus hyperthermic intraperitoneal chemotherapy (HIPEC) is now a clinical standard of care in selected patients with peritoneal metastases and primary peritoneal tumors. This comprehensive approach can offer many patients, who hitherto had no hope of cure, a good quality of life and survival despite limited morbidity. The increasingly successful results and chance of interfering in the natural history of disease has prompted research to develop for some clinical conditions a therapeutic strategy designed to prevent malignant peritoneal dissemination before it becomes clinically evident and treat it microscopically (tertiary prevention). The main factor governing successful cytoreductive surgery and predicting outcome is the extent of peritoneal spread assessed with the peritoneal cancer index (PCI). In peritoneal metastases from colorectal and gastric cancer the PCI score acquires a specific role acting as the cut-off between patients who can undergo curative surgery or palliation. Long-term results show that the only group enjoying favorable results are patients with limited disease (a statistical minority). By applying to appropriately selected patients with primary malignancies a proactive management strategy including HIPEC we can treat patients with microscopic peritoneal dissemination and therefore at PCI 0. Among treated conditions pseudomyxoma peritonei enjoys the best results. But a major future advance comes from identifying among lesions at major risk of pseudomyxoma.
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Affiliation(s)
- Paolo Sammartino
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Daniele Biacchi
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Tommaso Cornali
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Maurizio Cardi
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Fabio Accarpio
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Alessio Impagnatiello
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Bianca Maria Sollazzo
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Angelo Di Giorgio
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
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20
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Baratti D, Kusamura S, Pietrantonio F, Guaglio M, Niger M, Deraco M. Progress in treatments for colorectal cancer peritoneal metastases during the years 2010-2015. A systematic review. Crit Rev Oncol Hematol 2016; 100:209-22. [PMID: 26867984 DOI: 10.1016/j.critrevonc.2016.01.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/25/2015] [Accepted: 01/16/2016] [Indexed: 02/08/2023] Open
Abstract
Peritoneal metastases (PM) from colorectal cancer (CRC) were traditionally associated with bad prognosis. Only recently, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has resulted in survival improvements. A systematic literature search between January 2010 and June 2015 was performed. Studies were selected and appraised according to predetermined criteria. Nineteen cohort studies, and thirteen comparative studies of CRS/HIPEC were included. The weighted median overall survival was 31.6 months (range 16-51). Major morbidity was 17.6-52.4% (weighted average 32.6%). Mortality was 0-8.1% (weighted average 2.9%). Additional relevant topics, such as CRC-PM prevalence, results by systemic therapies, preoperative work-up, and technical aspects were summarized through a narrative review. The recent literature suggests that CRS/HIPEC is gaining acceptance as standard of care for selected CRC-PM patients. Refinement of selection criteria, and rationalization of comprehensive systemic and local-regional management is ongoing. Prevention and early treatment of PM are new and promising options.
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Affiliation(s)
- Dario Baratti
- Peritoneal Malignancy Program, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian, 1 20133 Milano, Italy
| | - Shigeki Kusamura
- Peritoneal Malignancy Program, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian, 1 20133 Milano, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian, 1 20133 Milano, Italy
| | - Marcello Guaglio
- Peritoneal Malignancy Program, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian, 1 20133 Milano, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian, 1 20133 Milano, Italy
| | - Marcello Deraco
- Peritoneal Malignancy Program, Fondazione IRCCS Istituto Nazionale Tumori, via Venezian, 1 20133 Milano, Italy.
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21
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Zhang L, Liu X, Zuo Z, Hao C, Ma Y. Sphingosine kinase 2 promotes colorectal cancer cell proliferation and invasion by enhancing MYC expression. Tumour Biol 2016; 37:8455-60. [PMID: 26733171 DOI: 10.1007/s13277-015-4700-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 12/17/2015] [Indexed: 02/02/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most commonly diagnosed cancers and causes of cancer death in developed countries. SphK2 is overexpressed in a number of aggressive human carcinomas; however, the expression profile and potential function of SphK2 in CRC are still unknown. In this study, we investigated the SphK2 expression in tumoral tissue and the matched normal mucosae using quantitative real-time PCR (qRT-PCR), Western blot, and immunohistochemistry. We also evaluated the impact of SphK2 knockdown on CRC cell proliferation and metastasis in vitro. SphK2 was significantly upregulated in CRC tissue as compared to the matched normal mucosae, and significant overexpression was found in the LoVo CRC cell line. SphK2 depletion by specific small interfering RNA (siRNA) in the CRC cell line was found to affect cell proliferation and cell migration. Our data suggest that the pathogenesis of CRC maybe mediated by SphK2, and SphK2 could represent a selective target for the molecularly targeted treatments of CRC.
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Affiliation(s)
- Lan Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Liaoning Medical University, Jinzhou, 121001, Liaoning, People's Republic of China.
| | - Xuezheng Liu
- Liaoning Medical University, Jinzhou, 121000, Liaoning, People's Republic of China
| | - Zhongfu Zuo
- Department of Anatomy, Histology and Embryology, Liaoning Medical University, Jinzhou, 121000, Liaoning, People's Republic of China
| | - Chunyan Hao
- Nursing Department, First Affiliated Hospital of Liaoning Medical University, No. 2, Section 5, Renmin Street, Jinzhou, 121001, Liaoning, People's Republic of China
| | - Yanmei Ma
- Nursing Department, First Affiliated Hospital of Liaoning Medical University, No. 2, Section 5, Renmin Street, Jinzhou, 121001, Liaoning, People's Republic of China
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22
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Sugarbaker PH, Sammartino P, Tentes AA. Eradication of minimal residual disease in the perioperative period in primary colon cancer. COLORECTAL CANCER 2015. [DOI: 10.2217/crc.15.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Colon adenocarcinoma is a disease process with a risk of local and regional treatment failure. This review seeks to identify the subset of patients with advanced primary disease who are at high risk for minimal residual disease after resection. These are the patients who may benefit from perioperative chemotherapy treatment that will improve the clearance of a small number of cancer cells disseminated prior to or at the time of the adenocarcinoma cancer resection. The selection factors for identifying these patients at high risk for local recurrence and peritoneal metastases and the special treatments they require are presented in this manuscript.
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Affiliation(s)
- Paul H Sugarbaker
- Center for Gastrointestinal Malignancy, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Paolo Sammartino
- Department of Surgery ‘Pietro Valdoni 6’, Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00155, Rome, Italy
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23
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Kim DW. Intraoperative peritoneal lavage: limitations of current evidence for clinical implementation. Ann Coloproctol 2015; 30:248-9. [PMID: 25580409 PMCID: PMC4286769 DOI: 10.3393/ac.2014.30.6.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Bae SJ, Shin US, Ki YJ, Cho SS, Moon SM, Park SH. Role of peritoneal lavage cytology and prediction of prognosis and peritoneal recurrence after curative surgery for colorectal cancer. Ann Coloproctol 2014; 30:266-73. [PMID: 25580413 PMCID: PMC4286773 DOI: 10.3393/ac.2014.30.6.266] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/14/2014] [Indexed: 12/16/2022] Open
Abstract
Purpose In colorectal cancer, the role of detecting free malignant cells from peritoneal lavage is currently unclear. In this study, we investigated the positive rate of free malignant cells in peritoneal lavage fluid and their predictive value for prognosis and peritoneal recurrence after a curative resection. Methods From October 2009 to December 2011, in a prospective manner, we performed cytologic examinations of peritoneal lavage fluid obtained just after the abdominal incision from 145 patients who underwent curative surgery for colorectal cancer. We used proportional hazard regression models to analyze the predictive role of positive cytology for peritoneal recurrence and survival. Results Among total 145 patients, six patients (4.1%) showed positive cytology. During the median follow-up of 32 months (range, 8-49 months), 27 patients (18.6%) developed recurrence. Among them, 5 patients (3.4%) showed peritoneal carcinomatosis. In the multivariate analysis, positive cytology was an independent predictive factor for peritoneal recurrence (hazard ratio [HR], 136.5; 95% confidence interval [CI], 12.2-1,531.9; P < 0.0001) and an independent poor prognostic factor for overall survival (HR, 11.4; 95% CI, 1.8-72.0; P = 0.009) and for disease-free survival (HR, 11.1; 95% CI, 3.4-35.8; P < 0.0001). Conclusion Positive cytology of peritoneal fluid was significantly associated with peritoneal recurrence and worse survival in patients undergoing curative surgery for colorectal cancer. Peritoneal cytology might be a useful tool for selecting patients who need intraperitoneal or systemic chemotherapy.
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Affiliation(s)
- Sung Joon Bae
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Ui Sup Shin
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Young-Jun Ki
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Sang Sik Cho
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Sun Mi Moon
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Sun Hoo Park
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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25
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Incidence and prognostic significance of positive peritoneal lavage in colorectal cancer. Surg Today 2014; 45:1073-81. [DOI: 10.1007/s00595-014-1066-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/14/2014] [Indexed: 12/23/2022]
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Murono K, Kazama S, Yamaguchi H, Kawai K, Ishihara S, Sunami E, Kitayama J, Satoh Y, Kurihara M, Yatomi Y, Watanabe T. Detection of carcinoembryonic antigen mRNA in peritoneal lavage by the transcription-reverse transcription concerted method indicates poor prognosis in patients with stage II and III colon cancer. Surgery 2014; 157:322-30. [PMID: 25311262 DOI: 10.1016/j.surg.2014.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 08/27/2014] [Accepted: 09/05/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Peritoneal dissemination and positive peritoneal lavage cytology are associated with poor prognosis in colorectal cancer. Carcinoembryonic antigen (CEA) messenger RNA (mRNA) is often used as a marker to detect micrometastases. We aimed to evaluate the prognostic significance of CEA mRNA in the peritoneal lavage of colon cancer patients. METHODS Colon cancer patients (n = 201) who underwent curative operative resection between August 2009 and February 2013 were enrolled. CEA mRNA in peritoneal lavage was measured using the transcription-reverse transcription concerted method, a quantitative RNA amplification method. The correlation between CEA mRNA and overall and peritoneal recurrence-free survival was evaluated. RESULTS Positive CEA mRNA in peritoneal lavage was an independent risk factor for overall recurrence-free survival in colon cancer (P < .0001). Positive CEA mRNA was a risk factor for poorer overall recurrence in stage II and III patients (P = .04 and P = .02, respectively). Moreover, among stage III patients with positive CEA mRNA, the postoperative chemotherapy group had significantly lower overall and peritoneal recurrence rates than the no postoperative chemotherapy group (P = .001). CONCLUSION Positive CEA mRNA in peritoneal lavage was associated with high overall recurrence rates in stage II and III colon cancer. Further study is necessary to determinate the efficacy of aggressive postoperative chemotherapy for stage II and III colon cancer patients with positive CEA mRNA.
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Affiliation(s)
- Koji Murono
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shinsuke Kazama
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hironori Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazushige Kawai
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Soichiro Ishihara
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eiji Sunami
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Joji Kitayama
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumiko Satoh
- Department of Clinical Laboratory, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makiko Kurihara
- Department of Clinical Laboratory, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Watanabe
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Long-term results after proactive management for locoregional control in patients with colonic cancer at high risk of peritoneal metastases. Int J Colorectal Dis 2014; 29:1081-9. [PMID: 24980687 DOI: 10.1007/s00384-014-1929-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE A major problem in treating patients with peritoneal spread from colorectal cancer is that at diagnosis wide peritoneal involvement often precludes all curative attempts. A possible solution is to identify those patients at risk for peritoneal metastases and intervene early to prevent locoregional disease spread before it develops and, thus, to improve outcome. METHODS We analyzed long-term results from a previous study and compared outcomes in 25 patients with advanced colon cancer considered at high risk for peritoneal spread (pT3/pT4 and mucinous or signet ring cell histology) prospectively included and managed with a proactive surgical approach including target organ resection for peritoneal spread plus hyperthermic intraperitoneal chemotherapy (HIPEC) and in 50 retrospectively well-matched controls who underwent standard surgical resection during the same period and in the same hospital by different surgical teams. RESULTS At 48 months after the study closed, peritoneal metastases and local recurrence developed significantly less often in proactively managed patients than in controls (4 vs 28%) (p < 0.03). Patients in the proactive group also survived longer than control patients (median overall survival 59.5 vs 52 months). Despite similar morbidity, Kaplan-Meier survival curves disclosed significantly longer disease-free and overall survival in the proactive than in the control group (p < 0.05 and <0.04). CONCLUSIONS In patients with advanced colon cancer at risk for peritoneal recurrence, the proactive surgical approach plus HIPEC seems to achieve good locoregional control preventing peritoneal spread thus improving outcome without increasing morbidity. These advantages merit investigation in a multicentric randomized trial.
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Sugarbaker PH. Optimization of Patient Selection for Surgical Approach to Peritoneal Metastases from Gastrointestinal Cancer Using Cytoreductive Surgery and Perioperative Chemotherapy. CURRENT COLORECTAL CANCER REPORTS 2014. [DOI: 10.1007/s11888-014-0226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Intraperitoneal chemotherapy as adjuvant treatment to prevent peritoneal carcinomatosis of colorectal cancer origin: a systematic review. Br J Cancer 2014; 111:1112-21. [PMID: 25025964 PMCID: PMC4453838 DOI: 10.1038/bjc.2014.369] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/20/2014] [Accepted: 06/09/2014] [Indexed: 01/05/2023] Open
Abstract
Background: Peritoneal carcinomatosis (PC) of colorectal cancer (CRC) origin is associated with poor outcome. This systematic review evaluates the available evidence about adjuvant (hyperthermic) intraperitoneal chemotherapy ((H)IPEC) to prevent the development of PC. Methods: A systematic search of literature was conducted in August 2013 in PubMed, Embase, and the Cochrane database for studies on (H)IPEC to prevent PC in patients who underwent curative surgery for primary CRC. Results: Seven comparative studies and five cohort studies were selected. Treatment schedules varied between repeated fluoropyrimidine-based IPEC administration in the ambulatory setting to intra-operative (H)IPEC procedures using mitomycin-C or oxaliplatin. The reported rates of major complications related to adjuvant (H)IPEC was low. Four out of five evaluable comparative studies reported a significant difference in the incidence of PC in favour of (H)IPEC. All three comparative studies reporting on survival after intra-operative (H)IPEC showed a significant survival benefit in favour of the experimental arm. Substantial heterogeneity in patient selection, treatment protocols, and treatment effect evaluation among studies was observed. Conclusions: The currently available evidence about adjuvant (H)IPEC in high-risk CRC is limited and subject to bias, but points towards improved oncological outcome and supports further randomised studies.
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Sugarbaker PH. Colorectal cancer: prevention and management of metastatic disease. BIOMED RESEARCH INTERNATIONAL 2014; 2014:782890. [PMID: 24783222 PMCID: PMC3982272 DOI: 10.1155/2014/782890] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/18/2014] [Indexed: 01/04/2023]
Abstract
This paper compared the similarities and differences of the two most common types of colorectal cancer metastases. The treatment of liver metastases by surgery combined with systemic chemotherapy was explained. The different natural history of liver metastases as compared to peritoneal metastases and the possibility for prevention of peritoneal metastases were emphasized. Perioperative cancer chemotherapy or second-look surgery must be considered as individualized treatments of selected patients who have small volume peritoneal metastases or who are known to be at risk for subsequent disease progression on peritoneal surfaces. However, the fact that peritoneal metastases, when diagnosed in the follow-up of colorectal cancer patients, can be cured with a combination of cytoreductive surgery and hyperthermic perioperative chemotherapy cannot be ignored. Careful follow-up and timely intervention in colorectal cancer patients with progressive disease are a necessary part of the management strategies recommended by the multidisciplinary team. After a critical evaluation of the data currently available, these strategies for prevention and management of colorectal metastases are presented as the author's recommendations for a high standard of care. As more information becomes available, modifications may be necessary.
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Affiliation(s)
- Paul H Sugarbaker
- Washington Cancer Institute, 106 Irving Street, NW, Suite 3900, Washington, DC 20010, USA
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31
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Baratti D, Kusamura S, Deraco M. Prevention and early treatment of peritoneal metastases from colorectal cancer: Second-look laparotomy or prophylactic HIPEC? J Surg Oncol 2014; 109:225-6. [DOI: 10.1002/jso.23492] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/19/2013] [Indexed: 01/09/2023]
Affiliation(s)
- Dario Baratti
- PeritonealSurfaceMalignancy Program; Colorectal Cancer Service; Department of Surgery; National Cancer Institute; Milan Italy
| | - Shigeki Kusamura
- PeritonealSurfaceMalignancy Program; Colorectal Cancer Service; Department of Surgery; National Cancer Institute; Milan Italy
| | - Marcello Deraco
- PeritonealSurfaceMalignancy Program; Colorectal Cancer Service; Department of Surgery; National Cancer Institute; Milan Italy
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Xiao X, Wang L, Wei P, Chi Y, Li D, Wang Q, Ni S, Tan C, Sheng W, Sun M, Zhou X, Du X. Role of MUC20 overexpression as a predictor of recurrence and poor outcome in colorectal cancer. J Transl Med 2013; 11:151. [PMID: 23787019 PMCID: PMC3702436 DOI: 10.1186/1479-5876-11-151] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 06/13/2013] [Indexed: 01/17/2023] Open
Abstract
Background Colorectal cancer (CRC) remains one of the most common cancers worldwide. We observed that MUC20 was significantly up-regulated in CRC patients with poor prognosis based on the microarray analysis. However, little is known about the role of MUC20 in CRC. Methods Microarray experiments were performed on the Affymetrix U133 plus 2.0 GeneChip Array. The protein and mRNA levels of MUC20 were examined by immunohistochemistry (IHC) and Real-Time quantitative PCR (RT-qPCR) in CRC tissues and adjacent noncancerous tissues (ANCT). ShRNA and overexpression plasmids were used to regulate MUC20 expression in CRC cell lines in vitro; wound healing, Transwell migration assays, and Western blotting were used to detect migration and invasion changes. Results MUC20 was one of the up-regulated genes in CRC patients with poor prognosis by microarray. Using IHC and RT-qPCR, we showed that MUC20 expression was significantly higher in CRC tissues than in ANCT (P < 0.05). We further showed that MUC20 overexpression was correlated with recurrence and poor outcome (P < 0.05). The Kaplan-Meier survival curves indicated that disease-free survival (DFS) and overall survival (OS) were significantly worse in CRC patients with MUC20 overexpression. The Cox multivariate analysis revealed that MUC20 overexpression and TNM stage were independent prognostic factors. Elevated expression of MUC20 in cells promoted migration and invasion, whereas ShRNA-mediated knockdown inhibited these processes. In addition, Western blotting demonstrated that MUC20-induced invasion was associated with MMP-2, MMP-3, and E-cadherin. Conclusions Cumulatively, MUC20 may serve as an important predictor of recurrence and poor outcome for CRC patients. MUC20 overexpression could enhance migration and invasion abilities of CRC cells. Translation of its roles into clinical practice will need further investigation and additional test validation.
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Affiliation(s)
- Xiuying Xiao
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Bosanquet DC, Harris DA, Evans MD, Beynon J. Systematic review and meta-analysis of intraoperative peritoneal lavage for colorectal cancer staging. Br J Surg 2013; 100:853-62. [PMID: 23536330 DOI: 10.1002/bjs.9118] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intraperitoneal cancer cells are detectable at the time of colorectal cancer resection in some patients. The significance of this, particularly in patients with no other adverse prognostic features, is poorly defined. Consequently peritoneal lavage is not part of routine practice during colorectal cancer resection, in contrast with other abdominal malignancies. The aim of this systematic review was to determine the effect of positive intraoperative peritoneal cytology on cancer-specific outcomes in colorectal cancer. METHODS A systematic review of key electronic journal databases was undertaken using the search terms 'peritoneal cytology' and 'colorectal' from 1980 to 2012. Studies including patients with frank peritoneal metastasis were excluded. Meta-analysis for overall survival, local/peritoneal recurrence and overall recurrence was performed. RESULTS Twelve cohort studies (2580 patients) met the inclusion criteria. The weighted mean yield was 11·6 (range 2·2-41) per cent. Yield rates were dependent on timing of sampling (before resection, 11·8 per cent; after resection, 13·2 per cent) and detection methods used (cytopathology, 8·4 per cent; immunocytochemistry, 28·3 per cent; polymerase chain reaction, 14·5 per cent). Meta-analysis showed that positive peritoneal lavage predicted worse overall survival (odds ratio (OR) 4·26, 95 per cent confidence interval 2·86 to 6·36; P < 0·001), local/peritoneal recurrence (OR 6·57, 2·30 to 18·79; P < 0·001) and overall recurrence (OR 4·02, 2·24 to 7·22; P < 0·001). CONCLUSION Evidence of intraoperative peritoneal tumour cells at colorectal cancer resection is predictive of adverse cancer outcomes.
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Affiliation(s)
- D C Bosanquet
- Department of Colorectal Surgery, Abertawe Bro Morgannwg University Trust, Singleton Hospital, Sketty Lane, Swansea, SA2 8QA, UK
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34
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Mohan HM, O'Connor DB, O'Riordan JM, Winter DC. Prognostic significance of detection of microscopic peritoneal disease in colorectal cancer: a systematic review. Surg Oncol 2013; 22:e1-6. [PMID: 23481599 DOI: 10.1016/j.suronc.2013.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 01/03/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Free intraperitoneal tumour cells are an independent indicator of poor prognosis, and are encorporated in current staging systems in upper gastrointestinal cancers, but not colorectal cancer. This systematic review aimed to evaluate the role and prognostic significance of positive peritoneal lavage in colorectal cancer. METHODS A search was undertaken of PUBMED/Medline and Cochrane databases for English language articles from 1990 to 2012 using a predefined search strategy. Both detection of free tumour cells and/or detection of tumour-associated antigens in peritoneal lavage fluid were considered a positive lavage. Primary endpoints were rates of positive lavage, recurrence and survival. RESULTS Of 3805 articles identified by title, 18 met inclusion criteria (n = 3197 patients, 59.5% colon, 40.5% rectal cancer). There was heterogeneity across studies in method of detection of peritoneal disease with 7 studies using more than one method (conventional cytology (14 studies), immunological techniques (6 studies), molecular techniques (4 studies)). The rate of positive lavage varied from 2.1% to 52% across studies, with a weighted mean rate of positive lavage of 13.17% overall (95% CI 12.74-13.59). In 10 studies (n = 2017) positive peritoneal lavage was associated with worse survival, and with increased recurrence in 12 (n = 2371). Clinicopathological factors frequently associated with positive lavage included macroscopic peritoneal disease, increasing tumour stage and nodal disease. CONCLUSION Positive peritoneal lavage is a negative prognostic factor in colorectal cancer. However, its utility in staging colorectal cancer is currently limited by wide variation in rates of positive lavage between studies due to differences in methods of peritoneal lavage fluid analysis.
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Affiliation(s)
- Helen M Mohan
- Department of Surgery, St. Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland.
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Hompes D, Tiek J, Wolthuis A, Fieuws S, Penninckx F, Van Cutsem E, D'Hoore A. HIPEC in T4a colon cancer: a defendable treatment to improve oncologic outcome? Ann Oncol 2012; 23:3123-3129. [PMID: 22831982 DOI: 10.1093/annonc/mds173] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Adequate estimation of the potential benefits of 'adjuvant' hyperthermia and intraperitoneal chemotherapy (HIPEC) in T4 patients through assessment of the burden of peritoneal carcinomatosis (PC) in T4 tumors and the risk of PC as the only metastatic site. PATIENTS AND METHODS Analysis of prospectively collected data on patients who underwent surgery for colon cancer (Jan 2004-Jan 2007). RESULTS About 379 patients (M/F = 204/175) were included, with a median age of 71.8 years (range 35.4-95.0): 39 stage I, 126 stage II, 89 stage III, 116 stage IV disease (+9 with unknown stage). The median follow-up was 34.8months [range 0.0-79.4]. The 3- and 5-year overall survival rates (OS) were 68.4% (95% confidence interval (CI) 63.9%-72.4%) and 60.3% (95%CI 55.6%-64.7%). Relapse analysis was restricted to stages II-III T3 (N = 154) and T4 tumors (N = 19) with complete relapse data, of which 13.2% developed PC. PC has a detrimental effect on OS [HR 6.3 (95%CI: 3.1-13.0, P < 0.0001)]. 50% of T4a and 20% of T4b developed PC. The 1- and 3-year PC percentage was significantly lower for T3 (4.5% and 9.3%) than T4 tumors (15.6% and 36.7%) (P = 0.008). PC was the only metastatic site in 3/15 T3 [proportion 0.20, 95%CI (0.043-0.481)] and 5/8 T4 tumors with PC [proportion 0.625, 95%CI (0.245-0.915)] (P = 0.071). CONCLUSIONS T4a colon tumors have a significantly higher risk of developing PC. Twenty-five percent (5/19) of stages II-III T4 tumors develop PC as the only metastatic site. This could define the possible window of opportunity for adjuvant HIPEC to prevent PC.
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Affiliation(s)
- D Hompes
- Department of Abdominal Surgery, University Hospitals Gasthuisberg, Leuven.
| | - J Tiek
- Department of Abdominal Surgery, University Hospitals Gasthuisberg, Leuven
| | - A Wolthuis
- Department of Abdominal Surgery, University Hospitals Gasthuisberg, Leuven
| | - S Fieuws
- Department of Digestive Oncology, University Hospitals Gasthuisberg, Leuven and Universiteit Hasselt, Leuven, Belgium
| | - F Penninckx
- Department of Abdominal Surgery, University Hospitals Gasthuisberg, Leuven
| | - E Van Cutsem
- Department of Digestive Oncology, I-Biostat, Katholieke Universiteit Leuven and Universiteit Hasselt
| | - A D'Hoore
- Department of Abdominal Surgery, University Hospitals Gasthuisberg, Leuven
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Abstract
Should be used to refine current management strategies
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Affiliation(s)
- D A Harris
- Department of Colorectal Surgery, Singleton Hospital, Sketty Lane, Swansea SA2 8QA, UK
| | - J Beynon
- Department of Colorectal Surgery, Singleton Hospital, Sketty Lane, Swansea SA2 8QA, UK
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Sugarbaker PH, Sammartino P, Tentes AA. Proactive management of peritoneal metastases from colorectal cancer: the next logical step toward optimal locoregional control. COLORECTAL CANCER 2012; 1:115-123. [DOI: 10.2217/crc.12.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
SUMMARY Although surgery for colorectal cancer has improved over the last decade, locoregional recurrence and peritoneal metastases continue as a mechanism of surgical treatment failure in 10–20% of patients. These patients have a dismal prognosis. Clinical information is available in order to identify patients who are at high risk for locoregional recurrence and peritoneal metastases. These patients, once identified, should be offered new treatment options shown to be of benefit in selected patients. Using perioperative chemotherapy at the time of colorectal cancer resection improves locoregional control and diminishes peritoneal metastases. Also, in patients at high risk, a proactive second-look surgery utilizing peritonectomy and hyperthermic intraperitoneal chemotherapy is of benefit, with reasonable morbidity and mortality.
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Affiliation(s)
- Paul H Sugarbaker
- Washington Cancer Institute, 106 Irving Street, NW, Suite 3900, Washington, DC 20010, USA
| | - Paolo Sammartino
- Department of Surgery, University of Rome La Sapienza, Rome, Italy
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